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O&G: Obstetrics > Infections in Pregnancy > Flashcards

Infections in Pregnancy Flashcards

1
Q

What is this a presentation of?
Mild maternal infection (fever, lymphadenopathy, rash, sore throat), can cause motor/cognitive impairment and sensorineural deafness in new born.

A

CMV infection

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2
Q

What percentage of transmission occurs vertically in primary maternal CMV infection, and what percentage of those are symptomatic?

A
  1. 40%
  2. 10%
    1/3 die, the rest left with severe sequalae
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3
Q

What defects is CMV associated with?

A

IUGR, microcephaly, hepatosplenomegaly, thrombocytopenia, jaundice.

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4
Q

How is CMV infection diagnosed in a pregnant woman and the foetus?

A
  1. Maternal CMV IgM

2. If +ve, amniocentesis >6 weeks later for vertical transmission

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5
Q

What type of HSV infection is dangerous for the foetus in pregnancy?

A

Primary (first-ever) infection during pregnancy, refer to GUM.

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6
Q

What is the management for a primary herpes infection in trimester 1 and 2?

A

Treat primary episode and restart acyclovir from 36/40 until delivery. Can delivery vaginally.

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7
Q

What is the management for a primary herpes infection in trimester 3?

A

Daily acyclovir/valaciclovir and if EDD within 6 weeks, offer C-section as delivery method.

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8
Q

Why is vaginal delivery dangerous in primary herpes infection and how should you proceed if the mother wants a vaginal delivery?

A
  1. Vertical transmission occurs at vaginal delivery

2. Give IV Ig in labour and new born high-dose acyclovir, LP HSV PCR neonates.

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9
Q

What is this a presentation of?

Neonate, blindness, reduced IQ, epilepsy, jaundice, DIC, 30% risk of death.

A

Neonatal herpes simplex infection

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10
Q

What should you do if a pregnant women is exposed to herpes zoster contacts?

A
  1. Test for immunity
  2. Give VZ Ig if non-immune
  3. Give acyclovir if infection occurs
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11
Q

What is the management if a mother develops chickenpox near delivery?

A
  1. Aim for delivery after 7 days

2. Give babies VZ Ig at birth

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12
Q

What are the foetal abnormalities associated with maternal infection with rubella?

A

Deafness, cardiac disease, eye problems, mental retardation.

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13
Q

What is the most appropriate management plan if a non-immune woman develops rubella before 16/40?

A

Termination of pregnancy

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14
Q

Can you give the rubella vaccine during pregnancy?

A

No, it is live and therefore contraindicated.

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15
Q

What is this a presentation of?

Pregnant woman, slapped cheek appearance, arthralgia, can be asymptomatic, recent contact with children.

A

Parvovirus B19 infection

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16
Q

What is the pathophysiology of a parvovirus B19 infection?

A

Suppresses foetal erythropoiesis causing anaemia, variable degrees of thrombocytopenia and cardiotoxicity.

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17
Q

How is parvovirus B19 diagnosed in mother and foetus?

A
  1. Maternal symptoms and IgM

2. If +ve, serial foetal monitoring for signs of anaemia.

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18
Q

What causes foetal hydrops in parvovirus B19 infection and how is it treated?

A
  1. Cardiac toxicity causing cardiac failure

2. In utero transfusion given if severe

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19
Q

What is the difference between Hep B and Hep C screening in pregnancy?

A
  1. All mothers given Hep B serum Ag screening

2. Screening restricted to high risk groups (HIV+)

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20
Q

What is the treatment for women with a high viral load of Hep B in pregnancy and their new born?

A

Antivirals from 32/40 with Ig given to children at birth.

21
Q

How is can risk of infection with Hep B in neonates be dropped by 90%?

A

Neonatal immunisation with vaccine and Ig at birth.

22
Q

What is the management for women with Hep C infection (usually asymptomatic)?

A
  1. Elective C-section, avoid breastfeeding.

2. IV Ig does not reduce vertical transmission.

23
Q

When should neonates be referred to a hepatologist in Hep C infection?

