TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors PPROM and Candidiasis          TEALE FENNING Forum Index -> Open Forum View previous topic :: View next topic   Author Message Xerxes I Century Club Joined: 01 Mar 2007 Posts: 228 Location: Winchester Posted: Tue Apr 15, 2008 12:20 pm    Post subject: PPROM and Candidiasis 30 week, ROM, not contracting, no signs of infection, draining clear liquor HVS comes back as heavy growth of Candida, She reports having had thrush for the last few weeks. 1/ Would you treat? or would you shred the report? 2/ Why would you and why wouldn't you? Is baby at risk of candidial infection? can it be clinically significant? 3/ If you would treat, how? Back to top rpwalavalkar Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 966 Posted: Tue Apr 15, 2008 1:44 pm    Post subject: Re: PPROM and Candidiasis Xerxes I wrote: 30 week, ROM, not contracting, no signs of infection, draining clear liquor HVS comes back as heavy growth of Candida, She reports having had thrush for the last few weeks. 1/ Would you treat? or would you shred the report? 2/ Why would you and why wouldn't you? Is baby at risk of candidial infection? can it be clinically significant? 3/ If you would treat, how? fab question, made me think hard. 1 & 2. i'll treat though congenital candidiasis is rare, presence of prematurity, and PPROM increase risk to the foetus. morbidity documented includes, extensive cutaneous lesions - like burns and behaving similarly, systemic infection and notoriously pneumonia. 3. i'll treat the mum with systemic and local antifungals, clotrimazole or fluconazole the baby will need observation and treatment with Amphotericin B systemically as required. the americans have a guideline for candidiasis in general that i had read some time back, will send you the link if i find it. will love to see what others think about treat / not to treat. _________________ Dr Miss. Raj Walavalkar MBBS MRCOG TealeFenning Administrator SR O&G Wessex Region Back to top Xerxes I Century Club Joined: 01 Mar 2007 Posts: 228 Location: Winchester Posted: Tue Apr 15, 2008 2:46 pm    Post subject: This was a lady I saw over the weekend. Isn't it surprising that both Candida and Prom are quite common and yet we have rarely had this situation. Whoever I talked to (including two consultants) go mmmmmm, good question and had come up with different answers. One said they would treat if the woman is symptomatic, the other wouldn't bother treating, my colleage was shocked by hearing I have given the woman a pessary and thought I am incompetent and nearly reported me to the GMC Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Tue Apr 15, 2008 3:40 pm    Post subject: The risk, I presume, would relate to vertical transmission only so why not wait and treat if labour ensues? If the woman is asymptomatic then oral would be fine as the vaginal route may not be that appropriate during labour. As you have both said it is something we should all have seen and have a plan for. N Last edited by Nick Raine-Fenning on Tue Apr 15, 2008 4:02 pm; edited 1 time in total Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Tue Apr 15, 2008 3:47 pm    Post subject: Well, I'm completeyl wrong (obviously)!! Found this: Mazor M, Chaim W, Shinwell ES, Glezerman M. Department of Obstetrics and Gynecology, Soroka Medical Center of Kupat Holim, Beer Sheva, Israel wrote: Asymptomatic amniotic fluid invasion with Candida albicans in preterm premature rupture of membranes. Implications for obstetric and neonatal management. A case of asymptomatic intraamniotic infection with Candida albicans in a woman presenting with preterm premature rupture of membranes is reported. Active prenatal diagnostic procedures and prompt and accurate neonatal treatment (Amphotericin B) improved significantly the usually poor outcome of these pregnancies. Ref: Acta Obstet Gynecol Scand. 1993 Jan;72(1):52-4 This would imply that it does cause antenatal problems and is a significant issue! _________________ "Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997 Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Tue Apr 15, 2008 3:57 pm    Post subject: There's more .... H. L. LOKE, I. VERBER, W. SZYMONOWICZ, V. Y. H. YU 1988: Systemic candidiasis and pneumonia in preterm infants. Journal of Paediatrics and Child Health 24 (2), 138–142 wrote: Twenty-two preterm infants with systemic candidiasis are reported, of which seven cases were presumed to be antenatally acquired and 15 postnatally acquired. All except one were of very low birthweight. Fifteen infants had positive cultures of blood, cerebrospinal fluid or urine and seven had candida pneumonia only. Clinical features included general instability, respiratory deterioration and a necrotizing enterocolitis-like presentation. The incidence of leukocytosis, shift to the left, eosinophilia and thrombocytopenia were not different from those with bacterial infection. The diagnosis was made after death in two infants. In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken. Complications of amphotericin and 5-flucytosine therapy which developed in five infants resolved on cessation of treatment. The mortality rate was 18% and impairment rate among the 17 very low birthweight survivors was 18%. A high index of suspicion is required for systemic candidiasis, especially in infants of less than 1000 g birthweight. If recognized early, effective and safe antifungal therapy is possible with favourable short- and long-term outcome. Back to top Xerxes I Century Club Joined: 01 Mar 2007 Posts: 228 Location: Winchester Posted: Tue Apr 15, 2008 4:07 pm    Post subject: That's very helpful as always Nick, So if she's not in labour, would you give her a pessary or oral or both? What is the risk of oral Fluconazole anyway, BNF gives its typical advice. Back to top cpeedahsa Century Club Joined: 21 Apr 2007 Posts: 921 Posted: Wed Apr 16, 2008 3:24 am    Post subject: Xerxes I wrote: That's very helpful as always Nick, So if she's not in labour, would you give her a pessary or oral or both? What is the risk of oral Fluconazole anyway, BNF gives its typical advice. Risk of oral Fluconazole in pregnancy : No risk( atleast not at this stage in pregnancy ) References 1)J Antimicrob Chemother. 2008 Apr 9 Maternal use of fluconazole and risk of congenital malformations: a Danish population-based cohort study.Nørgaard M, Pedersen L, Gislum M, Erichsen R, Søgaard KK, Schønheyder HC, Sørensen HT. population-based cohort study in Northern Denmark-1079 women who had a live birth or a stillbirth after the 20th week of gestation and who redeemed at least one prescription for fluconazole during the first trimester.--No overall increased risk of congenital malformations after exposure to short-course treatment with fluconazole in early pregnancy. 2)Br J Clin Pharmacol. 1999 Aug;48(2):234-8. Risk of malformations and other outcomes in children exposed to fluconazole in utero.Sorensen HT, Nielsen GL, Olesen C, Larsen H, Steffensen FH, Schønheyder HC, Olsen J, Czeizel AE. The study showed no increased risk of congenital malformations, low birth weight or preterm birth in offspring to women who had used single dose fluconazole before conception or during pregnancy. 3)Am J Obstet Gynecol. 2008 Feb;198(2):191.e1-7. Links Antifungal drugs and the risk of selected birth defects.Carter TC, Druschel CM, Romitti PA, Bell EM, Werler MM, Mitchell AA; National Birth Defects Prevention Study. First-trimester antifungal drug exposure was not strongly associated with the risk of most birth defects, but further studies should examine the preliminary results of an association with hypoplastic left heart syndrome. Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> Open Forum All times are GMT Page 1 of 1   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group