Infections In Pregnancy Flashcards
Ultrasound features of CMV (4)
IVEN
- intracranial calcification
- ventriculomegaly
- echogenic bowel
- non immune hydrops
What is the most common agent associated with maternal sepsis
Group A streptococcus
What is the mortality rate of severe sepsis
20-40%
What is the mortality rate of septic shock
60%
What is the definition of sepsis
Infection plus systemic manifestations
What is the definition of severe sepsis
Sepsis + end organ dysfunction or tissue hypoperfusion
What is the definition of speptic shock
Severe sepsis non responded to fluid resuscitation
What are the risk factors for sepsis
(11)
- obesity
- diabetes
- immunosuppression
- anaemia
- vaginal discharge
- GBS
- amniocentesis/CVS
- cervical cerclage
- PPROM
- GAS in close contacts
- black/minority groups
What are the clinical signs of sepsis (8)
- hypotension (systolic BP <90mmhg, MAP <70mmhg)
- hypo/hyperthermia (<36/>38 degrees)
- tachycardia (>100bpm)
- tachypnea (>20bpm)
- hypoxia
- oliguria (<0.5ml/kg over 2hrs)
- impaired consciousness
- poor response to therapy
Features of toxic shock syndrome (5)
- nausea/vomiting/diarrhea
- exquisite severe pain due to necrotising fascitis
- watery vaginal discharge
- generalized rash
- conjunctival suffusion
What are the causative agents of TSS
- staphylococcus
- streptococcus exotoxin
What is the sepsis 6
Task to be performed within the first 6hours of sepsis suspicion
- broad spectrum antibiotics within 1hr
- pan culture: Blood and urine and any obvious other sites eg hvs (ideally prior to antibiotics)
- measure serum lactate
- if lactate >4mmol/l then 20ml/kg crystalloid
- aim for MAP >65mmhg
- if in septic shock then CVP
What are indications for admission to ICU for sepsis
- septic shock
- pulmonary edema/mechanical ventilation required
- renal dialysis
- decreased GCS
- multi organ failure/uncorrected acidosis/hypothermia
What is the meaning of broad spectrum anribiotics
Covers
- gram negative bacteria
- prevents exotoxin production from gram positive
A pt presents at 24 weeks with a 1 day history of chicken pox. How do you manage
- oral acyclovir
- refer to MFM 5 weeks after rash
When is acyclovir indicated in the treatment of chickenpox in pregnancy
- if patient presents within 24hours of rash onset
- if classified as severe disease (iv route)
- if > 20 weeks
Can be considered under 20 weeks but not licensed
What is the risk of vertical transmission of parvovirus if contracted at term
70%
When is the greatest risk of intrauterine transmission of parvovirus
> 16weeks
25-70%
What is the management after confirmed parvovirus in pregnancy
Referral to MFM
- Serial fetal ultrasound and doppler to detect fetal anaemia heart failure and hydrops
Risk of miscarriage with rubella in T1
20%
What is the risk of congenital rubella if contracted <11weeks
90%
What is the risk of congenital rubella is contracted 11-16 weeks
20%
What are the most common features of congenital rubella syndrome
CDC
- Cataracts
- sensorineural Deafness
- Cardiac abnormalities (PDA)
What is the dose of acyclovir for
1) chicken pox
2) hsv
- chicken pox: 800mg po five times daily x 7days
- hsv: 400mg po tds x 5days
What is the treatment regime for toxoplasmosis
- maternal infection spiramycin
- fetal infection confirmed by amniocentesis then pyrimethamine/sulfadiazine
Must add folinic acid as pyrimethamine is a folate antagonist
What is the for line treatment for P Falciparum malaria
Quinine- 600mg tid 7days
Clindamycin 450mg tid 7days
- all patients should be admitted
- IV regime if vomiting
NB: All other species treated with Chloroquine
How is uncomplicated malaria defined
<2% parasitised red blood cells with no signs of severe disease
Severe features
- respiratory distress
- pulmonary edema
- hypoglycemia
- secondary gram neg sepsis
What is the treatment for complicated/severe malaria
Complicated : >2% parasites
IV artesunate 2.4mg/kg at 0,12,and 24hrs then daily
Or quinine and clindamycin IV
Prevalence of HIV in UK
2: 1000
Rate of MTCT with retroviral therapy
1.2%
What is the rate of vertical transmission with cART
<1%
What is the testing schedule for infants of HIV mothers
(Formula fed)
- within first 48hrs of birth and prior to discharge
- 2 weeks of ago if high risk
- 6 weeks
- 12 weeks
- HIV antibody @ 18-24 mnths
What is the infant testing schedule for HIV
(Breastfeeding)
- within 48 hours and prior to discharge
- 2weeks
- monthly once breastfeeding
- at 4 and 8 weeks post cessation of breastfeeding
- HIV antibody at 18-24mnths
What percentage of infants with congenital CMV are symptomatic at birth
10-15%
How is fetal CMV diagnosed
Via amniocentesis
Should not be done prior to 21 weeks and atleast 6 weeks after infection
