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week 3 Flashcards

infectious and hepatic (71 cards)

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1
Q

Which HSV is greater risk of transmission to the fetus and causing neonatal infection?

A

HSV 1 >65%

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2
Q

what is the dose of suppressive treatment for genital herpes in pregnancy?

A

valcacylovir 500mg BD or aciclovir 400mg TDS

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3
Q

what is a non primary first episode of genital HSV?

A

+ve swab one type
igG +ve of the OTHER serotype

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4
Q

what are the signs of baby with neonatal HSV?

A

vesicular skin lesions
lethargy
poor feeding
seizures
repsirtaory distress
low platelets
DIC
raised LFTs
unexplained sepsis

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5
Q

What is the medications of pulmonary TB?

A

isoniazid
rifampicin6/12
ethambutol
pyrazinamide 3/12

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6
Q

What are the risks to the neonate with maternal chlamydia?

A

conjunctivitis
sub acute pneumonia month 1-3

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7
Q

What are the risks to the pregnancy with maternal chlamydia?

A

IUFD
PTB
low birth weight

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8
Q

What are the concerns with symptomatic cCMV?

A
  1. early mortality within 3/12 5-10%
  2. neurological sequalae - microcephaly 35-50%, seizures 10%, developmental delay 70%, chorioretinitis 10-20%
  3. sensorineural hearing loss - 50% within 2 years
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9
Q

What are the concerns with asymptomatic cCMV?

A

SNHL 10% at birth and an additional 7-10% late onset
chorioretinitis 2%
no difference in neurodevelopment

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10
Q

What proportion of congential CMV is from non primary infection?

A

75%

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11
Q

What is the risk of transmission of CMV with a primary infection?

A

30%
(highest in T3 but less likely to have neurogical sequalae)

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12
Q

What is the risk of transmission of CMV with a non primary infection?

A

1%

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13
Q

When can you consider amniocentesis for cCMV diagnosis?

A

6-8 weeks after infection but not <21 weeks
CMV PCR

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14
Q

What are the findings of cCMV on USS?

A

microcephaly, ventriculomegaly, hyperchonic bowel, IUGR, AFI abnormal, ascites, intracranial or abdominal calcification, pleural or pericardial effusions, hydrops fetalis, hepatomegaly, pseudomeconium ileus.

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15
Q

What is the significance of quantitative PCR with cCMV?

A

doesn’t correlate with severity of disease

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16
Q

How do they class babies with cCMV into symptomatic and asymptomatic?

A
  • Moderate to severe – thrombocytopenia, petechiae, hepatomegaly, splenomegaly, IUGR, hepatitis eg raised transaminases or jaundice, microcephaly, radiological signs of ventriculomegaly, IC calcifications other abnormal brain findings. chorioretinitis, pneumonitis
  • Mild – transient blood findings eg transaminase or bili or low platelets
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17
Q

in primary episode of cCMV transmitted to fetus what is the risk of symptomatic cCMV?

A

10-15%

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18
Q

in primary episode of cCMV transmitted to fetus and fetus is symptomatic cCMV, what is the risk of sequalae?

A

50%

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19
Q

in primary episode of cCMV transmitted to fetus and fetus is asymptomatic cCMV, what is the risk of sequalae?

A

10-15%

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20
Q

in non primary episode of cCMV transmitted to fetus what is the risk of sequelae?

A

<10%

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21
Q

in non primary episode of cCMV transmitted to fetus what is the risk symptomatic cCMV?

A

<1%

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22
Q

what proportion of women og child bearing age are parvo suscpetible?

A

40%

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23
Q

what is the risk of community transmission and home transmission if susceptible to parvo?

A

community 20%
home 50%

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24
Q

when do you do amniocentesis in parvo virus?

