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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
What effects does toxoplasmosis have on the fetus?
mental retardation convulsions spasticity visual impairment
26
How is toxoplasmosis diagnosed in pregnancy?
IgM/IgG abs w amniocentesis after 20 weeks | diagnose babies w serology
27
What is the management of toxoplasmosis in pregnancy?
spiramycin as soon as diagnosed
28
What is the management of confirmed vertical transmission of toxoplasmosis in pregnancy?
pyrimethamine sulfadiazine calcium folate ALL until delivery
29
What are the fetal effects of herpes zoster? what is rx
teratogenicity | oral aciclovir ASAP
30
What gestation is the neonate at most risk of severe infection of herpes zoster?
4 weeks before delivery
31
What is the management of a pregnant woman who has had chickenpox contact?
Give VZIG
32
What is the management of women getting herpes zoster near delivery?
aim for delivery after 7 days, | give baby VZIG and aciclovir
33
What are the sx of parvovirus in pregnancy? (woman)
``` slapped cheek maculopapular rash fever arthralgia may be asymptomatic ```
34
What are the sx in the fetus w parvovirus?
cardiac failure | fetal hydrops
35
How is a diagnosis of parvovirus made in pregnancy?
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
What is the management of parvovirus during pregnancy?
serial US looking for signs of fatal anaemia (hydrops) | in utero transfusion if hydrops
37
What factors reduce the vertical transmission rate of HIV?
- maternal antiretroviral therapy - mode of delivery (caesarean section) - neonatal antiretroviral therapy - infant feeding (bottle feeding)
38
How is HIV detected during pregnancy?
screening
39
What is the management of HIV during pregnancy?
Antiretroviral therapy Vaginal delivery if viral load <50copies/ml at 36 weeks, otherwise CS Zidovudine infusion 4 hrs before CS
40
What is the management of HIV in the neonate?
Oral zidovudine if maternal viral load <50 otherwise HAART Continue therapy for 4-6 weeks dont breastfeed
41
When are babies tested for HIV?
DAY 1, 6weeks, 12 weeks | 18 m
42
What increases risk of vertical transmission of HIV?
* 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
What is management of HIV mothers w ROM >34 weeks
speed up delivery
44
What is management of HIV mothers w ROM <34w
steroids erythromycin HAART
45
What should be avoided during delivery of HIV mothers?
FBS | scalp electrodes
46
When is CS indicated in HIV motherS?
38 weeks if on zidovudine
47
what is given postpartum in HIV mothers to suppress lactation?
cabergoline
48
what should be given to high risk HIV babies?
zidovudine, HAART and cotrimoxazole
49
When is HIV tested for in pregnancy?
booking
50
What vaccines should be offered in pregnancy for HIV?
hep B, pneumococcal and influenza vaccines
51
What is the management of HIV during pregnancy regarding HAART
Continue if already on it | if not start by 24 weeks until delivered
52
What are chlamydia and gonorrhoea associated w in pregnancy/
preterm labour | neonatal conjunctivitis
53
What is the treatment of chlamydia during gpregnacy?
azithromycin or erythromycin
54
What is the treatment gonorrhoea during pregnancy?
cephalosporins e.g. cefuroxime
55
What is an effect of tetracycline during pregnancy?
causes fetal tooth discolouration
56
What is the full name of chlamydia?
chlamydia trachomitis
57
What is chlamydia infection during pregnancy associated with?
low birthweight prem ROM fetal death
58
what is the sign of chlamydia in the newborn?
conjunctivitis 5-14 days after birth
59
What are complications of chlamydia in pregnancy?
chlamydia pneumonitis pharyngitis otitis media
60
What is the treatment of chlamydia infection in the neonate?
local cleansing of eye | erythromycin for 3 weeks
61
what is the treatment of parents of chlamydia infection?
erythromycin or azithromycin stat
62
What gives a high risk of perinatal infection of hepatitis?
development of acute infection during 2nd/3rd trimester | mother not infected and not immunised
63
Can hep B be transmitted by breastfeeding?
no
64
What are the long term effects of hep B infection on the neonate?
* Most develop chronic infection and cirrhosis | * Infected males, lifetime risk of hepatocellular cancer is 50%
65
When are babies usually infected by hep B
during birth
66
what is the treatment of neonatal Hep B infection?
Immunoglobulin | vaccination

Women's Health (65 decks)

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