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MRCOG part 2 > Infectious Diseases In Pregnancy > Flashcards

Infectious Diseases In Pregnancy Flashcards

1
Q

U.K. prevalence of TB

A

4.2 per 100, 000

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2
Q

World wide prevalence of TB in pregnant women

A

0.25% low prevalence country
0.5% high prevalence country
11% in HIV positive women

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3
Q

Mycobacterium tuberculosis organism characteristics

A

Aerobic
Non-spore forming
Non-motile bacillus

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4
Q

Primary TB

A

Disease within 2 years of infection

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5
Q

Latent TB

A

Asymptomatic and non-infectious

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6
Q

Sites of extra pulmonary disease in pregnancy

A

Cervical lymph nodes (31%)
CNS
abdomen
Pericardium

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7
Q

Effects of TB on perinatal outcomes

A

Low APGAR
RDS with extra pulmonary disease
Preterm delivery
SGA
Oligohydramnios
PPROM

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8
Q

Effects of TB on maternal outcomes

A

Hypertension
Cholestasis
GDM
Anaemia
Death

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9
Q

Associations with HIV-TB coinfection

A

Anaemia
Eclampsia
Placenta accepts
Drug abuse
Depression

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10
Q

Treatment of TB (no CNS involvement)

A

Initial phase (2 months) - rifampicin, isoniazid, ethambutol and pyrazinamide
Continuation phase (4 months) - rifampicin and isoniazid

*give pyridoxine

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11
Q

Treatment of TB with CNS involvement

A

Rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months
Rifampicin and isoniazid for 10 months
Dexamethasone/prednisone for 4-8 weeks

*Give pyridoxine

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12
Q

Treatment of drug resistant TB

A

Continue 3 drug treatment for 2 months followed by continuation with sensitive agents for 4-7 months

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13
Q

Most common infective site of TB in the neonate

A

Liver

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14
Q

Diagnostic tests for perinatal TB

A

Placental histology and culture
CXR
CSF culture
GI/tracheal aspirated

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15
Q

Presentation of perinatal TB

A

RDS
Failure to thrive
Irritability
Lymphadenopathy
Pyrexia of unknown origin
Unexplained anaemia
Hepatosplemomegaly

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16
Q

Perinatal TB mortality

A

22% treated infants
38% non-treated infants

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17
Q

Breastfeeding in TB

A

Safe after completion of 2 weeks Rx
Not safe if multi-drug resistant or HIV coinfection

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18
Q

BGC vaccination recommendation

A

If neonate is in a high prevalence area 40/10000
If close relatives are from high incidence countries (40/100000)
If born to HIV mum, formula fed and HIV negative at 14 weeks

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19
Q

Commonest causative organisms for obstetric sepsis

A

Streptococcal groups A, B, D
Pneumococcus
E. coli

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20
Q

Septic shock management

A

If lactate >4 or hypotension is present then:
30ml/kg crystalloid within 3 hours of diagnosis
Vasopressor or inotrope to maintain MAP 65mmHg
Measure cardiac output with oesophageal Doppler or lithium dilution cardiac output (LiDCO)
Consider steroids if inadequate response to vasopressors
Remove septic focus
Thromboprophylaxis
+/- blood products

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21
Q

Who gets offered IAP for GBS

A

Preterm labour
GBS colonisation during current pregnancy
Previous baby with GBS disease
Clinical diagnosis of chorioamnionitis

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22
Q

Management of previous GBS colonisation in a previous pregnancy

A

Collect swab between 35-37 weeks or 3-5 weeks before expected delivery
If positive then offer IAP

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23
Q

GBS antibiotic choice (no allergy)

A

Benzylpenicillin if no chorioamnionitis
Add gentamicin if clinical chorioamnionitis

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24
Q

GBS treatment (mild penicillin allergy)

A

Cephalosporin with GBS activity with caution if no chorioamnionitis
Cephalosporin with metronidazole if clinical chorioamnionitis

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25
Q

GBS treatment (severe penicillin allergy)

A

Vancomycin or sensitivity guided choice if no chorioamnionitis
Vancomycin + gentamicin + metronidazole if clinical chorioamnionitis

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26
Q

When to deliver PPROM with GBS?

A

34-37 weeks

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27
Q

Incidence of early onset GBS disease

A

0.57/1000

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28
Q

Risk of disability with early onset GBS disease

A

7.4%

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29
Q

Recurrent GBS carriage in subsequent pregnancy risk

A

50%

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30
Q

Risk of early onset GBS if positive swab in a subsequent pregnancy

A

1 in 400

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31
Q

Incidence of early onset GBS if negative swab in subsequent pregnancy

A

1 in 5000

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32
Q

Incidence of GBS with maternal pyrexia in labour

A

5.3 per 1000

33
Q

Risk of mortality from sepsis

A

8%

34
Q

Risk of mortality from early onset neonatal GBS

A

5%

35
Q

Percentage of maternal deaths caused by sepsis

A

10%

36
Q

Sepsis MBRRACE data

A

5th commonest cause of death
(4th if covid is excluded)
10% of deaths
2.5 deaths per 100,000

37
Q

Malaria species that causes cerebral complications

A

P falciparum

38
Q

What type of parasite is malaria?

