IUI and infections in pregnancy

Question 1

Hutchinson’s triad (from congenital syphylis)

Answer 1

• ocular interstitial keratitis
• 8th nerve deafness
• Hutchinson’s teeth (murberry molars and Hutchinson’s incisors)

Question 2

The cdc and USPSTF recommend screening for HBV, HCV:

Answer 2

-All adults age 18-79
-Pregnant people, each pregnancy

Question 3

The incidence of UTI (pyelonephritis, cystitis) asymptomatic bacteriuria in pregnancy

Answer 3

5-10 %

Untreated asymptomatic UTI has 25% risk of pyelonephritis and 2.5% with treatment
وفي رواية:
Pyelonephritis develops in 30-40% w/o treatment and in 3-4% with treatment

Question 4

Leading bacterial killing in neonate is

Answer 4

GBS

If term 1-2% colonized develops infection, mortality 5%
If preterm, 8% of colonised develop infection, mortality rate 25 %

Question 5

Complications of pyelonephritis in pregnancy

Answer 5

Sepsis
Cunningham’s syndrome (ARDS)

Question 6

50% of women who are colonized with GBS will transmit the bacteria to their newborns.

Answer 6

In the absence of intrapartum antibiotic prophylaxis, 1–2% of those newborns will develop GBS EOD.

Question 7

ACOG recommends performing universal GBS screening between

Answer 7

36 0/7 and 37 6/7 weeks of gestation.

Question 8

Regardless of planned mode of birth, all pregnant women should undergo antepartum screening for GBS unless

Answer 8

unless intrapartum antibiotic prophylaxis for GBS is indicated because of GBS bacteriuria during the pregnancy or because of a history of a previous GBS-infected newborn.

Question 9

If the prenatal GBS culture result is unknown when labor starts, intrapartum antibiotic prophylaxis is indicated for women who have risk factors for GBS EOD.

Answer 9

At-risk women include those who present in labor with a substantial risk of preterm birth, who have preterm prelabor rupture of membranes (PPROM) or rupture of membranes for 18 or more hours at term, or who present with intrapartum fever (temperature 100.4°F [38°C] or higher).

Question 10

If intraamniotic infection is suspected, broad-spectrum antibiotic therapy that provides coverage for poly-microbial infections as well as GBS should replace the antibiotic that provides coverage for GBS prophylaxis specifically.

Answer 10

T

Question 11

GBS prophylaxis in case of penicillin allergy/anaphylaxis

Answer 11

First-generation cephalosporins (i.e., cefazolin) are recommended for women whose reported penicillin allergy indicates a low risk of anaphylaxis or is of uncertain severity. For women with a high risk of anaphylaxis, clindamycin is the recommended alternative to penicillin only if the GBS isolate is known to be susceptible to clindamycin.

Question 12

the only pharmacokinetically and microbiologically validated option for intrapartum antibiotic prophylaxis in women who report a high-risk penicillin allergy and whose GBS isolate is not susceptible to clindamycin.

Answer 12

Intravenous vancomycin, The dosage for intrapartum GBS prophylaxis should be based on weight and baseline renal function (20 mg/kg intravenously every 8 hours, with a maximum of 2 g per single dose.)

Question 13

the most common perinatal infection in the developed world.

Answer 13

(CMV) is a ubiquitous DNA herpes virus that eventually infects most humans. The virus is secreted into all body fluids, and person-to-person contact.
Naturally acquired immunity during pregnancy results in a 70-percent risk reduction of congenital CMV infection in future pregnancies

Question 14

Transmission rates for primary infection of CMV are – TO – percent in the 1st trimester, –to– percent in the 2nd, and – to – percent in the 3rd trimester
(ACOG, 2017; Picone, 2017).

Answer 14

Transmission rates for primary infection are 30 to 36 percent in the 1st trimester, 34 to 40 percent in the 2nd, and 40 to 72 percent in the 3rd trimester
(ACOG, 2017; Picone, 2017).

