Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

FRANZCOG OBSTETRICS > Perinatal infections > Flashcards

Perinatal infections Flashcards

1
Q

Maternal symptoms of toxoplasmosis

A

often asymptomatic. malaise, fever, lymphadenopathy.

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

Maternal complications of CMV in pregnancy?

A

Maternal infection: febrile illness, myocarditis, pneumonitis, hepatitis, retinitis, gastroenteritis, or meningoencephalitis

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

Symptoms of rubella infection

A
  1. maculopapular rash
  2. fever
  3. myalgia
  4. lymphadenopathy
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

antenatal obstetric complications from rubella infection?

A

miscarriage

preterm birth

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

What is the incidence in Australia (general population) of listeria?

A

1:100,000

15% of annual cases are pregnant women

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

Describe secondary syphilis timing?

A

Systemic dissemination 2-8 weeks after resolution of chancre

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Symptoms of secondary syphilis?

A

50% asymptomatic
Systemic illness
Condyloma lata

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

During what time period does early latent phase of syphilis develop?

A

Within 2 years of acquisition

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

During what stages is syphilis infectious?

A

primary, secondary and early latent phases only

Not infectious to sexual contacts during latent and tertiary stages. No longer infectious 48 hours after antibiotic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Complication of syphilis treatment in pregnancy?

A

Jarisch Herxheimer reaction (40%)

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

Incidence of congenital CMV?

A

0.2-2% neonates show signs of infection

primary = 30% fetal infection
secondary = 1% fetal infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Describe pathogen causing CMV?

A

herpes type DNA virus

multiple strains

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

Serological signs recent CMV

A 
elevated aminotransferases
lymphocytosis
IgM +
IgG +/-
low IgG avidity
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Toxoplasmosis epidemiology

  • NZ pregnancy cases/yr
  • fetus/yr
A

NZ pregnancy cases per year = 164

foetuses affected per year = 66

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

Neonatal sequelae of congenital CMV infection?

A
  • IUGR 50%
  • petechiae 76%
  • purpura 13%
  • jaundice 67%
  • hepatosplenomegaly 60^
  • microcephaly 53%
  • chorioretinitis/optic atrophy 20%
  • seizures 7%

mortality <3mo = 10%

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

Sequelae of neonatal rubella syndrome (6)?

A
  1. heart defects
  2. cataracts/retinopathy
  3. SNHL
  4. anaemia
  5. hepatosplenomegaly
  6. meningoencephalitis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What do non-treponema tests defect?

A

non specific
RPR and VRDL give indication of infectivity, response to treatment or reinfection.

False negatives in early infection, HIV or immunosuppression.

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

Maternal investigations for listeria?

A

blood cultures
MSU
vaginal swabs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Pregnancy/fetal complications of listeria infection?

A

miscarriage
preterm birth
high risk IUFD (40-50%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Neonatal sequelae of listeria infection?

A

early onset disease: <7 days 20-60% mortality

Conjunctivitis, pneumonitis, meconium, granulomatosis infantiseptica (skin granuloma, papular or pustular rash)
placental and cord granuloma

late onset disease (7d-6w). 10-20% mortality.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Vertical transmission rate of parvovirus once mother infected?

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Aspects of history which influence risk of maternal parvovirus infection?

A

maternal susceptibility = 40%

exposure at home (50% risk of transmission) = 20% infected

exposure at school = 20-30% transmission
10-15% infected

exposure in community = 20% risk transmission
10% infected.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

maternal symptoms parvovirus

A 
asymptomatic
slapped cheeck
arthropathy
aplasia
myocarditis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

If parvovirus suspected by IgG and IgM negative, when would you repeat serology?

