amboss pregnancy Flashcards
what is the best strategy for avoiding SIDS
having the baby sleep in supine position, without blankets or pillows, avoiding secondhand smoke. do not ever sleep with the baby
is a fetus at risk for rubella
yes, but only if infected after 20 weeks gestations
what is the presentation of rubella
post auricular lymphadenopathy, rash that spreads from the face to the periphery.
what is the treatment for rubella
there is no specific treatment
what is the presentation of congenital rubella infection
Cataracts: Other eye manifestations may also occur later in life (e.g., salt and pepper retinopathy, glaucoma).
Cochlear defect: bilateral sensorineural hearing loss
Cardiac defect: most common defect (e.g., patent ductus arteriosus, pulmonary artery stenosis)
TRIPLE C Cardiac anomaly, Cataracts, cochlear defects
what is the presentation of congenital CMV infection
Increased risk of fetal demise
Intrauterine growth restriction
Oligohydramnios or polyhydramnios, placental abnormalities
periventricular calcifications, hyperechogenic foci (bowel and liver, ascites), and hydrops fetalis intraventricular hemorrhage
Microcephaly .
Sensorineural hearing loss (∼ 30%)
Chorioretinitis (∼ 10%)
what is the treatment for congenital CMV
Severe anemia: intrauterine blood transfusions
Thrombocytopenia: platelet transfusions
Newborn
Supportive therapy of symptoms (e.g., fluid/electrolyte imbalances, anemia, thrombocytopenia, seizures, secondary infections)
Ganciclovir, valganciclovir, or foscarnet
Mother: valacyclovir is the only therapy approved during pregnancy; trials with CMV specific hyperimmune globulin ongoing
which herpes is responsible for congenital herpes
HSV-2; rarely 1
congenital herpes infection
Intrauterine HSV infection (congenital herpes simplex virus infection) (∼ 5% of cases)
Fetal demise, preterm birth, very low birth weight
Microcephaly, hydrocephalus, and other CNS defects
Microphthalmia → chorioretinitis
Vesicular skin lesions
Perinatal and postnatal transmission
Skin, eye, and mouth disease
Vesicular skin lesions
Keratoconjunctivitis → cataracts, chorioretinitis
Vesicular lesions of oropharynx
CNS disease
Meningoencephalitis (manifesting with fever, lethargy, irritability, poor feeding, seizures, bulging fontanelle)
Possibly vesicular skin lesions
what is the treatment for postpartum endometritis
IV clindamycin and gentimicin
alternatively amipicillin-sulbactam for clindamycin
what causes pulmonary and hepatic granuloma of the newborn
this is granuloma infantiseptica which is caused by listeriosis
if a Rh(-) mother gave birth to a Rh(+) baby what is the next child at risk of
hemolytic disease of the newborn.
what is the prevention for hemolytic disease
Rhogan anti-D immunoglobulin
what are the screening parameters for Rh-D
If the first anti-D screen shows that the mother is unsensitized, guidelines recommend that she should undergo repeat screening between 24 and 28 weeks’ gestation, If the anti-D screen remains negative, anti-D immunoglobulin should be administered in the 28 week’ gestation and within 72 hours following delivery of a Rh(D) positive child.
when do RhD(-) mothers not need anti-D immunoglobulin
If the father of the baby is Rh(D) negative.
what is the presentation of varicella in the newborn
vesicular like rash, pneumonia and encephalitis
what is the management for a birthing mother with active herpes infection
oral acyclovir and C-section
what is the risk for vertical transmission of HSV if the birthing mother has an active infection
The risk for vertical transmission to the neonate from an infected mother is high (up to 50%) among women who exhibit active genital herpes near the time of delivery.
what is the treatment for congenital chlamydial eye infection
oral erythromycin.
topical is preventative
what is the risk of oral erythromycin
hypertrophic pyloric stenosis
what is the risk of not treating chlamydial eye infection in the new born
chlamydial pneumonia
when is intubation recommended for neonate
if there is cyanosis, poor respiratory effort or wheezing
what is the treatment for neonatal pneumonia
ampicillin and gentamicin
what are the most likely pathogens for neonatal pneumonia
group B Streptococcus, E. coli, coagulase-negative Staphylococcus, S. aureus, Klebsiella)
what is the treatment Following confirmation of gonococcal neonatal conjunctivitis (using culture and Gram stain or PCR),
systemic treatment with either an IV or an IM 3rd-generation cephalosporin (e.g., ceftriaxone) is indicated. In addition, the eyes should be flushed with saline until the discharge clears.
Does topical antibiotic treatment cover chlamydial eye infections
NO. gonococcal only
what is the treatment for chorioamionitis
Treatment depends on whether the birth is vaginal (requiring IV ampicillin plus gentamicin) or cesarean (requiring IV ampicillin and gentamicin, plus clindamycin).
simply put, ampicillin and gentimicin. if C-section, add clindamycin
what is the most common ABO incompatibility
usually limited to mothers with O group. and this course is mild
do you give MMR to pregnant women
no. it is a live vaccine
what vaccines duo you give to unvaccinated pregnant women
Tdap and influenza
do you give varicella vaccine to pregnant women
no. live vaccine
why give Tdap top pregnant women
because of the risk of tetanus in delivery
if a pregnant woman is not vaccinated against Hep b and has never had an infection, do you vaccinate
no. low risk
what is the most likely cause of neonatal sepsis <72 hrs post birth
Strep agalacteia
what is the management of someone with chorioamionitis that is term
antibiotics and induce labor
what do you treat UTI in pregnancy
amoxicillin clav
Can you use fluoroquinolones in pregnnacy
no
Can you use Bactrim in pregnancy
yes as an alternative in the 2 and 3 trimesters. in general stay away from it
Indications for GBS prophylaxis include
maternal GBS colonization, GBS bacteriuria occurring during pregnancy, or history of a previous newborn with GBS infection (as in this patient).
what is the preferred treatment for GBS
intravenous penicillin G
if someone does not get screened for GBS and is in labor what is the management
do not screen, just treat
what is the presentation of congenital toxoplasmosis
calcifications throughout the brain, not just periventricular. hydrocephalus, ventriculomegaly, hearing loss.
what is the most immediate medical treatment for transposition of the great vessels
prostaglandin administration
baby that sweats and is uncomfortable during feedings
PDA
what is the treatment for PDA
percutaneous intervention if the child is >5kg and is full term;
indomethacin if premature or less than 5 KG
what is the presentation of meconium illues and what is the treatment for it
dilated loops of small bowel, meconium present, mircocolon.
gastrogaffin enema is both diagnostic and therapeutic. this assesses for obstruction
what cardiac condition is present in a high percentage of patients with fragile X
mitral valve prolapse/regurgitation
the prolapse leads to the regurg over time
where is cephalohematoma
under the periosteum but above the bone
subgaleeal hematoma is where
above the periosteum and under the epicranial aponeuroses
what is the presentation of subgaleal hematoma
hypotension, blood loss, pulsatile mass under the skin, tachycardia and pallor
what cardiac anomaly is present in Edwards syndroem
VSD
prognosis for edwards
The prognosis for patients with Edwards syndrome is poor, with the majority dying in utero and 5–10% surviving past 12 months of age
what cardiac malformations are present for downs and patau
VSD –same as edwards
Serum bilirubin levels > what level are suggestive of pathological jaundice
15 mg/dL
what serum bilirubin prompt phototherapy
Varies depending on age of infant.
>20 in a 4 day old infant
what is the quad test
beta hCG, inhibin A, estriol, AFP