A 17-week pregnant woman delivers a stillborn baby with a large size, and the placenta is also large. The baby has rashes on the face. What is the most likely cause of these findings?

1. A

   Congenital rubella syndrome

2. B

   Herpes Simplex Virus (HSV)

3. C

   Parvovirus syndrome

4. D

   Congenital syphilis syndrome

Appeared in: NORCET 8 Prelims-2025

Explanation

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• Congenital syphilis is caused by the spirochete Treponema pallidum transmitted from mother to fetus.
• The infection can lead to hydrops fetalis, a condition of severe fetal edema, which explains both the large size of the baby and the placenta (placentomegaly).
• A characteristic rash, which can be maculopapular or bullous, is a well-documented sign of congenital syphilis and can be present at birth.
• The combination of stillbirth, hydrops fetalis, placentomegaly, and rash is a classic presentation of severe, early congenital syphilis.

Why Other Options Were Wrong

• Option A: Congenital rubella syndrome is classically associated with intrauterine growth restriction (IUGR), leading to a small-for-gestational-age baby, which contradicts the finding of a 'large size' baby.
• Option B: Congenital Herpes Simplex Virus (HSV) infection does not typically cause a large baby or placenta. The rash is usually vesicular (blister-like) rather than the non-specific 'rashes' mentioned.
• Option C: While Parvovirus B19 is a known cause of hydrops fetalis (large baby and placenta) and stillbirth due to severe anemia, a prominent facial rash is not a classic fetal sign. The complete clinical picture, including the rash, makes syphilis a more probable diagnosis.

Related Visual

Clinical Relevance

• Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Identification of congenital infections based on fetal and placental findings as background academic context rather than a clinical decision trigger.
• Early and routine screening for syphilis (using VDRL or RPR tests) in all pregnant women is a critical nursing and public health intervention to prevent congenital syphilis.
• Nurses must be able to recognize the signs of congenital infections to ensure prompt diagnosis, appropriate isolation precautions, and treatment for the infant.
• Patient education is vital. Nurses should counsel pregnant women on the importance of antenatal screening and the risks of untreated infections.

How to Approach the Question

• First, identify the key findings from the clinical scenario: 1) Stillbirth, 2) Large baby, 3) Large placenta, 4) Facial rash.
• Next, evaluate each option (congenital infection) against this set of findings.
• Recall or look up the classic presentation of each TORCH infection. Note that 'large baby' in this context likely means hydrops fetalis (severe edema).
• Eliminate options that contradict the key findings. Congenital Rubella causes a small baby (IUGR), so it can be ruled out.
• Compare the remaining plausible options. Both Parvovirus and Syphilis can cause hydrops. However, a prominent rash is a more classic feature of congenital syphilis.
• Conclude that the constellation of all four signs (stillbirth, hydrops, placentomegaly, and rash) is most characteristic of congenital syphilis.

Concept Tested & Keywords

• Concept Tested: Identification of congenital infections based on fetal and placental findings.
• Stem keywords: 17-week pregnant, stillborn baby, large size, large placenta, rashes on face
• Lead-in keywords: most likely cause
• Clinical cues: The combination of a large fetus (hydrops), large placenta (placentomegaly), and rash in a stillborn points towards a severe systemic congenital infection.

Question ID

QdUQvUNaQBmfvCtTmHpIqt

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Reference Book

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 286-288

E6 Midwifery Obstetrics and Gynecology Nursing Sandeep Kaur p. 3-8

E6 Medicine Harrison 22e Part 1 p. 1685-1687