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9. CP - Diseases of the Reproductive System > (49) Infections of pregnancy, puerperium and neonate > Flashcards

(49) Infections of pregnancy, puerperium and neonate Flashcards

1
Q

What is puerperium?

A

The puerperal state - the few weeks following delivery during which the mother’s tissues return to their non-pregnant state (usually 6-8 weeks postpartum)

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2
Q

What is a neonate?

A

A recently born individual; specifically an infant less than four weeks old

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3
Q

Why do infections in pregnancy warrant special consideration?

A
  • some infections are more severe or more common in pregnancy eg. UTI, VZV, entamoeba histolytic
  • some infections can affect the foetus
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4
Q

What are the main 2 ways that infection can be spread from the mother to baby?

A
  • haematogenous (via placenta)

- during delivery

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5
Q

Name 6 pathogens that can spread to foetus by haemaotgenous spread

A
  • CMV
  • parovirus B19
  • toxoplasmosis
  • syphilis
  • VZV
  • zika virus
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6
Q

How does the mother acquire CMV, parovirus B19, VZV?

A

Respiratory droplets/secretions (requires reasonably close proximity)

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7
Q

How does the mother acquire toxoplasmosis?

A

Ingestion of oocysts from the parasite

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8
Q

How does the mother acquire syphilis?

A

Sexual transmission

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9
Q

How does the mother acquire zika virus?

A

Mosquito bite

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10
Q

Name 6 pathogens that can be transmitted from mother to baby during delivery

A
  • group B streptococcus
  • HSV
  • gonorrhoea
  • chlamydia
  • HIV
  • hep B
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11
Q

What actions are taken against HIV and Hep B during pregnancy?

A

Prophylaxis is available and screening is undertaken in pregnancy

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12
Q

Which bacteria may be harmful to baby but may be part of normal vaginal flora?

A

Group B streptococcus - mother offered prophylaxis if they have group b strep to prevent transmission

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13
Q

Since mucosal contact is needed for gonorrhoea transmission, what part of the baby is vulnerable?

A

The baby’s eyes - causes conjunctivitis

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14
Q

How is antimicrobial prescribing affected in pregnancy?

A
  • handling of drugs differs during pregnancy eg. increased GFR = increased renal excretion of many antimicrobials
  • serum levels of antimicrobials are generally lower during pregnancy
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15
Q

Since there is an increased glomerular filtration rate during pregnancy, what is there a risk of?

A

Under-dosing of antibiotics/ treatment failure through under-dosing

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16
Q

What must be considered when prescribing antimicrobials during pregnancy?

A

The potential to cause harm to the embryo/foetus/neonate

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17
Q

Why might prescribing antimicrobials to the mother affect the foetus?

A
  • all antimicrobials cross the placenta to some extent

- virtually all antimicrobials appear in breast milk if given in therapeutic amounts to breast feeding women

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18
Q

Which 2 types of antibiotics are considered “safe” during pregnancy?

A
  • penicillins

- cephalosporins

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19
Q

Which 4 types of antibiotics are considered unsafe during pregnancy?

A
  • chloramphenicol
  • tetracycline
  • fluoroquinolones eg. ciprofloxacin
  • trimethoprim-sulphamethoxazole
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20
Q

Is there ever a need to use “unsafe” antibiotics during the pregnancy?

A

Only when there is a severe need to eg. severe sepsis of the mother

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21
Q

Give 2 primary viral infections that cause mild symptoms or are asymptomatic during pregnancy

A
  • CMV

- Zika

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22
Q

Give 4 primary viral infections that are more severe during pregnancy?

A
  • VZV
  • HSV
  • measles
  • influenza
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23
Q

Some viruses are teratogenic. Give 2 examples

A
  • rubella

- Zika virus?

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24
Q

What does diagnosis of viral infection during pregnancy involve?

A

Serology and/or PCR of relevant samples

  • blood
  • vesicle fluid
  • amniotic fluid
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25
Q

How is asymptomatic bacteriuria defined?

A

No symptoms of UTI but 2 samples containing >10^5 of the same organism confirmed - treat even though asymptomatic

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26
Q

Why is asymptomatic dangerous and must be treated?

A

Bacteriuria can develop into symptomatic UTI if untreated - continuing bacteriuria is associated with premature delivery and increased perinatal mortality

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27
Q

Sime UTIs are common in pregnancy, what test is indicated in pregnancy?

A

Screening for bacteriuria

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28
Q

What is the typical treatment for UTI?

A
  • 7 days of relatively non-toxic antibiotic eg. amoxicillin or cefalexin (trimethoprim)
  • repeat urine culture post-treatment to confirm cure
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29
Q

Cefalexin (trimethoprim) is sometimes used to treat UTI during pregnancy but what is advised?

A

Avoid use in the first trimester

Give with folate (as it is a folate antagonist so can cause neural tube defects)

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30
Q

How common are intra-amnitoic infections?

A

Affects 1-2% term pregnancies

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31
Q

How many pre-term labour pregnancies are affected by intra-amnitoic infections?

A

20-25%

32
Q

Intra-amniotic infections are a major cause of what?

A

Perinatal morbidity and mortality

33
Q

What is chorioamnionitis?

A

Inflammation of the umbilical cord, amniotic membranes and placenta

34
Q

What are the clinical features of intra-amniotic infections?

A
  • sustained maternal fever
  • uterine tenderness
  • malodorous amniotic fluid
  • maternal or foetal tachycardia (sign of systemic illness)
  • raised white cell count
35
Q

What are the risk factors for intra-amniotic infections?

A
  • prolonged rupture of membranes
  • amniocentesis, cordocentesis, cervical cerclage, multiple vaginal examinations
  • bacterial vaginosis?
36
Q

What are the 3 main mechanisms of pathogenesis for intra-amniotic infections?