A

Protozoan

39
Q

Malaria species which lie dormant (hypnozoites) in the liver

A

P vivax
P ovale

40
Q

How long does immunity from malaria last?

A

2 years

41
Q

Risk factors for malaria infection and severe disease

A

2nd trimester
Primigravida
Young maternal age

42
Q

Maternal complications of malaria

A

Anaemia
Cerebral malaria
ARDS
Hypoglycaemia
Renal failure with haemoglobinuria
DIC

43
Q

Fetal complications of malaria

A

Miscarriage
PTB
SGA
IUFD/neonatal death
fetal anaemia
Congenital malaria (parasites in placenta in 25% cases)
Failure to thrive
Coinfection

44
Q

Hepatic phase of malaria lasts for

A

7 days

45
Q

Merozoite reproduction in Erythrocytes takes . . .

A

48 hours for p. Falciparum, vivax and ovale
72h for P. Malariae

46
Q

Erythrocytic phase of malaria lasts

A

4 weeks

47
Q

Drug excretion time for malaria prophylaxis agents

A

Doxycycline - 1 week
Mefloquine - 3 months
Proguanil - 1 week
Atovaquone and proguanil - 2 weeks

48
Q

Contraindications to mefloquine

A

Depression
Neuro-psychiatric disorders
Epilepsy
Hypersensitivity to quinine

49
Q

Anti-malaria agent in 2nd/3rd trimester or breast feeding

A

Mefloquine

50
Q

Malaria treatment

A

Uncomplicated - hospital admission, PO/IV quinine and clindamycin for P. Falciparum/vivax

Complicated - ICU admission, IV artesunate for P.falciparum

Chloroquine for p. Vivax/ovale/malariae

Primaquine contraindicated

51
Q

Symptoms of malaria

A

Cyclical Fever, cough, joint pains, anaemia, vomiting, headache, dark urine

Severe - jaundice, seizures, prostration, breathing difficulties, impaired consciousness and abnormal bleeding

52
Q

Clinical signs of malaria

A

Hepatosplenomegaly
Retinal damage on fundoscopy
Hypovolaemic shock
Pulmonary oedema

53
Q

Diagnosis of malaria

A

Blood film microscopy - 3 negative blood films 12-24hrs apart excludes malaria

Rapid detection tests for antigens are less sensitive than microscopy

54
Q

Complicated malaria is characterised by

A

Hypoglycaemia/hyperglycaemia
ARDS
Impaired consciousness
Severe anaemia <8
DIC/abnormal bleeding
Haemoglobinuria
Renal impairment
Acidosis
Hyperlactaemia
Hyper parasitaemia (>2% red cells infected)
Circulatory shock

55
Q

Neonatal management following malaria

A

Screen thick and thin blood films at north and weekly for 28 days

56
Q

CMV is a ______ virus

A

Double stranded DNA

57
Q

CMV primary infection happens in what proportion of pregnant women?

A

2%

58
Q

Neonatal CMV mortality

A

20-30%

59
Q

Fetal risks from CMV

A

Sensorineural deafness (commonest cause)
Hepatosplenomegaly
IUGR
Microcephaly and learning disability
Thrombocytopenia
Haemolytic Anaemia
Jaundice
Seizures

60
Q

Toxoplasmosis is caused by

A

Toxoplasmosis gondii

61
Q

Incubation period for toxoplasmosis

A

5-23 days

62
Q

Toxoplasmosis Gondii is ____

A

Obligate Intracellular protozoan

63
Q

Toxoplasmosis is spread via

A

Contaminated food

64
Q

Rate of toxoplasmosis infection in pregnancy

A

1 in 500

65
Q

Absence of ____ antigen is protective against P Vivax

A

Duffy antigen found in black people

66
Q

Treatment to prevent relapse of malaria in pregnancy

A

Oral chloroquine 300mg weekly until delivery

67
Q

MOD with Hep B or C

A

Vaginal birth not contraindicated
Caesarean birth if Hepatitis C and HIV co-infection

68
Q

Diagnosis of Zika virus

A

RT-PCR IgM
Cross reacts with yellow fever and dengue

69
Q

Length of time to avoid pregnancy after exposure to Zika virus

A

3 months if make partner travelled
2 months if female partner travelled

70
Q

Management of microcephaly secondary to Zika infection

A

If Hc <2 SD below mean for gestational age >20 weeks

71
Q

Advise for fertility after Zika exposure

A

Avoid for 28 days if exposed
Avoid for 6 months if infected

72
Q

Listeria monocytogenes is a _____

A

Gram positive beta-haemolytic facultative anaerobe

73
Q

Early onset neonatal listeriosis

A

Disseminated granulomas AKA granulomatosis infantisepticum

74
Q

Listeriosis treatment

A

Ampicillin/penicillin G + gentamicin

75
Q

Risk of fetal colonisation from chlamydia

A

50%

76
Q

Prevalence of chlamydia in pregnancy

A

2-7%

77
Q

Neonatal sequalae of chlamydia

A

Conjunctivitis
Pneumonia 20%

78
Q

Treatment of covid

A

Steroids for 10/7 or until discharge if O2 requirement
VTE prophylaxis if admitted
Tocilizumab if CRP >75
Remdesivir if worsening symptoms despite Rx

MRCOG part 2 (22 decks)

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