W04: Infections in Preg, Multiple Gestation, Eclampsia, Growth Chart Flashcards
CHICKENPOX in PREGNANCY
fever, malaise, vesicular rash
48hr prior to rash => crusted lesions (infective period)
- for adults = higher morbidity: hepatitis, pneumonitis, encephalitis
for IMM COMPR. & PREGNANT PEOPLE - congenital infection in first 28w = FOETAL VARICELLA SYNDROME
- check history for chicken pox
- check. serum IgG
> offer VZ immunoglobulin (if non-immune)
> oral aciclovir if mild and within 24hr rash onset OR
IV aciclovir
PARVOVIRUS B19 in PREGNANCY
- common mild febrile, erythema of cheeks but MOST ADULTS are asymptomatic
- imm compromised and pregnancy
- foetal anemia, cardiac failure, hydrops fetalis, fetal death
rarely: pre-eclampsia with oedema
TOXOPLASMOSIS in PREGNANCY
a
What is shingles
Reactivation of dormant chickenpox virus in sensory nerve root ganglion since infection
HIV in PREGNANCY
- screened
- risk of pre-eclampsia, miscarriage, low birth wt, and PRETERM
- birth scan offered to HIV+ mothers
MDT input - LFT monitored
Hep B in PREGNANCY
- screened
- vertical transmission as well as bodily fluids
- acute = severe pres.
- fetal acquisition and cirrhosis and hepatocellular ca. risk
- chronic HBV with high. viral load
> TENOFOVIR monotherapy - Hep B vaccine given to at risk
> Hep B immunoglobulin for babies with positive mothers
+ accelerated imm. schedule
Hep C in PREGNANCY
- severe hepatitis; chronic liver disease; risk to liver ca.
- associated with hx of IVDU
- vertical transmission
- higher risk of vertical transmission when HIV(+)
- nil preventative methods, nil tx (dt teratogenic)
- vaginal birth relatively safe
Syphilis in PREGNANCY
- spirochete treponema pallidum; direct contact (sexual contact)
- increasing prevalence
- preg = risk of miscarriage, stillbirth, hydrops fetalis, growth restriction, congenital infection
- congenital infection = first 2y of life presentation
- urgent referral
- HUTCHINSONS TRIAD
> abx
intramuscular penicillin
! LT sequelae
! nil protective antibodies thus re-infection possible
Aims of HIV Tx
combined anti-retroviral treatment
> Viral load <50 HIV RNA copies/ml = allows vaginal delivery
> reduce risk of vertical transmission
> improve mother’s health
Classification of Syphyllis
1º = ulcer painless = chankry
2º = 4-10w progression
3º = 20-40y
What is HUTCHINSONS TRIAD
a triad in late congenital syphilis consisting of
notched incisors
interstitial keratitis
and eighth cranial nerve deafness.
> penicillin
Multiple Births: Reasons
- 1+ egg during 1 menstrual cycle
- Zygote divides after fertilisation => identical twins
- IVF tx => 1+ embryo to uterus
Amnioncity
No. of amnions (inner membranes) surrounding babies in a multiple pregnancy
Chorionicity
No. of outer membranes surrounding babies in multiple pregnancy.
Types of Twin Pregnancy
Are described by amniocity and chorionicity and are detected by fetal USS
Lambda sign = 2 placentas = dichorionic diamniotic twins
T sign = 1 placenta = monochorionic diamniotic twins
Complications of mult. births
- pre term
- hypermeesis
- anemia
- HT
- DM
- PPart.Haemorr.
- Fetal growth restriction
- prematurity
- increased mortality, morbidity
monochorionic = twin-twin transfusion syndrome
Eclampsia
Severe pre-eclampsia complicated with generalised convulsions
- ante partum, intrapartum, post-partum
dt cerebral oedema, haemorrhage
*BP >150 systolic, hyper-reflexia, headache, visual changes
= tonic-clonic seizures
> ABC approach
LFT, UE, coag., FBC
Mg Sulfate = cerebral dilatation and competitively blocks calcium
- calcium gluconate combats Mg Sulfate
antihypertensives
Delivery
> prophylactic low-dose aspriing from 12w
Antenatal Growth Chart
Detect large/small fetuses.
small
* uteroplacental insuff.
* chrom.
* foetal infections
large
* gest. DM
* insulin-dependent DM
- customised growth chart = wt., parity, ethnicity
- symphsys-fundal height against fetal weight (estimated) against gestation (x axis)
Nausea and vomiting preg-safe tx
> cyclizine (antihistamine)
prochloroperazine
(2)
> ondansetron
> metoclopramide
Hypertension preg-safe tx
> Labetolol
Nifedipine
methyldopa
hydralzine
Epilepsy preg-safe tx
> Carbamaezpine
Lamotrigine
(safest option)
+ high dose folic acid
DM preg-safe tx
> insulin
metforming (gest. DM / DM2)
Thromboembolism preg-safe tx
> LMWH
> Warfarin = fetal warfarin syndrome
Asthma preg-safe tx
Risk of medication use are lower than risk of untreated asthama
> B2 agonist- albuterol, salbutamol - safe
Inhaled corticosteroid- budesonide
- Theophyline- potential toxicity
- Systemic corticosteroid- severe asthama
Morphine in pregnancy
- nil risk of abn. BUT
neonatal resp depression and withdrawal risk - labour analgesia
!avoid codeine during lactation - infant opiate tox.
