Infections in pregnancy - hep B,C, HIV and syphills

Question 1

what infections are screened for at the booking appointment

Answer 1

hep b, HIV, syphillis

Question 2

HIV doesn’t increase the risk of?

what does it increase risk of (4)

Answer 2

congenital abnormalities

• pre-eclampsia
• miscarriage
• low birth weight
• pre term delivery

Question 3

what can be offered to women with HIV whilst pregnant

Answer 3

serial 4 weekly fetal growth scans

Question 4

babies born to HIV positive women should be?

Answer 4

referred for HIV testing to neonatology

Question 5

MDT input includes

Answer 5

• obs consultant team
• com midwifery team
• hiv specialist
• neonatologist
• GP

Question 6

aims of combined anti-retroviral treatment include? (cART) (3)

Answer 6

• viral load <50 HIV rna copies = allows for vaginal delivery
• reduce risk of vertical transmission
• improve mothers health

Question 7

what increases the risk of vertical transmission of hiv

Answer 7

breastfeeding

Question 8

throughout pregnancy with HIV- women need frequent monitoring of ? (3)

Answer 8

LFT’S
CD4 count
HIV viral load

Question 9

viral load > 400 in HIV??

Answer 9

PRE-LABOUR CS recommended between 38 and 39 weeks

Question 10

What can also be recommended for hiv?

Answer 10

intrapartum anti retro viral infusions

Question 11

how are many cases of hep B spread?- how else does it spread

Answer 11

vertical transmission

blood and bodily fluids

Question 12

Acute hep B infection in pregnancy can be?

Answer 12

very severe

Question 13

babies born to women with acute hep b infection at birth will?

Answer 13

contract hep b
cirrhosis
hepatocellular cancer

Question 14

Women with chronic HBV with HIGH viral load should be offered?

Answer 14

tenofovir monotherapy in 3rd trimester to reduce risk of transmission

Question 15

HEP b vaccine can be given to pregnant women safely as it is?

Answer 15

inactivated

- can be give to high risk IV drug uses or IVDU partner or who has HIV/HBV

Question 16

what should be offered to babies whos mother has hep B

what will they get given?

Answer 16

hep b immunoglobulin
accelerated immunisation schedule

• initial dose of the vaccine at birth within 24hrs of delivery

Question 17

tests for hep b at 1 year old will show?

less response to vaccine seen in?

Answer 17

where treatment wasn’t successful

• who is chronically infected
• may be lower in preterm or low weigh babies

Question 18

Hep C can lead to? (RNA virus)

Answer 18

severe hepatitis
chronic liver disease
increased risk of liver cancer

Question 19

Hep C is found in what % of pregnant women ?

Answer 19

1-2%

Question 20

most cases of hep c are associated with

Answer 20

prior injecting drug use

Question 21

pregnancy in women with hep c is associated with

Answer 21

declining liver function

Question 22

when is vertical transmission higher in hep C

Answer 22

if the women is co infected with HIV

Question 23

When should HEP C screening be offered? (4)

Answer 23

• history of IV drug use / current substance missuse
• hep B or HIV
• PREV OR CURRENT partner with ivdu
• deranged liver function tests

Question 24

Hep C infection should not be treated in pregnancy.. why?

Answer 24

the drugs used are teratogenic

• you can breastfeed

Question 25

What is syphilis caused by?

Answer 25

Treponema pallidum | -skin lesion spread during sexual contact

Question 26

syphilis can be cured by?

Answer 26

course of antibiotics - IM penicillin

Question 27

if left untreated syphilis can cause?

Answer 27

neurological, cardiac, skeletal and skin abnormalities | for adults and babies affected in utero

Question 28

infection more than once is possible in ?

Answer 28

syphilis

Question 29

syphilis infection is associated with an increase risk of? (5)

Answer 29

``` miscarriage stillbirth hydrops fetalis growth restriction congenital infection ```

Question 30

syphilis can be transferred from baby to mother.. (2)

Answer 30

trans placentally | exposure to infected lesion at time of birth

Question 31

Primary syphilis is characterised by? | - if left untreated?

Answer 31

painless local ulcer - chancre | - secondary syphilis - tertiary (20-40) years

Question 32

congenital infection of syphilis can present in | 2/3 of neonates will be?

Answer 32

first 2 years of life | - asymptomatic at birth

Question 33

babies at risk of congenital infection must be referred to?

Answer 33

neonatology

Question 34

congenital infection of syphilis - what is in HUTCHINSON'S TRIAD (3)

Answer 34

deafness interstitial keratitis hutchinson's teeth , widely spaced - peg like