Question 15

CMV infection. Congenital infection is a
syndrome that may include

Answer 15

growth restriction, microcephaly, intracranial calcifications”Periventricular”, chorioretinitis, mental and motor retardation, sensorineural deficits, hepatosplenomegaly, jaundice, hemolytic anemia, and thrombocytopenic purpura

Question 16

Routine prenatal CMV serological screening is currently not recommended by the Society for Maternal–Fetal Medicine (2016).

Answer 16

Pregnant women should be tested for CMV if they present with a mononucleosis-like illness or if congenital infection is suspected based on
abnormal sonographic findings.

Question 17

fetal abnormalities associated with CMV infection may be seen antenatal with US, CT, MRI INCLUDES:

Answer 17

Findings include microcephaly, ventriculomegaly, and cerebral calcifications; ascites, hepatomegaly, splenomegaly, and hyperechoic bowel; hydrops; and
oligohydramnios (Society for MFM 2016).

Question 18

the gold standard for the diagnosis of CMV fetal infection.

Answer 18

CMV nucleic acid amplification testing (NAAT) of amniotic fluid (Sensitivity is highest when
amniocentesis is performed at least 6 weeks after maternal infection and after 21
weeks’ gestation) A negative result from amniotic
fluid polymerase chain reaction (PCR) testing does not exclude fetal infection and
may need to be repeated if suspicion for fetal infection is high.

Question 19

Varicella–zoster virus VZV Mortality is predominately due to

Answer 19

VZV pneumonia, which is thought to be more
severe during adulthood and particularly in pregnancy, 2 to 5 % of infected pregnant women develop
pneumonitis. Risk factors for VZV pneumonia include
smoking and having more than 100 cutaneous lesions

Question 20

congenital varicella syndrome. Some features include

Answer 20

chorioretinitis, microphthalmia, cerebral cortical atrophy, growth restriction, hydronephrosis, limb
hypoplasia, and cicatricial skin lesions

Question 21

If the fetus/neonate is exposed to active infection just before or during delivery, and therefore before maternal antibody has been formed, the newborn
faces a serious threat. Attack rates range from 25 to 50%, and mortality rates approach 30%.

Answer 21

neonates develop disseminated visceral
and CNS disease, which is commonly fatal. For this reason, (VZIG) should be administered to neonates born to mothers who have clinical evidence of varicella 5 days before and up to 2 days after delivery.

Question 22

Maternal varicella Diagnosis

Answer 22

is usually diagnosed clinically. Infection may be confirmed by NAAT of vesicular fluid. The virus may also be isolated by scraping the vesicle base during primary infection and performing a Tzanck smear,
tissue culture, or direct fluorescent antibody testing.

Question 23

Varicella Management, when to give Varicella Immunoglobulins ?

Answer 23

Although best given within 96 hours of exposure, its use is approved for up to 10 days to prevent or attenuate varicella infection. + Acyclovir to be started 24 hours after the onset of Rash.
In women with known history of varicella, VariZIG is not indicated.

VZIG to the baby&raquo_space; if the fetus was delivered within 5 days of infection.

Question 24

management of influenza virus?/ what are the available option of antivirals?

Answer 24

Neuraminidase inhibitors are highly effective for the treatment of early influenza A and B. include ORAL oseltamivir (Tamiflu), INHALER zanamivir (Relenza); IV peramivir (Rapivab).

Question 25

Influenza vaccine in pregnancy

Answer 25

for mothers vaccinated during pregnancy, several studies found lower rates of influenza in their infants up to 6 months of age. A live attenuated influenza virus vaccine is available for intranasal use but is not recommended for pregnant women

Question 26

MEASLES characteristics

Answer 26

Fever, coryza, conjunctivitis, and cough are typical symptoms. characteristic erythematous maculopapular rash develops on the face and neck and then spreads to the back, trunk, and extremities. Koplik spots are small white lesions with surrounding erythema found within the oral cavity. Immediate or delayed neurological sequelae of measles may manifest in several forms, making diagnosis difficult

Question 27

Diagnosis of acute measles infection

Answer 27

most commonly performed by serological evidence of IgM antibodies, although RTPCR tests are available.