A

2-4 weeks after exposure

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Recommended fetal monitoring in pregnancy following parvovirus infection?
2w USS with MCA PSV for 12 weeks
26
When should IVIG be given in pregnancy after varicella exposure?
non immune <96 hours after exposure exposure <7 days prior to delivery, until 2 days postnatal
27
Within what time Fram can VZIG be given after exposure to varicella?
<96 hours | some effect demonstrated up to 10 days
28
What is the risk of fetal disease after infection with toxoplasmosis in pregnancy in first trimester?
10% fetal infection | 85% fetal damage (severe)
29
SYPHILIS Epidemiology (NZ cases/yr + CS cases/yr)
2018 NZ 500 infectious cases. Between 2016 and 2020, 14 congenital syphilis reported cases (>100/year cases, >4 CS cases/year)
30
What is the initial screening test for syphilis (1)?
``` Enzyme immunoassay (EIA) in guidelines. VRDL NZ ```
31
Syphilis treatment in pregnancy
Benzathine benzylpenicillin tetrahydrate. 1 dose 1st and 2nd trimester. Two doses third trimester. Daily if neurosyphilis.
32
Antenatal complications of syphilis in pregnancy
Mid-trimester miscarriage | Stillbirth
33
Congenital anomalies caused by syphilis evident on fetal USS
``` Small bowel dilatation PolYhydramnios Placentamegaly Hydrocephalus/hydrops IUGR Lower limb abnormalities IUFD S ```
34
Neonatal abnormalities caused by syphilis?
``` KISS DR: keratitis, illness (jaundice, anaemia, low plt) saber shins saddle nose Deafness Rhagades (perioral lesions) Other: cerebral palsy, hepatosplenomegaly. ```
35
Diagnosis of CMV
Serum IgM and IgG positive with low (<65%) IgG avidity (<3mo since infection)
36
TOXOPLASMOSIS Transmission
Transmission: raw or undercooked meat, not washing hands or veges, contact with cat faeces
37
Treatment of toxoplasmosis <18 weeks
spiramycin
38
Treatment of toxoplasmosis >18 weeks
pyrimethamine, sulfadiazine and folonic acid (latter two teratogenic in 1st trimester)
39
Sensitivity and specificity of amniotic fluid PCR for toxoplasmosis?
high sensitivity between 17-21 weeks (90-100%)
40
Ultrasound findings with congenital toxoplasmosis?
hydrocephalus, brain or hepatic calcifications, ascites, splenomegaly (CASH)
41
Rubella virology
Rna togavirus
42
Mode of transmission rubella (2)?
droplet and vertical
43
Highest risk gestation of contracting congenital rubella syndrome?
<12w = 85% CRS, 80% maternal infection
44
From what gestation is there minimal risk of congenital defects secondary to fetal infection with rubella?
17 weeks
45
Neonatal specialist assessments recommended with congenital rubella syndrome?
Ophthalmology Hearing screening Cardiac screening
46
List trepononemal and non-treponemal investigations?
non-treponemal: RPR, VDRL | treponema = TPPA, TPHA, EIA
47
What do treponemal tests detect?
Antibodies to T. pallidum Will demonstrate if someone has ever had syphilis, whether or not they were treated. Does not indicate when infection occurred. Small false positive rate.
48
If someone is at increased risk of syphilis infection in pregnancy, when would you screen them?
Booking, 28w, 36w, birth, 6w PP.
49
What are the microbial features of listeria?
Gram positive rod, facultative anaerobe. | flagellated
50
Antenatal complications of listeria infection (4)?
miscarriage IUFD 19% NND 60%
51
For what congenital infections would you not perform amniocentesis for diagnostic purposes?
parvovirus listeria COVID-19 Syphilis
52
Prevalence of parvovirus in pregnancy?
1:400 pregnancies
53
Risk of parvovirus fetal infection and loss after exposure at home?
40% susceptible 50% fetal infection 10% miscarriage < 10% fetal hydrops
54
Risk of parvovirus fetal infection and loss after exposure in community?
``` 40% susceptible (20% transmission mum) = 8% maternal infection = 4% fetal infection = 0.4% fetal loss ```
55
What infections may cause fetal anaemia?
parvovirus, syphilis, rubella
56
When would one expect onset of hydrops after parvovirus infection?
2-17 weeks
57
Maternal investigations parvovirus?
Paired parvovirus IgG and IgM. Can compare to booking screening. If both negative repeat in 2w for seroconversion
58
What tests can be performed for rubella with invasive fetal testing?
PCR culture fetal IgM can be performed after CVS and amniocentesis
59
Describe fetal varicella syndrome (5 systems).
Rash/scar (80%) Limb hypoplasia (70%) Cataracts (60%) Microcephaly, ventriculomegaly. Neurodevelopmental delay (50%) mortality (30%) Hydrops IUGR Hyperechoic bowel and hepatic calcifications. Hepatosplenomegaly.
60
What are some maternal complications of varicella?
Severe maternal disease: pneumonia, hepatitis, encephalitis, death.
