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Obstetrics & Gynaecology - Things I forget > Medical complications and infections in pregnancy > Flashcards

Medical complications and infections in pregnancy Flashcards

1
Q

What are the risks of poor glycaemic control in pregnancy?

A 
Neural tube defects
Cardiac anomalies
Foetal macrosomia
Stillbirth
Risk of pre-eclampsia
Hyper/Hypoglycaemia 
DKA
Increased risk of miscarriage
Increased risk of infection
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2
Q

What is the management of diabetes in pregnancy?

A

MDT approach: Specialist diabetes midwife, dietician, obstetrician

Blood glucose monitoring 7 times a day (before meal and 1 hour after meal)
Aim is to maintain blood glucose of:
<5.3 mmol/l pre-meal
<7.8 mmol/l 1 hour post meal

Serial growth scans to detect macrosomia and polyhydramnios

Aim for delivery by 39 weeks, 50% end up having C-section

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3
Q

How is hyperthyroidism treated in pregnancy?

A

Medical treatment only

Carbimazole and propylthiouracil at lowest dose

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4
Q

What are the risks of suboptimal thyroid hormone replacement?

A

Developmental delay

Pregnancy loss

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5
Q

What are the three criteria required to diagnose postpartum thyroiditis?

A

< 12 months of giving birth
Clinical manifestations of hypothyroidism
TFTs to support

NOTE: TPO antibodies present in 90%

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6
Q

How is post-partum thyroiditis managed?

A

Thyrotoxic phase: propanolol

Hypothyroid phase: thyroxine

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7
Q

What measures are taken during labour in a patient with heart disease?

A

Aim to wait for spontaneous labour
Epidural anaesthesia usually recommended (reduces pain-related stress/increase in CO)
Prophylactic antibiotics (Prevent bacterial endocarditis)
Use syntocinon (ergometrine CI in hypertension/CHD)
Consider instrumental delivery to keep second stage short
Avoid supine position

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8
Q

Which medications that are commonly used in labour/delivery should be avoided in asthmatic patients?

A

Ergometrine
Carboprost (Prostaglandin F2a)
Labetalol

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9
Q

What advice should be given to a woman with epilepsy considering getting pregnant?

A

Start folic acid 5mg/day 3 months before getting pregnant
Explain that epilepsy is associated with much greater risk of congenital abnormalities due to anticonvulsant medications
- Neural tube defects
- Cardiac defects
- Facial clefts

Sodium valproate should be avoided unless no other AED is affective

Lamotrigine is the safest antiepileptic drug to give

Breastfeeding is safe whilst on AEDs

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10
Q

What are the risks of sickle cell in pregnancy?

A 
Miscarriage
Pre-eclampsia
Increased risk of sickle cell crises
FGR
Preterm labour
VTE
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11
Q

What is the management of sickle cell in pregnancy?

A

5mg Folic Acid daily preconception

75mg Aspirin daily in early pregnancy

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12
Q

What infections are screened for antenatally?

A

Syphillis
HIV
Hepatitis B

Note: Rubella is no longer screened for because the incidence rate is so low

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13
Q

What are the features of congenital rubella syndrome?

A

If infected before 20 weeks, there is a risk of having congenital rubella syndrome, features include:
Cataracts
Deafness
Congenital cardiac defect (Most commonly PDA)

If infected in 3rd trimester, main risk is diabetes

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14
Q

What is the management of congenital rubella syndrome?

A

If infected, CRS should be screened for

If infected <16 weeks, then termination of pregnancy offered

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15
Q

What are the features of syphilis?

A

In mother:
Painless genital ulcer 3-6 weeks after infection
Maculopapular rash 6 weeks-6 months later

Risk to foetus:
25% stillbirth
FGR
Congenital syphilis
Preterm birth
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16
Q

How is syphilis managed in pregnancy?

A

Benzathine penicilin (parenteral)

17
Q

What is the management of HIV in pregnancy?

A

Reduce risk of vertical transmission:

  • Antiretroviral therapy to keep viral load low
  • Delivery by C-Section
  • Breastfeeding

Women with a high viral load should receive Azidothymidine (IV) before C-section or following SROM

Management of infant:
Should be given Azidothymidine for 6 weeks after birth
Direct Viral PCR at birth, 3 weeks, 6 weeks and 6 months (Can’t test antibodies because mother’s antibodies cross placenta)

18
Q

What is the management of hepatitis B in pregnancy?

A

After birth, baby should receive:
Hep B immunoglobins at birth
Hep B vaccine at birth, 1 month and 6 months

19
Q

How is a diagnosis of toxoplasmosis made?

