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MRCOG part 2 > Infections in Pregnancy > Flashcards

Infections in Pregnancy Flashcards

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1
Q

Rubella incubation

A

12-23 days

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2
Q

What type of organism is Rubella

A

RNA togavirus

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3
Q

Risk of fetal infection with Rubella

A

<11 = >90%
11-16/40 = 20%
>20/40 = 0%

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4
Q

Rubella vaccination

A

Live vaccine

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5
Q

Congenital rubella syndrome features

A

Sensorineural deafness, cataracts and cardiac anomalies

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6
Q

What type of organism is Measles

A

single stranded enveloped RNA

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7
Q

Measles incubation and infectious periods

A

Incubation = 10-12 days, rash 14 days post exposure
Infectious = 4 days pre until 4 days post rash

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8
Q

Fetal complications of measles

A

No increased congenital abnormalities
increased IUGR, NICU adm, IUD

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9
Q

What type of organism is Parvovirus B19

A

dsDNA virus

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10
Q

Incubation period of Parvovirus

A

4-14 days (7 average)

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11
Q

Infectious period of Parvovirus

A

7-10 days pre rash

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12
Q

Test for recent parvovirus infection

A

IgM - if positive, suggests recent infection
IgG +ve = immune

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13
Q

Fetal risks of parvovirus

A

hydrops, anaemia, heart failure
Death = 1-4%

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14
Q

Risk of parvovirus vertical transmission

A

<15 weeks gestation - 15%
15 - 20 weeks - 25%
Term - 70%

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15
Q

What type of organism is VZV

A

DNa virus

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16
Q

VZV incubation period

A

10-21 days

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17
Q

Incidence of VZV in pregnancy

A

3 in 1000

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18
Q

Maternal complications of VZV in pregnancy

A

Pneumonia (10%)
Hepatitis
Encephalitis

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19
Q

Risk of fetal varicella syndrome
Signs

A

1% if <28/40
0% if >28/40
Skin scarring, eye defects, limb hypoplasia, developmental delay

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20
Q

Timing of scan following VZV infection in pregnancy

A

16-20/40 or 5 weeks post infection

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21
Q

Management of vzv exposure

A

Check VZV Ig
- +ve –> reassure
- -ve –> <10 days from exposure –> VZIG and inform infections 8-28 days

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22
Q

Treatment of VZV in pregnancy

A

> 20/40 and <24 hours from rash = aciclovir 800mg 5x/day for 7 days
Severe infection = IV aciclovir

