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Clinical Pathology > 49 - infections of pregnancy, peurperium and neonates > Flashcards

49 - infections of pregnancy, peurperium and neonates Flashcards

1
Q

Puerperium definition

A

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)

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2
Q

Neonate goes up to how many weeks old?

A

less than 4

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3
Q

why does infection warrent special treatment during pregnancy?

A

Often more severe + common

Can affect foetus

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4
Q

Route of acquisition + route of transmission to baby - CMV

A

Resp. droplet

Haemato

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5
Q

Route of acquisition + route of transmission to baby - parvovirus B19

A

resp.droplet

Haemato

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6
Q

Route of acquisition + route of transmission to baby - toxoplasmosis

A

Ingestion of oocysts

Haemato

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7
Q

Route of acquisition + route of transmission to baby - syphilis

A

Sexual

Haemato

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8
Q

Route of acquisition + route of transmission to baby - VZV

A

Resp. droplet

Haemato

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9
Q

Route of acquisition + route of transmission to baby - zika

A

mosquito bite

Haemato

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10
Q

Infections to be transmitted from mother to baby during pregnancy

A 
Group B strep
HSV
Gonorrhoea
Chlamydia
HIV and Hep B (prophylaxis can be used)
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11
Q

Antimicrobial prescribing in pregnancy

A

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

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12
Q

Safe antimicrobials

A

Penicillins

Cephalosporins

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13
Q

Unsafe antimicrobials

A

Chloramphenicol
Tetracycline
Fluoroquinolones (e.g. ciprofloxacin)
Trimethoprim-sulphamethoxazole

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14
Q

Viral diagnosis in pregnancy

A

Serology

PCR of relevant samples

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15
Q

UTI during pregnancy

A

Screening for bacteriuria is indicated in pregnancy

Can be asymptomatic

Continuing bacteriuria is associated with premature delivery and increased perinatal mortality

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16
Q

UTI treatment

A

Current recommendation is 7 days of relatively non-toxic antibiotic - amoxicillin or cefalexin

Repeat urine culture

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17
Q

Intra-amniotic infections

A

20-25% pregnancies with pre-term labour

Major cause of perinatal morbidity and mortality

Chorioamnionitis

18
Q

Chorioamnionitis

A

Refers to inflammation of umbilical cord, amniotic membranes, placenta

19
Q

Intra-amniotic infections - clinical features

A 
Maternal fever
Uterine tenderness
Malodorous amniotic fluid
Maternal or foetal tachycardia
Raised white cell count
20
Q

Intra-amniotic infections - risk factors

A

Most common after prolonged rupture of membranes

Amniocentesis, cordocentesis, cervical cerclage, multiple vaginal exam

21
Q

Intra-amniotic infections - pathogenesis

A

bacteria present in the vagina cause infection by ascending through the cervix

Haematogenous is rare

22
Q

Intra-amniotic infections - causative organisms

A

Group B strepto
Enterococci
E. coli

23
Q

Intra-amniotic infections - management

A

Antimicrobials and delivery of foetus

Antimicrobials should be administered at time of diagnosis

24
Q

Puerperal endometritis -

A

Infection of the womb during puerperium (5% of pregnancies)

Puerperal sepsis major cause of maternal death

25
Q

Puerperal endometritis - risk factors

A

Caesarean section
Prolonged labour
Prolonged rupture of membranes
Multiple vaginal exams

26
Q

Puerperal endometritis - clinical features

A 
Fever (24hrs after delivery)
Uterine tenderness
Purulent, foul-smelling lochia
Increased WCC
General malaise, ab pain
27
Q

Puerperal endometritis - causative organisms

A

E.Coli
Beta-haemolytic streptococci
Anaerobes

28
Q

Puerperal endometritis - diagnosis

A

The role of transvaginal endometrial swabs is controversial

29
Q

Puerperal endometritis - treatment

A

Broad-spec IV antimicrobials

30
Q

Puerperal mastitis -

A

Infection gains access via cracked/fissured nipples

31
Q

Puerperal mastitis - clinical features

A

Mean onset 5.5 weeks post delivery
Abrupt onset fever, chills and breast soreness

Redness, warmth and tenderness of affected breast

32
Q

Puerperal mastitis - causative mechanisms

A

Staph. aureus

33
Q

Puerperal mastitis - diagnosis

A

Clinical

Culture of pus

34
Q

Puerperal mastitis - management

A

Continue nursing
Optimise nursing technique and breast care
Anti-staph antibiotics
Incision/drainage if abscess present

35
Q

Puerperal sepsis -

A

Pneumonia
IV catheter-related infection
Wound infection (caesarean section)

36
Q

Neonatal sepsis / meningitis

A

Sepsis is a syndrome resulting from invasion of pathogenic bacteria into the blood

37
Q

Neonatal sepsis - presentation after birth

A

early onset presents within 2 weeks of birth

38
Q

Neonatal sepsis - common causative diseases

A

Group B strep
E.Coli
Listeria monocytogenes

39
Q

Neonatal sepsis - diagnosis

A

Blood, urine and CSF culture

40
Q

Neonatal sepsis - management

A

Broad spectrum antimicrobials active against common causes

Clinical Pathology (65 decks)

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