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MRCOG part 2 > Infectious Diseases In Pregnancy > Flashcards

Infectious Diseases In Pregnancy Flashcards

(78 cards)

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1
Q

U.K. prevalence of TB

A

4.2 per 100, 000

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2
Q

World wide prevalence of TB in pregnant women

A

0.25% low prevalence country
0.5% high prevalence country
11% in HIV positive women

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3
Q

Mycobacterium tuberculosis organism characteristics

A

Aerobic
Non-spore forming
Non-motile bacillus

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4
Q

Primary TB

A

Disease within 2 years of infection

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5
Q

Latent TB

A

Asymptomatic and non-infectious

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6
Q

Sites of extra pulmonary disease in pregnancy

A

Cervical lymph nodes (31%)
CNS
abdomen
Pericardium

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7
Q

Effects of TB on perinatal outcomes

A

Low APGAR
RDS with extra pulmonary disease
Preterm delivery
SGA
Oligohydramnios
PPROM

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8
Q

Effects of TB on maternal outcomes

A

Hypertension
Cholestasis
GDM
Anaemia
Death

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9
Q

Associations with HIV-TB coinfection

A

Anaemia
Eclampsia
Placenta accepts
Drug abuse
Depression

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10
Q

Treatment of TB (no CNS involvement)

A

Initial phase (2 months) - rifampicin, isoniazid, ethambutol and pyrazinamide
Continuation phase (4 months) - rifampicin and isoniazid

*give pyridoxine

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11
Q

Treatment of TB with CNS involvement

A

Rifampicin, isoniazid, pyrazinamide and ethambutol for 2 months
Rifampicin and isoniazid for 10 months
Dexamethasone/prednisone for 4-8 weeks

*Give pyridoxine

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12
Q

Treatment of drug resistant TB

A

Continue 3 drug treatment for 2 months followed by continuation with sensitive agents for 4-7 months

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13
Q

Most common infective site of TB in the neonate

A

Liver

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14
Q

Diagnostic tests for perinatal TB

A

Placental histology and culture
CXR
CSF culture
GI/tracheal aspirated

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15
Q

Presentation of perinatal TB

A

RDS
Failure to thrive
Irritability
Lymphadenopathy
Pyrexia of unknown origin
Unexplained anaemia
Hepatosplemomegaly

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16
Q

Perinatal TB mortality

A

22% treated infants
38% non-treated infants

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17
Q

Breastfeeding in TB

A

Safe after completion of 2 weeks Rx
Not safe if multi-drug resistant or HIV coinfection

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18
Q

BGC vaccination recommendation

A

If neonate is in a high prevalence area 40/10000
If close relatives are from high incidence countries (40/100000)
If born to HIV mum, formula fed and HIV negative at 14 weeks

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19
Q

Commonest causative organisms for obstetric sepsis

A

Streptococcal groups A, B, D
Pneumococcus
E. coli

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20
Q

Septic shock management

A

If lactate >4 or hypotension is present then:
30ml/kg crystalloid within 3 hours of diagnosis
Vasopressor or inotrope to maintain MAP 65mmHg
Measure cardiac output with oesophageal Doppler or lithium dilution cardiac output (LiDCO)
Consider steroids if inadequate response to vasopressors
Remove septic focus
Thromboprophylaxis
+/- blood products

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21
Q

Who gets offered IAP for GBS

A

Preterm labour
GBS colonisation during current pregnancy
Previous baby with GBS disease
Clinical diagnosis of chorioamnionitis

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22
Q

Management of previous GBS colonisation in a previous pregnancy

A

Collect swab between 35-37 weeks or 3-5 weeks before expected delivery
If positive then offer IAP

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23
Q

GBS antibiotic choice (no allergy)

A

Benzylpenicillin if no chorioamnionitis
Add gentamicin if clinical chorioamnionitis

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24
Q

GBS treatment (mild penicillin allergy)

A

Cephalosporin with GBS activity with caution if no chorioamnionitis
Cephalosporin with metronidazole if clinical chorioamnionitis

