Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Pathology in pregnancy > Other conditions + sepsis in pregnancy and postpartum > Flashcards

Other conditions + sepsis in pregnancy and postpartum Flashcards

(75 cards)

Start Studying
1
Q

Which autoimmune condition may improve in pregnancy and why?

A

rheumatoid arthritis due to reduction in T helper 1 cell activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Why does SLE flare in pregnancy?

A

Increased T helper 2 activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is placenta accreta?

A

chorionic villi attached to the myometrium (75%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is placenta increta?

A

chorionic villi invade the myometirum (17%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What is placenta percreta?

A

chorionic villi invade through the myometrium into the serosa (7%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Define sepsis

A

infection + systemic manifestations

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Define severe spesis

A

infection + sepsis induced organ dysfunction or tissue hypoperfusion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Define septic shock

A

Persistence of hypo perfusion despite adequate fluid resuscitation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Which ethnic groups are at highest risk of sepsis?

A

black or other ethnic minority

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the primary organisms to cause toxic shock syndrome?

A

streptococcus and staphylococcus (exotoxic shock)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the potential signs of toxic shock syndrome?

A 
GI symptoms - vomiting/diarrhoea/nausea
abdo pain - severe due to necrotising fasciitis
Watery vaginal discharge
Suffusion of eyes/tongue/mouth - red
Generalised rash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Key investigations for sepsis

A

blood culture before antibiotics, lactate within 6 hours, ABG

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What is a concerning lactate level?

A

> 4mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

If hypotension and/or lactacte >4 - initial management

A

20ml/kg crystalloid

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

When would you give a vasopressor in sepsis?

A

To maintain a mean arterial BP of >65mmHg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

In severe sepsis/septic shock, what CVP/central venous saturation are you aiming to maintain?

A

CVP >/= 8
Central venous O2 >/= 70%
Central venous mixed o2 >/= 60%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

What factors prompt transfer to ITU?

A 
Septic shock (hypotension not responding to fluid resuscitation) or lactate >/= 4 - needs ionotropes
Acute renal failure requiring dialysis
hypothermia
reduced consciousness
multi-organ failure
uncorrected acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Most commonly identified organisms leading to mortality in sepsis?

A 
E coli (uti/cerclage/preterm premature rupture of membranes)
Group B streptococcus
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Limitation of co-amoxiclav treatment of sepsis in pregnancy

A

Does not cover pseudomonas or MRSA and increased risk of neonatal enterocolitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Limitation of metronidazole treatment of sepsis in pregnancy

A

Only covers anaerobes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Limitation of clindamycin treatment of sepsis in pregnancy

A

excreted renally- potentially nephrotoxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Limitation of Tazocin treatment of sepsis in pregnancy

A

Does not cover MRSA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Limitation of gentamicin treatment of sepsis in pregnancy

A

Requires monitoring, only poses problem to kidneys if renal function is abnormal

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What conditions are intravenous immunoglobulins used in sepsis?

