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Infection in Pregnancy

By AdminPosted On 05-Oct-2016


1. Hepatitis B Virus Infection in Pregnancy

12 weeks pregnant woman hepatitis B virus (HBV) screening results. What is the significance of these results? HBsAg +ve, Anti-HBc +ve, Anti-HBc IgM -ve, HBeAg -ve, Anti-HBe +ve, HBV DNA 203 iu/ml


a) Acute HBV infection

b) Chronic infection (immune control phase)

c) Natural HBV immunity (resolved infection)

d) Occult HBV infection

e) Post vaccination

Correct Answer: b) Chronic infection (immune control phase). HBsAg is a marker of infectivity. Its presence indicates either acute or chronic HBV infection. Anti-HBc (IgG antibody to core antigen) usually remains positive for life following HBV infection. Anti-HBc IgM is found in high concentrations in acute infection, gradually declining and complementing the rise in Anti-HBc IgG. The presence of Anti-HBe suggests a low viral titre and a low degree of infectivity. HBV DNA is a dynamic parameter in chronic HBV. Below 20 000 iu/mlthere is a relatively low likelihood of hepatic damage.


2. Fulminant H epatitis Infection in Pregnancy

Pregnant woman presents with fulminant hepatitis. Which of the following is the most likely causative agent


a) Hepatitis A

b) Hepatitis B

c) Hepatitis E

d) Hepatitis D

e) Hepatitis C


Correct Answer: c) Hepatitis E. Although most waterborne epidemics of hepatitis in developing countries were initially thought to be hepatitis A disease, it is now known they are due to hepatitis E infection.


3. Chickenpox Infection in Pregnancy

Delivery during the viraemic period, while the chickenpox vesicles are active, may be extremely hazardous. Minimum of —- days should elapse between onset of the rash and delivery.


a) 3 days

b) 5 days

c) 7 days

d) 14 days

e) 21 days

Correct Answer: c) 7 days. If maternal infection occurs in the last 4 weeks of a woman’s pregnancy, there is a significant risk of varicella infection of the newborn. A planned delivery should normally be avoided for at least 7 days after the onset of the maternal rash to allow for the passive transfer of antibodies from mother to child, provided that continuing the pregnancy does not pose any additional risks to the mother or baby.


4. Fetal Varicella Syndrome

Fetal Varicella Syndrome reported to complicate chickenpox Infection in Pregnancy occurring as early as 3 weeks and as late as 28 weeks of gestation. Can varicella infection (Chickenpox) of the fetus be diagnosed prenatally?


a) Yes

b) No

Correct Answer: a) Yes. Amniocentesis has a strong negative predictive value but a poor positive predictive value in detecting fetal damage that cannot be detected by non-invasive methods. Women who develop varicella infection during pregnancy should be counselled about the risks versus benefits of amniocentesis to detect varicella DNA by polymerase chain reaction (PCR).

Amniocentesis should not be performed before the skin lesions have completely healed.


5. Varicella-Zoster virus Infection in Pregnancy

If the pregnant woman is not immune to Varicella-Zoster virus and she has had a significant exposure. She should be offered VZIG as soon as possible. VZIG is effective when given up to 10 days after contact.


a) True

b) False

Correct Answer: a) True. VZIG is effective when given up to 10 days after contact. In the case of continuous exposures, this is defined as 10 days from the appearance of the rash in the index case.


6. Chickenpox

A mother in contact with chickenpox is unaware of ant past history of vericella. Which laboratory method should be used to detect immunity so that VZIG can be given if required?


a) Detection of specific IgG

b) Detection of specific IgM

c) Qualitative molecular detection

d) Quantitative molecular detection

e) Viral culture


Correct Answer: a) Detection of specific IgG. Blood tests can be used to identify acute viral infection by detection of specific IgM or previous infection by detection of specific IgG.


