PTL, PPROM, infections in pregnancy

Question 1

How many preterm births occur in women without any risk factors?

Answer 1

50%

Question 2

PPV and NPV of FFN

Answer 2

Neg = 0.5% chance of PTB in next 14 days
Pos = 16% chance of PTB in next 14 days

Question 3

Best tocolytic <32 wga

Answer 3

Indomethacin (50 mg, then 25-50 mg q6hrs x 48 hrs)

Question 4

Contraindications to indomethacin

Answer 4

Over 32 wga or oligohydramnios

Question 5

Best tocolytic 32-34 wga

Answer 5

Nifedipine (10-20 mg q3-6 hrs, then 30-60 mg XL q8-12 hrs x 48 hrs)

Question 6

Benefit of mg gtt at < 32 wga

Answer 6

Reduces CP risk by half

Question 7

pH of amniotic fluid vs vagina

Answer 7

7.1 - 7.3 vs 4.5 - 6.0

Question 8

Latency abx

Answer 8

1 g azithromycin x1 dose, then IV ampicillin 2 g + erythromycin 250 mg q6hrs x48 hrs, followed by amoxicillin 250 mg + erythromycin 333 mg q8 hrs x 5 days

Question 9

Protocol for 17OHP

Answer 9

Start 16-20 wga, continue to 36 wga

Question 10

Indication for vaginal progesterone

Answer 10

CL < 25 mm (no hx of PTB)

Question 11

Indication for cerclage

Answer 11

CL < 25 mm prior to 24 wga (only if hx of PTB)

Question 12

How often to repeat GBS culture

Answer 12

q 5 wks

Question 13

When to check viral load in HIV pos pregnancy

Answer 13

Initial visit, 2-4 wks after new therapy, monthly until undetectable, at least q3mos, and at 34-36 wga for delivery plannning

Question 14

HIV VL >1000 copies / mL OR VL unk

Answer 14

IV ZDV + C/S at 38 wga

Question 15

Uterotonic contraindicated on integrase inhibitors or cobicistat

Answer 15

Methergine (exaggerated vasoconstrictive response)

Question 16

Primary syphilis presentation and timing

Answer 16

Chancre (nontender ulcer with raised borders), most often occurs at 3 wks and resolves by 3-6 wks

Question 17

Secondary syphilis presentation and timing

Answer 17

Maculopapular rash (condyloma lata), constitutional symptoms, lymphadenopathy, major organ involvement, occurs 2-12 wks after chancre and resolves over 2-6 wks

Question 18

Latency period of syphilis

Answer 18

1-25 yrs

Question 19

Tertiary syphilis presentation and timing

Answer 19

Organ involvement, obliterative endarteritis, neurosyphilis, cardiovascular syphilis involving aorta

Question 20

Disease presenting as non-immune fetal hydrops, hepatomegaly, polyhydramnios, placentomegaly, IUFD

Answer 20

Syphilis

Question 21

Which syphilis tests become negative after treatment?

Answer 21

Non-treponemal (RPR or VDRL)

Question 22

Which syphilis tests remain positive for life after infection?

Answer 22

Treponemal tests (MHA-TP, FTA-ABS)

Question 23

Treatment for early and later syphilis

Answer 23

PCN G x1 dose or x3 doses (weekly)

Question 24

Syphilis treatment with PCN allergy if pregnant

Answer 24

Desensitization and PCN

Question 25

Neurosyphilis treatment

Answer 25

Daily IV PCN x 10-14 days

Question 26

Most common outcome of CMV infection in first trimester

Answer 26

Low transmission overall but 24% chance of hearing loss, 32% of CNS symptoms in general; in total, 6-12% risk of fetal effects with acute CMV

Question 27

Disease presenting as microcephaly, ventriculomegaly, calcifications, liver and bowel calcifications, FGR, oligydramnios, hydrops

Answer 27

CMV

Question 28

Treatment for CMV

Answer 28

None

Question 29

Newborn findings of CMV

Answer 29

(Blueberry muffin), thrombocytopenia, hepatosplenomegaly, petechiae, jaundice, chorioretinitis, hearing loss

Question 30

Primary fetal risk of parvovirus

Answer 30

Hydrops

Question 31

Parvovirus cytopathic to…

Answer 31

RBC precursors and cardiac muscle

Question 32

Rare but dangerous complications of varicella; how to treat

Answer 32

Encephalitis (<1% of adults)
Pneumonia (20% of pregnant women)
IV acyclovir q8hrs till symptoms resolve

Question 33

Treatment for uncomplicated varicella

Answer 33

Acyclovir 800 mg PO 5x / day for 7-10 days

Question 34

Treatment for exposure to varicella in pregnancy

Answer 34

VZIG, or alternative IVIG with acyclovir

Question 35

Implications of amnio pos for varicella

Answer 35

Maybe nothing; 25% of fetuses seroconvert but may not get symptoms

Question 36

Disease presenting as polyhydramnios, hydrops, abdominal calcifications, cardiac malformations, limb deformities, microcephaly, FGR

Answer 36

Varicella

Question 37

Disease presenting as chorioretinitis, microcephaly, skin lesions

Answer 37

HSV

Question 38

HSV ppx regimens

Answer 38

Acyclovir 400 mg TID

Valcyclovir 500 mg BID