49 Infections of pregnancy, puerperium and neonate Flashcards
Define puerperium:
The weeks following delivery in which the mothers tissues return to a non-pregnant state. 6-8 weeks.
Define neonate.
An infant less than 4 weeks old.
Which infections can be transmitted from mother to baby during pregnancy? (6).
Cytomegalovirus. Parvovirus B19. Toxoplasmosis. Syphilis. Varicella Zoster. Zika.
Which infections can be transmitted form mother to baby during delivery? (6).
Group B streptococcus. Herpes simplex virus. Gonorrhoea. Chlamydia. HIV. Hepatitis B.
How do serum levels of antimicrobials change during pregnancy?
Increased glomerular filtration rate increase renal excretion.
Serum levels lower.
Which antimicrobials cross the placenta?
All to some extent.
Which antimicrobials are safe in pregnancy? (2).
Penicillins.
Cephalosporins.
Which antibiotics aren’t safe in pregnancy? (4).
Chloramphenicol.
Tetracycline.
Fluoroquinolone (ciprofloxacin).
Co-trimoxazole.
How are viral infections diagnosed during pregnancy?
Serology/PCR of blood, vesicle fluid, amniotic fluid.
What is bacteriuria associated with in pregnancy? (2).
Premature delivery.
Increased peri-natal mortality.
How are UTI’s treated in pregnancy?
7 days non-toxic antibiotic:
Amoxicillin or trimethoprim.
How should trimethoprim be used in pregnancy? (2).
Not in first trimester.
Given with folate.
What are intra-amniotic infections associated with in pregnancy? (3).
Pre-term labour.
Peri-natal morbidity and mortality.
Define chorioamnionitis:
Inflammation of umbilical cord, amniotic membranes and placenta.
What are the clinical features of intra-amniotic infection? (5).
Sustained maternal fever >38o. Uterine tenderness. Malodorous amniotic fluid. Increased white cell count. Maternal/foetal tachycardia.
What are the risk factors for intra-amniotic infection? (5).
Prolonged rupture of the membrane. Amniocentesis. Chordocentesis. Cervical cerclage. Multiple vaginal examinations.
What is the pathogenesis of intra-amniotic infection? (2).
Spread up cervix.
Rarely haematogenous: listeria monocytogenes.
What are the organisms that commonly cause intra-amniotic infections?
Group B Streptococcus.
Enterococci.
Escherichia coli.
What is puerperal endometritis?
Infection of the womb in puerperium.
What are the risk factors for puerperal endometritis? (4).
C sections.
Prolonged labour.
Prolonged rupture of membranes.
Multiple vaginal examinations.
What are the features of puerperal endometritis? (6).
Fever (38.5 in 1st 24hr or 38 >4hrs after 24hr). Uterine tenderness. Purulent, foul smelling lochia. Increased white cell count. General malaise. Abdominal pain.
What are the causes of puerperal endometritis? (3)
Escherichia coli.
Beta-Haemolytic streptococci.
Anaerobes.
How is puerperal endometritis treated?
Broad spectrum IV antimicrobials until 48 hours apyrexial.
What are the clinical features of puerperal mastitis? (6).
Mean onset?
Abrupt onset chills, fever and soreness.
Red, warm and tender breast.
5.5 weeks post delivery.
What is the most common form of puerperal mastitis?
How is it treated? (3).
Staphylococcus aureus.
Optimising nursing techniques and breast care, flucloxacilllin, incision + drainage if abscess.
What are the clinical features of neonatal sepsis/meningitis?
Abnormal temperature. Dyspnoea, apnoea, cyanosis. Tacky/bradycardia, hypotension. Hepatomegaly + jaundice. Anorexia, D+V, abdominal distension. Bleeding disorders. Lethargy, irritability, seizures.
What are the common causes of neonatal meningitis/sepsis?
Group B streptococcus.
Escherichia coli.
Listeria monocytogenes.
What is the common antibiotic combination for neonatal sepsis/meningitis?
Amoxicillin and gentamicin.