7. Congenital Rubella Syndrome causes


a) Congenital renal defects

b) Limb deformities

c) Congenital heart defects as V.S.D.

d) Congenital lung defects

e) Cleft lip and palate


Correct Answer: c) Congenital heart defects as VSD. The classic triad for congenital rubella syndrome is:

1) Sensorineural deafness (58% of patients)

2) Eye abnormalities—especially retinopathy, cataract and microphthalmia (43% of patients)

3) Congenital heart disease—especially patent ductus arteriosus (50% of patients)


8. CMV infection in Pregnancy

Primary maternal cytomegalovirus infection may result in fetal infection. Which laboratory test should be used initially to confirm infection in the mother?


a) Detection of specific IgG

b) Detection of specific IgM

c) Qualitative molecular detection

d) Quantitative molecular detection

e) Viral culture

f) IgG avidity assays

Correct Answer: f) IgG avidity assays (Ref: CDC 2010)


The presence of CMV IgM is not solely indicative of primary infection. CMV IgM is detectable when a person 1) is newly infected, 2) has been infected in the past but recently re-exposed to CMV, 3) is undergoing reactivation of CMV infection that was acquired in the past, or 4) has a false-positive test result. Thus, the presence of CMV IgM should not be used by itself to diagnose primary CMV infection.


Recently, IgG avidity assays, which measure antibody maturity, have been shown to reliably detect recent primary CMV infection. When a person is infected with CMV for the first time, the body produces low-avidity IgG. After 2-4 months, the body begins to produce high-avidity CMV IgG. Low CMV IgG avidity suggests a primary CMV infection occurred within the past 2-4 months. High CMV IgG avidity suggests that CMV infection occurred at some point in the past.


9. Cytomegalovirus infection in Pregnancy


30-year-old woman presents to the antenatal clinic with a history of cytomegalovirus (CMV) infection. Which test would be the most sensitive for diagnosis of congenital infection in pregnancy?


a) Amniotic fluid PCR

b) Antenatal serology

c) CMV-specific IgG

d) CMV-specific IgM

e) Ultrasound scan of the fetus


Correct Answer: a) Amniotic fluid PCR.

There is no method of antenatal diagnosis that will reliably identify infected fetuses at risk of adverse outcome. Serological diagnosis of primary CMV infection during pregnancy can be difficult because CMV IgM, while suggestive of recent infection, can remain positive for many months and can also represent reactivation of past infection. The quantitative PCR detection of the CMV virus in the amniotic fluid has good sensitivity for fetal infection.


10. Toxoplasma Infection in Pregnancy

All of the following are fetal complications of perinatal Toxoplasmosis infection EXCEPT :


a) Spina bifida

b) hepatosplenomegaly

c) Hydrocephalus

d) brain calcification

e) chorioretinitis

Correct Answer: a) Spina bifida. Transmission of T. gondii to the fetus can result in serious health problems, including mental retardation, seizures, blindness, and death. The classic triad of signs suggestive of congenital toxoplasmosis includes chorioretinitis, hydrocephalus, and intracranial calcifications. Other signs are microcephaly, fetal growth retardation, ascites, or hepatosplenomegaly.


11. Toxoplasmosis


What is the drug of choice for a pregnant woman diagnosed with toxoplasmosis for reducing the risk of fetal infection ?


a) Aciclovir

b) Septran

c) Metronidazole

d) Sulfamethoxazole + Trimethoprim

e) Spiramycin


Correct Answer: e) Spiramycin. Toxoplasmosis gondii is an obligate intracellular protozoan.

Aciclovir is an antiviral agent. Metronidazole may be used in protozoan infections but is not considered useful with toxoplasmosis.

Spiramycin is a macrolide antibiotic and has been shown to reduce the risk of mother-to-child transmission in pregnant woman by up to 70% but there is insufficient evidence that it reduces the severity of the disease. Sulfamethoxazole/trimethoprim (Septran) can not be used in pregnancy.


