Pregnancy

Question 1

How common is group B strep in pregnancy?

Answer 1

Affects 1 in 500

Question 2

Are all women screened from group B strep in pregnancy?

Answer 2

No.
Only if previous group B strep or incidentally found
If screened should ideally be 35-37 weeks

Question 3

What treatment is offered if women found to have group B strep in pregnancy?

Answer 3

IV benzypenicillin 4 h in labour
3g IV at onset labour
1.5 g 6 x day

(alternatives are cefuroxime or vancomycin)

Question 4

When is greater risk of HSV in pregnancy?

Answer 4

In 3rd trimestre
<6 weeks from delivery
Primary HSV

Question 5

How is neonatal HSV transmitted?

Answer 5

Genital secretions- direct contact
~25% postnatal
Congenital- transplacental is RARE

Question 6

Aetiology of HSV in pregnancy

Answer 6

50% HSV1 50% HSV2

Question 7

When does metal infection in syphilis usually occur?

Answer 7

Usually late in pregnancy

although has been seen at 8 /40

Question 8

What are complications of fetal syphilis infection in pregnancy?

Answer 8

Polyhdramnios
Miscarriage
Preterm labour
Stillbirth
Hydrops
Pericardial effusion
Skin oedema
Placental oedema

Question 9

When do women with STS in pregnancy need referral to fatal medicine?

Answer 9

If 26/40 or more and not yet had treatment

Or if immune hydros/hepatosplenomegaly

Question 10

What is treatment of STS in pregnancy?

Answer 10

Single dose Benzathine penicillin 2.4 ,U
If 3rd need 2nd dose after 7 days
Assess neonate at brith

Question 11

What is non penicillin treatment of STS in pregnancy?

Answer 11

Ceftriaxone
erythromycin
Azithromycin

If any of above baby needs penicillin at birth

Question 12

How many cases of congenital syphlis in UK per year

Answer 12

10 cases per year

Question 13

Clinical signs of congenital syphilis

Answer 13

jaundice
anaemia
LN
hepatosplenomegaly
non immune hydrops
pyrexia
pseudo paralysis of parrot
Low brith weight
Rash
condylomata lata
osteochondritis/periostitis
ulceration of nasal mucosa (SNUFFLES)

Question 14

What should happen to passage of maternal non treponemal/treponeme antibodies?

Answer 14

Passive maternal non treponemal antibodies should drop by 3 months (RPR/VDRL)
Treponemenal antibodies should be negative at 18 months

Question 15

What is risk of local/disseminated neonatal HSV?

Answer 15

Of neonatal HSV
30%- localised
70%- local /disseminated

Local- encephalitis only (6% mortality)
Disseminated- multiple organ involvement (30% mortality)

Question 16

What is the difference between congenital and neonatal HSV infection?

Answer 16

Congenital is rare (in utero)

Neonatal is at time of birth