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Infections Flashcards

1
Q

When across pregnancy is there a risk to fetus of foetal varicalla syndrome

A

If exposure prior to 20 weeks then 1%
Very small risk if after 20 weeks

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2
Q

How does foetal varicella syndrome present

A

Skin scarring
Micropthalmia
Limb hypoplasia
Microcephaly
Learning disabilities

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3
Q

What is management of exposure to chickenpox in pregnancy

A

If any doubt has been exposed measure antibodies
- under 20weeks if not immune give VZIG ASAP
- over 20 weeks if not immune give VZIG or aciclovir/valaciclovir 7-14 days AFTER exposure

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4
Q

How long after exposure pre 20 weeks is VZIG effective

A

10 days

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5
Q

What is risk of varicella in pregnancy to mother

A

Greater pneumonia risk

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6
Q

What is risk for severe neonatal varicella

A

Mother develops rash from 2 days antenatally to 5 post

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7
Q

Management of chickenpox if pregnant

A

Avoid contact with pregnant women until crusted over
Aciclovir if over 20 weeks and within 24 hours, if not consider
Good hygiene to prevent secondary bacterial infection

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8
Q

When can aciclovir be used to treat varicella in pregnancy

A

If after 20 weeks and within 24 hours
Consider if before 20 weeks

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9
Q

Can fetal varicella syndrome be diagnosed prenatally

A

If have had varicella then should be referred to fetal medicine either at 16-20 weeks or 5 weeks post infection
Do USS
Can also do amniocentesis to find varciella DNA however amniocentesis risks should be weighed up

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10
Q

What do if history of GBS in a previous pregnancy

A

Offer either intrapartum benzylpenicillin or testing at either 35-37 weeks or 3-5 weeks prior to expected delivery

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11
Q

What do if history of neonatal GBS in prior pregnancy but are negative

A

Still offer IAP

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12
Q

What do if GBS bacteriuria

A

If BGS bacteriuria identified at any point in pregnancy with colonisation over 10^5 cfu then treat infection and offer IAP

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13
Q

If reach 37 weeks and is rupture of membranes with known GBS colony what do

A

Offer IAP with immediate induction of labour

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14
Q

Antibiotic choice if allergic to penicillin in GBS IAP

A

If non-severe allergy use a cephalosporin
If severe use vancomycin

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15
Q

What do if preterm prelabour rupture of membranes and BGS status is positive

A

Before 34 weeks expectant management
After 34 weeks can expedite delivery

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16
Q

Management of rubella in pregnancy

A

Notify health protection unit
Keep away from other pregnant women

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17
Q

What investigations are done for suspected rubella infection

A

Rubella IgM
Parvovirus B19 IgM as can be difficult to distinguish clinically

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18
Q

What is done if baby born to mother with chronic or acute Hep B in pregnancy

A

Complete vaccination schedule and hep B immunoglobulin

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19
Q

What is chorioamnionitis

A

Infection of the amniotic fluid, membranes and placenta

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20
Q

What is exact name of a GBS

A

Streptococcus agalactiae

21
Q

Management of pregnant woman with HIV

A

Should be taking ART
Delivery
- if viral load less than 50 can have vaginal delivery
- if higher must do C-section

22
Q

Management of neonate born to HIV positive woman

A

If viral load less than 50 in mother
- oral zidovudine
If viral load over 50
- triple ART for 4-6 weeks
Do not breast feed

23
Q

How does Hep B vaccination schedule work if

A

One within 12 hours of birth
One at 1-2 months
One at 6 months

24
Q

What is done post-natally for all children born to HIV mothers

A

Blood tests
- within 2 days
- discharge
- 6 weeks
- 12 weeks
- 18 months

25
Q

What do if woman does not want to take ART

A

Zidovudine including infusion during delivery

26
Q

Management of herpes infection in pregnancy

A

In first and second trimester
- treat with oral acyclovir unless encephalitis
- for delivery treat from 36 weeks with aciclovir until delivery
If in third trimester
- aciclovir until delivery and should be C-section

27
Q

What do if present with herpes in labour

A

C-section

28
Q

How is parvovirus B19 infection confirmed in pregnancy

A

2 positive IGM readings

29
Q

Management if confirmed parvovirus B19 in pregnancy

A

Infection takes 6 weeks to affect baby
Therefore referral to foetal medicine within 4 weeks to do an USS of the middle cerebral artery every 2 weeks

30
Q

Vulval warty lesions with basilar hyperplasia and binucleated and mutinucleated cells

A

Condylomata (genital warts)

31
Q

Management of genital warts in pregnany

A

Cryotherapy as podopyllin contraindicated in pregnancy

32
Q

Chlamydia treatment if pregnant

A

Azithromycin

33
Q

Gonorrhoea treatment if pregnant

A

Refer to GUM
If refused then IM ceftriaxone in primary care

34
Q

Management of UTI in pregnancy first 2 trimesters

A

First line- nitrofurantoin for 7 days
Second line (no response in 48 hours or contraindicated)- cephalexin, amoxicillin

35
Q

How manage refusing a c-section with HSV

A

IV infusion of aciclovir during the pregnancy and close liason with neonatologist

36
Q

In HIV vaginal delivery, what is not recommended

A

Prolonged rupture of membranes
Artificial rupture of membranes

37
Q

How can parvovirus be confirmed antentally

A

Amniocentesis PCR analysis

38
Q

How are women with B19 monitored and how often

A

Middle cerebral artery USS
Fortnightly

39
Q

What suggests foetal anaemia on middle cerebral artery USS

A

Elevated peak systolic velocity

40
Q

What suggests hydrops fetalis on USS

A

Polyhydramnios

41
Q

What most commonly causes post puerperal sepsis

A

Strep pyogenes

42
Q

Management if varicella infection around the time of birth

A

Try to give birth at least 7 days after onset of rash
If give birth within 7 days then give baby VZIG

43
Q

What additional test is offered to pregnant HIV women

A

Hep C

44
Q

Management of chickenpox if breastfeeding

A

Aciclovir within 24 hours of onset of rash

45
Q

What is done for all HIV positive women in pregnancy

A

Zidovudine infusion

46
Q

What do if contract chickenpox in 1 week post partum

A

Give VZIG

47
Q

Management if get PID in pregnancy

A

IV erythomycin and ceftriaxone

48
Q

What do if known GBS but having a c-section

A

No need for antibiotics unless preterm or has been rupture of membranes

49
Q

Under what circumstances are intrapartum abx given for GBS positive patients having a c-section

A

preterm
Been a rupture of membranes

Obs (9 decks)

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