A

Sabin Feldman dye test

Treated with spiramycin, to prevent transplacental infection

20
Q

Which test should be performed if an ultrasound suggests that there is a risk of congenital toxoplasmosis?

A

Amniocentesis followed by PCR of amniotic fluid for T. gondii.

Termination of pregnancy should be offered if there are abnormalities found in ultrasound and toxoplasmosis infection is confirmed on scan

21
Q

What are the features of toxoplasmosis infection in infants?

A 
Ventriculomegaly
Microcephaly
Chorioretinitis
Cerebral calcification
Normally asymptomatic at birth
22
Q

What are the features of CMV infection in infants?

A 
Deafness
Cataracts
IUGR
Microcephaly
Hepatosplenomegaly
Ascites
23
Q

How is CMV investigated?

A

If abnormalities are seen on ultrasound, PCR of amniotic fluid may be conducted

If CMV confirmed, TOP offered

24
Q

What are the features of VZV infection in pregnancy?

A

Risk to the mother: pneumonia/encephalitis

Risk to the infant: Congenital Varicella Syndrome
	○ Low birth weight 
	○ Cutaneous scarring (In dermatomal pattern) 
	○ Limb hypoplasia 
	○ Microcephaly 
	○ Cortical atrophy 
	○ Chorioretinitis 
	○ Cataracts

If infected 7 days before delivery, there is a risk of neonatal varicella infection: Pneumonia, disseminated skin lesion, high risk of mortality. Delivery should be postponed till 7 days of infection to allow time for maternal antibodies to protect child. If birth occurs within 7 days of rash onset, baby should be given VZIG and monitored for 1 month

25
Q

What is the management of VZV infection in pregnancy?

A

If the mother has not had the vaccine or previously had chickenpox, she should be given VZIG within 10 days of exposure

If she presents with a rash, oral aciclovir for 7 days should be given within 24 hours

26
Q

How can VZV immunity be confirmed?

A

Detection of VZV IgG

27
Q

What is the main risk of parvovirus B19 infection in pregnancy? At what point in pregnancy does it pose the greatest risk to the foetus?

A

Aplastic anaemia leading to hydrops fetalis and intrauterine death

May resolve spontaneously or may need intrauterine blood transfusion

Poses the greatest risk at < 20 weeks

28
Q

What are the risks of listeria in pregnancy?

A

Miscarriage
Stillbirth
Sepsis

29
Q

How is listeria treated?

A

IV antibiotics (Ampicillin 2g every 6 hours and erythromycin)

30
Q

How should first-episode genital herpes in pregnancy be diagnosed and treated?

A

Refer to GUM
Viral culture and PCR
Aciclovir 400 mg TDS

No matter when they were initially infected, from 36 weeks gestation, they should receive aciclovir TDS till delivery

31
Q

How should women with primary herpes infection in the 3rd trimester be managed?

A

C-section should be recommended (especially if within 6 weeks of onset)
Give intrapartum IV aciclovir

32
Q

How should recurrent episodes of herpes simplex infection in pregnancy be managed?

A

NOT an indication for C-section
Consider oral aciclovir from 36 weeks
Avoid invasive procedures if there are genital lesions

33
Q

How would you manage a woman who is found to have GBS in her genital tract?

A

Intrapartum antibiotics (IV benzylpenicillin) as soon as possible after the onset of labour

Penicillin allergy: clindamycin

34
Q

List some indications for GBS prophylaxis

A 
Intrapartum fever
PROM
Prematurity
Previous infant with GBS
Incidental detection of GBS in pregnancy
GBS bacteriuria
35
Q

Outline the management of the newborn with risk factors for early-onset GBS disease.

A

1 minor risk factor = remain in hospital for observation for 24 hours
2 or more minor risk factors = full septic screen AND IV penicillin + gentamicin

36
Q

What are the consequences of neonatal GBS infection?

A 
Neonatal sepsis immediately after birth:
Collapse
Tachypnoea
Nasal flaring
Poor tone
Jaundice
37
Q

What are the clinical features of malaria in pregnancy?

A 
Cyclical spiking pyrexia
Jaundice
Pulmonary oedema (High mortality)
Hypoglycaemia
Associated with preterm birth and miscarriage

Managed with antimalarials

38
Q

What are the clinical features of TB in pregnancy?

A

May lead to miscarriage, preterm labour, LBW

Anti-TB medications are safe to use in pregnancy

Obstetrics & Gynaecology - Things I forget (16 decks)

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