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https://soundcloud.com/drtmcf/28-november-2013
Tonight we had an EMQ, 4 essay plans and a bit of a roleplay.
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EMQ3. Parvovirus
infection and pregnancy
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Cytomegalovirus
infection.
A woman books at 8 weeks’ gestation in her first
pregnancy. She is concerned because she works in a nursery where there has
been an outbreak of cytomegalovirus infection. Critically evaluate the
management.
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Critically
evaluate the “Top Ten Recommendations” in “Saving Mothers’ Lives”, The Eighth Report of the Confidential Enquiries
into Maternal Deaths in the United Kingdom. 2006–2008.
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Delayed cord
clamping.
A 25-year-old primigravida attends the antenatal clinic
at 36 weeks. She has read a magazine article about delayed cord clamping.
Critically evaluate the issues relating to delayed cord clamping.
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With regard to
anti-phospholipid syndrome:
1. outline the
clinical manifestations of APS. 4
marks.
2. outline the
implications of APS for pregnancy 4 marks.
3. critically
evaluate how the diagnosis is made. 4
marks.
4. critically
evaluate the management in the woman wishing to be pregnant. 8 marks.
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Roleplay. Healthy,
nulliparous woman referred for pre-pregnancy counselling. Brother has cystic
fibrosis. You are asked to explain cystic fibrosis and the implications for
her.
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Lead-in.
The following scenarios relate to parvovirus infection
Pick one option from the option list.
Each option can be used once, more than once or not at
all.
Abbreviations.
GOVRIP: Guidance
on Viral Rash in Pregnancy. HPA. 2011
PSVMCA: peak
systolic velocity middle cerebral artery.
PvB19: parvovirus
B19
PvIgG: parvovirus B19 IgG
PvIgM: parvovirus B19 IgM
Option list.
There is none: make up your own
answers!
Scenario 1.
What type of virus is
parvovirus?
Scenario 2.
Is the title B19 something to do with the American B19
bomber, its potentially devastating bomb load and the comparably devastating
consequences of the parvovirus on human erythroid cell precursors?
Scenario 3.
PVB19 in the UK occurs in mini-epidemics at 3 – 4 year
intervals, usually during the summer months.
Scenario 4.
Which animal acts as the main
reservoir for infection?
Scenario 5.
What percentage of UK adults are immune to parvovirus
infection?
Scenario 6.
What names are given to acute
infection in the human?
Scenario 7.
What is the incubation period for parvovirus infection?
Scenario 8
What is the duration of infectivity for parvovirus
infection?
Scenario 9.
What are the usual symptoms of parvovirus infection in
the adult?
Scenario 10.
What is the incidence of parvovirus infection in
pregnancy?
Scenario 11.
How is recent infection diagnosed?
Scenario 12.
How long does PvIgM persist and why is this important?
Scenario 13.
What is the rate of vertical transmission of parvovirus
infection?
Scenario 14.
Are women with parvovirus infection who are asymptomatic
less likely to pass the virus to their fetuses?
Scenario 15.
To what degree is parvovirus infection teratogenic?
Scenario 16.
What proportion of pregnancies infected with parvovirus are
lost?
Scenario 17.
What is the timescale for the onset of hydrops?
Scenario 18.
Laboratories are advised to retain bloods obtained at
booking for at least 2 years for possible future reference. True or false?
Scenario 19.
What ultrasound features would trigger consideration of
cordocentesis?
Scenario 20.
Must suspected parvovirus infection be notified to the
authorities? Yes or No.
Scenario 21.
Possible parvovirus infection
does not need to be investigated after 20 week’s gestation. True or false?
Scenario 22
If serum is sent to the
laboratory from a woman with a rash in pregnancy for screening for rubella, the
laboratory should automatically test for parvovirus infection too. True or false?
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