OB 6

Question 1

What is ToRCH?

Answer 1

Infections acquired in utero or during delivery that lead to significant fetal or neonatal mortality

• Toxoplasmosis
• Other: syphilis
• Rubella
• Cytomegalovirus
• Herpes simplex virus

Question 2

Pt comes into contact w/ cat feces & poorly cooked meat. What bacteria is she at risk of being infected with? Leading to fetal OR neonatal mortality…

Answer 2

Toxoplasma gondii

Question 3

Dx of Toxoplamosis

• What will show on US?
• At birth, what sxs do pt have?
• What is the classic triad at birth?
• What are the other 5 sxs?

Answer 3

• US: intracranial calcifications
• Most are asymptomatic
• Triad: Chorioretinitis, hydrocephalus, intracranial calcifications
• Fever, jaundice, thrombocytopenia, seizures, maculopapular rash

Question 4

How is Toxoplasmosis dx and tx?

Answer 4

Dx: Anti-Toxoplasma immunoglobulin IgM & IgG

Tx: 3 meds for 1 year (Pyrimethamine, Sulfadiazine, Folinic Acid)

Question 5

What bacteria causes syphilis?

What is the transmission rate?

How is it transferred?

Answer 5

• Treponema pallidum
• 100%
• Sexual & Vertical

Question 6

Infant w/ syphillis will show what 3 sxs of early disease?

Answer 6

• Blood tinged nasal secretions (snuffles)
• Diffuse osteochondritis
• Saddle nose (secondary to syphilitic rhinitis)

Question 7

Infant w/ syphilis in late disease will show what 2 signs?

Answer 7

• Hutchinson teeth (notching of permanent incisors)
• Anterior bowing of tibia (Saber shins)

Question 8

How is syphilis in infant diagnosed?

Answer 8

If infant has clinical findings suggestive of syphilis, mother is tested for RPR/VDRL + Fluorescence Treponemal Antigen (FTA) serology

Question 9

How is syphilis treated?

Answer 9

Procaine Penicillin G x 10-14 days

Question 10

Hematogenous spread infecting the placenta spreading through vascular system of fetus

• Prevented w/ universal immunization
• 1st trimester maternal infection is 80% transmission
• 2nd trimester maternal infection is 50% transmission

Answer 10

Rubella

Question 11

• Hearing loss***
• Blueberry muffin rash*** (purpuric skin lesions)
• Cataracts
• Patent ductus arteriosus
• Jaundice
• Thrombocytopenia
• Hepatosplenomegaly

Answer 11

Rubella

Question 12

How is Rubella diagnosed and treated?

Answer 12

IgM rubella antibody (serum or culture)

Tx: No effective therapy for active infection

Question 13

• Member of herpes family
• Transmitted via bodily fluids / secretions

Answer 13

Cytomegalovirus

Question 14

What is the #1 congenital infection?

Answer 14

Cytomegalovirus

Question 15

What is the #1 cause for sensorineural hearing loss?

Answer 15

Cytomegalovirus

Question 16

• Microcephaly
• Intracranial calcifications
• IUGR
• Chorioretinitis
• Severe mental retardation

Dx? How is it diagnosed?

Answer 16

Cytomegalovirus

• • CMV detection via urine or saliva

Question 17

Herpes Simplex Virus

• How is it transmitted?
• Rate of transmission?
• How is transmission to baby prevented?

Answer 17

• Vertical
• 50%
• C-section

Question 18

• Seizures
• Resp distress
• Mucocutaneous vesicles
• Meningitis
• Encephalitis
• Conjunctivitis

Dx? Diagnosed how? Tx?

Answer 18

Herpes Simplex Virus

• Oropharyngeal culture
• LP
• HSV serology
• Tx: Acyclovir

Question 19

What is the purpose of Intrapartum Fetal Heart Monitoring? (4)

Answer 19

◦Assesses adequacy of fetal oxygenation

◦Presence of fetal metabolic acidemia

◦Allows for timely intervention

◦Reduces likelihood of neurologic injury and death

Question 20

What is a normal FHR pattern?

Answer 20

• Baseline FHR is 110-160 bpm
• Moderate FHR variability (6-25 bpm)
• Absence of LATE or variable FHR decelerations
• Change in above requires prompt intervention

Question 21

What are “accelerations?”

Answer 21

• Elevations in HR above baseline (110-160) so if above 160 bpm
• Reassuring
  
  • >32 w: 15 bpm lasting 15 seconds
  • <32 w: 10 bpm lasting 15 seconds
• Non-stress test: 2 or more accelerations in a 20 min period

Question 22

3 types of Decelerations in fetal distress?

Answer 22

Early, Late, or Variable

Question 23

Early, Late, or Variable deceleration of fetal distress?

• Mirror contractions
• Seen with head compression

Answer 23

Early

Question 24

Early, Late, or Variable deceleration of fetal distress?

• Falls in heart rate after contraction has started
• Seen with fetal hypoxia

Answer 24

Late (do a C-section)

Question 25

Early, Late, or Variable deceleration of fetal distress?

• Irregular dips in fetal heart rate
• Seen with temporary cord compression

Answer 25

Variable

Question 26

Postpartum Depression

• When do sxs begin?
• Criteria for dx?

Answer 26

• Sxs begin during pregnancy or within 4 weeks following delivery
• 5 mood & cognitive sxs for at least 2 consecutive weeks (1 symptom must either be depressed mood or loss of interest in pleasure)

Question 27

Postpartum Blues

• Sxs begin when?
• Criteria for dx?

Answer 27

• Sxs begin 2-3 days after delivery & resolve within 2 weeks
• Sxs are mild/self limited
• Diagnosis DOES NOT require a minimum # of sxs

Question 28

RF of Post-Partum depression?

Answer 28

• Hx of depression
• ◦↑Postnatal stress (move, relationship strain)
• ◦Prior history of postpartum depression
• ◦< 25yo
• ◦Unintended/unwanted pregnancy
• ◦Poor self body image
• ◦Family history of depression

Question 29

What are screening recommendations for Postpartum Depression?

Answer 29

◦Administer Edinburgh Postnatal Depression Scale

◦All post-partum women regardless of symptoms (4-8w after delivery)

Question 30

T/F

The Edinburgh Postnatal Depression Scale is NOT used to dx depression

Answer 30

True!

• Women are at low risk if score is <10
• There are 10 questions

Question 31

Tx for Post-Partum Depression?

Answer 31

• Referral to trained specialist
• Inpatient admission for any suicidal/homicidal patient
• Outpatient psychotherapy
• SSRI’s

Question 32

Tx for Post-Partum Blues?

Answer 32

• Self-limited
• ↑ Support of family member, healthcare professionals