Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

A - ObsNGynae > Obs - infections in pregnancy > Flashcards

Obs - infections in pregnancy Flashcards

1
Q

which is the most common vertically transmitted virus in pregnancy?

A

CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what are signs of a CMV infection in pregnancy?

A
  • asymptomatic
  • sore throat, fever, fatigue,
  • swollen glands

outside pregnancy - usally harmless for mum

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are the differnt phases of CMV infection and when can it spread?

A

CMV can only be passed on when it’s “active”. The virus is active when:

a. you get CMV for the first time – young children often get CMV for the first time at nursery
b. the virus has “re-activated” – because you have a weakened immune system
c. you’ve been re-infected – with a different type (strain) of CMV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what impact can CMV have on neonates? in childhood?

A 
 IUGR
 Pneumonia
 Thrombocytopenia
 Neurological sequelea: hearing,
visual and mental impairment
 Death

childhood: childhood disability and deafness

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what is risk of catching CMV from mum?

A

40% vertical transmission rate

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

how would CMV be investigated/ diagnosed?

A
  1. Ultrasound
     Intracranial and hepatic calcification
    echogenic bowel
  2. CMV IgM titres rise with low IgG avidity if recent infection
  3. Amniocentesis 6 weeks after
    maternal infection – CONFIRM vertical transmission
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

how is CMV managed?

A
  1. • Monitering
    o Fetal ultrasound every 2-4 weeks from diagnosis
    o +/- fetal MRI at 28-32 weeks gestation

• If fetus is asymptomatic
o Expectant management

• If fetus is symptomatic
o Vanciclovir, PO, 8g/day

• If fetus is severly symptomatic
o Vanciclovir, PO, 8g/day
o Discuss TOP - termination of pregnancy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

why is it important to ask about hepres in PMH?

A

can reactivate in pregnancy

ask about when they had their last episode

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is the management of herpes simplex?

A

C-section if delivery within 6 weeks of primary attack or genital herpetic lesions at the time of delivery.

In early pregnancy; Treat with aciclovir till asymptomatic then stop then restart at 36 weeks?

  • If primary infection occurs earlier in the pregnancy, offer prophylactic ORAL ACICLOVIR daily from 36 weeks until delivery
  • Aciclovir or valaciclovir can be given prophylactically to the baby during the at-risk period (recently born - if exposed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the gold standard test for Herpes simiplex?

A

Pcr test of vesicular fluid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what are the signs of rubella infection in mother?

A

asymptomatic

flu like sx; fever, sore throat, cold,

macular rash

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the consequences for fetus of rubella infection?

A

 Deafness
 Cardiac disease - only difference from cmv infection
 Eye problems
 Mental retardation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is the risk of herpes infection to baby?

A

rarely transmitted

but if so, mortality is high!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the prognosis of rubella?

A

high likelihood of malformation in 1st trimester

likelihood greatly drops as months go on.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

how is rubella ivx and treated?

A

Routine screening at antenatal booking -> identify
those who need vaccination - only given after end of pregnancy because

Live vaccine is contraindicated during pregnancy

A. Offer TOP - high risk of neonatal infection if rubella <16 wks

B. Rubella Immunoglobulin IM - if doesnt want TOP.
reduce the likelihood of a clinical attack which may
possibly reduce the risk to the fetus

C. Notify the Health Protection Unit (HPU) and refer to high-risk perinatal specialist + paediatric
infectious disease specialist

D• Recommend rest, adequate fluid intake and paracetamol for symptomatic relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

responsible organism in toxoplasmosis?

A

Toxoplasma Gondii

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

how is toxoplasmosis transmitted?

A

Follows contact with cat faeces, soil or

eating infected meat

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

how is toxoplasmosis ivx / diagnosed?

A

Ultrasound findings
- Hydrocephalus

Maternal IgM

Amniocentesis after 20 weeks to confirm vertical
transmission

19
Q

what is the treatment of toxoplasmosis in utero and in the newborn?

A

Maternal infection:
Spiramycin during pregnancy

Fetal infection:
Pyrimethamine + Sulfadiazine + Folic acid

Newborn:
1st Line: Pyrimethamine + Sulfadiazine + Calcium Folinate
• Adjunct: Prednisolone

20
Q

whiich infections are teratogenic in pregnancy?

A

Syphilis

Herpes zoster - 1-2% risk f early pregnancy

21
Q

management of chicken pox?

