Travel Flashcards
Air travel at what gestation has been associated with an increased risk of PTB?
34-37/40
Malaria is associated with (6)
Spontaneous miscarriage PTB LBW Stillbirth Congenital infection Maternal death
What advice would you give regarding travel in the: 1. First trimester 2. Second trimester 3. Third trimester
Always have travel insurance. 1. First trimester: - Avoid travelling as pregnancy emergencies occur more frequently. - Travel itself does not increase risk of pregnancy emergencies. 2. Second trimester: - Safest time to travel. - Air travel: extra leg room; exercise and move around cabin; compression stockings; hydration; belt low under belly and over hips; wear non-restrictive clothing. - Exposure to cosmic-radiation negligible. 3. Third trimester: - Avoid travelling as pregnancy emergencies occur more frequently. - Airlines often restrict travel after 36 weeks; may be restricted from 32 weeks if long-haul.
What advice would you give regarding food and water while travelling?
Water: - Bottled water is safest even for brushing teeth. - If bottled not available: boil water or use chlorine tablets to purify water. Food: - Wash hands before preparing food - Fruit: wash with bottled water or peel it. - Avoid: raw and undercooked food, unpasteurised milk products, soft cheeses, pates and prepared salads due to risk of listeria and toxoplasmosis.
What advice would you give regarding travel destinations?
- Avoid developing countries during pregnancy. - Get new or update vaccinations. - Extreme conditions may not be well tolerated in pregnancy. - Consider remoteness of location and emergency transport if complications arise. - Malaria risk: avoid travelling if possible.
Malaria: How does pregnancy affect malaria?
- More likely to get malaria in pregnancy. - Can develop up to 1 year after travel.
Malaria: How does malaria affect pregnancy?
Maternal effects: - Severe febrile illness - Maternal mortality Fetal/neonatal effects: - Miscarriage - Stillbirth - Preterm birth - IUGR - Vertical transmission (at time of birth) / congenital malaria - Fetal anaemia
Malaria: What advice would you give to avoid getting malaria in a malaria endemic country?
- Avoid travel to malaria endemic country during pregnancy. - Minimise outdoor activities from dusk till dawn - Use DEET insect repellent (safe in 1st trimester but less absorption with spray) - Wear long sleeves/pants - Sleep under mosquito net - Kill mosquitos: sprayed permethrin and pyrethroids and vaporised synthetic pyrethroids - Oral medication with resistant malaria strains.
Malaria: What anti-malarials can be used in pregnancy? What are the side-effects What anti-malarials can’t be used in pregnancy?
Chemoprophylaxis: mefloquine 5 mg/kg once weekly. - Side-effects: nausea, diarrhoea Antimalarials not safe in pregnancy: doxycycline, primaquine.
Malaria: What pre-conceptual advice would you give a woman who has recently used anti-malarial drugs?
Avoid conception for: - If taken mefloquine: 3 months - If taken doxyxycline: 1 week - If taken atovaquone/proguanil: 2 weeks.
Malaria: What symptoms are associated with malaria? What investigations would you order if you suspected a pregnant woman had malaria?
Symptoms: - Fever - Flu-like symptoms - Nausea and vomiting - Diarrhoea - Jaundice - Splenomegaly - SOB Severe symptoms: collapse, altered LOC, RDS, pulmonary oedema, seizures, shock, DIC, haemoglobinuria, jaundice. Investigations: - Blood smear: needs 3 x negative smears 12-24 hours apart to be negative. - Cord, placental and neonatal blood films.
Malaria: How should you treat a pregnant woman with malaria?
Anti-malarial treatment: - P falciparum: quinine, clindamycin; IV artesunate if severe. - P vivax, ovale or malariae: chloroquine.
What travel vaccinations are NOT recommended in pregnancy?
- BCG - Japanese encephalitis - Typhoid - Small pox pre-exposure (post-exposure recommended)
Zika virus: How is Zika virus transmitted?
- Mosquito bites from the Aedes aegypti and Aedes albopictus mosquitoes.
- Sexual intercourse from male to female; stays in semen for 188 days after infection.
- Vertical transmission
Zika virus:
What preconceptual advice do you have regarding Zika virus?
- If planning pregnancy, avoid travel to affected areas.
- If in Zika affected area:
- Use protection against mosquitoes
- Use condoms with all types of sexual intercourse while in affected area.
- Wait 3 months after leaving affected area before donating semen or trying to conceive.
- Wait 2 months if only female partner travelled to affected area.
- Serology testing 8 weeks preconception and regularly throughout pregnancy if from endemic area up to 12 weeks.