A

if the fetus is showing signs of infection - anaemia or hydrops

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25
when can you do MCAvmax in parvo virus, when should you do it?
16-34 weeks do 1-2 weekly for 12 weeks if confirmed maternal infection before 20 weeks
26
what is the risk of miscarriage <20 weeks with proven parvo infection?
10%
27
What is the risk of fetal death from hydrops or it's treatment in parvovirus?
0.6% 1 in 170
28
in maternal parvo virus infection when can you stop monitoring for fetal anaemia if no signs?
30 weeks
29
what gestation is the highest risk time for congenital rubella syndrome in preganncy?
<12 weeks uncommon after 20
30
what is the main domains of congenital rubella syndrome?
eye, heart, ear, other (FGR, pneumonitis)
31
how long should you avoid pregnancy after MMR vaccine?
28 days
32
What are the antenatal signs of congenital syphilis?
hepatomegaly, placentomegaly, oligo/polyhydramnios, FGR, ascites, anaemia
33
What is treatment for primary and secondary syphilis?
benzathine penicillin 1.8gIM repeat after one week
34
What is the follow up for primary and secondary syphilis?
test at 26-28 weeks and 34-36 weeks if four fold drop, this is adequate if increased titre retreat
35
What is the inflammatory response to treatment called for syphilis?
jarisch herxheimer reaction
36
What is the prevalence of jarisch herxheimer reaction?
45%
37
What should you do if a patient has jarisch herxheimer reaction in pregnancy?
consider fetal monitoring
38
What are the treatment options for toxoplasmosis?
<18 weeks spiramycin - this treats mum and prevents vertical transmission. It doesn't treat the fetus >18 weeks pyramethamine and sulfadizine and folinic acid- treats Mum and baby but toxic T1
39
What are the USS signs of congenital toxoplasmosis?
splenomegaly, hepatic or intracranial calcifications, ascites, hydrocephalus
40
When is chicken pox infectious?
2 days prior to rash until they are crusted
41
What is the time frame of efficacy of ZIG after exposure to chicken pox?
ideally prior to 96 hours, but can be up to 10 days
42
Who should get tested for VZV immunity?
women who are planning pregnancy and haven't been immunised or have been exposed and unknown immunity
43
What is the treatment of chicken pox in pregnancy?
if <24 hours of rash. aciclovir 800mg 5x daily. If over 24 hours, no benefit
44
What is the treatment if complications of VZV?
IV acyclovir 10mg/kg q8hrly
45
What are the symptoms that can occur with severe VZV that need IV tx?
raspiratory symptoms, persistent fever >6 days, new lesions after 6/7, neurological symptoms, bleeding or haemorrhagic rash
46
why are pregnant people more prone to gall stones?
increased estrogen causes more cholesterol secretion progesterone reduces soluble bile acid secretion reduced smooth muscle motility, sludge and stones are created
47
Why are pregnant people prone to intrahepatic cholestasis?
estrogens - reduce sulphation of bile acids. Sulphation is important to reduce their cholestatic potentional estrogen effects bile acid transporters in hepatocytes hepatocyte cell membrane fluidity is reduced
48
What are ths SOMANZ IOL time liens for ICP?
BS 19-39 - by 40 weeks BS 40-99 - 38-39 weeks BS >100 35-36 weeks
49
What are the expected lab values for HELLP syndrome?
platelets <100 ALT and AST >70 LDH >600 shistocytes, increased unconjugated bili, reduced haptoglobin mild hypoglycemia coagulopathy metabolic acidosis
50
what are the complications of HELLP?
eclampsia 15-20% mortality 1% PN mortality pulmonary oedema acute renal failure liver capsule haematoma infarction liver rupture or necrosis transfusion 50%
51
what is the recurrence rate of HELLP?
15-27%
52
What signs would make you think of AFLD?
epigastric pain and vomiting after a vague history of being unwell jaundiced after 2/52
53
What blood test makes you think AFLD over HELLP?
severe coagulopathy hypoglycemia low glucose
54
What is the gene associated with AFLD and what does it do?
L CHAD - beta fatty acid oxidation patient heterozygous and fetus homozygous
55
How long does the pertussis vaccine take to become effective?
10-14 days
56
What long term outcomes can occur if the fetus is infected with pertussis prior to 12 months?
50% hospitalised 1-2% will die sequelae - blindness, paralysis, Hypoxic brain injury,
57
What is the risk of transmission of parvo virus to fetus if mum infected?
50%
58
How can you reduce the risk of transmission of CMV?
educate pregnant women and women TTC 1. do not share food, drinks or cutlery with children less than 3y 2. do not put children's dummies in your mouth 3. Do not kiss children on the mouth 4. clean you hands with soap and water for 15-20 seconds after handling nappies, feeding or wiping their nose 5. wash surfaces in contact with those fluids 6. don't share a tooth brush
59
What should be tested with suspected CMV infection in pregnancy? what would confirm an infection?
Test CMV IgG and IgM. If positice IgG add aviditiy IgM +ve with IgG and low aviditiy transition from IgG -ve previously to IgG +ve
60
What testing should be done for a baby of a women diagnosed with primary CMV infection in pregnancy?
at less than <3. week have urine or saliva PCR for CMV testing
61
what % of births are effected by congenital CMV infection?
0.2-2.2%
62
What % of babies infected with CMV at birth will be well but develop health problems later?
10-15%
63
Why are children <3y more likely to transmit CMV?
Children are most likely to pass it on as they shed high levels of the virus for long periods of time in the saliva, urine and nasal secretions. Can continue to secrete the virus for months to years.
64
What are the long term sequelae of cCMV?
SNHL, developmental delay, cerebral palsy, visual impairment
65
What is the seropositivity for CMV in child bearing age women?
40-60%
66
What does CMV IgG avidity low mean for timing of last infection?
< 3 months
67
What should you do if IgG avidity for CMV is intermediate?
either test stored samples for IgG at lab or treat as primary. intermediate is not useful in timing of infection
68
What monitoring should be done in confirmed congenital CMV?
serial USS +/- MRI to assess for FGR and structural anomalies if normal prognosis is generally good
69
How should the neonate with congenital CMV have?
Involvement of paeds with ID experience hearing follow up regardless of newborn hearing screening
70
What is the advice for breast feeding in CMV?
encouraged, no evidence that postnatal CMV transmission has any adverse effect on the neonate
71
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