Question 28

fetal complications of measles infection

Answer 28

The virus does not appear to be teratogenic (Siegel1973). However, rates of spontaneous abortion, preterm delivery, and low-birthweight neonates are increased with maternal measles. If a woman develops measles shortly before birth, risk of serious infection developing in the neonate is considerable, especially in a preterm neonate.

Question 29

fetal complications of rubella infection

Answer 29

poses significant risk for abortion and severe congenital malformations amenable in prenatal diagnosis like cardiac septal defects, pulmonary stenosis, microcephaly, cataracts, microphthalmia, and hepatosplenomegaly, sensorineural deafness, intellectual disability, neonatal purpura, and radiolucent bone disease.

Question 30

rubella infection transmission

Answer 30

Transmission occurs via nasopharyngeal secretions, and the transmission rate is 80% to susceptible individuals. The peak incidence is late winter and spring in endemic areas

Question 31

clinical presentation of Maternal rubella infection:

Answer 31

Maternal rubella is usually a mild febrile illness with a generalized maculopapular rash beginning on the face and spreading to the trunk and extremities. That said, 25 to 50 percent of infections are asymptomatic.

Question 32

dx of rubella infection:

Answer 32

Specific IgM antibody can be detected using enzyme-linked immunoassay for 4 to 5 days after onset of clinical disease, but antibody can persist for up to 6 weeks after appearance of the rash.

Question 33

rubella infection fetal transmission

Answer 33

Pregnant women with rubella and a rash during the first 12 wks GA have an affected fetus with congenital infection in up to 90% of cases, At 13 to 14 wks’ GA, this incidence is 50%, and by the end of the second trimester, it is 25% . Defects are rare after 20 WKS’ GA.

Question 34

Management and Prevention of rubella infection:

Answer 34

There is no specific treatment for rubella. Droplet precautions for 7 days after the onset of the rash are recommended. Postexposure passive immunization with polyclonal immunoglobulin may be of benefit if given within 5 days of exposure.

Question 35

causes erythema infectiosum, or fifth disease.

Answer 35

PARVO B19 virus

Question 36

Fetal infection has been associated with

Answer 36

anemia, which is its primary fetal effect. (In women with severe hemolytic anemia‒for example, sickle-cell disease‒parvovirus infection may cause an aplastic crisis), abortion, nonimmune hydrops, and stillbirth. Comorbid fetal myocarditis may induce hydrops with lesser degrees of anemia.

Question 37

clinical presentation of Maternal Infection of parvo B19 virus

Answer 37

20 to 30% is asymptomatic. Fever, headache, and flulike symptoms may begin in the last few days of the viremic phase. Several days later, a bright red rash with erythroderma affects the face and gives a slappedcheek appearance. The rash becomes lacelike and spreads to the trunk and extremities. symmetrical polyarthralgia

Question 38

vertical transmission rate to the fetus in parvo virus infection

Answer 38

in up to a third of maternal parvovirus infections

Question 39

the rate of fetal loss with serologically proven parvovirus infection is

Answer 39

8 to 17 percent before 20 weeks’ gestation, and 2 to 6 percent after midpregnancy. Hydrops develops in only approximately 1 percent of fetuses of women infected with parvovirus. Still, it is the most frequent infectious agent of nonimmune hydrops in autopsied fetuses

Question 40

parvo virus Fetal infection is diagnosed by

Answer 40

detection of B19 viral DNA in amniotic fluid or IgM antibodies in fetal serum obtained by cordocentesis

Question 41

important points to be counseled with a mother with parvo virus induced non-immune hydrops

Answer 41

Mortality rates as high as 30% have been reported in hydropic fetuses without transfusions. With transfusion, 94% of hydrops cases resolve within 6 to 12 wks, and the overall mortality rate is <10%. Most fetuses require only one transfusion because hemopoiesis resumes as infection resolves. Concurrent fetal thrombocytopenia worsens the prognosis.

Question 42

important points to be counseled with pregnant woman regarding parvo virus infection

Answer 42

Pregnant women should be counseled that risks for infection approximate 5 percent for casual, infrequent contact; 20 percent for intense, prolonged work exposure such as for teachers; and 50 percent for close, frequent interaction such as in the home. Workers at day-care centers and schools need not avoid infected children because infectivity is greatest before clinical illness. Finally, infected children do not require isolation.

Question 43

In the most severely affected fetuses, a congenital Zika syndrome has been described that includes

Answer 43

microcephaly, lissencephaly, ventriculomegaly, intracranial calcifications, ocular abnormalities, and congenital contractures.

Question 44

Diagnosis of zica virus infection in pregnant women is made with

Answer 44

detection of Zika virus RNA in blood or urine or by serological testing. Detection of Zika virus RNA by PCR confirms infection. Serological assays for Zika IgM antibodies may cross react with other flaviviruses. Thus, a positive assay result is followed by another assay containing virus-specific neutralizing antibodies

Question 45

the most common cause of severe maternal postpartum infection and death worldwide

Answer 45

Group A Streptococcus Infections caused by Streptococcus pyogenes Can cause also streptococcal pharyngitis, scarlet fever, and erysipelas are not life threatening. Treatment, usually with penicillin, is similar in pregnant and nonpregnant women.

Question 46

streptococcal toxic shock syndrome, manifested by

Answer 46

hypotension, fever, and evidence of multiorgan failure with associated bacteremia.

Question 47

streptococcal toxic shock syndrome treatment

Answer 47

Treatment includes clindamycin plus penicillin therapy and often surgical debridement

Question 48

S agalactiae (GBS) has been implicated in adverse pregnancy outcomes that include

Answer 48

preterm labor, prematurely ruptured membranes, clinical and subclinical chorioamnionitis, and fetal infections. Can also cause maternal bacteriuria, pyelonephritis, osteomyelitis, postpartum mastitis, and puerperal infections.

Question 49

the leading infectious cause of morbidity and mortality among infants in US

Answer 49

GBS infection

Question 50

neonates Complications of GBS Infection

Answer 50

septicemia involves signs of serious illness that usually develop within 6 to 12 hours of birth. These include respiratory distress, apnea, and hypotension.

Question 51

GBS early-onset disease Vs. Late-onset disease

Answer 51

GBS Infection <7 days after birth is defined as early-onset disease while Late-onset disease caused by GBS is noted in 0.32 per 1000 live births and usually manifests as meningitis 1 week to 3 months after birth

Question 52

GBS +VE Women with a penicillin allergy and no history of anaphylaxis are given ------ (Briody, 2016). Those at high risk for anaphylaxis should have antimicrobial susceptibility testing performed to exclude ------ resistance.

Answer 52

CEFAZOLIN, If +ve h/o anaphylaxis clindamycin, if resistant vancomycin should be administered. Erythromycin is no longer used for penicillin-allergic patients.

Question 53

MRSA risk factors include

Answer 53

prior MRSA infection, hospitalization, dialysis or surgery within the past year, and indwelling catheters or devices

Question 54

treatment of MRSA infections Uncomplicated superficial infections/ Severe superficial infections

Answer 54

antibiotic therapy in addition to incision and drainage of smaller abscesses. Severe superficial infections, especially those that fail to respond to local care or those in patients with medical comorbidities, are treated with Vancomycin remains the first-line therapy for inpatient serious MRSA infections. Purulent cellulitis should be treated empirically for CA-MRSA (trimethoprim-sulfamethoxazole and clindamycin) until culture results are available.

Question 55

+VE CULTURE MRSA PROPHYLAXIS

Answer 55

For women with culture-proven CA-MRSA infection during pregnancy, we add single dose vancomycin to routine beta-lactam perioperative prophylaxis for cesarean deliveries and higher-order perineal lacerations. Breastfeeding in these women is not prohibited, but optimal hygiene and attention to minor skin breaks is encouraged.

Question 56

Treatment of listeriosis

Answer 56

ampicillin plus gentamicin is usually recommended because of synergism against Listeria species Trimethoprim-sulfamethoxazole can be given to penicillin-allergic women.

Question 57

listeriosis fetal presentation

Answer 57

Occult or clinical infection also may stimulate labor. Discolored, brownish, or meconium-stained amnionic fluid is common with fetal infection, even in preterm gestations. fetal infection that characteristically produces disseminated granulomatous lesions with microabscesses. Chorioamnionitis is common, and placental lesions include multiple, well-demarcated macroabscesses. Early- and late-onset neonatal infections are similar to group B streptococcal sepsis.

