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Labour

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15 out of 23
 

Premature baby at 34wk was delivered & had bullous lesion on body. X ray shows periostitis next investigation is (AIIMS Nov. 2011)



A ELISA for HIV

B PCR for TB

C VDRL for mother & baby

D HbsAg for mother

Ans. C

VDRL for mother & baby

1. Syphilis, Congenital
Onset of symptoms may be from birth to 3 months of age.

2. Common features:

a. stillbirth

b. prematurity, low birth weight, IUGR

c. hepatomegaly, splenomegaly

d. skeletal abnormalities

e. skin lesions

f. pneumonia

g. hyperbilirubinemia

h. anemia

i. snuffles (nasal discharge)

CSF abnormalities.

3. Common late manifestations (appear > 2 yrs of age):

a. Teeth -Hutchinson teeth (notched, pegged), mulberry molars

b. Eye -interstitial keratitis

c. Cranial nerves -8th nerve deafness

Skeletal -frontal bossing, high arched palate, saddle nose (markedlydepressed bridge), saber shin sharp

d. Skin -rhagades(cracks, fissures atmucocutaneousjunctions)

e. #1, 2, & 3 are part of Hutchinson’s triad

f. edgedanteriorlyconvextibia).

4. Presentation

a. Intrauterine infection presents with stillbirth, hydropsfetalis, or prematurity (40%)

b. Early congenital syphilis represents manifestations of disease in first two years of life

i. Transplacental spirochetemia

ii. Analogous to secondary syphilis

iii. Earliest signs poor feeding and snuffles(syphilitic rhinitis)-often bloody and associated with laryngitis

iv. Diffuse maculopapulardesquamativerash(particularly on palms, soles around the mouth and anus)

5. Diagnosis: Serology

a. Screening during pregnancy 1stand 3rd trimester

b. Nontreponemal tests (VDRL and RPR) detect antibodies toward a lipoidal antigen from T. pallidum; useful for following disease progression

c. Treponemal tests (FTA-ABS): Remain reactive for life; not useful to follow disease activity

d. Tests do not distinguish disease in an infant from passively transferred maternal antibody thus titers must be followed a rising titeror titer 4:1 of mothermakes infection likely

Other evaluation:CSF for VDRL, cell ct, protein; CBC; Long-bone films looking for periostitis

v. Periostitis, osetochondritis and perichondritis (90% symptomatic and 20% asymptomatic infants with radiographic abnormalities of long bones)

vi. CSF often will show increased protein and pleocytosis (aseptic meningitis)

vii. Severely ill can have hydrops, anemia, hepatosplenomegaly, pneumonitis, glomerulonephritis

viii. Summary of Sx

• Gen: LAD, FTT

• CNS: Chorioretinitis

• Pulmonary: Snuffles

• GI: HSM, jaundice, inc LFT’s, cholestasis

• Skin: Extramedulary hematopoeisis, mucocutaneous rash (hands and feet), condylomatous lesions

• Heme: Hemolytic anemia

• Ortho: Osteochondritis, periostitis (painful >> pseudoparalysis of Parrot)

• Periostitis: #1 clinical manifestation of early congenital syphilis; Usually affects long bones; Usually asymptomatic; May be painful

Labour Flashcard List

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