Tutorial 16 June 2014

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3	EMQ3. Parvovirus infection and pregnancy
7	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.
8	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.
9	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.
10	A woman of 18 attends the A&E Department requesting emergency contraception. 1.  Outline the history you will take.                        4 marks. 2.  Justify the investigations you will arrange.      2 marks. 3.  Outline the methods of emergency contraception and their pros and cons.                                                              8 marks                                                                                                                               3.  Justify your management.                                  8 marks.
	Roleplay. Explain Down syndrome screening to a primigravid 35 year-old primigravida booking at 8 weeks.

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.

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?