Question 58

enteric (typhoid) fever caused by salmonella treatment

Answer 58

Fluoroquinolones and third-generation cephalosporins are the preferred treatment.

Question 59

Shigellosis Clinical manifestations range from

Answer 59

mild diarrhea to severe dysentery, bloody stools, abdominal cramping, tenesmus, fever, and systemic toxicity.

Question 60

Shigellosis treatment

Answer 60

Antimicrobial therapy is imperative, and effective treatment during pregnancy includes fluoroquinolones, ceftriaxone, or azithromycin.

Question 61

toxoplasmosis Maternal infection is associated with a ---fold increased preterm delivery rate before 37 weeks

Answer 61

toxoplasmosis Maternal infection is associated with a fourfold increased preterm delivery rate before 37 weeks

Question 62

The incidence and severity of fetal toxoplasmosis depend on gestational age at the time of maternal infection.

Answer 62

Risks for fetal infection rise with gestational age. A metaanalysis estimated the risk to be 15 percent at 13 weeks, 44 percent at 26 weeks, and 71 percent at 36 weeks. Conversely, the severity of fetal infection is much greater in early pregnancy, and these fetuses are much more likely to have clinical findings of infection

Question 63

fetal complications of toxoplasmosis

Answer 63

Clinically affected neonates usually have low birthweight, hepatosplenomegaly, jaundice, and anemia, microcephaly. learning disabilities. This classic triad—chorioretinitis, intracranial calcifications, and hydrocephalus—is often accompanied by convulsions.

Question 64

diagnosis of toxoplasmosis

Answer 64

With IgG antibody confirmed before pregnancy, there is no risk for a congenitally infected fetus. Although IgM antibodies appear by 10 days after infection and usually become negative within 3 to 4 months, they may remain detectable for years. Thus, IgM antibodies are not used alone to diagnose acute toxoplasmosis. , if a high-avidity IgG result is found, infection in the preceding 3 to 5 months is excluded. Multiple tests are available that allow high avidity results to confirm latent infection with a 100-percent positive-predictive value. Prenatal diagnosis of congenital toxoplasmosis is performed using PCR amplification of toxoplasma DNA in amnionic fluid. The sensitivity of PCR varies with gestational age and is lowest before 18 weeks.

Question 65

Congenital toxoplasmosis is suspected when sonography reveals findings such as

Answer 65

hydrocephaly, intracranial or hepatic calcifications, ascites, placental thickening, hyperechoic bowel, and growth restriction.

Question 66

Prenatal treatment is based on two regimens

Answer 66

spiramycin alone or a pyrimethamine–sulfonamide combination given with folinic acid. most experts will use spiramycin in women with acute infection early in pregnancy to reduce vertical transmission. Because it does not cross the placenta, spiramycin may not be used to treat fetal infection. Pyrimethamine–sulfadiazine with folinic acid is selected for maternal infection after 18 weeks’ gestation or if fetal infection is suspected.

Question 67

TOXOPLASMOSIS management

Answer 67

Maternal >> Spiramycin 1G Q8h till delivery. Fetal infection >> Pyrimethamine , sulfadiazine and folinic acid for 1 year

Question 68

most serious congenital infection.

Answer 68

Rubella

Question 69

most common congenital infection occurring in 0.2-2.2%

Answer 69

CMV

Question 70

classification of neonatal HSV infection:

Answer 70

1) localized disease of the skin , eye and mouth >> the most common 45% , not associated with mortality. 2) CNS disease with to without skin , eye and mouth disease >> 30% 3) Disseminated disease >> 25 % , 30% mortality rate.

Question 71

what situations should cesarean delivery be considered for prevention of neonatal HSV?

Answer 71

If there is active genital lesions or symptoms such as vulvar pain or burning at delivery .

Question 72

When does hydrops develop due to parvovirus B19 virus ?

Answer 72

Within 10 weeks of maternal infection.

Question 73

During what weeks of pregnancy is the risk of congenital varicella syndrome is the highest?