A

streptococcal or stapylococcal invasive systemic infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Role of intravenous immunogobulin therapy
used for invasive stroptcoccal or staphyloccocal infectins - inhibits tumour necrosis factor release and interleukin release and neutralises exotoxins
26
What is intravenous immunoglobulin therapy not useful in?
endotoxic shock from gram negative bacteria
27
When is intravenous immunoglobulin therapy contraindicated?
In congenital IgA deficiency
28
Neonatal risks of intrauterine sepsis
Cerebral palsy and encephalopathy
29
What is pyrexia in pregnancy?
>/=38 or 37.5 on two occasion 2 hours apart
30
Recommended anaesthesia for delivery in maternal sepsis
GA for caesarean section not spinal or epidural
31
Measures for group A sespsis
Isolation, discussion with paediatrics for neonatal prophylaxis and notifiable disease if invasive group A present
32
What is the most common site of sepsis in the puerperieum?
postnatal sepsis is most commonly due to genital tract sepsis, uterine infection, endometritis
33
What common organisms cause sepsis in the puerperium?
group A beta haemolytic strep (streoptococcus pyogenes) E coli Staph aureus streptococcus pneumoniae MRSA, clostridium strepticum, morganella morganii
34
What are common causes of postpartum sepsis?
Genital tract most common | Elsewhere - mastitis, uti, pneumonia, skina nd soft tissue, GI and pharyngitis
35
When should a patient with mastitis be transferred to hospital?
signs of sepsis no improvement with oral antibiotics in 48 hours severe or unusual symptoms
36
High risk organism associated with mastitis
PVL producing MRSA - high risk of transmission in breast milk
37
High risk organism associated with UTI
ESBL producing coliforms
38
Clinical signs of PVL associated staphylococcal necrotising pneumonia
Severe haemoptysis and low WCC
39
Which infection sites are particularly associated with postpartum toxic shock syndrome
soft tissue and skin
40
Postpartum recurrent abscess formation, particularly labial abscess formation is associated with which oragnism
PVL producing staphylococci
41
Cardinal sign of necrotising fasciitis
agonising pain
42
What factors prompt antibiotic treatment of pharyngitis?
3/4 centor criteria - fever, tonsillar exudate, no cough, tender anterior cervical lymphadenotpathy
43
What are the centor criteria?
``` criteria used to stratify risk of bacterial infection in pharyngitis and therefore need for antibiotics. Criteria include tonsillar exudate no cough tender anterior cervical lymphadenopathy fever 3/4 = antibiotics advised ```
44
usual organisms causing regional anaesthesia associated infection
staphyloccocus aureus (+ streptococci)
45
What would a generalised maculopapular rash indicate post partum with fever?
streptococcal/staphylococcal infection | toxic shock only 10% in streptococcal shock syndrome
46
What analgesia should be avoided in sepsis?
NSAIDs as they limit polymorph ability to fight GAS
47
What features in the history increase risk of streptoccocal infection
family history of streptococcal infection i.e. pharyngitis cellulitis/impetigo/pharynigitis IV drug use/generalised immunosuppression
48
What is GI symptoms with fever suggestive of in postpartum period
may be food borne salmonella or camplylobacter but these rarely cause sepsis Toxic shock syndrome often cause GI symptoms, rash and red conjunctivae
49
Which organism causes "Q fever"
coxiella burnettii from birthing animals/contaminated dust
50
What vital signs are suggestive of sepsis postpartum?
HR >90, RR >20, T 38 or <36 | systolic <90, MAP <70, systolic BP drop >40
51
if sepsis develops within 12 hours of delivery, which organism is this suggestive of?
streptococcal infection
52
Signs of collected pus or infected haematoma?
Rising CRP, swinging pyrexia, high platelet count (thrombocytosis)
53
Role of clindamycin in sepsis
inhibits endotoxin production, but MRSA may be resistant - use with Tazocin or a carbapenam
54
Limitations of cefuroxime and metronidazole
increased risk of c diff with cefuroxime | neither provides protection against MRSA, pseudomonas or ESBL
55
Treatment of c diff
oral metronidazole or vancomycin
56
Indication for ITU admission
septic shock or signs or organ hypoperfusion
57
When is GAS prophylaxis advised?
family with close contact - kissing/household contacts | health care workers with respiratory contact - suctioning
58
Blood results suggestive of sepsis
wcc <4/>12, CRP >7
59
Hypoxaemia in sepsis/ severe sepsis
Hypoxaemia <40 | Severe sepsis <33.3 if no pneumonia, <46.7 if pneumonia
60
Creatinine in sepsis/severe sepsis (indicating end organ failure)
>44.2 rise | severe sepsis >176 rise
61
Coagulation abnormality suggestive of end organ failure
INR >1.5 or APTT >60 seconds
62
Common organisms causing mastitis sepsis
``` staph aureus (MSSA) streptococcus ```
63
Treatment of mastitis sepsis
fluclox + clindamycin (against endotoxins) | or vanc + clindamycin if pen allergic
64
Common organisms causing c-section wound or cannulate infection
MRSA | streptococci
65
Treatment of c-section wound or cannulate infection
fluclox or vanc + clindamycin
66
Common organisms causing endometritis
gram negative organisms | streptococci
67
Treatment of postpartum endometritis
Cefotaxime + metronidazole + gent | Gent+ clindamycin + cipro if allergic
68
Common organisms causing pyelonephritis
gram neg bacteria (e coli) | occasionally staphylococci/streptococci
69
Treatment of pyelonephritis
cefotaxime + gent or gent + cipro if allergic gent + merapenam if ESBLs
70
Common organisms causing Toxic shock syndrome
staphylococci | streptococi
71
Treatment of TSS
flucoclox+clindamycin+gent or vanc + clinda + gent if MRSA consider Intrevenous immunoglobulin
72
Common organisms causing severe sepsis with no clear focus
MRSA Gram negatives including ESBL producers Anaerobes
73
Treatment of severe sepsis with no clear focus
mero+clinda+gent | or clinda+gent+metro+cipro if allergic
74
Signs of TSS staphylococcus
``` 1 Fever >/=39 2 Macular rash 3 Desquamation 4 Systolic BP <90 5 Multisystem involvement (3 or more): GI sx. severe myalgia mucous membranes - i.e. conjunctival suffusion Renal- creatinine x 2 normal limit heam - thrombocytopenia liver - bili x 2 normal limit CNS- reduced consciousness 4/5 = probable 5 = confirmed ```
75
Signs of TSS streptococcus
GAS from sterile site (blood/CSF/peritoneum/tissue) or non-sterile site (vagina/throat/sputum) and multiorgan involvement either hypotension or two or more the following: renal - creat >176 heam - thrombocytopaenia or DIC liver - raised AST/ALT or bili x2 upper limit skin - generalised macular rash (desqumation in 10%) ARDS Soft tissue necrosis Probable - signs + GAS from non sterile site Definite - signs + GAS from sterile site

Pathology in pregnancy (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions