O&G Councilling

Question 1

HIV

Answer 1

Untreated risk: 25%

Managed: <2%

CD4+ <200: Pneumocystic Jirovecii prophylaxis Co-Trimoxazole

1. Maternal ART: continue or start between 28-32wks
2. Fetal ART
   
   • Oral Zidovudine <50
   • ART >50
3. Delivery
   
   • C-Section >50 (requires Zidovudine infusion 4hrs prior to cord clamp)
   • Vaginal <50
4. Breastfeeding only!

Question 2

Downs screening

Answer 2

Overall 1/700 births

• 35⇒ 1/ 300
• 40⇒ 1/ 100

Screening

• 11<14 CST: thick Nuchal translucency, high HCG, low PAPP-A
  
  • Detection rate 85%
  • False positive 2.2%
• 14-20 Quadruple: high HCG, high Inhibin A, low Oestradiol, low AFP

Risk >1/150 then considered high risk

⇒ Genetic testing, results in 2-3wks;

• 11<14 Chorionic villus sampling
  
  • Cells from placenta
  • 1- 2% miscarriage
• 16 (13-20) Amniocentesis
  
  • Fluid from around the baby
  • 0.5- 1% miscarriage
• Incorrect in 1/1000 due to maternal cells