61
What is a significant exposure to chickenpox?
5 minutes face to face, 1 hour same room.
62
What are the obstetric complications of varicella?
no increased risk of miscarriage | PTB
63
What risk factors would prompt you to consider PEP with PO valaciclovir after varicella exposure after 20 weeks?
immunocompromised lung disease smoker <24hrs of symptoms
64
Highest risk gestation of FVS?
Highest risk between 12-28 weeks (1.4%)
65
What is the prevalence of varicella infection in pregnancy?
3:1000
66
Maternal symptoms of varicella virus?
Rash: papules, vesicles + crusts. Pneumonia 5% Encephalitis rare
67
Fetal investigations for CMV infection
Amniocentesis with CMV NAAT. Perform >6w after infection and after 22/40 if possible for best sensitivity.
68
What are the classic fetal complications of toxoplasmosis in pregnancy?
hydrocephalus chorioretinitis intracranial arteriosclerosis +/- hydrops, deafness, blindness, neurodevelopment delay, seizures.
69
Highest risk gestation for infection causing congenital toxoplasmosis?
>27 weeks gestation
70
What is the risk of fetal disease after infection with toxoplasmosis in the third trimester?
30-75% fetal infection | 10% fetal damage (mild)
71
For what congenital infection should termination not be offered?
Parvovirus | Malaria
72
What are the maternal/antenatal implications of toxoplasmosis infection?
miscarriage IUFD. Usually maternal disease is mild, with fever malaise and lymphadenopathy.
73
What is the risk of perinatal transmission at vaginal delivery with previous HSV-1 or 2 with no lesions?
<1%
74
What is the risk of perinatal transmission with recurrent genital HSV-1 at time of vaginal delivery?
15%
75
What is the risk of perinatal transmission with vaginal delivery after primary HSV at 36 weeks?
25-50% transmission risk
76
What is the risk of perinatal transmission of HSV to the neonate?
HSV encephalitis
77
Discuss increase risks associated with HSV and scalp electrodes
OR 6.8 if virus present.
78
Discuss evidence around maternal antiviral suppression of HSV for vaginal delivery.
Reduces risk of clinical recurrence and asymptomatic shedding. Clinical trials underpowered to evaluate efficacy of preventing transmission to newborn.
79
What are signs of neonatal HSV infection?
vesicular skin lesions, seizures, unexplained sepsis, low platelets, elevated LFTs, DIC, respiratory distress, corneal ulcer/keratitis
80
After an HIV +ve screening result, what further testing should be done?
Vaginal swabs VRDL, HCV, HBV HIV RNA viral load, HIV resistance testing, CD4+lymphocytes, FBC, LFT, UEC
81
If HIV+, when would vaginal delivery be suitable?
on HAART from at least 24 weeks, viral load <50copies/mL at 36 weeks.
82
If HIV+ with viral load 50-399 copies/mL @36 weeks, what mode of delivery would be recommended?
+/- intrapartum zidovudine planned CS 38-39w formula fed
83
What is the risk of HIV transmission without modern therapy +/- breastfeeding?
20% no modern therapy | 40% no modern therapy + breastfeeding.
84
HIV-What are the criteria to be fulfilled for low risk of MTCT <2%.
maternal viral load undetectale appropriate mode of delivery formula fed baby baby received PEP
85
What is the MTCT risk of a women on HAART breastfeeding?
1-5%
86
Risk vertical transmission of syphilis if 1. primary 2. secondary 3. early latent
1. 70% 2. 70% 3. 40%
87
Implications of symptomatic congenital infection CMV (occurring in 10% of infected fetus')?
50% will have long term sequelae. early mortality <3mo = 5-10% neurodevelopmental and sensory deficits (eyes, hearing)
88
Risk of 'symptomatic' CMV infection after fetal transmission?
10% 50% of those will have long term sequelae. Only 10% of asymptomatic foetuses/neonates have long term sequelae.
89
Investigations after delivery for toxoplasmosis infection?
placenta- histo and PCR | neonate: whole blood PCR, cerebral USS, CSF for PCR
90
Trend for vertical transmission of toxo in pregnancy?
Increasing incidence of infection with GA (10-->30--->50%) | Decreasing proportion of fetal damage (85-->20-->10%)
91
Trends in rubella infection with advancing GA
rUbella- u shape fetal infection <12-36+ (80-->50-->30-->60-->100%) with GA fetal disease most likely <12w 85% Then decreases with time (35%@13-16, rare after)
92
Incubation and infectious period of varicella?
incubation 10-21 days infectious 2 days prior to rash rash lasts 6 days infectious until two days after lesions crusted
93
Testing for neonate after delivery at risk of congenital parvovirus?
FBC and plt check on day 1

FRANZCOG OBSTETRICS (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions