Intrapartum Infections Flashcards

1
Q

Chickenpox is caused by

A

primary infection with varicella-zoster virus

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2
Q

Shingles is caused by

A

the reactivation of dormant virus in dorsal root ganglion

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3
Q

In VSV infection in pregnancy, there is a risk to

A

both the mother and also the fetus, a syndrome now termed fetal varicella syndrome

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4
Q

Chickenpox exposure, Risks to the mother?

A

5 times greater risk of pneumonitis

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5
Q

Fetal varicella syndrome (FVS)

risk?

A

risk of FVS following maternal varicella exposure is around 1% if occurs before 20 weeks gestation

studies have shown a very small number of cases occurring between 20-28 weeks gestation and none following 28 weeks

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6
Q

features of FVS

A

skin scarring, eye defects (microphthalmia), limb hypoplasia, microcephaly and learning disabilities

shingles in infancy:
severe neonatal varicella

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7
Q

severe neonatal varicella occurs when?

A

if the mother develops rash between 5 days before and 2 days after birth there is a risk of neonatal varicella, which may be fatal to the newborn child in around 20% of cases

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8
Q

shingles in infancy risks

A

1-2% risk if maternal exposure in the second or third trimester

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9
Q

Management of chickenpox exposure in pregnancy,

if there is any doubt about the mother previously having chickenpox do what

A

maternal blood should be urgently checked for varicella antibodies

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10
Q

if the pregnant woman <= 20 weeks gestation is not immune to varicella she should be given

A

varicella-zoster immunoglobulin (VZIG) as soon as possible

RCOG and Greenbook guidelines suggest VZIG is effective up to 10 days post exposure

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11
Q

if the pregnant woman > 20 weeks gestation is not immune to varicella then what should be given

A

either VZIG or antivirals (aciclovir or valaciclovir) should be given days 7 to 14 after exposure

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12
Q

PEP for chicken pox
The decision on choice of PEP for women exposed from 20 weeks of pregnancy should take into account patient and health professional preference as well as the ability to offer and provide PEP in a timely manner’

A

true

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13
Q

Management of chickenpox in pregnancy

A

if a pregnant woman develops chickenpox in pregnancy then specialist advice should be sought
there is an increased risk of serious chickenpox infection (i.e. maternal risk) and fetal varicella risk (i.e. fetal risk) balanced against theoretical concerns about the safety of aciclovir in pregnancy
consensus guidelines (Health Protection Authority and RCOG) suggest oral aciclovir should be given if the pregnant women is ≥ 20 weeks and she presents within 24 hours of onset of the rash
if the woman is < 20 weeks the aciclovir should be ‘considered with caution’

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14
Q

Group B Streptococcus (GBS) is the most common cause of early-onset severe infection in the neonatal period

A

true

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15
Q

It is thought around ?% of mothers have GBS present in their bowel flora and may therefore be thought of as ‘carriers’ of GBS

A

20-40%

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16
Q

Infants may be exposed to maternal GBS during labour and subsequently develop potentially serious infections.

A

true

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17
Q

Risk factors for Group B Streptococcus (GBS) infection:

A

prematurity
prolonged rupture of the membranes
previous sibling GBS infection
maternal pyrexia e.g. secondary to chorioamnionitis

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18
Q

Mx Group B Streptococcus (GBS) infection

A

If women are to have swabs for GBS this should be offered at 35-37 weeks or 3-5 weeks prior to the anticipated delivery date

IAP should be offered to women with a previous baby with early- or late-onset GBS disease

IAP should be offered to women in preterm labour regardless of their GBS status
women with a pyrexia during labour (>38ºC) should also be given IAP

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19
Q

? is the antibiotic of choice for GBS prophylaxis

A

benzylpenicillin

20
Q

universal screening for GBS should not be offered to all women

A

true

21
Q

The guidelines also state a maternal request is not an indication for screening
women who’ve had GBS detected in a previous pregnancy

What should you do with these women?

A

should be informed that their risk of maternal GBS carriage in this pregnancy is 50%.

