Maternal Infections and Haemorrhage

Question 1

1. What is the triad of Rubella birth defects.
2. How does it present on the mother?
3. The later the infection in gestation, the ______ the chance of birth defects.
4. How can Rubella be detected?
5. How is it managed in immune patients and non-immune patients?

Answer 1

1. Microcephaly, Cataracts, PDA (Patent Ductus Arteriosus)
2. Fever, rash, lymphadenopathy, polyarthritis.
3. Lesser
4. Rubella IgG antibody can be detected in infection or vaccination
5. Supportive management and isolation from other pregnant women if immune. TOP if not immune.

Question 2

1. Name the virus that causes measles
2. What are the characteristic clinical features of measles?
3. Measles is not __________ but if it causes a high fever it can cause fetal problems.

Answer 2

1. Paramyxovirus
2. Fever, Koplick spots (in mouth), rhinorrhoea, cough, red eye, rash begins on forehead.
3. Teratogenic

Question 3

1. Name the virus that causes chicken pox
2. Typical clinical presentation?
3. Under what conditions would Acyclovir be given?
4. How might severe chicken pox present? How should this be managed?
5. What are the signs of fetal varicella syndrome?

Answer 3

1. Varicella Zoster Virus
2. Fever, Malaise, Vesicular rash which begins on chest
3. Considered if 20+ weeks
4. Hepatitis, Encephalitis, Pneumonia. Hospitalise and IV acyclovir.
5. Limb Hypoplasia, psychomotor retardation, IUGR, Chorioretinal scarring, cataracts, microcephaly, cutaneous scarring.

Question 4

1. Identify two of the major fetal features of CMV infection
2. How is it best treated?
3. Name the virus that causes slapped cheek syndrome. How is it detected?

Answer 4

1. Intracranial calcifications, mental retardation.
2. Valacyclovir
3. Parvovirus. Detection of virus specific IgM.

Question 5

1. What is the mode of transmission of the zika virus?
2. What is the characteristic clinical feature?
3. If a patient has HIV what does this indicate for pregnancy?

Answer 5

1. Mosquito bite.
2. Microcephaly.
3. Should have Caesarean and avoid breastfeeding

Question 6

1. Identify some of the major signs of sepsis.

2. Name the checklist that summarises sepsis management.

Answer 6

1. Raised RR, Tachycardia, Hypotension, High or low temperature, low sats, poor capillary refill, confusion/agitation, claminess, rash.
2. PROMPT checklist.

Question 7

1. How might Toxoplasmosis Gondii be contracted?
2. How does it present in babies?
3. How is this infection treated?

Answer 7

1. Eating contaminated meat, from cat faeces in cat litter.
2. Hydrocephalus
   Chorioretinitis
   Cerebral calcifications
   Microcephaly
   Mental retardation
3. Pyramethamine and sulfadiazene.

Question 8

1. Pregnant women are 10 times more likely than other women to get _______ infection. The symptoms resemble _____ or ____ ________. It is largely contracted by consuming infected food.
2. How is it treated?
3. How can it be prevented?

Answer 8

1. Listeria, Flu, Food poisoning
2. Antibiotics
3. Pregnant women should avoid : unpasteurised milk, soft cheese, refrigerated smoked seafood.

Question 9

1. What is considered bleeding in Early pregnancy and then Late pregnancy?
2. Define Ante-partum haemorrhage
3. How is APH graded?

Answer 9

1. Early- <24 weeks; Late- =>24 weeks.
2. Bleeding from the genital tract after 24 weeks gestation and before the end of the second stage of labour
3. Volume of blood and presence/absence of shock.

Question 10

1. Define placental abruption

2. Clinical features? Signs?

Answer 10

1. It is separation of a normally implanted placenta – partially or totally before birth of the fetus
2. Continuous severe abdominal pain. Backache, APH, preterm labour, maternal collapse.
   Signs: Abnormal uterus. Fetal bradycardia/absent pulse (intrauterine death).

Question 11

Summarise the steps to Placental abruption management

Answer 11

ABCDE approach
RESUSCITATE MOTHER
Assess & Deliver the baby
Manage the complications
Debrief the parents

Question 12

1. Define Placental Praevia

2. Define Low lying placenta

Answer 12

1. When the placenta lies DIRECTLY over the internal cervical os.
2. When the placental edge is less then 20mm from the internal os on Transabdominal or Transvaginal scan.

Question 13

1. What is the major risk factor for placenta praevia?
2. What are the main clinical features?
3. Any major signs?

Answer 13

1. Previous Caesarean section
2. Painless APH, fetal movements present, bleeding provoked by coitus.
3. Patient’s condition is directly proportional to amount of observed bleeding. Often uterus soft rather than tender, malpresentation common

Question 14

1. How do you diagnose Placenta Praevia?
2. When should delivery be considered?
3. Summarise the management

Answer 14

1. Transvaginal Ultrasound
2. if risk factors- 34 to 36 weeks, if not 36 to 37.
3. Resuscitation Mother : ABCDE
   Large bore IV Access and G+S

Assess Baby’s condition +/-
Steroids and MgSO4,Anti D if Rhesus Negative, Conservative management if stable and observe in hospital for at least 24 hours

Question 15

1. Define Placenta Accreta
2. Define Uterine Rupture
3. Symptoms of uterine rupture?

Answer 15

1. A morbidly adherent placenta: abnormally adherent to the uterine wall
2. Full thickness opening of uterus
   Including serosa
   If serosa is intact-dehiscence
3. Severe abdominal pain
   Shoulder-tip pain
   Maternal collapse
   PV bleeding

Question 16

1. Define Vasa Praevia

2. How should it be managed if presents with APH?

Answer 16

1. unprotected fetal vessels traverse the membranes below the presenting part over the internal cervical os
2. Emergency Caesarean delivery

Question 17

1. Define Post-Partum Haemorrhage (PPH)
2. How does Primary and Secondary PPH differ?
3. What does treatment centre around?
4. What does prevention centre around?

Answer 17

1. Blood loss equal to or greater than 500ml following birth of the baby.
2. Primary- within 24hrs of birth, Secondary- after 24hrs of birth
3. Assess aetiology, stop bleeding, fluid replacement
4. Identifying risk factors and active management with Syntocinon/syntometrine IM/IV