12. Toxoplasma Infection

A 30-year-old pregnant woman is suffering from flu-like symptoms, myalgia and her posterior cervical lymph nodes are found to be enlarged. Her temperature is 38.4°C. Her blood test results are:Hb: 14 g/dl, WBC: 9 x 109/l, Platelets: 150 x 109/Ll, ESR: 6 mm/hr, CRP:

a) Brucellosis

b) Epstein-Barr virus

c) Leptospirosis

d) Toxoplasmosis

e) Typhoid fever


Correct Answer: d) Toxoplasmosis. Acute toxoplasmosis may be present with the above symptoms. The lymphadenopathy is characteristic. The white blood count, ESR, CRP is usually normal. In other bacterial infections the CRP and white cell count is uaually raised with generalised lymphadenopathy. Typhoid fever is associated with neutropenia.


13. GBS infection in Pregnancy

29-year-old, 39 weeks is in labour. Her previous child was affected by group B streptococcus (GBS) infection. She is allergic to penicillin. Which antibiotic should be prescribed for her as a prophylaxis for GBS?


a) Ampicillin

b) Cephalosporins

c) Clindamycin

d) Gentamycin

e) Metronidazole


Correct Answer: c) Clindamycin. Ampicillin may be used as an alternative to penicillin, however, it should be avoided because it covers a broader spectrum and may be associated with Gram-negative sepsis. Cephalosporins may have 10% cross reactivity with penicillin allergy. Gentamycin is not relevant in this situation. Vancomycin and erythromycin can potentially be used when clindamycin is not recommended.


14. TORCH Infection in Pregnancy

A variety of infectious agents produce hydrops fetalis through effects on fetal bone marrow, myocardium, or vascular endothelium. Which of the following does not cause hydrops?


a) Rubella

b) CMV

c) HIV

d) Toxoplasma gondii

e) Fifth Disease

f) Syphilis

g) Herpes simplex virus

h) Rubeola


Correct Answer: c and h. Fifth disease or Erythema infectiosum is one of several possible manifestations of infection by erythrovirus, previously called parvovirus B19. Rubeola (and not to be confused with rubella or roseola) is also known as measles. Rubella also causes hydrops fetalis.


15. TORCH


Transplacental infection occur with all, EXCEPT : 

a) Cytomegalovirus.

b) Toxoplasma

c) Rubella

d) Syphilis

e) Gonorrhea

Correct Answer: e) Gonorrhea. Gonorrhea can be transmitted from a pregnant woman to her baby during a vaginal delivery. During birth, babies are exposed to maternal blood and body fluids without the placental barrier intervening and to the maternal genital tract. Because of this, blood-borne microorganisms (Hepatitis B, HIV), organisms associated with sexually transmitted disease (e.g., Gonorrhoea and Chlamydia), and normal fauna of the genito-urinary tract (e.g., Candida) are among those commonly seen in infection of newborns.


16. Toxoplasmosis in Foetus


Toxoplasmosis in the foetus can be best confirmed by


a) IgG antibodies against Toxoplasma in the mother

b) IgM antibodies against toxoplasma in the Foetus

c) IgG antibodies against toxoplasma in the mother

d) IgG antibodies against toxoplasma in the foetus

Correct Answer: None or maybe b). The most common way to test for in utero infection is a polymerase chain reaction test of amniotic fluid for Toxoplasma. Cordocentesis is not usually done because the fetal risk is higher than with amniocentesis, and cordocentesis is less sensitive. If results are positive, sonographic follow up is indicated. Signs such as calcifications, microcephaly, hydrocephalus, and severe in utero growth restriction strongly suggest in utero infection in the presence of documented maternal infection. About a third of infected babies have detectable ultrasound features and baby’s blood can be tested after birth.


17. The following organisms cross the placenta (Select FALSE)


a) Veriola vaccinia

b) Coxsackie virus

c) Listeria

d) Neisseria meningitidis

e) Toxoplasma

Correct Answer: d) Neisseria meningitidis, often referred to as meningococcus, is a bacterium that can cause meningitis. In children and teens, meningococcus is the most common cause of bacterial meningitis. In adults, it is the second most common cause.

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