Answer 73

Between 13-20 weeks.

Question 74

How should HIV RNA levels be monitored in pregnancy?

Answer 74

4 weeks after initiation of treatment , then monthly until undetectable , then every 3 months including a value near term.

Question 75

What is the regimen of zidovudine antepartum ?

Answer 75

100 mg orally five times a day , 200 mg three times daily or 300 mg twice daily.

Question 75

What is the regimen of zidovudine antepartum ?

Answer 75

100 mg orally five times a day , 200 mg three times daily or 300 mg twice daily.

Question 76

When should IV zidovudine be started prior to elective cesarean section ?

Answer 76

3 hours prior to surgery

Question 77

what is the maternal treatment if the HIV RNA level is >1000 copies/mL?

Answer 77

Combination antiretroviral therapy ( CART )

Question 78

What is the recommended mode of delivery ?

Answer 78

Scheduled cesarean section at 38 weeks is recommended for women with a viral load >1000 copies/mL.

Question 79

Whats the detection rate of quad test for trisomy 21?

Answer 79

75% for women younger than 35 yo. 90% for women whose older than 35 yo.

Question 80

Without intervention, the risk of HIV transmission Intrapartum is

Answer 80

50%

Question 81

most genital infections with HSV are caused by

Answer 81

HSV-2. However, HSV-1 infections are becoming increasingly common as a cause of oral and genital infections, particularly among adolescent women and young women!

Question 82

the incidence of new HSV-1 or HSV-2 infection during pregnancy is approximately

Answer 82

2%

Question 83

diagnosis of herpes simplex virus

Answer 83

The tests used to confirm the presence of HSV infection can be divided into two basic groups: 1) viral detection techniques and 2) antibody detection techniques. Virologic tests are preferred for patients who present with genital vesicles, ulcers, or other mucocutaneous lesions and include viral culture and HSV antigen detection by polymerase chain reaction (PCR).

Question 84

If both IgG and IgM are positive what test can be done to know whether there is an acute infection or chronic persistent

Answer 84

Avidity test If high means chronic If low means acute

Question 85

What happens During the S phase ?

Answer 85

new DNA is synthesized.

Question 86

The G2 (premitotic) phase is characterized by

Answer 86

cells having twice the DNA content as they prepare for division.

Question 86

The G2 (premitotic) phase is characterized by

Answer 86

cells having twice the DNA content as they prepare for division.

Question 87

،actual mitosis and chromosomal division take place during the --- phase.

Answer 87

actual mitosis and chromosomal division take place during the M phase.

Question 88

Prophylaxis of malaria during pregnancy :

Answer 88

Mefloquin in 2nd and 3rd trimester

Question 89

Listeria monocytogenes, listeriosis microbiology description

Answer 89

food-borne infection, small, facultatively anaerobic, Gram-positive, flagellated, linear motile rod, which is non-spore forming, grows well in broth, blood agar and most routine culture media

Question 90

CDC Recommendations for the Prevention of Listeriosis

Answer 90

Thoroughly cook raw food from animal sources and Wash raw vegetables before eating Keep uncooked meats separate from vegetables and from cooked foods and ready-to-eat foods Avoid unpasteurized (raw) milk/ foods made from it Wash hands, knives, and cutting boards after the handling of uncooked foods Consume perishable and ready-to-eat foods ASAP Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot Avoid getting fluid from hot dog packages on other foods, utensils, and food preparation surfaces, and wash hands after handling hot dogs, luncheon meats, and deli meats Do not eat soft cheeses, such as feta, brie, and camembert; blue-veined cheeses; or Mexican-style cheeses, such as queso blanco, queso fresco, and Panela, unless they have labels that clearly state they are made from pasteurized milk Do not eat refrigerated pâtés or meat spreads. Canned or shelf-stable pâtés and meat spreads may be eaten. Do not eat refrigerated smoked seafood, unless it is contained in a cooked dish, such as a casserole. Refrigerated smoked seafood, such as salmon, trout, whitefish, cod, tuna or mackerel, is most often labeled as “nova-style,” “lox,” “kippered,” “smoked,” or “jerky.” The fish is found in the refrigerator section or sold at deli counters of grocery stores and delicatessens. Canned or shelf-stable smoked seafood may be eaten.

