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OB > Infectious Diseases > Flashcards

Infectious Diseases Flashcards

1
Q

What are the characteristics of Rubella?

A
  • RNA toga virus
  • transmitted by droplets
  • MMR vaccination decreased its incidence
  • if lady got infected in first trimester < 12 weeks there is a 90% risk of congenital infection
  • if lady got infected at end of second trimester the risk is < 25 %
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2
Q

What is the maternal presentation of rubella?

A
  • 50% asymptomatic
  • febrile rash
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3
Q

What are the symptoms of Congenital Rubella syndrome?

A
  • sensorineural hearing loss
  • cataract & blindness
  • congenital heart disease (VSD)
  • encephalitis
  • endocrine problems
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4
Q

How is infection with Rubella managed during pregnancy?

A

Depending on gestational age
- if infected < 16 weeks -> termination
- If after 16 weeks -> reassure

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5
Q

How is diagnosis of Rubella made during pregnancy?

A
  • IgM antibody after 4 - 5 weeks from onset of symptoms
  • antibodies can last up to 2 weeks
  • in baby -> ultrasound
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6
Q

What are the characteristics of toxoplasmosis?

A
  • parasite found in cat feces, soil, & uncooked meat
  • transmitted by ingestion
  • asymptomatic infection of glandular-like fever illness
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7
Q

What is the transmission risk versus fetal damage percentage?

A
  • in first trimester -> transmission 10% but damage is 85%
  • in third trimester -> transmission is 85% but damage is 10%
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8
Q

What are the signs of congenital toxoplasmosis infection?

A
  • ventriculomegaly
  • microcephaly
  • chorioretinitis
  • cerebral calcifications
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9
Q

How is toxoplasmosis diagnosed?

A
  • Sabin Feldman dye test
  • ELISA -> IgM looking for rising titer
  • if suspected by US -> amniocentesis then PCR
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10
Q

How is toxoplasmosis treated during pregnancy?

A
  • Spiramycine for 3 weeks (2 - 3 g/d)
  • termination is ultrasound features are secondary to toxoplasmosis
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11
Q

What is the cause for Syphilis infection?

A
  • Spirochete bacteria -> treponema pallidum
  • sexually transmitted -> screen at booking
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12
Q

What are the maternal presentations for syphilis?

A

Primary
- localized disease
- painless genital ulcer with indurated border

Secondary
- from 6 weeks to 6 months
- maculopapular rash or lesions in the mucous membranes & condylomata lata

Untreated Primary & secondary
- 70 - 100% transmission to baby
- 25% still birth
Tertiary
- if untreated
- 20% cardiovascular tertiary syphilis
- 10% neurosyphilis

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13
Q

What are the complications of syphilis transmission to baby?

A
  • stillbirth
  • fetal growth restriction
  • fetal nonimmune hydrops
  • maculopapular rash
  • anemia & hepatosplenomegaly
  • preterm birth
  • neonatal death
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14
Q

What are the diagnostic tests for syphilis?

A

For Screening
- VDRL
- RPR

For Confirmation
- Enzyme immunoassay (EIA)
- T. Pallidum hemagglutination assay
- fluorescent treponema antibody absorbed test (FTA-abs)

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15
Q

How is syphilis managed during pregnancy?

A

Parental Penicillin for mother
- start in the hospital to manage Jarish-Herxheimer reaction

  • if mother is not treated -> baby should be treated to avoid seizures & developmental delay after birth
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16
Q

What are the characteristics of herpes simplex virus?

A
  • DNA virus
  • HSV2 in genital infections
  • STD
  • high neonatal mortality & morbidity
17
Q

What is the presentation of HSV in mother?

A
  • painful genital ulcers in vulva, vagina, & cervix
  • could cause systemic symptoms -> urinary retention
18
Q

What are the types of neonatal herpes?

A

Acquired during labour from contact with lesion
1- Localized -> skin, eye, & mouth
2- Localized to CNS -> encephalitis
3- Disseminated -> high death rate

19
Q

What are the risk factors that may lead to transmission of HSV to baby?

A
  • mode of delivery -> vaginal
  • interventions during labour -> fetal scalp sampling
  • if infection was acquired within 6 weeks of delivery
  • presence of maternal transplacental antibodies
20
Q

What are the measures that should be taken to reduce risk of transmission of HSV during pregnancy?

A

Third Trimester
- acyclovir 400mg 3 times a day
- plan elective C section if EDD is within 6 weeks

First & Second Trimesters
- daily suppressive acyclovir from 36 weeks gestation
- if mother will have vaginal delivery -> intrapartum IV acyclovir

Recurrent Infection
- daily suppressive acyclovir + no need for C section
- inform neonatologist

21
Q

What are the signs of congenital CMV in ultrasound examination?

A
  • growth restriction
  • microcephaly
  • ventriculomegaly
  • ascites
  • hydrops
  • intracranial calcifications
22
Q

How is CMV diagnosed during pregnancy?

A
  • antibodies in seronegative mother
  • if suspected by US -> PCR through amniocentesis
23
Q

How is congenital CMV infection managed?

A

Termination of pregnancy

24
Q

What are the characteristics of HIV?

A
  • RNA retrovirus
  • transmitted by: sexual intercourse, blood, IV needles
  • vertical transmission during 3rd trimester, delivery, or breastfeeding
25
Q

What are the tests used for screening of HIV?

A

Screening done at booking
- ELISA
- Western Blot test

If lady is at risk
- screen again at 3rd trimester

If lady presents in labour unbooked
- rapid test

26
Q

How is HIV transmission risk reduced?

A

Depends on 3 factors
- maternal plasma viral load, OB factors, infant feeding

Reducing transmission from 25-30% to 2%
1- preconception all ART
2- antepartum ART
3- intrapartum continuation of oral ART + IV zidovudine
4- delivery by C section if high viral load
5- avoid breast feeding

27
Q

How is the type of delivery decided in patient with HIV?

A

Planned vaginal
- if 1000 copies/ml or less at 39 weeks
- avoid amniotomy, fetal scalp electrode, instrumental delivery

Planned C section at 38 weeks
- if > 1000 copies/ml
- hepatitis C confection

28
Q

What are the post delivery interventions that should be done to prevent transmission of HIV?

A
  • early cord clamping
  • early bathing of baby
  • in PPH -> avoid methylergonovine
  • oral ART 4-6 weeks for neonate Zidovudine
  • PCR for the baby:
    1- at birth
    2- at 3 weeks
    3- at 6 weeks
    4- at 6 months
29
Q

What are the characteristics of HBV?

A
  • DNA virus
  • transmitted via blood, saliva, seminal fluid, IV drug users
  • risk of transmission reaches 90% if Hbe Ag is positive as well as HBs Ag
30
Q

How is transmission of HBV from mother to child reduced?

A

1- give neonate Ig immediately after delivery to reduce transmission risk by 95%
2- give hepatitis B vaccine at birth, at 1 month, & 6 months
3- Tenofovir for mothers with viral load of 1 000 000 to 100 000 000 & is safe in pregnancy
4- If mother is not immune & is high risk -> HBV vaccine can be given during pregnancy

31
Q

What are the risk factors for HBV?

A
  • chronic liver disease
  • drug abuser
  • occupational exposure
  • household contact
  • HIV & HCV coinfection
  • HBV infected partner

OB (42 decks)

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