Perinatal Infections Flashcards

Question

Risks of delivery during chickenpox viraemia

Answer 1

``` Bleeding TCP DIC Hepatitis Varicella of the newborn ```

Answer 2

Sig. risk of neonatal varicella if within 4wks of delivery Elective delivery avoided until 7d after rash onset (passive Ig transfer) Neonatal opthalmix exam. VZIG to baby if born within 7d of rash onset or mother dev. CP 7d PP Monitor for 28d Neonatal infection = aciclovir

Answer 3

Low risk of non immune woman getting CP from someone with singles

Answer 4

Any doubt if mother immune check blood for VZV antibodies Non-immune: VZIG asap up to 10d post exposure Oral aciclovir if <24 hrs rash >20wks

Answer 5

``` Risks: limb hypoplasia, cutaneous scar, IUGR Stay away from pregnant women IVIG If rash come back Referral to fetal medicine in 5wks time amniocentesis can be done ```

Answer 6

Dx: seroconversion (IgM development) PCR of mother/foetus best Hydropic foetus may recover or need in utero transfusion Infection <20w can lead to hydrops and IUD Higher rate of foetal loss If anaemia is treatd by intrauterine transfusions then complete recovery possible No neurodamage so should be normal

Answer 7

Culture Meconium staining may raise suspicion IV amox.

Answer 8

Ix: culture, PCR Mx: aciclovir 400mg tds (if infection during T1-2 Rx from 36w-del., if T3 cont. until del.) If <6w until del. type-speciic HSV Ab testing available

Answer 9

If >6wks prior to expected del. manage expectantly and anticipate vaginal del. C-sec first line for genital herpes in T3 If chooses vaginal: - avoid ROM and invasive procedures - IV aciclovir to M+F

Answer 10

NOT indication for C-sec Daily supressive 400mg aciclovir from 36w considered avoid invasive procedures if genital lesions

Answer 11

AN: if detected Abx not recommended, doesnt reduce GBS at time of del ?Intra-partum Abx proph.: benpen/clindamycin PP: newborn w/risk factor stay in hosp. 24hr 2+ RFs get IV penicillin and gent. and full septic screen

Answer 12

asap after start of labour | clindamycin 900mg IV 8hrly if penicillin allergic

Answer 13

``` Intrapartum fever PROM >18 hours Prematurity <37wks Previous GBS infant Incidental finding during current preg GBS bacteruria If c-sec in absence of labour or ROM NOT indicated ```

Answer 14

Parenteral Abx given to woman for suspected invasive bacterial infection (not inc. proph.) Resp distress >4hrs after birth seizure need for mechanical ventilation

Answer 15

Risk of GBS carriage in future pregnancy is 50% (offer testing) If going to have swabs do this 3-5wks before delivey ?IV proph. (Hx, fever, PTL, PROM)

Answer 16

- CD4 at booking, VL every 2-4wk and 36wk and after del. - VL <50 aim for vaginal del. 36wks - C-sec if HCV co-inf. - High VL receive IV AZT if C-sec or SROM

Answer 17

Obstetric factors, VL, infant feeding

Answer 18

ART (AN and intrapartum and for 4-6wks of life for baby) C-sec if high VL Avoid bf

Answer 19

``` Cord clamped ASAP wash baby ASAP no bf AZT for 4-6wks (start within 4hr) Will test +ve bc of maternal transfer so do direct viral amplification by PCR (birth, 6w, 12w, 18m) ```

Answer 20

All offered ART Del: vaginal if undetectable VL at 36w otherwise c-sec zidovudine infusion4hr before beginning c-sec Neonatal art: AZT if <50/mL otherwise triple ART. Mx for 4-6wk Avoid bf

Answer 21

``` Risk of vertical trans. Importance of adherence VL measured every 2-4wk and at 36w <50 vaginal, >50 c-sec Explain need for AZT 6wks for neonate and HIV testing ```

Answer 22

Screening in ALL Babies born to infected mothers receive vaccination and HBV Ig within 12h birth Vaccine: birth, 1m, 6m C-sec does not reduce transmission (indicated if HIV+HBV) Not trans by bf Serological HBV test at 12m

Answer 23

Detect anti-HCV PCR IFN, ribavirin CI in pregnancy