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Women's Health > Infections in pregnancy > Flashcards

Infections in pregnancy Flashcards

1
Q

Is there screening for GBS in the uk

A

no

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2
Q

Where is GBS found normally?

A

Bowel

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3
Q

What are RF for GBS?

A

prematurity
prolonged ROM
prev. GBS infecton
maternal pyrexia e.g. secondary to chorioamnionitis

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4
Q

when should swabs for GBS be offered?

A

35-37 weeks

3-5 weeks prior to anticipated delivery date

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5
Q

What is the management of women who’ve previously had GBS in pregnancy?

A

offer maternal IV abx (benzylpenicillin + gentamicin) prophylaxis OR
testing in late pregnancy and then abx if still positive

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6
Q

When should women be given IV abx prophylaxis for GBS?

A

If had a prev. baby w early/late onset GBS
preterm labour regardless of GBS status
pyrexia during labour

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7
Q

What does CMV cause to children?

A

handicap

sensorineural deafness

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8
Q

What is transmission rate of CMV

A

40%

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9
Q

What sx at birth can present in CMV?

A

IUGR
pneumonia
thrombocytopenia

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10
Q

What are the Ix for cMV?

A
  1. paired sera (presence of IgM and IgG abs)
  2. amniocentesis >20 weeks to detect fatal transmission
  3. US - intracranial/hepatic calcification
  4. Throat swab, urine culture and baby’s serum after birth
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11
Q

What is management of CMV?

A

Most infected neonates not seriously affected
close surveillance for US abnormalities
no prenatal treatment, offer termination

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12
Q

Which types of herpes are responsible of oral and genital herpes?

A

1 and 2

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13
Q

What are the fetal effects of herpes simplex?

A 
blindess
reduced IQ
epilepsy 
jaundice
resp distress
DIC
Death
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14
Q

when does vertical transmission of herpes occur

A

at vaginal delivery if vesicles are present

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15
Q

how is herpes diagnosed in pregnancy?

A

clinically

type specific w PCR

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16
Q

What is the management of herpes simplex infection?

A

last trimester: aciclovir or valociclovir +/- elective CS

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17
Q

what must be avoided in birth involving herpes simplex infection?

A

FBS
scalp electrodes
instrumental delivery

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18
Q

When are fetuses most at risk of rubella infection?

A

first 16 weeks

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19
Q

What metal abnormalities are caused by maternal infection of rubella?

A
  • Deafness
  • Cardiac disease
  • Eye problems - cataracts
  • Mental retardation
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20
Q

How does severity of malformation change with advancing gestation?

A

decreases

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21
Q

What is the management of women w rubella infection before 16 weeks?

A

offer termination

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22
Q

How is rubella infection diagnosed during pregnancy?

A

screened for at booking to identify those in need of vaccination after the end of pregnancy

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23
Q

What is the cause of toxoplasmosis?

A

protozoan parasite toxoplasma gondii

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24
Q

how does someone acquire toxoplasmosis?

A

contact w faeces soil

eating infected meat

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25
Q

What effects does toxoplasmosis have on the fetus?

A

mental retardation
convulsions
spasticity
visual impairment

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26
Q

How is toxoplasmosis diagnosed in pregnancy?

A

IgM/IgG abs w amniocentesis after 20 weeks

diagnose babies w serology

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27
Q

What is the management of toxoplasmosis in pregnancy?

A

spiramycin as soon as diagnosed

28
Q

What is the management of confirmed vertical transmission of toxoplasmosis in pregnancy?

A

pyrimethamine
sulfadiazine
calcium folate
ALL until delivery

29
Q

What are the fetal effects of herpes zoster? what is rx

A

teratogenicity

oral aciclovir ASAP

30
Q

What gestation is the neonate at most risk of severe infection of herpes zoster?

A

4 weeks before delivery

31
Q

What is the management of a pregnant woman who has had chickenpox contact?

A

Give VZIG

32
Q

What is the management of women getting herpes zoster near delivery?

A

aim for delivery after 7 days,

give baby VZIG and aciclovir

33
Q

What are the sx of parvovirus in pregnancy? (woman)

A 
slapped cheek
maculopapular rash
fever 
arthralgia
may be asymptomatic
34
Q

What are the sx in the fetus w parvovirus?

