T7 - L4 childhood and pregnancy

Question 1

what affect may an infection have on pregnancy?

Answer 1

• miscarriage
  
  • congenital anomalies
  • fetal hydrops
  • fetal death
  • preterm delivery
  • preterm rupture of the membranes

Question 2

which infections can be transmitted from mother to baby during pregnancy (in utero)?

Answer 2

TORCH

• Toxoplasmosis.
• Others (syphilis, HIV, coxsackie virus, hepatitis B, varicella-zoster).
• Rubella.
• Cytomegalovirus disease.
• Herpes simplex disease.

Question 3

what route of transmission do infections take to a baby in utero?

Answer 3

haematogenous

by the blood

Question 4

which neonatal infections can be acquired during passage through the birth canal?

Answer 4

• Group B Streptococcus
• Herpes simplex virus (HSV)
• Gonorrhoea
• Chlamydia
• Human immunodeficiency virus*
• Hepatitis B virus*

Question 5

Symptomatic UTI in pregnancy is frequently preceded by what?

Answer 5

asymptomatic bacteriuria

Question 6

what is Asymptomatic bacteriuria in pregnancy?

Answer 6

larger than normal numbers of bacteria are present in the urine

Question 7

what happens if Asymptomatic bacteriuria is left untreated?

Answer 7

at least 30% of women with ASB will develop acute pyelonephritis

Question 8

what is a cost effective approach to preventing pyelonephritis?

Answer 8

Screening for ASB

Question 9

what is IAP?

Answer 9

Maternal intrapartum antibiotic prophylaxis

• the most effective means to reduce neonatal GBS infections and the burden of the disease

Question 10

who is IAP offered to?

Answer 10

• Women with a previous baby with neonatal Group B Streptococcal disease
• Women with GBS in current pregnancy
• Women who are pyrexial in labour should be offered broad-spectrum antibiotics including an antibiotic for prevention of neonatal EOGBS disease

Question 11

women in labour who are pyrexial should be offered what?

Answer 11

broad-spectrum antibiotics including an antibiotic for prevention of neonatal EOGBS disease

Question 12

what are Intra-amniotic infections?

Answer 12

Intra-amniotic infection is infection of the chorion, amnion, amniotic fluid, placenta, or a combination.

Infection increases risk of obstetric complications and problems in the fetus and neonate.

Question 13

what is a major cause of perinatal morbidity and mortality?

Answer 13

Intra-amniotic infections

Question 14

what is Chorioamnionitis?

Answer 14

to inflammation of umbilical cord, amniotic membranes/fluid, placenta

(Intra-amniotic infections)

Question 15

what are risk factors of intra-amniotic infections?

Answer 15

• rupture of membranes
• amniocentesis,
• cordocentesis,
• cervical cerclage,
• multiple vaginal examinations,
• Bacterial vaginosis

Question 16

what is the pathogenesis of intra-amniotic infections?

Answer 16

Bacteria present in the vagina cause infection by ascending through the cervix

Haematogenous (via blood ) infection is rare e.g. Listeria monocytogenes

Question 17

what are causative organisms of intra-amniotic infections?

Answer 17

Group B Streptococcus

Escherichia coli

Genital Mycoplasma

Question 18

what is the management of intra-amniotic infections?

Answer 18

antimicrobials and delivery of the foetus

antimicrobials should be administered at the time of diagnosis (not after delivery)

Question 19

what is Puerperal endometritis?

Answer 19

infection of the womb during puerperium affects ~5% of pregnancies

NB: Puerperal sepsis remains a major cause of maternal death

Question 20

what are the risk factors of Puerperal endometritis?

Answer 20

• caesarean section,
• prolonged labour,
• prolonged rupture of membranes,
• multiple vaginal examinations

Question 21

what are clinical features of Puerperal endometritis?

Answer 21

• fever
• uterine tenderness
• purulent, foul-smelling lochia
• increased white cell count
• general malaise
• abdopain

Question 22

what are causative organisms of Puerperal endometritis?

Answer 22

Escherichia coli

Beta-haemolytic Streptococci

Anaerobes

Question 23

what is the treatment for Puerperal endometritis?

Answer 23

Broad-spectrum intravenous antimicrobials - continued until the patient has been apyrexial for 48 h

Question 24

why are children more susceptible to infections?

Answer 24

• hand to mouth behaviours
• lack of hygiene skills
• not fully immunised
• Children have close physical contact/do not practice much social distancing

Question 25

how does otitis media present in a child?

Answer 25

• irritability
• difficulty sleeping
• tugging at one or both ears
• fever
• fluid draining from the ear
• loss of balance
• hearing difficulty

Question 26

what is Pertussis?

Answer 26

also known as whooping cough, is a highly contagious respiratory disease.

It is caused by the bacterium Bordetella pertussis.

Question 27

what are the 3 stages of Pertussis?

Answer 27

1. catarrhal phase
2. paroxysmal phase
3. convalescent phase

Question 28

what are features of the catarrhal phase of Pertussis?

Answer 28

• first stage
• Cold-like (coryza, conjunctival irritation, occasionally a slight cough)
• 7-10 days

Question 29

what are features of the paroxysmal phase of Pertussis?

Answer 29

• second phase
• Long duration (2-6 weeks);
• No fever
  a series of rapid, forced expirations, followed by gasping inhalation the typical whooping sound
• Post-tussive vomiting common
• Very young infants may present with apnea or cyanosis in the absence of cough

Question 30

what is Meningococcemia?

Answer 30

meningococci (Neisseria meningitidis) into the bloodstream