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MRCOG part 2 > Infections in Pregnancy > Flashcards

Infections in Pregnancy Flashcards

1
Q

Rubella incubation

A

12-23 days

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2
Q

What type of organism is Rubella

A

RNA togavirus

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3
Q

Risk of fetal infection with Rubella

A

<11 = >90%
11-16/40 = 20%
>20/40 = 0%

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4
Q

Rubella vaccination

A

Live vaccine

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5
Q

Congenital rubella syndrome features

A

Sensorineural deafness, cataracts and cardiac anomalies

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6
Q

What type of organism is Measles

A

single stranded enveloped RNA

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7
Q

Measles incubation and infectious periods

A

Incubation = 10-12 days, rash 14 days post exposure
Infectious = 4 days pre until 4 days post rash

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8
Q

Fetal complications of measles

A

No increased congenital abnormalities
increased IUGR, NICU adm, IUD

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9
Q

What type of organism is Parvovirus B19

A

dsDNA virus

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10
Q

Incubation period of Parvovirus

A

4-14 days (7 average)

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11
Q

Infectious period of Parvovirus

A

7-10 days pre rash

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12
Q

Test for recent parvovirus infection

A

IgM - if positive, suggests recent infection
IgG +ve = immune

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13
Q

Fetal risks of parvovirus

A

hydrops, anaemia, heart failure
Death = 1-4%

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14
Q

Risk of parvovirus vertical transmission

A

<15 weeks gestation - 15%
15 - 20 weeks - 25%
Term - 70%

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15
Q

What type of organism is VZV

A

DNa virus

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16
Q

VZV incubation period

A

10-21 days

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17
Q

Incidence of VZV in pregnancy

A

3 in 1000

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18
Q

Maternal complications of VZV in pregnancy

A

Pneumonia (10%)
Hepatitis
Encephalitis

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19
Q

Risk of fetal varicella syndrome
Signs

A

1% if <28/40
0% if >28/40
Skin scarring, eye defects, limb hypoplasia, developmental delay

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20
Q

Timing of scan following VZV infection in pregnancy

A

16-20/40 or 5 weeks post infection

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21
Q

Management of vzv exposure

A

Check VZV Ig
- +ve –> reassure
- -ve –> <10 days from exposure –> VZIG and inform infections 8-28 days

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22
Q

Treatment of VZV in pregnancy

A

> 20/40 and <24 hours from rash = aciclovir 800mg 5x/day for 7 days
Severe infection = IV aciclovir

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23
Q

Risk of neonatal VZV infection

A

If birth within 1-4 weeks –> 50% infected and 23% these have clinical varicella

Birth within 7 days –>give VZIG

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24
Q

CMV incubation period

A

3-12 weeks

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25
Q

Risk of congenital CMV

A

Primary infection = 20-30%
Recurrent infection = 1-2%

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26
Q

Percentage of pregnant women CMV sero+ve

A

50%

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27
Q

Percentage of pregnant women who will have primary CMV infection in pregnancy

A

2%

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28
Q

Risk of symptoms following congenital CMV
What are the symptoms

A

10-15% symptoms at birth
10-15% develop symptoms at later life
Sensorineural deafness, microcephaly, visual impairment, IUGR, CP

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29
Q

Mortality with neonatal CMV
% of survivors with sequelae

A

20-30%
90% survivors have sequelae

30
Q

Timing of amniocentesis for CMV

A

6 weeks post infection and after 21/40

31
Q

Incubation of toxoplasmosis

32
Q

Fetal risks of toxoplasmosis
%
Features

A

60% no effect
10% chorioretinitis
20-30% TORCH anomalise

Spontaneous first trimester miscarriage, Chorioretinitis, IUGR
Microcephaly, Hydrocephalus, Intra-cranial calcification
Learning disability, Hepatosplenomegaly

33
Q

Investigation for toxoplasmosis

A

IgM+ve
Then 2nd sample 3 weeks later
- high IgM
Or - IgG 4fold rise

34
Q

Treatment for toxoplasmosis

A

Spiromycin –> 60% reduction in fetal risk
If fetus infection –> pyrimethamine + sulfonamide + folinic acid (slows fetal disease)

35
Q

Treatment of chlamydia in pregnancy

A

Amoxicillin
Erythromycin
Azithromycin

36
Q

What kind of virus is HSV

37
Q

Risk of neonatal transmission with:
Primary infection
reccurent infection

39
Q

Whats the proportion of HSV cases in neonate due to HSV 1 vs HSV 2

39
Q

HSV infection treatment
<28/40
>28/40
Recurrent
In HIV

A
  1. 5/7 aciclovir 400mg TDS then from 36/40
  2. Aciclovir 400mg TDS until birth, CS if primary
  3. Usually self limiting, consider aciclovir from 36/40
  4. Aciclovir from 32/40
39
Q

Treatment of malaria

A

Simple = quinine 600mg TDS for 5-7 days or clindamycin 450mg TDS for 5-7 days then mefloquine for 7 days

Severe:
Uncomplicated = IV quinine
Complicated = IV artenusate

Non faciparum = chloroquine

40
Q

How long should you not get pregnant after exposure to Zika virus?

