infxn

Question 1

congenital VZV

Answer 1

skin scarring
limb hypoplasia
chorioretinitis 
microcephaly  
high death rate if maternal dz 5 days before delivery

Question 2

exposed to VZV during pregnancy

Answer 2

VZIG w/in 72-96 hrs - does not prevent transmission

may give acyclovir for 7 days

Question 3

parvovirus mid-pregnancy exposure

Answer 3

fetal hydrops (2/2 to anemia + high-output CHF)

Question 4

incubation period of parvovirus + diagnosis

Answer 4

10-20 days; IgM positive = acute infxn

IgG = previous immunity

Question 5

management of positive parvo exposure > 20 wks

Answer 5

serial u/s for 8-10 wks 
MCA doppler (incr. peak systolic velocity) & possible intrauterine blood transfusion

Question 6

CMV diagnosis

Answer 6

seroconversion from IgM-IgG / significant incr. in titer

IgM may stick around

Question 7

maternal prodrome of CMV

Answer 7

subclinical infxn

• incubation 28-60 days
• mild viral illness

Question 8

sonographic findings suggestive of CMV infxn

Answer 8

intercerebral calcification
IGUR
microcephaly
ventriculomegaly
oligohydrmanios

Question 9

additional CMV associations

Answer 9

fetal heart block
renal dysplasia
ascites, pleural effusions

Question 10

complications of fetal CMV

Answer 10

hearing loss
chorioretinits, thrombocytopenia
hepatosplenomegaly
interstitial pneumonitis

Question 11

congenital rubella syndrome

Answer 11

deafness, cataracts/retinopathy, CNS defects, cardiac malformations (patent ductus arteriosus / supravalvular pulmonic stenosis)

Question 12

latent sequelae of congenital rubella syndrome

Answer 12

diabetes
thyroid disease
growth hormone deficiency

Question 13

HIV delivery algorithm?

Answer 13

> 1K viral load = c/s

Question 14

HIV management

Answer 14

3-drug (1 zidovudine) as part of HAART regimen during gestation

• viral loads every month until undetectable
• cd4 counts each trimester

Question 15

HIV testing

Answer 15

• ELISA for screening

- western blot / PCR for confirmation

Question 16

HIV infxn in labor

Answer 16

1) ziduovudine in labor IV + 6 wks to neonate
2) nevirapine - single dose
3) zidovudine/lamivudine - in labor / neonate 1 wk

Question 17

amniotic infxn syndrome

Answer 17

placental, fetal membrane, umbilical cord inflammation

-infected oral / gastric aspirate, leukocytosis, neonatal infection, maternal fever

Question 18

fetal sequelae of gonorrhea infxn

Answer 18

corneal ulceration –> corneal scarring / blindness

Question 19

meaning of hep B e antigen?

Answer 19

active viral replication = high infectivity

Question 20

treatment of gonorrhea

Answer 20

• diagnosis w/ nucleic acid amplification (NAAT) test / culture
• IM ceftriaxone / IM spectinomycin (if allergy)

Question 21

treatment of toxo for infxn in pregnancy

Answer 21

spiramycin - no teratogenic effects - does not cross placenta

Question 22

if fetal infxn of toxo documented by DNC PCR by amnio

Answer 22

pyrimethamine (teratogenic in 1st trim. supplement w/ folic acid)
sulfadiazine

Question 23

features of toxo infxn

Answer 23

chorioretinitis
periventricular calcifications
seizures

Question 24

GBS positive: when to receive antbiotics?

Answer 24

1) hx of GBS affected neonate
2) urine culture + GBS
3) preterm labor < 37 wks
4) ROM > 18 hrs
5) temp > 38.0 in labor (100.4)
6) screening for GBS at 35-37 wks

Question 25

GBS + mild penicillin allergy

Answer 25

cefazolin

Question 26

gentamycin coverage

Answer 26

gram-neg

Question 27

clindamycin

Answer 27

anaerobic organisms

Question 28

what are vaccines not recommened during pregnancy?

Answer 28

live intranasal flu vaccine
smallpox
VZV
MMR
HPV

Question 29

UTI antibiotics contraindicated in pregnancy

Answer 29

TMP-SFX, fluoroquinolones, tetraclycines

Question 30

recommended UTI antibiotics in pregnancy

Answer 30

nitrofurantoin