Question 91

pregnant women is diagnosed with toxoplasmosis .what is the drug of choice for reducing the risk of fetal infection?

Answer 91

spiramycin

Question 92

Toxoplasmosis caused by which organism and mode of transmission?

Answer 92

Question 93

Syphilis diagnostic tests

Answer 93

Question 94

Management options of syphilis:

Answer 94

Question 95

Management (dx and prevention and treatment ) of malaria in pregnancy

Answer 95

Question 96

Toxoplasmosis management

Answer 96

Question 97

warm phase of septic shock

Answer 97

capillary leakage initially causes hypovolemia, if intravenous crystalloid is given at this point, sepsis hemodynamically can be described as a high-cardiac-output, low-systemic-vascular-resistance condition . pulmonary hypertension develops, and despite the high cardiac output, severe sepsis also causes myocardial depression

Question 98

cold phase of septic shock

Answer 98

severe and unresponsive extracellular fluid extravasation with vascular insufficiency, overwhelming myocardial depression, or both. Oliguria and continued peripheral vasoconstriction characterize a secondary, cold phase of septic shock

Question 99

Tdap vaccine offered to pregnant woman btw

Answer 99

27-36 wks GA

Question 100

Risk of intrauterine infection in case of HSV infection

Answer 100

5%

Question 101

Women chronically infected with HBV and high viral load (>106 log copies/ml (200,000 IU/ml) and higher) should be offered

Answer 101

antiviral medication with teno- fovir or telbivudine in the third trimester to reduce perinatal transmission of HBV (strong recommendation, low level of evidence). ACG Guidelines*

Question 102

Fetal infection develops in >-- percent of untreated early maternal syphilis cases and in up to -- percent of late latent disease.

Answer 102

Fetal infection develops in >50 percent of untreated early maternal syphilis cases and in up to 10 percent of late latent disease

Question 103

Early-stage syphilis includes primary, secondary, and early latent syphilis. These are associated with high spirochete loads, and partner transmission rates range from -- to -- percent (Garnett, 1997; Singh, 1999). Late-stage syphilis includes latent syphilis, unknown duration or late and tertiary syphilis. In these, transmission rates decline because of smaller inoculum sizes.

Answer 103

Early-stage syphilis includes primary, secondary, and early latent syphilis. These are associated with high spirochete loads, and partner transmission rates range from 30 to 60 percent (Garnett, 1997; Singh, 1999). Late-stage syphilis includes latent syphilis, unknown duration or late and tertiary syphilis. In these, transmission rates decline because of smaller inoculum sizes.

Question 104

15% to 45% the absence of intervention, the rate of transmission of HIV from a mother living with HIV to her child during pregnancy, labour, delivery or breastfeeding ranges from --% - --%

Answer 104

15% to 45%

Question 107

Chorioamnionitis is associated with maternal and neonatal complications. Which are ?

Answer 107

Obstetric complications include dysfunctional labor, increased risk of cesarean delivery, postpartum hemorrhage, blood transfusion, and postpartum infection (eg, endomyometritis or abscess formation). Although 10% of women with chorioamnionitis will have bacteremia, incidences of septic shock, disseminated intravascular coagulation, adult respiratory distress syndrome, and maternal death are rare. Neonatal complications of chorioamnionitis include neonatal sepsis, septic shock, pneumonia, intraventricular hemorrhage, cerebral white matter damage, long-term disability (including cerebral palsy), asphyxia, and perinatal death. Up to 40% of early-onset neonatal sepsis is associated with chorioamnionitis, and near-term or term infants are at a fourfold risk of cerebral palsy when delivery is complicated by chorioamnionitis.

Question 109

Presumptive Diagnostic Criteria for Chorioamnionitis

Answer 109

Maternal fever of 39° or greater, or fever between 38.0°C (100.4°F) and 38.9°C on two occasions, and at least one of the following risk factors: • Elevated maternal white blood cell count • Fetal tachycardia • Purulent material draining from cervix