A

Non-immune women exposed to chickenpox
o Should be given VZIG - within 10 days

Chickenpox in pregnancy - active rash

  • Oral Aciclovir 5/day for 7 days
  • Iv if resp symptoms/ complications

Neonatal infection
- IV Acyclovir

Given birth within 7 days of rash
VZIG to baby

Mum gets chicken pox wiithin 7 days of delivery
VZIG to baby

22
Q

what are the risks associated with chicken pox infection at diifferent tiimepoinrts?

A

1st trimester - teratogeniiciity eg Limb defects

Significant risk of neonatal varicella of the newborn if within 4 weeks of delivery

23
Q

Erythema infectiosum = “slap-cheek”

appearance is pathognomic of?

A

parvovirus b19

24
Q

what iis the effect of pavoviirus b19 on fetus?

A

Virus suppressed fetal erythropoiesis -> anaemia and
variable thrombocytopenia

causes hydrops fetalis - Infection in the first 20 weeks
neurological damage
death

25
Q

management of parvovirus infection?

A

Conservative
o Rest, fluids, paracetamol

• Medical
§ In utero transfusions - if hydrops - may allow complete recovery

26
Q

how is parvovirius ivx?

A

50% spontaneous resolution

maternal IgM

fetal surveillance

Anaemia detectable on ultrasound
(increased blood flow in MCA and then oedema from cardiac failure)

27
Q

list risk facotrs for GBS infection?

A 
 Positive urine culture for GBS
 Previous infant with GBS
 Intrapartum fever >38c
 PTL
 ROM >18h
 Previous hx
28
Q

what is the management of GBS?

A

IV abx for vaginal deliveries
(after rupture of membranes, ideally 4 hours before delivery).

o No penicillin allergy: IV benzylpenicillin
o Mild penicillin allergy: cephalosporin
o Severe penicillin allergy: vancomycin

• Neonate with signs of early-onset GBS infection
o IV Penicillin and gentamicin

2 strategy:
can decide to screen and give abx if present
or can decide to not screen but give abx if risk factors

29
Q

hwo do you test for hep b in pregnancy?

A

maternal bloods - booking appointment

30
Q

how is hep B treated?

A

Tenofovir - if high viral load in 3rd trimester

31
Q

what are complications of baby inheriting hep B?

A

liver cirrhosis
hepatocellular carcinoma

in later life

32
Q

how is HIV manged in pregnancy?

A

Antenatal:
Mum start / continue `HAART. aim viral load <50 copies/ml (zidovudine preferred)
- manage patient with Infect dis specialist

Intrapartum:
< 50 copies/mL, vaginal delivery is appropriate
o >50 copies/mL: pre-labour C-section should be considered

Postpartum:
infants - zidovudine for 2-4 weeks after birth. start by 4hours!

33
Q

how does group A strep present? which agent?

impact on fetus?

A

strep pyogenes

Chorioamnionitis + abdominal pain, diarrhoea and severe sepsis

notorious for puerperal sepsis

fetus dies in utero

34
Q

How is syphilis managed?

A

Benzylpenicilin / Benzathine penicillin 2.4 million units IM once

o If penicillin allergy, erythromycin oral - 14 days

LATE syphilis
IM Benzylpenicilin - 3 weeks
Erythromycni 30 days

35
Q

how would you test for syphilis?

A

iideally - serology VDRL (veneral dsiease research lab)

Dark ground microscopy.

Serology (specific and non specific treponema test - eg vdrl)- blood test

36
Q

how is hep C treated in pregnancy?

A

The usual treatments for HCV, interferon and ribavirin, are contraindicated in pregnancy and
should be deferred to the postpartum period.

No specific precautions are recommended: there is a low risk of vertical or blood transmission
from mother to fetus.

37
Q

what are the risk factors of listeria infection?

A

pate, soft cheese, pre-packed meals

38
Q

how is listeria managed?

A

If mother is symptomatic,

IV amoxicillin should be used, 6g/day for 14 day

39
Q

how would you manage group A strep infection?

A

Sepsis - sepsis 6 protocol

monitor fetus with CTG

40
Q

how would you manage antepartum TB?

A

RIPE:
PE for 2, RI for 6

Viitamin B6 - pyriidoxine

41
Q

which durg is contraindiicated in chlamydia rx in pregnancy? why?

A

doxyxycline - grey discoulration of bones and teeth

42
Q

what is the risk of congenital rubella syndrome ?

A

before 10 weeks - 80% chance of congenital rubella syndrome, advise termination

after 20 weeks - low chance

43
Q

how does congenital rubella syndrome present?

A

sensorineural deafness

eye abnormalities - eg cataracts

congenital heart disease eg pateent ductus arteriosus

A - ObsNGynae (37 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions