Chikenpox and herpes - Maternal medicine 2 Part 2
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1) A 23-year-old woman in her first pregnancy attends the GP’s surgery with a con-
tact history of chickenpox. Her 8-year-old son developed a rash the previous
day. She is now 28 weeks pregnant. Her booking bloods show absent expo-
sure/immunity.
2) A 21-year-old woman presents to the early pregnancy assessment unit at 9-week
gestation with fever and vesicular generalised rashes of 3 days duration. There is no
difficulty in breathing or neck stiffness. Clinical examination shows a PR of 96 bpm and
BP of 110/60 mmHG.
3) A woman who has previously had genital herpes presents with preterm prelabour
rupture of membranes (PPROM) at 32 weeks of gestation. Clinical examination
reveals that she has typical lesions of recurrent genital herpes. Assessments of fetal
and maternal well-being are otherwise normal.
What is the most appropriate management plan?
Management of genital herpes Use of antenatal corticosteroids Delivery
4) A 26-year-old lady attends the antenatal clinic at 18 weeks of gestation following
her booking results, which have shown her to be positive for hepatitis B. Antigen
analysis demonstrates that she is hepatitis surface antigen positive, hepatitis e
antigen negative and anti-Hbe reactive. Her liver function tests are as follows:
bilirubin 10 mg/dl, aspartate aminotransferase 36 IU, alanine aminotransferase
40 IU and alkaline phosphatase 600 IU. What is the most appropriate interven-
tion to prevent vertical transmission?
5) A 20-year-old primigravida presents at term +4 to the delivery suite for induction of
labour. She perceives fetal movements well and obstetric ultrasonogram is normal.
On examination, she is noted to have painful ulcers over the perineum. She denies any
difficulty in passing urine or facing similar episodes in the past.
6) A 28-year-old woman presents to the A & E at 30 weeks gestation with fever, flank
pain and palpitations. On examination, she is found to be febrile with pulse rate (PR)
100 bpm and BP 100/60 mmHG. She has diffuse tenderness over the abdomen with soft,
non-tender uterus. Vaginal examination is normal and the fetal heart rate is found to be
200 bpm.
7) Registrar on call receives a phone call from a GP regarding a patient, 24 weeks
pregnant in her fi rst pregnancy. She has developed chicken pox rash since one day.
What is the most appropriate advice she should be given?
8) A 30-year-old woman in her fourth pregnancy is admitted in labour at 37 weeks’
gestation. She gives history of sharp radiating pain in the left shoulder and arm
with pins and needles. She develops vesicular rashes along the areas of der-
matomes C6 and C8 on the second postnatal day.
9) A 30-year-old woman presents to the early pregnancy assessment unit with difficulty in
passing urine at 12 weeks gestation. She denies any fever, dysuria or vaginal bleeding.
On examination, she is found to have shallow painful ulcers over the perineum.
10) Which of the following conditions is not a known complication of maternal chicken
pox in pregnancy?
11) A 34-year-old woman had a normal vaginal delivery at 36 weeks’ gestation. She
developed chickenpox on the second postnatal day. The baby is found to be
healthy without any obvious lesions. The blood test shows mild thrombocy-
topenia with a normal haemoglobin level.
12) Ms XY is a primigravida who is 32/40 weeks pregnant. She visits a friend over the
weekend who informs her 5 days later that she has had shingles during their visit.
Ms XY is unclear about her history of chickenpox and has recently travelled to the
UK from the tropics. Which of the following treatment options are best suited to
her?
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