A 21-year-old woman has just delivered a term infant. She has had only one visit to her obstetrician

Discussion in 'MRCPCH forum' started by samuel, Sep 19, 2014.

  1. samuel

    samuel New Member

    A 21-year-old woman has just delivered a term infant. She has had only one visit to her obstetrician, and that was at about 6 weeks of pregnancy. She provides her laboratory results from that visit. The delivered infant is microcephalic, has cataracts, a heart murmur, and hepatosplenomegaly. Your
    further evaluation of the child demonstrates thrombocytopenia, mild hemolytic
    anemia, and, on the echocardiogram, patent ductus arteriosus and peripheral
    pulmonary artery stenosis. Which of the following maternal laboratory tests
    done at 6 weeks gestation is likely to explain the findings in this child?
    a. Positive hepatitis B surface antibody
    b. Positive rapid plasma reagin (RPR) with negative Microhemagglutination-Treponema pallidum test (MHATP)
    c. Negative rubella titer
    d. Negative triple screen
    e. Positive varicella titer
  2. samuel

    samuel New Member

    Ans is C:
    When German measles (rubella) occurs during the first 2 months of pregnancy, it has a severe effect on the fetus, including cardiac defects, cataracts, and glaucoma. The most common cardiac defects are patent ductus arteriosus, which can be accompanied by peripheral pulmonary artery stenosis, and atrial and ventricular septal defects. A myriad of other complications vary in incidence with the timing of the infection during pregnancy, including thrombocytopenia, hepatosplenomegaly, hepatitis, hemolytic anemia, microcephaly, and a higher risk of developing insulin-dependent diabetes mellitus. The mother’s negative rubella titer early in the pregnancy indicates she is susceptible to the infection and its sequelae; her titer undoubtedly now is positive.
    A positive hepatitis B surface antibody indicates successful vaccination
    or old, resolved infection. The positive RPR (a screening test for syphilis)
    with negative MHATP (the confirmatory test for syphilis) points away from
    this TORCH infection, but can be associated with a variety of conditions,
    such as systemic lupus erythematosus or other collagen vascular diseases.
    The triple screen, usually done at 16 to 18 weeks’ gestation, identifies infants at risk for conditions such as Down syndrome or neural tube defects. The positive varicella titer indicates either previous natural infection or successful vaccination.

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