Obs- TORCH MX

Question 1

Syphillis Mx

Answer 1

early BenPen IM
can use erythro if allergic but doesnt pass placenta- neonate needs mx

late- BenPen IM once weekly for 3w
same thing with erythrio

Question 2

Toxoplasmosis mx

Answer 2

Spriamycin Mx for pregnancy - 3w course
reduce transplacental inf

fetal inf- pyrimethamine, sulfadiazine and folic acid 6m

Question 3

CMV mx

Answer 3

Fetal USS every 2w from diagnosie
fetal MRI at 30w

if asympto- expectant (90% asymto)
Symptomatic- vanciclovir
Very symptomatic- vanciclovir, discuss TOP

Question 4

chickenpox mx

Answer 4

check serology

if <24w - IVIG within 10days of exposure
avoid other preg woman0infectious for 21d

aciclovir if present with rash, 7-14d post inf and over 20w
hosp admission if risky
USS/refer after 5w post inf

child- risk within first 4w
adelivery avoid until 7d post rash onset
if <7 days- neonate IVIG
infant monitored for 28d
can mx with aciclovir

Question 5

Parvovirus mx

Answer 5

rest./fluid/paracetamol

Inf in first 20w can lead to hydrops fetalis - transfusion can allow complete recover

Question 6

Listeria mx

Answer 6

if mother is sx - IV amox for 14d

Question 7

HSV Mx

Answer 7

First episode - aciclovir 5d initially
if early in preg- aciclovir from 36w onwards
if in 3rd trim - until delivery
Csec should be prefered method if inf <6w prior

if vaginal-avoid rupture and invasive procedure, + IV aciclovir

Reccurent- not Csec
Self limiting,
daily oral aciclovir from 36w onwards

Question 8

GBS mx

Answer 8

Intrapartum abx for vaginal deliveries- start when ruptures stop (ideally 4h before delivery)

neonates- Penicillin and gentamicin

Question 9

HIV mx

Answer 9

ART continued in preg women, except Protease inhib monotherapy

if not on ART- should start as soon as possible
aim is viral load under 50

if under 50- vaginal
>50 viral - csec

always for baby-
cord clamped fast and bathing
All infants- zidovidine monotherapy 2-4w (start within 4h of birth)

If copies high/unkown, neonatal PEP

and PCR at birth, 6w, 12w, last at 18m

Question 10

hep b mx

Answer 10

Antental0 offer tenofivir to women with significant HBV DNA
stop 4-12w after birth

infant-
give Hep B immunise at birth, 1m after, 2m after and 12m after

Question 11

Hep C mx

Answer 11

everything contraindicated but risks are low