A
  • bacteria in vagina ascending through cervix
  • direct inoculation (by procedures etc)
  • haematogenous (rare, eg. listeria monocytogenes)
37
Q

What is cervical cerclage?

A

Stitches used to close the cervix during pregnancy to help prevent pregnancy loss or premature birth (give when recurrent miscarriages)

38
Q

What are the 3 main causative organisms of intra-amniotic infections?

A
  • group B streptococcus
  • enterococci
  • escherichia coli
39
Q

Enterococci and escherichia coli may cause intra-amnitoic infections, but where is their normal habitat?

A

Gastrointestinal tract (GIT)

40
Q

How are intra-amniotic infections managed?

A
  • antimicrobials and delivery of foetus as soon as possible

- antimicrobials should be administered at the time of diagnosis (not after delivery)

41
Q

What is puerperal endometritis?

A

Infection of the uterus during puerperium

42
Q

How many pregnancies does puerperal endometritis affect?

A

Around 5% of pregnancies

43
Q

Puerperal sepsis is a major cause of what?

A

Maternal death

44
Q

What are the risk factors for puerperal endometritis?

A
  • caesarean section
  • prolonged labour
  • prolonged rupture of membranes
  • multiple vaginal examinations
45
Q

What are the clinical features of puerperal endometritis?

A
  • fever
  • uterine tenderness
  • purulent, foul-smelling lochia
  • increased white cell count
  • general malaise, abdominal pain
46
Q

What is lochia?

A

The vaginal discharge after giving birth (puerperium) containing blood, mucus, and uterine tissue

47
Q

What defines ‘fever’ in puerperal endometritis?

A

38.5 in first 24h post delivery OR over 38 for 4 hours, 24h+ after delivery

48
Q

What are the 3 main causative organisms of puerperal endometritis?

A
  • escherichia coli
  • beta-haemolytic streptococci
  • anaerobes

key organism = group A strep

49
Q

Why is role of transvaginal endometrial swabs in diagnosis of endometritis controversial?

A

Microbiological diagnosis not very useful as you will get vaginal flora so unsure as to what is going on in the uterus (blood culture more useful)

50
Q

How is puerperal endometritis treated?

A

Usually caused by mixed organisms so use broad-spectrum intravenous antimicrobials - continue until patient has been apyrexial for 48 hours

51
Q

Co-amoxiclax is a suitable antibiotic for puerperal endometritis. What does it contain?

A

Amoxicillin and clavulanic acid

52
Q

How does infection gain access to the breast tissue in puerperal mastitis?

A

Through cracked/fissured nipples

53
Q

Puerperal mastitis may be confused with which other condition?

A

Blocked milk ducts (also red and sore but shouldn’t have general malaise and fever)

54
Q

Describe the clinical features of puerperal mastitis?

A
  • mean onset = 5.5 weeks post delivery
  • abrupt onset of fever, chills and breast soreness
  • redness, warmth and tenderness of affected breast
55
Q

How are rigours described?

A

Sequence of cold and shivering and then hot and sweaty - almost always caused by infection

56
Q

What is the predominant causative organism in puerperal mastitis?

A

Staphylococcus aureus

57
Q

Does puerperal mastitis occur in breast feeding or non-breast feeding mothers?

A

Usually in breast feeding mothers but not necessarily - don’t stop breast feeding though!

58
Q

How is puerperal mastitis diagnosed?

A
  • clinical

- culture of pus

59
Q

How is puerperal mastitis managed?

A
  • continue nursing
  • optimise nursing technique and breast care (also key to prevention)
  • anti-staphylococcus antibiotics eg. flucloxacillin
  • incision/drainage if abscess present
60
Q

Which antibiotic should be used in puerperal mastitis?

A

Flucloxacillin

61
Q

Why should abscesses be drained before use of antibiotics?

A

Antibiotics don’t tend to work if there is pus present

62
Q

Give 3 other causes of puerperal sepsis

A
  • pneumonia
  • intravenous catheter-related infection
  • wound infection eg. C-section
63
Q

What is neonatal sepsis?

A

A syndrome resulting from invasion of pathogenic bacteria into the blood

64
Q

What is a common complication of neonatal sepsis?

A

Neonatal meningitis

65
Q

“early onset” infection present within how many weeks of birth?

A

Within 2 weeks of birth

66
Q

Signs of neonatal sepsis/meningitis may be what?

A

Subtle/atypical eg. not feeding, diarrhoea etc

67
Q

What are the temperature symptoms of neonatal sepsis/meningitis?

A

hypothermia or pyrexia

68
Q

What are the respiratory symptoms of neonatal sepsis/meningitis?

A
  • dyspnoea
  • apnoeas
  • cyanosis
69
Q

What are the cardiovascular symptoms of neonatal sepsis/meningitis?

A
  • tachycardia
  • bradycardia
  • hypotension
70
Q

What are the hepatic symptoms of neonatal sepsis/meningitis?

A
  • hepatomegaly

- jaundice

71
Q

What are the GI symptoms of neonatal sepsis/meningitis?

A
  • anorexia
  • vomiting
  • abdominal distension
  • diarrhoea
72
Q

What are the haematological symptoms of neonatal sepsis/meningitis?

A

Bleeding disorders

73
Q

What are the CNS symptoms of neonatal sepsis/meningitis?

A
  • lethargy
  • irritability
  • seizure
74
Q

What are the common causative organisms of neonatal sepsis/meningitis?

A
  • group B streptococcus
  • escherichia coli
  • (listeria monocytogenes - very rare)
75
Q

How is neonatal sepsis/meningitis diagnosed?

A

Blood, urine, and CSF culture (lumbar puncture) - to determine origin of sepsis

9. CP - Diseases of the Reproductive System (5 decks)

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