Chikenpox and herpes - Maternal medicine 2 Part 2

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1) 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.

2) 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


3) Which of the following conditions is not a known complication of maternal chicken

pox in pregnancy?

4) 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.

5) 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.

6) 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.

7) 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


8) 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?

9) 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-


10) 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.

11) 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?

12) 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.

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