A

3 months from last exposure if both partners/only male exposed
2 months if only woman

41
Q

What fetal impact does Zika have

A

Microcephaly

42
Q

What ARVs should you start newly dx HIV on?

A

tenofovir or abacavir or lamivudine
PLUS efavirenz or atazanavir / ritonavir

If v high VL, include raltegravir or dolutegravir

43
Q

Which ARV is associated with increased neural tube defects

A

Dolutegravir - give 5mg folic acid

44
Q

Neonatal management of HIV
Very Low risk
Low risk
High risk

A

Very low risk = 2 weeks zidovudine
- On cART >10/52 + 2xVL<50 4 weeks apart + 36/40 VL <50
Low risk = 4 weeks zidovudine
High risk = neonatal PEP

45
Q

Infant testing for HIV

A

Not breastfeeding = within 48hrs, at 6 weeks and 12 weeks

Breastfeeding = within 48hrs, at 2 weeks, monthly whilst BF and 4 + 8 weeks post stopping BF

46
Q

When do you start cART for HIV in pregnancy

A

by 24/40 for everyone
VL <30,000 = when can in T2
VL 30-100,000 = start of T2
VL >100,000 or CD4<200 = ASAP, can start T1

47
Q

What are examples of a-haemolytic strep?
How to differentiate between?

A

S viridans
S pneumoniae

Optochin disc test

48
Q

How do you differentiate between alpha and beta haemolytic strep

A

a = green colour around colony
b = complete lysis of red cells

49
Q

Grouping of B-haemolytic strep?

A

Lancefield grouping = based on carbohydrate composition of cell walls

50
Q

Rate of GBS colonisation

51
Q

Rate of EOGBS

A

0.57 per 1000 births

52
Q

Risk of EOGBS
General pop
Previous GBS
Preterm
Temp in labour

A

General pop = 0.6 in 1000
Previous GBS = 1.25 in 1000
Preterm = 2.3 in 1000
Temp in labour = 5 in 1000

53
Q

Risk of death and disability with EOGBS

A

Death = 5.2%
Disability = 7.5%

54
Q

Risk factors of EOGBS

A

Previous baby with GBS
GBS bacturia
+ve GBS swab in pregnancy
Maternal temp in labour

55
Q

GBS abx if pen allergic

A

Cefuroxime 1.5g loading then 750mg 8hrly
OR
vancomycin 1g 12hrly

56
Q

Neonatal tx of suspected GBS

A

Penicillin + gentamicin

57
Q

Maternal mortality of COVID

A

2.4 per 100,000 maternities

58
Q

Treatment of MRSA colonisation

A

Mupirocin ointment TDS for 5 days

59
Q

Treatment of MRSA infection

A

Vancomycin or teicoplanin
Linezolid if resistant to above

60
Q

Treatment of sepsis in pregnancy

A

Not critically ill:
Co-amox + metro
Cefuroxime 1.5g 8hrly + metro
Cefotaxime 1-2g 6-12hrly + metro
Clarithro/clinda + gent +/- metro

Severe sepsis:
tazocin + gent
meropenem + gent

61
Q

Treatment of group A strep

A

Clindamycin

62
Q

Sepsis bundles to be completed within:
3 hours
6 hours

A

3 hours:
Sepsis 6 - lactate, blood cultures, IV abx, O2 (sat >94%), urine output, give 30ml/kg crystalloid

6 hours:
- recheck lactate if raised
- vasopressors if needed to maintain MAP >65

63
Q

Most common postpartum infection

A

Endometritis

64
Q

Rate of false positive and negative tests in syphilis

A

1% (VDRL and Abs)

65
Q

In preterm labour, what drug do you give to help load baby in HIV

A

Double dose tenofovir

66
Q

How long should you wait post Zika for fertility treatment?
Exposure?
Infection?

A

Exposure = 28 days
Infection = 6 months, test semen for Zika on RT-PCR

67
Q

Risk of fetal transmission of toxoplasmosis

A

<4 weeks: <1%
13/40: 10%
>36/40: 60%

MRCOG part 2 (9 decks)

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