49 - infections of pregnancy, peurperium and neonates Flashcards
Puerperium definition
The puerperal state or pregnancy - the few weeks following delivery during which the mother’s tissues return to their non-pregnant state (6-8 weeks post-partum)
Neonate goes up to how many weeks old?
less than 4
why does infection warrent special treatment during pregnancy?
Often more severe + common
Can affect foetus
Route of acquisition + route of transmission to baby - CMV
Resp. droplet
Haemato
Route of acquisition + route of transmission to baby - parvovirus B19
resp.droplet
Haemato
Route of acquisition + route of transmission to baby - toxoplasmosis
Ingestion of oocysts
Haemato
Route of acquisition + route of transmission to baby - syphilis
Sexual
Haemato
Route of acquisition + route of transmission to baby - VZV
Resp. droplet
Haemato
Route of acquisition + route of transmission to baby - zika
mosquito bite
Haemato
Infections to be transmitted from mother to baby during pregnancy
Group B strep HSV Gonorrhoea Chlamydia HIV and Hep B (prophylaxis can be used)
Antimicrobial prescribing in pregnancy
Potential to cause harm to foetus/embryo/neonate must be considered
All antimicrobials cross the placenta to some extent
Virtually all antimicrobials appear in breast milk at therapeutic levels
Safe antimicrobials
Penicillins
Cephalosporins
Unsafe antimicrobials
Chloramphenicol
Tetracycline
Fluoroquinolones (e.g. ciprofloxacin)
Trimethoprim-sulphamethoxazole
Viral diagnosis in pregnancy
Serology
PCR of relevant samples
UTI during pregnancy
Screening for bacteriuria is indicated in pregnancy
Can be asymptomatic
Continuing bacteriuria is associated with premature delivery and increased perinatal mortality
UTI treatment
Current recommendation is 7 days of relatively non-toxic antibiotic - amoxicillin or cefalexin
Repeat urine culture
Intra-amniotic infections
20-25% pregnancies with pre-term labour
Major cause of perinatal morbidity and mortality
Chorioamnionitis
Chorioamnionitis
Refers to inflammation of umbilical cord, amniotic membranes, placenta
Intra-amniotic infections - clinical features
Maternal fever Uterine tenderness Malodorous amniotic fluid Maternal or foetal tachycardia Raised white cell count
Intra-amniotic infections - risk factors
Most common after prolonged rupture of membranes
Amniocentesis, cordocentesis, cervical cerclage, multiple vaginal exam
Intra-amniotic infections - pathogenesis
bacteria present in the vagina cause infection by ascending through the cervix
Haematogenous is rare
Intra-amniotic infections - causative organisms
Group B strepto
Enterococci
E. coli
Intra-amniotic infections - management
Antimicrobials and delivery of foetus
Antimicrobials should be administered at time of diagnosis
Puerperal endometritis -
Infection of the womb during puerperium (5% of pregnancies)
Puerperal sepsis major cause of maternal death
Puerperal endometritis - risk factors
Caesarean section
Prolonged labour
Prolonged rupture of membranes
Multiple vaginal exams
Puerperal endometritis - clinical features
Fever (24hrs after delivery) Uterine tenderness Purulent, foul-smelling lochia Increased WCC General malaise, ab pain
Puerperal endometritis - causative organisms
E.Coli
Beta-haemolytic streptococci
Anaerobes
Puerperal endometritis - diagnosis
The role of transvaginal endometrial swabs is controversial
Puerperal endometritis - treatment
Broad-spec IV antimicrobials
Puerperal mastitis -
Infection gains access via cracked/fissured nipples
Puerperal mastitis - clinical features
Mean onset 5.5 weeks post delivery
Abrupt onset fever, chills and breast soreness
Redness, warmth and tenderness of affected breast
Puerperal mastitis - causative mechanisms
Staph. aureus
Puerperal mastitis - diagnosis
Clinical
Culture of pus
Puerperal mastitis - management
Continue nursing
Optimise nursing technique and breast care
Anti-staph antibiotics
Incision/drainage if abscess present
Puerperal sepsis -
Pneumonia
IV catheter-related infection
Wound infection (caesarean section)
Neonatal sepsis / meningitis
Sepsis is a syndrome resulting from invasion of pathogenic bacteria into the blood
Neonatal sepsis - presentation after birth
early onset presents within 2 weeks of birth
Neonatal sepsis - common causative diseases
Group B strep
E.Coli
Listeria monocytogenes
Neonatal sepsis - diagnosis
Blood, urine and CSF culture
Neonatal sepsis - management
Broad spectrum antimicrobials active against common causes
