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ORAL EXAM > Perinatal infections > Flashcards

Perinatal infections Flashcards

1
Q

Parvovirus risk of infection in pregnancy by exposure location

A

20% if at home
8-12% at childcare
8% in community

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2
Q

Outcomes with proven maternal infection of Parvo

A

10% miscarriage
3% hydrops - 1/3 resolve, 1/3 IUT, 1/3 die without IUT
<1% congenital abnormalities

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3
Q

Monitoring in recent parvo infection

A

USS at 1-2 weekly intervals for 12 weeks
If no fetal abnormality noted after 30 weeks - stop scanning
anaemia - refer MFM for IUT

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4
Q

Positive Syphilis

A

VDRL +ve
RPR titre +ve
TPPA +ve

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5
Q

Latent infection/past treated Syphilis

A

VDRL -ve
RPR -ve
+ve TPPA

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6
Q

Possible false positive or early infection syphilis

A

VDRL +
RPR +
- TPPA
Repeat test in 4 weeks

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7
Q

Syphilis stage and risk of infection

A

Primary (chancre)-high
Secondary (systemic illness)-Moderate
Latent and tertiary - neglibile

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8
Q

Management of Syphilis

A

Treat with Benzathine Penicillin 1.8g
MDT with infectious diseases and paediatric team
Monthly RPR and VDRL until delivery
-if _ve or >4 fold drop in titre - successful tx
-retreat if rise in titre

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9
Q

CMV risk of fetal infection by primary or secondary infection

A

primary:30% chance of fetal infection
30% chance of fetus being affected
Non-primary: approx 1%

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10
Q

risk of sequelae with CMV symptomatic or asymptomatic infection

A

Primary: symptomatic 50%
asymptomatic 10-15%
Secondary: <10%

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11
Q

CMV testing - recent infection

A

+igG
+IgM
low avidity
if intermediate avidity - treat as recent infection

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12
Q

CMV management

A

Fetal USS (6 weeks after maternal infection) - CNS signs, hydrops, echogenic bowel, IUGR
Fetal MRI-microcephaly
Amnio-higher sensitivity if after 20 weeks
If woman immunocompromised can do valaciclovir

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13
Q

Fetal risks with CMV infection

A

CP
Sensorineural hearing loss
Visual impairment
Delayed psychomotor development

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14
Q

Secondary herpes infection risk of transmission

A

<1%if no active disease
1-3% if HSV in genital tract at time of delivery
(higher risk if recurrent HSV 1 (15%) than HSV 2 (<0.01%)

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15
Q

Primary herpes with no seroconversion before 34 weeks risk of transmission

A

25-50%

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16
Q

Primary herpes management (and secondary)

A

If diagnosis in 3rd trimester then need C/S
If vaginal delivery unavoidable avoid FBS, instrumental,
prophylaxis from 36 weeks (valcyclovir 500mg BD)
Swab baby eye, throat, and rectum at 24 hrs post delivery

17
Q

Hepatitis B bloods and management based on viral load

A

HbsAg +ve
HBV >10^7 treat mum w tenofivir from 30 weeks; stop 4-12weeks PP
HBV <10^7 baby needs vaccination at birth and at 2,4 &6 months, HB immunoglobulin and bath at birth
Screen mum for Hep C and HIV

18
Q

Hepatitis C management

A

RNA positive - perinatal transmission risk 5%
No evidence CS reduces risk of transmission
Avoid invasive procedure in labour
Can BF but caution with cracked nipples and bleeding

19
Q

HIV management (pre preg)

A 
MDT approach
Identify partner status
Aim viral load to be at a minimum
cervical smears UTD (yearly screening)
Screening for other STIs (bloods/swabs)
Ensure vaccinations UTD
Mother to child transmission counselling
20
Q

HIV tran

smission risk with or without treatment

A

25-30% without

<1% with full treatment

21
Q

HIV intrapartum management

A

avoid fetal invasive procedures
avoid PROM
Can consider vaginal birth if load undetectable
IV zivudine if viral copies 50 and above
C/S at 36 weeks (C/S if 400 or above, consider if 50 and above)

22
Q

HIV antepartum management

A 
Continue on HAART regime if effective
Viral load
CD4 count, 
viral resistance
FBC, LFTs, U/Es
other STI screen
late presenting - commence HAART asap
23
Q

HIV postpartum management

A

formula fed baby
Treat with AZT at birth
PJP prophylaxis if high risk of transmission
Baby needs viral PCR

24
Q

acute listeriosis

A

gram stain and cultures of genital tract
amoxicillin for 14 days (oral if well, IV if unwell)
Can consider gent if mum unwell
Delivery depends on condition of mother and prematurity
Risk to baby - SB or sepsis (granulomas, pneumonitis, purulent conjunctivitis)

25
Q

Food Safety advice in pregnancy

A 
Avoid undercooked meats and soft cheeses
Buy fresh produce and meats
Cook meats and wash vegetables thoroughly
Don't kiss baby on the mouth
Exercise good hand hygiene
Forego pre-prepared salads and foods
Heat until piping hot
26
Q

TB in pregnancy management

A

Tx - INH, rifamapin, ethambutol
CXR, sputum, urine sample
Neonate likely effected due to haematogenic spread so therefore needs close follow up

27
Q

Positive rubella

A

positive IgM and IgG

28
Q

Risk of fetal infection of Rubella

A

highest in first and third trimesters
lowest in 2nd trimester (30%)
Risk of congenital defects low after 16 weeks, otherwise risk 85% 1st trimester, 36% up to 16 weeks

29
Q

Management rubella

A

consider TOP if first trimester
consider fetal testing if second trimester - 6 weeks after infection and after 20 weeks
low risk of CRS if after 20 weeks

30
Q

Toxo infection blood results

A

IgG +
IgM +
IgA+
low IgG avidity

31
Q

Toxo risk of fetal infection

A

lowest risk in first trimester, highest in third

highest risk if contracted in first trimester, lowest risk if contracted in third

32
Q

CRS effects

A 
Cardiac defects
bone disease
eye disease
intellectual diability
encephalitis
33
Q

Congenital toxo

A 
chorioretinitis
microcephaly
hydrocephalous
intracranial calcifications
mental retardation
34
Q

Toxoplasmosis management

A

perform serology to confirm active infection
Refer MDM
Tertiary USS + MRI
consider fetal sampling
antibiotics - ?spiramycin; pyramethadine and sulfadiazine from 18 weeks
Consider TOP if confirmed infection
Confirm diagnosis infant with paediatric involvement

35
Q

Varicella in pregnancy

A

ZIG if <96 hours exposure
acyclovir if >96 hrs since exposure and <24 hours since onset of rash
IV aciclovir if complications develop
C/S if fetal compromise or maternal status deterioration/ respiratory failure
1% risk of infection prior to 28 weeks, virtually no risk after this
Give ZIG to baby if mum has 7 days before delivery or 2 days after OR if mum has >2 days after and baby prem or <1000g
BFing ok

ORAL EXAM (20 decks)

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