Infection in Pregnancy

Question 1

Which infections are included in antenatal screens?

Answer 1

HIV, syphillis and hepatitis B

Question 2

When can congenital fetal varicella syndrome develop?

Answer 2

If a mother develops chickenpox in the first 20 weeks of pregnancy 0.4% 1-2 weeks 2% 3-20 weeks

Question 3

When is there a risk of neonatal varicella syndrome?

Answer 3

If a mother develops chickenpox within 5 days prior to labour

Question 4

What type of virus is cytomegalovirus?

Answer 4

A double stranded DNA virus (from the herpes family)

Question 5

What are the consequences of congenital cytomegalovirus infection?

Answer 5

Hearing loss, visual impairment, petechial rash (thrombocytopenia), low birth weight, microcephaly/seizures/cerebral palsy

Question 6

What can cytomegalovirus cause in adults?

Answer 6

Mononucleosis, with a negative mono-spot test, pneumonia, inflammation of retina/oesophagus

Question 7

Define pueperal sepsis

Answer 7

Sepsis within 6 weeks of delivery

Question 8

HIV in pregnancy - when is vaginal delivery recommended?

Answer 8

Viral load <50 copies/ml at 36 weeks

Question 9

HIV in pregnancy - when is PLSCS recommended?

Answer 9

Viral load 400 copies/ml at 36 weeks, should also be considered if more than 50
Patients taking Zidovudine monotherapy (regardless of viral load)

Question 10

Give an example of a double stranded RNA virus

Answer 10

Rotavirus

Question 11

Give an example of a single stranded DNA virus

Answer 11

parvovirus B19

Question 12

What kind of microbe is rubella?

Answer 12

A single stranded RNA virus

Question 13

What kind of microbe is hepatitis ACDE

Answer 13

A singles stranded RNA virus

Question 14

What kind of microbe is hepatitis B

Answer 14

A double stranded DNA virus

Question 15

Which hepatitis virus has a different structure from the others?

Answer 15

Hep B = DNA Hep A, C, D, E = RNA

Question 16

Herpes simplex 1 and 2 - what kind of microbe?

Answer 16

Double stranded DNA virus

Question 17

Epstein Barr - what kind of microbe?

Answer 17

Double stranded DNA virus

Question 18

Human papilloma virus - what kind of microbe?

Answer 18

Double stranded DNA virus

Question 19

Varicella - what kind of microbe?

Answer 19

Double stranded DNA virus

Question 20

What is the indication for group B strep prophylaxis

Answer 20

Labour/ruptured membranes (patients having a planned caesarean who have not gone into labour and have intact membranes, do not need group B strep prophylaxis)

Question 21

What is the prophylactic treatment for group B strep?

Answer 21

3g Benpen after labour commenced, then 1.5g Benpen 4 hourly until delivery . OR clindamycin 900mg IV 8 hourly for pen allergic

Question 22

Toxoplasmosis gondii- what kind of microbe?

Answer 22

intracellular protozoan

Question 23

What is streptococcus agalatica?

Answer 23

group B strep

Question 24

What kind of microbe is group B streptococcus?

Answer 24

gram positive bacteria

Question 25

What microbe causes scarlet fever?

Answer 25

Streptococcus pyogenes

Question 26

What microbe causes slapped cheek?

Answer 26

Parvovirus B19

Question 27

What proportion of infected infants with CMV will present with symptoms?

Answer 27

10%

Question 28

HIV positive mother breastfeeds - how often should the neonate be tested?

Answer 28

monthly

Question 29

HIV positive mother gives formula milk - how often should the baby be tested?

Answer 29

first 48 hours, then 4 weeks, 12 weeks, 18 months for antibody seroconversion

Question 30

When is vaginal delivery recommended in HIV positive mother?

Answer 30

women taking cART and <50 HIV RNA at 36 weeks | no other contraindications

Question 31

When is Planned ELSCS recommended in HIV?

Answer 31

Women taking cART -if viral load >400 at 36 weeks, should also be considered if 50-399 at 36 weeks Women taking zidovudne monotherapy

Question 32

Frequency of CMV congenital infection in pregnancy

Answer 32

1 in 150

Question 33

CMV - type of virus

Answer 33

herpes

Question 34

Woman in labour + previous group B strep but negative group B strep - management

Answer 34

Intrapartum benzylpenicillin IV 3g | or clindamycin IV 900mg

Question 35

Testing for congenital CMV in utero

Answer 35

PCR of CMV on amniotic fluid

Question 36

Antibiotic for toxoplasmosis

Answer 36

spiramycin

Question 37

role of spiramycin in pregnancy

Answer 37

reduces toxoplasmosis transmission but does not reduce severity

Question 38

Type of drug spiramycin

Answer 38

macrolide - inhibit peptidyltransferase

Question 39

Treatment of chlamydia in pregnancy

Answer 39

Erythromycin 500mg QDS for 7 days or BD for 14 days | or amoxicillin - do not use doxycyline or oflaxacin