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25
GBS treatment (severe penicillin allergy)
Vancomycin or sensitivity guided choice if no chorioamnionitis Vancomycin + gentamicin + metronidazole if clinical chorioamnionitis
26
When to deliver PPROM with GBS?
34-37 weeks
27
Incidence of early onset GBS disease
0.57/1000
28
Risk of disability with early onset GBS disease
7.4%
29
Recurrent GBS carriage in subsequent pregnancy risk
50%
30
Risk of early onset GBS if positive swab in a subsequent pregnancy
1 in 400
31
Incidence of early onset GBS if negative swab in subsequent pregnancy
1 in 5000
32
Incidence of GBS with maternal pyrexia in labour
5.3 per 1000
33
Risk of mortality from sepsis
8%
34
Risk of mortality from early onset neonatal GBS
5%
35
Percentage of maternal deaths caused by sepsis
10%
36
Sepsis MBRRACE data
5th commonest cause of death (4th if covid is excluded) 10% of deaths 2.5 deaths per 100,000
37
Malaria species that causes cerebral complications
P falciparum
38
What type of parasite is malaria?
Protozoan
39
Malaria species which lie dormant (hypnozoites) in the liver
P vivax P ovale
40
How long does immunity from malaria last?
2 years
41
Risk factors for malaria infection and severe disease
2nd trimester Primigravida Young maternal age
42
Maternal complications of malaria
Anaemia Cerebral malaria ARDS Hypoglycaemia Renal failure with haemoglobinuria DIC
43
Fetal complications of malaria
Miscarriage PTB SGA IUFD/neonatal death fetal anaemia Congenital malaria (parasites in placenta in 25% cases) Failure to thrive Coinfection
44
Hepatic phase of malaria lasts for
7 days
45
Merozoite reproduction in Erythrocytes takes . . .
48 hours for p. Falciparum, vivax and ovale 72h for P. Malariae
46
Erythrocytic phase of malaria lasts
4 weeks
47
Drug excretion time for malaria prophylaxis agents
Doxycycline - 1 week Mefloquine - 3 months Proguanil - 1 week Atovaquone and proguanil - 2 weeks
48
Contraindications to mefloquine
Depression Neuro-psychiatric disorders Epilepsy Hypersensitivity to quinine
49
Anti-malaria agent in 2nd/3rd trimester or breast feeding
Mefloquine
50
Malaria treatment
Uncomplicated - hospital admission, PO/IV quinine and clindamycin for P. Falciparum/vivax Complicated - ICU admission, IV artesunate for P.falciparum Chloroquine for p. Vivax/ovale/malariae Primaquine contraindicated
51
Symptoms of malaria
Cyclical Fever, cough, joint pains, anaemia, vomiting, headache, dark urine Severe - jaundice, seizures, prostration, breathing difficulties, impaired consciousness and abnormal bleeding
52
Clinical signs of malaria
Hepatosplenomegaly Retinal damage on fundoscopy Hypovolaemic shock Pulmonary oedema
53
Diagnosis of malaria
Blood film microscopy - 3 negative blood films 12-24hrs apart excludes malaria Rapid detection tests for antigens are less sensitive than microscopy
54
Complicated malaria is characterised by
Hypoglycaemia/hyperglycaemia ARDS Impaired consciousness Severe anaemia <8 DIC/abnormal bleeding Haemoglobinuria Renal impairment Acidosis Hyperlactaemia Hyper parasitaemia (>2% red cells infected) Circulatory shock
55
Neonatal management following malaria
Screen thick and thin blood films at north and weekly for 28 days
56
CMV is a ______ virus
Double stranded DNA
57
CMV primary infection happens in what proportion of pregnant women?
2%
58
Neonatal CMV mortality
20-30%
59
Fetal risks from CMV
Sensorineural deafness (commonest cause) Hepatosplenomegaly IUGR Microcephaly and learning disability Thrombocytopenia Haemolytic Anaemia Jaundice Seizures
60
Toxoplasmosis is caused by
Toxoplasmosis gondii
61
Incubation period for toxoplasmosis
5-23 days
62
Toxoplasmosis Gondii is ____
Obligate Intracellular protozoan
63
Toxoplasmosis is spread via
Contaminated food
64
Rate of toxoplasmosis infection in pregnancy
1 in 500
65
Absence of ____ antigen is protective against P Vivax
Duffy antigen found in black people
66
Treatment to prevent relapse of malaria in pregnancy
Oral chloroquine 300mg weekly until delivery
67
MOD with Hep B or C
Vaginal birth not contraindicated Caesarean birth if Hepatitis C and HIV co-infection
68
Diagnosis of Zika virus
RT-PCR IgM Cross reacts with yellow fever and dengue
69
Length of time to avoid pregnancy after exposure to Zika virus
3 months if make partner travelled 2 months if female partner travelled
70
Management of microcephaly secondary to Zika infection
If Hc <2 SD below mean for gestational age >20 weeks
71
Advise for fertility after Zika exposure
Avoid for 28 days if exposed Avoid for 6 months if infected
72
Listeria monocytogenes is a _____
Gram positive beta-haemolytic facultative anaerobe
73
Early onset neonatal listeriosis
Disseminated granulomas AKA granulomatosis infantisepticum
74
Listeriosis treatment
Ampicillin/penicillin G + gentamicin
75
Risk of fetal colonisation from chlamydia
50%
76
Prevalence of chlamydia in pregnancy
2-7%
77
Neonatal sequalae of chlamydia
Conjunctivitis Pneumonia 20%
78
Treatment of covid
Steroids for 10/7 or until discharge if O2 requirement VTE prophylaxis if admitted Tocilizumab if CRP >75 Remdesivir if worsening symptoms despite Rx

MRCOG part 2 (22 decks)

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