142 Obstetrics and Gynecology Board Review •••
❍ During what weeks of pregnancy is the risk of congenital varicella syndrome the highest?
Between 13 and 20 weeks when 2% of fetuses of women with primary varicella develop the syndrome.
❍ What is the most dangerous time for varicella zoster virus (VZV) infection in regard to neonatal death?
When the maternal infection develops between 5 days prior to delivery and 48 hours postpartum (these infants
should receive VZIG).
❍ What is the treatment of maternal varicella?
Oral acyclovir. A chest X-ray should be performed to look for varicella pneumonia, and if present women should
be hospitalized and given IV acyclovir.
❍ How should a susceptible woman exposed to varicella be managed?
VZIG should be given as soon as possible, ideally within 96 hours of exposure.
❍ Is screening for maternal toxoplasmosis recommended?
Only in women with HIV.
❍ What is the rate of vertical transmission of toxoplasmosis?
10% to 15% in the first trimester, 25% in the second trimester, and 60% in the third trimester. The earlier the
fetus is infected the more severe the disease.
❍ What is the treatment of maternal toxoplasmosis infection?
Spiramycin. If fetal infection is established, pyrimethamine, sulfadiazine, and folic acid are added.
❍ What antibiotic should be given during labor to a woman who is GBS positive and developed a rash when
given penicillin as a child?
Cefazolin 2 g initially then 1 g every 8 hours until delivery.
❍ If GBS status is unknown, what risk factors should be used to determine which women should receive
prophylaxis?
Previous infant with invasive GBS disease, GBS bacteriuria during current pregnancy, delivery at <37 weeks’
gestation, amniotic membrane rupture ≥18 hours, and intrapartum temperature ≥100.4°F.
❍ What foods should pregnant women avoid to prevent listeriosis?
Raw vegetables, coleslaw, apple cider, melons, milk, fresh Mexican-style cheese, smoked fish, and processed foods,
such as pâté, hummus, wieners, and sliced deli meats.
❍ What are characteristics of maternal and fetal listeriosis?
Maternal listeriosis may present similarly to meningitis, pyelonephritis, or influenza. Fetal infection is characterized
by disseminated granulomatous lesions with microabscesses.
❍ What is the most common route of fetal acquisition of syphilis?
Transplacental. Infection may also be caused by contact with lesions at delivery.