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MC > Infections in Pregancy > Flashcards

Infections in Pregancy Flashcards

1
Q

This infection, usually due to Escherichia coli, is one
of the most common infective complications of
pregnancy

A

Acute pyelonephritis

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2
Q

Acute pyelonephritis, why the need to hospitalize?

A

The patient should
be hospitalised and usually requires intravenous
antibiotic therapy and possibly rehydration

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3
Q

Abx for Acute pyelo

A

amoxycillin 1 g IV 6 hourly for 48 hours, then
500 mg (o) 8 hourly (if bacteria sensitive) for
14 days

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4
Q

Alternatives to Amox

A

Alternatives: cephalosporins (e.g. ceftriaxone 1 g

IV and cephalexin 500 mg (o))

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5
Q

Patients with _______ typically have dysuria and

frequency. Treat for 10–14 days

A

acute cystitis

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6
Q

Tx for acute cystitis

A

cephalexin 250 mg (o) 6 hourly 2
or
amoxycillin/potassium clavulanate (500/125 mg)
(o) 12 hourly
or
nitrofurantoin 50 mg (o) 6 hourly, if a betalactam
antibiotic is contraindicated

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7
Q

_______ is contraindicated in
the third trimester of pregnancy as it may
lead to haemolytic diseases in the newborn

A

Nitrofurantoin

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8
Q

_________of pregnant asymptomatic women have

positive cultures during pregnancy

A

5–10%

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9
Q

Ideally all women should be screened for

___________at their first visit

A

bacteriuria

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10
Q

Puerpuerial infection

It especially involves the______ and ______

A

placental site in the uterus and laceration or incisions of the birth canal

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11
Q

____________is infection of the placenta and membranes usually from normal vaginal flora
(e.g. Group B Streptococcus (GBS), E. coli ).

A

Chorioamnionitis

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12
Q

It is worth recalling that ___________
infection was the outstanding cause of septic maternal
death before the introduction of penicillin

A

Lancefield group A Streptococcus

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13
Q

Routine testing for GBS is recommended
at 36 weeks because:

if antibiotics are not given to carriers (the
15–20% who carry GBS) in labour, 50% of babies
become colonised and _______ of these are severely
affected and often die

A

1%

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14
Q

if antibiotics are given in labour (at least _______
prior to delivery) fetal colonisation and infection
almost never occurs

A

2 hours

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15
Q

Intrapartum GBS prophylaxis is indicated for:

A

Indicated for GBS carrier in current pregnancy and

previous baby with early onset disease

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16
Q

Intrapartum GBS prophylaxis TX

A

benzylpenicillin 1.2 g IV statim then 600 mg IV
4 hourly until delivery (clindamycin 600 mg IV 8
hourly if hypersensitive to penicillin)

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17
Q 
Maternal puerperal GBS infection usually has the
following features:
1
2
3
A
  • high fever >38 ° C on any 2 days from days 1 to 14
  • tachycardia (maternal and fetal)
  • endometritis—offensive or purulent discharge
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18
Q

Tx of uterine sepsis

A 
amoxycillin 2 g IV 6 hourly
plus
gentamicin 4–6 mg/kg IV daily
plus
metronidazole 500 mg IV 12 hourly
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19
Q

___________is common in pregnancy since
pregnancy is a predisposing factor to the growth of
the fungus

A

Candida (thrush)

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20
Q

______ is a first-line treatment for vaginal candidiasis

A

Clotrimazole

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21
Q

Rubella _______ indicates recent infection, rises
7–10 days after infection, and a real risk if
pregnant

A

IgM:

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22
Q

Dx of rubella infection

Fourfold rise in ____________ If initial test –ve repeat in 2 weeks

A

IgG titres or rubella specific IgM

antibody.

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23
Q

• Greatest risk if infection for varicella is in______ and _______

A

first trimester and very late pregnancy

24
Q

______________ is rare—includes limb
abnormalities, microcephaly, optic atrophy, mental
impairment, IUGR—but it appears to occur in 3% of
pregnancies where the mother contracts varicella

A

Fetal varicella syndrome

25
Q

Maternal infection in early pregnancy: greatest

risk <20 weeks gestation. Give a course of_________________

A

an antiviral

(e.g. acyclovir, valaciclovir); consider ultrasound

26
Q

Consider VZ-Ig for baby if _________ before delivery and up to 4 weeks after. Isolate mother from baby until not
contagious.

