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Obstetrics and Gynaecology > Infections in Pregnancy > Flashcards

Infections in Pregnancy Flashcards

1
Q

How is CMV transmitted?

A

Personal contact

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2
Q

Give 4 fetal/neonatal effects of CMV.

A

IUGR
Pneumonia
Thromocytopenia
Hearing, visual and mental impairment

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3
Q

Give 3 ix done in CMV.

A

CMV IgM
USS shows intracranial / hepatic calcifications
Amniocentesis at least 6 weeks after maternal infection will confirm or refute transmission

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4
Q

Describe the pathology of herpes simplex.

A

Type 2 DNA virus is responsible for most genital herpes.

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5
Q

How is herpes simplex transmitted to the fetus and what effects does it pose to the fetus?

A

Vertical transmission at vaginal delivery, especially following recent primary maternal infection
Neonatal infection is rare, but high mortality

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6
Q

How is herpes simplex diagnosed?

A

Clinical dx

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7
Q

Give 4 mx of herpes simplex.

A
  1. Refer to GUM clinic
  2. C-section for those delivering within 6 weeks of a primary attack, and those with genital lesions at time of delivery
  3. Daily aciclovir in late pregnancy
  4. Give aciclovir to exposed neonates
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8
Q

Which period does herpes zoster virus cause severe neonatal infection?

A

4 weeks preceeding delivery, especially 5 days after or 2 days before maternal symptoms

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9
Q

What is the mx of herpes zoster?

A
  1. Maternal blood checked for varicella antibodies
  2. VZ Ig within 10 days if non-immune
  3. Aciclovir if infection occurs
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10
Q

List 5 teratogenic infections.

A 
CMV
Rubella
Toxoplasmosis
Syphillis
Herpes zoster
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11
Q

List 9 effects of rubella infection on the fetus,

A
  1. sensorineural deafness
  2. congenital cataracts
  3. congenital heart disease (e.g. patent ductus arteriosus)
  4. growth retardation
  5. hepatosplenomegaly
  6. purpuric skin lesions
  7. ‘salt and pepper’ chorioretinitis
  8. microphthalmia
  9. cerebral palsy
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12
Q

Give 2 mx of rubella.

A
  1. If a non-immune woman develops rubella before 16 weeks’ gestation, TOP is offered
  2. Vaccinate after end of pregnancy
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13
Q

List 3 consequences of Parvovirus on the fetus.

A
  1. Anaemia (virus suppresses fetal erythropoesis)
  2. Thrombocytopenia
  3. Fetal death (usually before 20 weeks)
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14
Q

How is parvovirus diagnosed?

A

Positive maternal IgM test

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15
Q

How is anaemia detected on USS?

A
  1. Initially increased blood flow velocity in the fetal middle cerebral artery on Doppler USS
  2. Subsequently fetal hydrops from cardiac failure
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16
Q

Give 2 mx of parvovirus.

A
  1. Mothers are scanned regularly

2. When hydrops is detected, in utero transfusion

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17
Q

List 2 ways Hep B is transmitted.

A
  1. Blood products
  2. Sexual activity
  3. Vertical transmission during delivery
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18
Q

List 3 mx of Hep B.

A
  1. Women with a high viral load are treated with antiviral agents from 32 weeks
  2. Babies born to mothers who are chronically infected with hepatitis B or to mothers who’ve had acute hepatitis B during pregnancy should receive a complete course of vaccination + hepatitis B immunoglobulin
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19
Q

List 2 risk factors of Hep C.

A
  1. Drug abuse

2. Sexual transmission

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20
Q

List 2 factors that increase the risk of vertical transmission of Hep C.

A
  1. High viral loads

2. Coexisting HIV infection

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21
Q

List 4 effects of HIV on the mother and fetus.

A
  1. Stillbirth
  2. Pre-eclampsia
  3. IUGR
  4. Prematurity
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22
Q

Give 5 factors which increase the risks of HIV vertical transmission.

A
  1. Low CD4 counts
  2. High viral load
  3. Coexistent infection
  4. Premature delivery
  5. During labour
  6. Ruptured membranes >4h
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23
Q

Give 3 mx of HIV in resourced countries.

A
  1. Regular CD4 and viral load tests
  2. Screen for genitral tract infections
    3, Prophylaxis against Pneumocystic carinii pneumonia (PCP) is given if CD4 is low
  3. HAART during prenancy and delivery
  4. Neonate treated for first 6 weeks
  5. HAART started at 28 weeks if no pre-pregnancy tx
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24
Q

How is drug toxicity monitored in HIV mothers?

A
  1. Liver test
  2. Renal test
  3. Haemogloblin levels
  4. Blood glucose test
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25
Q

List 2 indicators of C-section in HIV women.

A
  1. Viral load > 50 copies/mL

2. Coexistent Hep C infection

26
Q

List 2 mx of HIV in under-resourced countries.

A
  1. Single dose of nevirapine in labour and to the neonate

2. Advise breastfeeding limited to 6 months

27
Q

List 4 methods to prevent vertical transmission of HIV.