A

If +ve for Hep C virus RNA

24
Q

What should be offered to HIV +ve mothers?

A

HBV, pneumococcal, and influenza vaccines.

Screen for genital infections.

25
Q

What are the maternal and foetal effects of HIV infection?

A
  1. Pre-eclampsia

2. Prematurity, IUGR, stillbirth

26
Q

What should you do if a pregnant woman is already on HAART?

A

Continue throughout pregnancy, offer GDM screening at 28/40.

27
Q

What is the management in a new diagnosis of HIV in a pregnant woman?

A

Take HAART from 24 weeks

28
Q

What is the birth management for HIV infection in the mother?

A
  1. C-section at 38 weeks if co-infected with Hep C/>50 copies/ml viral load
  2. Vaginal delivery if <50 copies/ml, avoid FBS/scalp electrodes.
  3. Avoid breastfeeding, give cabergoline 1mg PO to suppress lactation.
  4. Treat new born with HAART for first 6 weeks.
29
Q

What is group A streptococcus infection associated with in pregnancy, what is the most common symptom, and how is it treated?

A
  1. Puerperal sepsis
  2. Sore throat
  3. High dose antibiotics
30
Q

In what percentage of women is group B streptococcus commensal?

A

25%

31
Q

When can the foetus be infected with group B streptococcus and what can it cause?

A
  1. During labour after membranes have ruptured

2. Neonatal sepsis and mortality

32
Q

How is vertical transmission of group B streptococcus prevented?

A

High dose IV Benzylpenicillin throughout labour if:

  1. Previous GBS+ history in this pregnancy
  2. Any intrapartum fever
  3. Current preterm labour <37/40
  4. Rupture of membranes at term >18 hours.
33
Q

What is the screening test for syphilis and how is it treated in pregnancy?

A
  1. VDRL test

2. IM Benzylpenicillin

34
Q

How is toxoplasmosis infection spread?

A

Contact with cat faeces, soil, or eating infected meat.

35
Q

What are the symptoms/signs of toxoplasmosis infection?

A

Fever, rash, eosinophilia

36
Q

How is toxoplasmosis diagnosed?

A
  1. Maternal IgM and IgG

2. Vertical transmission diagnosed with amniocentesis performed after 20 weeks.

37
Q

What is the treatment for toxoplasmosis infection?

A
  1. Treat mother with spiramycin. Add pyrimethamine, sulfadiazine, and follinic acid. Termination of pregnancy can be requested.
  2. Give all of the above to foetus and prednisolone for CNS inflammation.
38
Q

Should you give the BCG vaccine in pregnancy?

A

No, it is contraindicated.

39
Q

When should the BCG vaccine be given in at risk groups?

A

After birth

40
Q

What should be given along with BCG to new born with maternal TB infection?

A

Isoniazid

41
Q

What is the treatment for pregnant women with TB?

A

RIPE, safe in pregnancy

42
Q

What is the treatment for malaria infection in pregnancy?

A

Artemisin combination therapy

43
Q

How is listeriosis infection aquired?

A

Consumption of unpasteurised milk, pates, and soft cheeses.

44
Q

What type of bacteria is listeriosis?

A

Gram +ve bacillus

45
Q

How is listeriosis diagnosed and treated?

A
  1. Blood cultures

2. IV ampicillin and IV gentamicin

46
Q

What is the treatment for chlamydia infection in pregnancy and after the baby is born?

A
  1. Azithromycin (avoid doxycycline as it causes tooth discolouration in foetus).
  2. Baby treated with erythromycin and local eye cleansing if conjunctivitis develops.
47
Q

What is the treatment for gonorrhoea infection in pregnancy and after the baby is born?

A
  1. Ceftriaxone

2. IM ceftriaxone and chloramphenicol eye drops within 1 hour of birth

48
Q 
What is this a presentation of?
New born (within 4 days of birth), purulent eye discharge, lid swelling.
A

Gonococcal conjunctivitis

49
Q

How is gonococcal conjunctivitis diagnosed and treated?

A
  1. Swab eye

2. Chloramphenicol eye drops

O&G: Obstetrics (36 decks)

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