A

<7 days

27
Q

What to screen if suspicious for Parvo

A

• Screen for immunity with parvovirus B19 IgG
antibodies (reassure if positive).
• Screen for infection with acute and convalescent
sera for IgM antibodies

28
Q

Miscarriage rate for Parvo

A

Miscarriage rate is 4% <20 weeks

29
Q

__________ is anaemia–hydrops

fetalis with cardiac failure and possibly death

A

Fetal parvovirus syndrome

30
Q

___________ is the commonest cause of intra-uterine

infection

A

CMV

31
Q
  • Up to 30% of CMV-affected infants have ____

* In up to 50% the effects are restricted to ___

A

mental impairment.

hearing loss

32
Q
    • ve HBsAg indicates _______
    • ve anti-HBs indicates ______
    • ve HBeAg indicates_____
A

acute infection.
recovery and immunity.
high infectivity but low transmission in utero.

33
Q

Infected infants have a ______ risk of becoming

chronic carriers with liver disease

A

90%

34
Q

When to give passive hep b vaccine

A

At delivery or ASAP give newborn babies of carrier
mothers both hepatitis B vaccine and immunoglobulin
(HBIg). This gives efficacy of about 90–95%.

35
Q

When to give booster of hep b

A

Follow
up with booster doses of vaccine at 2, 4 and 6 (or 12)
months.

36
Q

HCV

If positive, the transmission rate to fetus is _____ and much higher if there is maternal infection during pregnancy.

A

5%

37
Q

The risk from primary infection of genital herpes is greatest if it occurs after

A

28 weeks gestation.

38
Q 
Risk factors for intrapartum genital herpes
infection include 
1
2
3
A

primary infection, multiple lesions,
premature rupture of the membranes and premature
labour

39
Q

When to give prophylactic antiviral therapy in herpes?

A

Consider prophylactic antiviral (e.g. acyclovir) for
mother from 38 weeks until time of delivery—to
try to prevent recurrent herpes in late pregnancy

40
Q

When to do CS in herpes?

1
2

A

— there are active lesions present (cervix/vulva)
at time of delivery or within preceding 4 days
— membranes ruptured <4 hours

41
Q

T or F

Genital herpes

If vaginal delivery, give acyclovir to the neonate

A

T

42
Q

T or F

the risk of transmission of
the HPV virus from the maternal genital tract to the fetus
is very high

A

false (low)

43
Q

What condition?

• Incidence 2:1000
• Usually transmitted in second trimester
• May cause fetal death; congenital infection with
mental handicap

A

Syphilis

44
Q

What are the tests for Syphilis

A

VDRL, TPHA, FTA-Abs

45
Q

Syph Tx

Acquired early syphilis including latent
<12 months: ______

A

benzathine penicillin 1.8 g IM as single dose

46
Q

Syph Tx

• Late latent syphilis (incubation period
>12 months): _______

A

benzathine penicillin 1.8 g IM once each week for 3 doses

47
Q

The fetal infection rate from an HIV-positive mother
is about ______ unless appropriate ART has been
given

A

15–25%,

48
Q

If screening detects an HIV-positive mother, both

she and her newborn infant require ______

A

antiretroviral

therapy.

49
Q

T or F

Breastfeeding is inadvisable in HIV because it doubles
the risk of vertical transmission

A

T

50
Q

The risk of HIB transmission can be reduced to
<5%:

• by treatment with _____ prescribed for the
mother antenatally and during labour and to the
neonate for the first 6 weeks postpartum
• by _______, and
• by ________

A

zidovudine

elective caesarean

avoiding breastfeeding

51
Q

Both gonorrhoea and chlamydia urethritis can
transmit infection to the fetus, causing ________, which develops in the first 2 weeks of
life

A

neonatal

conjunctivitis

52
Q

Chlamydia can also cause neonatal pulmonary
infection such as pneumonia, which usually appears
at ________

A

2 or 3 months of age

53
Q

• Acquired by close contact with infected cats or
eating uncooked or undercooked meat
• About 2:1000 maternal infection rate with about
30% passed to fetus

A

Toxoplasmosis

54
Q 
Well-proven transplacental vertically transmissible
pathogens include 
1
2
3
4
5
A

cytomegalovirus, rubella, syphilis, toxoplasmosis and varicella

55
Q

The best serological evidence of recent infection is
________ so the first specimen should be
collected ASAP after the onset of symptoms

A

IgG seroconversion

MC (90 decks)

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