OB-GYN Revision 9 Flashcards
Describe the risk of infection of chickenpox during pregnancy [+]
Risk of Fetal varicella syndrome (FVS):
- skin scarring
- eye defects (microphthalmia) and cataracts
- scars and significant skin changes located in dermatomes
- limb hypoplasia
- microcephaly
- learning disabilities
Lecture notes:
- soft-tissue calcification
* polyhydramnios,
* limb defects and dermatomal skin scarring (due to fetal herpes zoster),
* soft-tissue calcification
* damage to the eyes and CNS.
Neurological defects include cortical atrophy, microcephaly, limb paresis, spinal cord atrophy, encephalitis, seizures and Horner’s syndrome.
severe neonatal varicella:
* if the mother develops rash between [] days before and [] days after birth there is a risk of neonatal varicella, which may be fatal to the newborn child in around 20% of cases
severe neonatal varicella:
- 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
Describe how you manage chickenpox exposure during pregnancy [1]
Describe how you manage chickenpox infection during pregnancy [1]
oral aciclovir (or valaciclovir) is now the first choice of PEP for pregnant women at any stage of pregnancy who are exposed to chickenpox
- antivirals should be given at day 7 to day 14 after exposure, NOT immediately
Infection:
- 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’
NB why wait: n a study evaluating the comparative effectiveness of 7 days course of aciclovir given either immediately after exposure or starting at day 7 after exposure to healthy children, the incidence and severity of varicella infection was significantly higher in those given aciclovir immediately (10/13 (77%) who received aciclovir immediately developed clinical varicella compared with 3/14 (21%) who started aciclovir at day 7
Describe the features of congenital rubella syndrome [5]
What is the clinical triad? [3]
- Congenital deafness
- Congenital cataracts
- ‘Salt and Pepper’ chorioretinitis
- Congenital heart disease (PDA and pulmonary stenosis)
- Learning disability
- Cerebral palsy
Triad:
- Microcephaly
- PDA
- Cataracts
Lecture:
- Hearing loss, learning disability, heart malformations and eye defects, neurodevelopmental delay, and endocrinopathies.
Rubella infection causing congenital rubella sydnrome is caused by maternal infection within the first [] weeks of pregancy.
When is there the highest risk? [1]
What is the clinical significance of this? [1]
First 20 weeks - but first 10 weeks poses highest risk
When primary infection occurs before 12weeks’ gestation, given the risk of fetal infection and the risk of an infected fetus developing severe abnormalities, it is reasonable to consider termination of pregnancy when appropriate
Pregnant women are advised to avoid high-risk foods (e.g. blue cheese) and practice good food hygiene to prevent which infection? [1]
What is the clinical manifestation of having this infection in pregnancy? [1]
Listeria:
- Listeriosis in pregnant women has a high rate of miscarriage or fetal death.
- It can also cause severe neonatal infection.
The features of congenital CMV are [5]
The features of congenital CMV are:
* ‘Blueberry muffin rash’
* Petachial rash
* Fetal growth restriction
* Microcephaly
* Hearing loss - this is the key one to remember
* Vision loss
* Learning disability
* Seizures
NB: With approximately 40,000 infected children per year, congenital CMV infection is the most common cause of congenital non-genetic hearing loss
Bilateral cataracts in a newborn would most likely indicate..[1]
Congential rubella infection
There is a classic triad of features in congenital toxoplasmosis.
What is it? [3]
Intracranial calcification
Hydrocephalus
Chorioretinitis (inflammation of the choroid and retina in the eye)
How do you treat listeriosis infection in pregnancy? [2]
Ampicillin and gentamicin
Fetal hydrops would indicate infection from..?[1]
Parvovirus B19
Blueberry muffin rash has which 2 key ddx? [2]
CMV
Rubella
Infections with parvovirus B19 in pregnancy can lead to several complications, particularly in the first and second trimesters. Complications are: [4]
- Miscarriage or fetal death
- Severe fetal anaemia
- Hydrops fetalis (fetal heart failure)
- Maternal pre-eclampsia-like syndrome
What causes fetal anaemia from parvovirus B19 infection? [1]
What effect does this have? [1]
Fetal anaemia is caused by parvovirus infection of the erythroid progenitor cells in the fetal bone marrow and liver.
- This anaemia leads to heart failure, referred to as hydrops fetalis.
What is the triad of seen in pregnant parvovirus b19 infection? [3]
It involves a triad of hydrops fetalis, placental oedema and oedema in the mother
- + hypertension and proteinuria.
Women suspected of parvovirus infection need which tests? [3]
- IgM to parvovirus, which tests for acute infection within the past four weeks
- IgG to parvovirus, which tests for long term immunity to the virus after a previous infection
-
Rubella antibodies (as a differential diagnosis)
*
A baby born with congenital Zika syndrome which would [2]
Microcephaly
Fetal growth restriction
Other intracranial abnormalities, such as ventriculomegaly and cerebellar atrophy
Parvovirus
Fetal anaemia and fetal hydrops both visible on ultrasound. Anaemia can be assessed measuring at the how exactly? [1]
Fetal anaemia and fetal hydrops both visible on ultrasound. Anaemia can be assessed measuring at the Peak Systolic on Middle Cerebral artery (raised MCA-PSV).
An abortion can be performed at any time during a pregnancy in which circumstances? [3]
Continuing the pregnancy is likely to risk the life of the woman
Terminating the pregnancy will prevent “grave permanent injury” to the physical or mental health of the woman
There is “substantial risk” that the child would suffer physical or mental abnormalities making it seriously handicapped
What are the legal requirements for an abortion to proceed? [2]
Two registered medical practitioners must sign to agree abortion is indicated - have to be doctors. Sign an HSA1 form
- Form retained for 7 years in the notes
It must be carried out by a registered medical practitioner in an NHS hospital or approved premise
Under which clause are 98% of abortions under? [1]
Clause C:
- carrying a pregnancy to term is physically more dangerous than having an abortion
- if dont want a pregnancy - then this clause protects their mental health
Descrine the difference in types of medical / surgical abortion offered depending on gestation time [4]
Medical
* < 12 weeks: early medical abortions: at home or clinical facility
* >12 weeks: have to be at a clinic
Surgical
* < 14 weeks: manual or electic aspiration
* > 14 weeks: dilatation or evacuation
How do you perform vacuum aspiration - up to 14 weeks? [2]
- Dilation of cervix and aspiration of pregnancy tissue with electric or manual suction
- Local (manual suction) or general anaesthesia (electric) or conscious sedation
What is the most common complication from EMA? [1]