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23
Q

Risk of neonatal VZV infection

A

If birth within 1-4 weeks –> 50% infected and 23% these have clinical varicella

Birth within 7 days –>give VZIG

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24
Q

CMV incubation period

A

3-12 weeks

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25
Risk of congenital CMV
Primary infection = 20-30% Recurrent infection = 1-2%
26
Percentage of pregnant women CMV sero+ve
50%
27
Percentage of pregnant women who will have primary CMV infection in pregnancy
2%
28
Risk of symptoms following congenital CMV What are the symptoms
10-15% symptoms at birth 10-15% develop symptoms at later life Sensorineural deafness, microcephaly, visual impairment, IUGR, CP
29
Mortality with neonatal CMV % of survivors with sequelae
20-30% 90% survivors have sequelae
30
Timing of amniocentesis for CMV
6 weeks post infection and after 21/40
31
Incubation of toxoplasmosis
5-23 days
32
Fetal risks of toxoplasmosis % Features
60% no effect 10% chorioretinitis 20-30% TORCH anomalise Spontaneous first trimester miscarriage, Chorioretinitis, IUGR Microcephaly, Hydrocephalus, Intra-cranial calcification Learning disability, Hepatosplenomegaly
33
Investigation for toxoplasmosis
IgM+ve Then 2nd sample 3 weeks later - high IgM Or - IgG 4fold rise
34
Treatment for toxoplasmosis
Spiromycin --> 60% reduction in fetal risk If fetus infection --> pyrimethamine + sulfonamide + folinic acid (slows fetal disease)
35
Treatment of chlamydia in pregnancy
Amoxicillin Erythromycin Azithromycin
36
What kind of virus is HSV
DNA virus
37
Risk of neonatal transmission with: Primary infection reccurent infection
41% 0-3%
38
39
Whats the proportion of HSV cases in neonate due to HSV 1 vs HSV 2
50% each
39
HSV infection treatment <28/40 >28/40 Recurrent In HIV
1. 5/7 aciclovir 400mg TDS then from 36/40 2. Aciclovir 400mg TDS until birth, CS if primary 3. Usually self limiting, consider aciclovir from 36/40 4. Aciclovir from 32/40
39
Treatment of malaria
Simple = quinine 600mg TDS for 5-7 days or clindamycin 450mg TDS for 5-7 days then mefloquine for 7 days Severe: Uncomplicated = IV quinine Complicated = IV artenusate Non faciparum = chloroquine
40
How long should you not get pregnant after exposure to Zika virus?
3 months from last exposure if both partners/only male exposed 2 months if only woman
41
What fetal impact does Zika have
Microcephaly
42
What ARVs should you start newly dx HIV on?
tenofovir or abacavir or lamivudine PLUS efavirenz or atazanavir / ritonavir If v high VL, include raltegravir or dolutegravir
43
Which ARV is associated with increased neural tube defects
Dolutegravir - give 5mg folic acid
44
Neonatal management of HIV Very Low risk Low risk High risk
Very low risk = 2 weeks zidovudine - On cART >10/52 + 2xVL<50 4 weeks apart + 36/40 VL <50 Low risk = 4 weeks zidovudine High risk = neonatal PEP
45
Infant testing for HIV
Not breastfeeding = within 48hrs, at 6 weeks and 12 weeks Breastfeeding = within 48hrs, at 2 weeks, monthly whilst BF and 4 + 8 weeks post stopping BF
46
When do you start cART for HIV in pregnancy
by 24/40 for everyone VL <30,000 = when can in T2 VL 30-100,000 = start of T2 VL >100,000 or CD4<200 = ASAP, can start T1
47
What are examples of a-haemolytic strep? How to differentiate between?
S viridans S pneumoniae Optochin disc test
48
How do you differentiate between alpha and beta haemolytic strep
a = green colour around colony b = complete lysis of red cells
49
Grouping of B-haemolytic strep?
Lancefield grouping = based on carbohydrate composition of cell walls
50
Rate of GBS colonisation
20-40%
51
Rate of EOGBS
0.57 per 1000 births
52
Risk of EOGBS General pop Previous GBS Preterm Temp in labour
General pop = 0.6 in 1000 Previous GBS = 1.25 in 1000 Preterm = 2.3 in 1000 Temp in labour = 5 in 1000
53
Risk of death and disability with EOGBS
Death = 5.2% Disability = 7.5%
54
Risk factors of EOGBS
Previous baby with GBS GBS bacturia +ve GBS swab in pregnancy Maternal temp in labour
55
GBS abx if pen allergic
Cefuroxime 1.5g loading then 750mg 8hrly OR vancomycin 1g 12hrly
56
Neonatal tx of suspected GBS
Penicillin + gentamicin
57
Maternal mortality of COVID
2.4 per 100,000 maternities
58
Treatment of MRSA colonisation
Mupirocin ointment TDS for 5 days
59
Treatment of MRSA infection
Vancomycin or teicoplanin Linezolid if resistant to above
60
Treatment of sepsis in pregnancy
Not critically ill: Co-amox + metro Cefuroxime 1.5g 8hrly + metro Cefotaxime 1-2g 6-12hrly + metro Clarithro/clinda + gent +/- metro Severe sepsis: tazocin + gent meropenem + gent
61
Treatment of group A strep
Clindamycin
62
Sepsis bundles to be completed within: 3 hours 6 hours
3 hours: Sepsis 6 - lactate, blood cultures, IV abx, O2 (sat >94%), urine output, give 30ml/kg crystalloid 6 hours: - recheck lactate if raised - vasopressors if needed to maintain MAP >65
63
Most common postpartum infection
Endometritis
64
Rate of false positive and negative tests in syphilis
1% (VDRL and Abs)
65
In preterm labour, what drug do you give to help load baby in HIV
Double dose tenofovir
66
How long should you wait post Zika for fertility treatment? Exposure? Infection?
Exposure = 28 days Infection = 6 months, test semen for Zika on RT-PCR
67
Risk of fetal transmission of toxoplasmosis
<4 weeks: <1% 13/40: 10% >36/40: 60%
68

MRCOG part 2 (9 decks)

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