They should be offered intrapartum antibiotic prophylaxis (IAP) OR testing in late pregnancy and then antibiotics if still positive

22
Q

With the increased incidence of HIV infection amongst the heterosexual population there are an increasing number of HIV positive women giving birth in the UK.

A

true

23
Q

The aim of treating HIV positive women during pregnancy is

A

to minimise harm to both the mother and fetus, and to reduce the chance of vertical transmission.

24
Q

Factors which reduce vertical transmission

A

maternal antiretroviral therapy
mode of delivery (caesarean section)
neonatal antiretroviral therapy
infant feeding (bottle feeding)

25
Q

NICE guidelines recommend offering HIV screening to all pregnant women

A

true

26
Q

Factors which reduce vertical transmission reduce rates from 25-30% to ?%?

A

2%

27
Q

All HIV+ve pregnant women should be offered antiretroviral therapy regardless of whether they were taking it previously

A

true

28
Q

Mode of delivery HIV pts

A

vaginal delivery is recommended if viral load is less than 50 copies/ml at 36 weeks, otherwise caesarian section is recommended
a zidovudine infusion should be started four hours before beginning the caesarean section

29
Q

Neonatal antiretroviral therapy

A

zidovudine is usually administered orally to the neonate if maternal viral load is <50 copies/ml. Otherwise triple ART should be used. Therapy should be continued for 4-6 weeks.

30
Q

Infant feeding HIV?

A

all women should be advised not to breast feed

31
Q

Rubella, also known as German measles, is a viral infection caused by

A

togavirus

32
Q

If rubella contracted during pregnancy there is a risk of

A

congenital rubella syndrome

33
Q

rubella

infectivity and incubation

A

incubation period is 14-21 days and individuals are infectious from 7 days before symptoms appear to 4 days after the onset of the rash.

34
Q

risks of rubella?

A

in first 8-10 weeks risk of damage to fetus is as high as 90%
damage is rare after 16 weeks

35
Q

Features of congenital rubella syndrome

A

sensorineural deafness
congenital cataracts, ‘salt and pepper’ chorioretinitis, microphthalmia
growth retardation, cerebral palsy
hepatosplenomegaly
congenital heart disease (e.g. patent ductus arteriosus)
purpuric skin lesions

36
Q

Diagnosis rubella?

A

suspected cases should be discussed immediately with the local Health Protection Unit (HPU) as type/timing of investigations may vary

IgM antibodies are raised in women recently exposed to the virus

it should be noted that it is very difficult to distinguish rubella from parvovirus B19 clinically. It is therefore important to also check parvovirus B19 serology as there is a 30% risk of transplacental infection, with a 5-10% risk of fetal loss

37
Q

Management rubella immunity antenatally?

A

suspected cases of rubella in pregnancy should be discussed with the local Health Protection Unit
since 2016, rubella immunity is no longer routinely checked at the booking visit
if a woman is however tested at any point and no immunity is demonstrated they should be advised to keep away from people who might have rubella
non-immune mothers should be offered the MMR vaccination in the post-natal period
MMR vaccines should not be administered to women known to be pregnant or attempting to become pregnant

38
Q

all pregnant women are offered screening for hepatitis ?

A

B

39
Q

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

a complete course of vaccination + hepatitis B immunoglobulin

40
Q

hepatitis B - caesarean section reduces vertical transmission rates

A

false

there is little evidence to suggest caesarean section reduces vertical transmission rates

41
Q

hepatitis B & HIV can be transmitted via breastfeeding

A

false

hepatitis B cannot be transmitted via breastfeeding (in contrast to HIV)

42
Q

Chorioamnionitis can affect up to ?% of all pregnancies

A

5%

43
Q

Chorioamnionitis is a medical emergency

A

True

threatening condition to both mother and foetus and is therefore considered a medical emergency

44
Q

Chorioamnionitis is usually the result of

A

ascending bacterial infection of the amniotic fluid / membranes / placenta

45
Q

Chorioamnionitis mx

A

Prompt delivery of the foetus (via cesarean section if necessary) and administration of intravenous antibiotics is widely considered the mainstay of initial treatment for this condition.