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DM2 Prep- Obstetrics > Infections In Pregnancy > Flashcards

Infections In Pregnancy Flashcards

1
Q

Ultrasound features of CMV (4)

A

IVEN

  • intracranial calcification
  • ventriculomegaly
  • echogenic bowel
  • non immune hydrops
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2
Q

What is the most common agent associated with maternal sepsis

A

Group A streptococcus

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3
Q

What is the mortality rate of severe sepsis

A

20-40%

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4
Q

What is the mortality rate of septic shock

A

60%

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5
Q

What is the definition of sepsis

A

Infection plus systemic manifestations

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6
Q

What is the definition of severe sepsis

A

Sepsis + end organ dysfunction or tissue hypoperfusion

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7
Q

What is the definition of speptic shock

A

Severe sepsis non responded to fluid resuscitation

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8
Q

What are the risk factors for sepsis
(11)

A
  • obesity
  • diabetes
  • immunosuppression
  • anaemia
  • vaginal discharge
  • GBS
  • amniocentesis/CVS
  • cervical cerclage
  • PPROM
  • GAS in close contacts
  • black/minority groups
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9
Q

What are the clinical signs of sepsis (8)

A
  • 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
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10
Q

Features of toxic shock syndrome (5)

A
  • nausea/vomiting/diarrhea
  • exquisite severe pain due to necrotising fascitis
  • watery vaginal discharge
  • generalized rash
  • conjunctival suffusion
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11
Q

What are the causative agents of TSS

A
  • staphylococcus
  • streptococcus exotoxin
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12
Q

What is the sepsis 6

A

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
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13
Q

What are indications for admission to ICU for sepsis

A
  • septic shock
  • pulmonary edema/mechanical ventilation required
  • renal dialysis
  • decreased GCS
  • multi organ failure/uncorrected acidosis/hypothermia
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14
Q

What is the meaning of broad spectrum anribiotics

A

Covers

  • gram negative bacteria
  • prevents exotoxin production from gram positive
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15
Q

A pt presents at 24 weeks with a 1 day history of chicken pox. How do you manage

A
  • oral acyclovir
  • refer to MFM 5 weeks after rash
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16
Q

When is acyclovir indicated in the treatment of chickenpox in pregnancy

A
  • 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
17
Q

What is the risk of vertical transmission of parvovirus if contracted at term

A

70%

18
Q

When is the greatest risk of intrauterine transmission of parvovirus

A

> 16weeks

25-70%

19
Q

What is the management after confirmed parvovirus in pregnancy

A

Referral to MFM
- Serial fetal ultrasound and doppler to detect fetal anaemia heart failure and hydrops

20
Q

Risk of miscarriage with rubella in T1

A

20%

21
Q

What is the risk of congenital rubella if contracted <11weeks

A

90%

22
Q

What is the risk of congenital rubella is contracted 11-16 weeks

A

20%

23
Q

What are the most common features of congenital rubella syndrome

A

CDC

  • Cataracts
  • sensorineural Deafness
  • Cardiac abnormalities (PDA)
24
Q

What is the dose of acyclovir for
1) chicken pox
2) hsv

A
  • chicken pox: 800mg po five times daily x 7days
  • hsv: 400mg po tds x 5days
25
Q

What is the treatment regime for toxoplasmosis

A
  • maternal infection spiramycin
  • fetal infection confirmed by amniocentesis then pyrimethamine/sulfadiazine

Must add folinic acid as pyrimethamine is a folate antagonist

26
Q

What is the for line treatment for P Falciparum malaria

A

Quinine- 600mg tid 7days
Clindamycin 450mg tid 7days

  • all patients should be admitted
  • IV regime if vomiting

NB: All other species treated with Chloroquine

27
Q

How is uncomplicated malaria defined

A

<2% parasitised red blood cells with no signs of severe disease

Severe features
- respiratory distress
- pulmonary edema
- hypoglycemia
- secondary gram neg sepsis

28
Q

What is the treatment for complicated/severe malaria

A

Complicated : >2% parasites

IV artesunate 2.4mg/kg at 0,12,and 24hrs then daily

Or quinine and clindamycin IV

29
Q

Prevalence of HIV in UK

A

2: 1000

30
Q

Rate of MTCT with retroviral therapy

A

1.2%

31
Q

What is the rate of vertical transmission with cART

A

<1%

32
Q

What is the testing schedule for infants of HIV mothers
(Formula fed)

A
  • 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
33
Q

What is the infant testing schedule for HIV
(Breastfeeding)

A
  • 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
34
Q

What percentage of infants with congenital CMV are symptomatic at birth

A

10-15%

35
Q

How is fetal CMV diagnosed

A

Via amniocentesis

Should not be done prior to 21 weeks and atleast 6 weeks after infection

DM2 Prep- Obstetrics (23 decks)

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