A
  1. Maternal antiretroviral therapy
  2. Neonatal antiretroviral therapy
  3. Elective C-section
  4. Avoidance of breastfeeding
28
Q

List 3 effects of ZIKA virus on the fetus.

A
  1. Intracranial calcification
  2. Ventriculomegaly
  3. Microcephaly
29
Q

How is ZIKA prevented?

A

Aedes is active during the day , so best protected by repellent

30
Q

List 3 signs and symptoms of ZIKA on the mother.

A
  1. Rash
  2. Fever
  3. Guillain-Barre symptoms
31
Q

How is ZIKA diagnosed?

A

PCR

32
Q

List 2 mx of mothers suggestive of ZIKA symptoms.

A
  1. Fetal assessment for CNS abnormalities

2. TOP

33
Q

Give an eg of Group A Strep.

A

Strep pyogenes

34
Q

How is group A strep transmitted?

A

Maternal hand to perineal contamination

35
Q

List 4 consequences of Group A strep.

A
  1. Chrorioamnionitis
  2. Abdo pain
  3. Diarrhoea
  4. Sepsis
36
Q

How is Group A strep managed?

A
  1. High does abx

2. Intensive care

37
Q

Give an eg of GBS.

A

Strep agalactiae

38
Q

List 4 factors which increase the risk of GBS vertical transmission.

A
  1. Ruptured membranes
  2. Preterm labours
  3. Prolonged labour
  4. Maternal fever
39
Q

Describe the prevention of vertical transmission of GBS.

A 
Strategy 1: Risk factors
Treat with IV penicillin in labour if:
1. Previous hx 
2. Intrapartum fever >38C
3. Current preterm labour
4. ROM >18h

Strategy 2: Screening

  1. Vaginal and rectal swabs at 35-37w
  2. Treat with IV penicillin if swabs positive or risk factors present
40
Q

What is the name of the microorganism which causes syphilis?

A

Treponema pallidum

41
Q

List 3 consequences of syphilis in pregnancy.

A
  1. Miscarriage
  2. Severe congenital disease
  3. Stillbirth
42
Q

How is syphilis managed?

A

Benzylpenicillin

43
Q

Give the name of the screening test of syphilis.

A

Venereal Disease Research Laboratories (VDRL) test

44
Q

Name the organism which causes toxoplasmoxis.

A

Toxoplasma gondii

45
Q

List 2 methods toxoplasmosis is transmitted.

A
  1. Contact with cat faeces or soil

2. Eating infected meat

46
Q

List 4 effects of toxoplasmosis on the fetus.

A
  1. Mental handicap
  2. Convulsions
  3. Spasticities
  4. Visual impairment
47
Q

List 2 ix done on toxoplasmoxis mothers.

A

Maternal IgM test

USS may show hydrocephalus

48
Q

List 3 mx of toxoplasmoxis.

A
  1. Health education
  2. Spiramycin
  3. If vertical transmission confirmed, add pyrimethamine and sulfadiazine with folinic acid
49
Q

List 3 consequences of TB on pregnancies.

A
  1. Prematurity
  2. IUGR
  3. Maternal mortality
50
Q

List 3 consequences of malaria on pregnancies.

A
  1. Severe maternal anemia
  2. IUGR
  3. Stillbirth
51
Q

List 3 mx of malaria.

A
  1. Artemisinin combination therapy (ACT)
  2. Intermittent preventive Tx (IPT) of 2 doses at least a month apart
  3. Insecticide-impregnated mosquito nets
52
Q

List 3 foods which increase the risk of Listeriosis.

A

Pates, soft cheeses, prepacked meals

53
Q

List 3 consequences of Chlamydia and gonorrhoea.

A
  1. PID
  2. Subfertility
  3. Neonatal conjunctivitis
  4. Preterm labour
54
Q

What is the tx for Chlamydia?

A

Azithromycin

if pregnant then azithromycin, erythromycin or amoxicillin

55
Q

What is the tx for Gonorrhoea?

A

IM ceftriaxone

56
Q

List 2 organisms which cause BV.

A
  1. Gardnerella vaginalis

2. Mycoplasma hominis

57
Q

List 2 consequences of BV.

A
  1. Preterm labour

2. Late miscarriage

58
Q

How is BV treated?

A

Clindamycin (best before 20w)

59
Q

List 5 features of fetal varicella syndrome.

A
  1. skin scarring
  2. eye defects (microphthalmia)
  3. limb hypoplasia
  4. microcephaly
  5. learning disabilities
60
Q

Give the mx of chickenpox exposure in pregnancy.

A
  1. if there is any doubt about the mother previously having chickenpox maternal blood should be urgently checked for varicella antibodies
  2. if the pregnant women is not immune to varicella she should be given varicella zoster immunoglobulin (VZIG) as soon as possible. VZIG is effective up to 10 days post exposure
  3. oral aciclovir should be given if pregnant women with chickenpox present within 24 hours of onset of the rash

Obstetrics and Gynaecology (27 decks)

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