A

cardiac failure

fetal hydrops

35
Q

How is a diagnosis of parvovirus made in pregnancy?

A

paired samples w IgM/IgG increased
− Anaemia detected on US as increased blood flow velocity in the middle cerebral artery and subsequently as oedema from cardiac failure

36
Q

What is the management of parvovirus during pregnancy?

A

serial US looking for signs of fatal anaemia (hydrops)

in utero transfusion if hydrops

37
Q

What factors reduce the vertical transmission rate of HIV?

A
  • maternal antiretroviral therapy
  • mode of delivery (caesarean section)
  • neonatal antiretroviral therapy
  • infant feeding (bottle feeding)
38
Q

How is HIV detected during pregnancy?

A

screening

39
Q

What is the management of HIV during pregnancy?

A

Antiretroviral therapy
Vaginal delivery if viral load <50copies/ml at 36 weeks, otherwise CS
Zidovudine infusion 4 hrs before CS

40
Q

What is the management of HIV in the neonate?

A

Oral zidovudine if maternal viral load <50
otherwise HAART
Continue therapy for 4-6 weeks
dont breastfeed

41
Q

When are babies tested for HIV?

A

DAY 1, 6weeks, 12 weeks

18 m

42
Q

What increases risk of vertical transmission of HIV?

A
  • Vaginal delivery
  • Breastfeeding
  • Membrane rupture for >4hrs
  • Viral load >400copies/ml
  • Seroconversion during pregnancy (ab develops and becomes detectable in blood)
  • Advanced disease
  • Premature labour
  • Hep C
43
Q

What is management of HIV mothers w ROM >34 weeks

A

speed up delivery

44
Q

What is management of HIV mothers w ROM <34w

A

steroids
erythromycin
HAART

45
Q

What should be avoided during delivery of HIV mothers?

A

FBS

scalp electrodes

46
Q

When is CS indicated in HIV motherS?

A

38 weeks if on zidovudine

47
Q

what is given postpartum in HIV mothers to suppress lactation?

A

cabergoline

48
Q

what should be given to high risk HIV babies?

A

zidovudine, HAART and cotrimoxazole

49
Q

When is HIV tested for in pregnancy?

A

booking

50
Q

What vaccines should be offered in pregnancy for HIV?

A

hep B, pneumococcal and influenza vaccines

51
Q

What is the management of HIV during pregnancy regarding HAART

A

Continue if already on it

if not start by 24 weeks until delivered

52
Q

What are chlamydia and gonorrhoea associated w in pregnancy/

A

preterm labour

neonatal conjunctivitis

53
Q

What is the treatment of chlamydia during gpregnacy?

A

azithromycin or erythromycin

54
Q

What is the treatment gonorrhoea during pregnancy?

A

cephalosporins e.g. cefuroxime

55
Q

What is an effect of tetracycline during pregnancy?

A

causes fetal tooth discolouration

56
Q

What is the full name of chlamydia?

A

chlamydia trachomitis

57
Q

What is chlamydia infection during pregnancy associated with?

A

low birthweight
prem ROM
fetal death

58
Q

what is the sign of chlamydia in the newborn?

A

conjunctivitis 5-14 days after birth

59
Q

What are complications of chlamydia in pregnancy?

A

chlamydia pneumonitis
pharyngitis
otitis media

60
Q

What is the treatment of chlamydia infection in the neonate?

A

local cleansing of eye

erythromycin for 3 weeks

61
Q

what is the treatment of parents of chlamydia infection?

A

erythromycin or azithromycin stat

62
Q

What gives a high risk of perinatal infection of hepatitis?

A

development of acute infection during 2nd/3rd trimester

mother not infected and not immunised

63
Q

Can hep B be transmitted by breastfeeding?

A

no

64
Q

What are the long term effects of hep B infection on the neonate?

A
  • Most develop chronic infection and cirrhosis

* Infected males, lifetime risk of hepatocellular cancer is 50%

65
Q

When are babies usually infected by hep B

A

during birth

66
Q

what is the treatment of neonatal Hep B infection?

A

Immunoglobulin

vaccination

Women's Health (65 decks)

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