Hepatitis, HIV, HSV

Question 1

What is the incidence of hepatitis A in pregnancy?

Answer 1

33%

Question 2

What is the incidence of hepatitis B in pregnancy?

Answer 2

40%

Question 3

What is the incidence of hepatitis C in pregnancy?

Answer 3

<1%

Question 4

What is the route of transmission for hepatitis A?

Answer 4

Fecal-oral
Associated with travel

Question 5

What is the route of transmission for hepatitis B?

Answer 5

Parenteral
IV drug use

Question 6

What is the route of transmission for hepatitis C?

Answer 6

Parenteral
IV drug use

Question 7

What pregnancy effects are seen with hepatitis A infection?

Answer 7

Self limited,
no fetal effects

Question 8

What pregnancy effects are seen with hepatitis B infection?

Answer 8

Risk of vertical transmission
Just HBS ag+= 20% risk
HBS eAg= 90% risk

Question 9

What pregnancy effects are seen with hepatitis C infection?

Answer 9

neonatal infection

Question 10

Are you able to breastfeed if you have hepatitis A infection?

Answer 10

Yes

Question 11

Are you able to breastfeed if you have hepatitis B infection?

Answer 11

Yes, if active disease give vaccine

Question 12

Are you able to breastfeed with hepatitis C infection?

Answer 12

Yes

Question 13

What is the treatment for hepatitis A infection during pregnancy?

Answer 13

Vaccine + HBIG within 2 weeks of exposure

Question 14

what is the treatment for hepatitis B infection in pregnancy?

Answer 14

Vaccine at 0,1,6 months + HBIG within 24hrs of exposure

Question 15

HBsAg?

Answer 15

Hepatitis B surface antigen
Found in serum

Question 16

HBcAg?

Answer 16

Hepatitis B core antigen
Found in hepatocytes

Question 17

HBeAg?

Answer 17

Hepatitis e antigen
Found in hepatocytes
High infectivity
Associated with cirrhosis and liver cancer

Question 18

HBsAb?

Answer 18

Hepatitis antibody
Indicated immunity

Question 19

When is vertical transmission for hepaitis B virus highest in pregnancy?

Answer 19

3rd trimester

Question 20

What should the infant of seropositive mother receive post delivery?

Answer 20

Vaccine and HBIG simultaneously within 12hrs of delivery

Question 21

What is the definition of AIDS?

Answer 21

HIV+ and CD4 count < 200

Question 22

What is the screening test for HIV?

Answer 22

ELISA

Question 23

What is the confirmatory test for HIV?

Answer 23

Western blot

Question 24

What is the next step if HIV testing positive?

Answer 24

CD4 count
viral load
HBsAg, HBCAb, CBC and LFTs

Question 25

When would you perform rapid HIV testing?

Answer 25

Recommended for all patients presenting in labor with unknown HIV status

Question 26

What should you do if there is a positive rapid HIV test when a woman presents in labor with unknown HIV status?

Answer 26

1. Inform patient of positive result and risk to fetus 2. Perform confirmatory test 3. Treat for HIV until test returns 4. Consider C-section if ,labor and SROM has not happened 5. Postpone breastfeeding until results

Question 27

What is the vertical transmission rate without treatment for HIV in pregnancy?

Answer 27

24%

Question 28

What is the vertical transmission rate with treatment with zidovudine?

Answer 28

8%

Question 29

What is the vertical transmission rate with treatment with zidovudine and CD?

Answer 29

2%

Question 30

What is the vertical transmission rate with viral load< 1000 copies and no CD?

Answer 30

1-2%

Question 31

What is the prenatal treatment of HIV in pregnancy?

Answer 31

1. Zidovudine 200mg TID 2. CART

Question 32

What is the intrapartum treatment of HIV in pregnancy?

Answer 32

IV zidovudine 1mg/kg until delivery If CD planned should receive 3hrs of treatment before c-section If viral load consistently <1000 in late pregnancy and med compliant no zidovudine needed

Question 33

What is the route of delivery for HIV patient with viral load > 1000?

Answer 33

C-section prior to labor and ROM

Question 34

What is the route of delivery for HIV patient with viral load < 1000?

Answer 34

Scheduled induction of labor

Question 35

What is the route of delivery for HIV patient with unknown viral load?

Answer 35

C-section if labor and SROM have not occurred

Question 36

What is the timing for planned c-section in regards to HIV positive patient?

Answer 36

38 weeks

Question 37

How do you classify primary HSV infection?

Answer 37

Antibody negative IgM positive

Question 38

How do you classify non primary 1st episode?

Answer 38

Antibody positive IgM positive but don't match each other

Question 39

How do you classify recurrent HSV infection

Answer 39

Antibody positive HSV positive with match

Question 40

How can you diagnose HSV?

Answer 40

1. Culture 2. Clinical ID 3. Serology with PCR

Question 41

What is the test of choice for HSV diagnosis?

Answer 41

Serology with PCR

Question 42

What is the risk of transmission of HSV during delivery?

Answer 42

Primary infection= 50% non primary 1st episode= 33% recurrent infection= 3%

Question 43

What is the rationale for suppressive therapy for HSV during pregnancy?

Answer 43

Reduces risk of recurrence which reduces the need for C-section

Question 44

If a patient is ruptured with active HSV lesions on presentation what mode of delivery is indicated?

Answer 44

If term c-section as soon as possible If preterm expectant management and delivery based on if lesions still active at time of delivery