CBL 5 – Teen Pregnancy, GBS bacteriuria, PPROM Flashcards
What is an emancipated minor?
Simple emancipation allows a minor to perform certain acts as though they were of full age : living independently from guardian and/or is a guardian themselves.
Age of consent?
16 but some allowance if there is a 5 year age difference
What is a mature minor?
Fully appreciate medical choices and fully give consent for med choices – able to give consent
Mature minor means a person less than eighteen years of age who has been determined by a qualified physician, a qualified psychologist or an advanced nurse practitioner to have the capacity to make health care decisions.
Risk factors associated w teen pregnancy? (8)
PTL/PTB
PPROM
Alcohol and substance use
IPV
Mood disorders
Anemia
Congenital anomalies
Higher rates of BF discontinuation
How many cases of chlamydia are asymptomatic?
75%
If someone comes back with positive screen for BV but is asymptomatic should you treat?
YES
BCCNM indications for teen preg?
Discussion with another HCP >17 yo
Consultation physician >14 yo
Rate of teen pregnancy in Canada?
5.5 % ?
Threshold CFU for Tx for GBS bacteriuria?
Greater/Equal 100,000 CFU/mL (reported sometimes as:
* 1 x 10^8 CFU/L
* 1 x 10^5 CFU/mL)
Tx for chlamydia?
Amox 500 mg PO TID x 7 days OR arythromycin 1 g PO single dose
Partner: doxycycline 100 mg BID x 7 day OR arythromycin 1 g PO single dose
Test of cure 3-4 wks AND be tested again in T3
Don’t have unprotected sex 7 days after Tx
Things to remember for chlamydia mgmgt?
Reportable to public health or BCCDC
If G Tx fails?
Reported to local health authorities/consult with infectious disease specialist
Partner reporting for C/G?
All partners who have had sexual contact within 60 days before symptoms started/positive testing conducted should be notified, tested, and treated before results come back (1,9)
The last partner (even if it’s been longer than 60 days) should be notified (9)
What approach should be taken to caring for pregnant teens?
The SOGC recommends multidisciplinary care from early in pregnancy, preferably in a model that allows them to access all practitioners/needs at a single site.
What is often present with Chlamydia?
Gonorrhea and vice versa
When is Tx for gonorrhea/chlamydia indicated? (3)
- Positive test result
- Presumed case before test results because of symptoms
- Partner diagnosed
- If positive for G or C
What is the most common STI?
Chlamydia
Care for newborns born to parent with untreated gonnorhea?
Tx
Care for nb born to parent with untreated chlamydia?
Don’t Tx unless results positive
What is GBS bacteriuria?
- GBS bacteriuria is the presence of Group B Streptococcus in the urine at any time in pregnancy.
- Most often seen as an Asymptomatic bacteriuria (ASB)
How is GBS bacteriuria managed in birth?
Anyone with documented bacteriuria should be treated as GBS positive at delivery and do not need routine GBS swabbing
Risk factors of GBS bacteriuria? (3)
- History of UTI’s
- Pre-Existing Diabetes
- Low socioeconomic status
Should PPROM do expectant mgmt.?
If everyone stable, expectant mgmt. may be reasonable
Management of PPROM?
- Discuss with clients regarding the benefits and risks of expectant management vs IOL, in the context of their GA.(2,8)
o For clients <35 weeks GA, delaying birth is recommended (if no other risks or contraindications).(2,8) - Offer GBS swab to confirm GBS status (2)
- Offer vitals, CBC, EFM, and US (as recommended per SOGC guidelines)(2)
- For those <35 weeks GA – consider offering antenatal corticosteroids.(2,8)
o Betamethasone and dexamethasone - For those <37 weeks GA – offer antibiotics to delay onset of labour & prevent infection.(2,8)
Abx and mgmt for PPROM if expectant mgmt.?
Mercer Protocol
- Prophylactic antibiotics should be stopped after 7 days of treatment.(8)
- Continue fetal surveillance, and monitor for signs of infection.(8)
o Recommendations per PSBC (8):
§ Take temperature q 6 – 8 hours
§ Fetal movement counts daily
§ NSTs x 3 weekly (or daily if admitted)
§ Growth & fluid US q 2 weeks
Risks of GBS bacteriuria? (4)
- Pyelonephritis: Upper urinary tract-> kidneys(1,4)
- Increased risk of chorioamnionitis (1,2,3)
- Untreated can lead to pre-term birth, preeclampsia
- GBS disease of the NB
Positive GBS bacteriuria, but below 100x10^6 no symptoms?
No Tx
GBS pos for birth
Postive GBS bacteriuria but below 100^6 symptoms?
Tx AND GBS + birth
Positive GBS bacteriuria above 100^6 symptoms or none?
Tx AND GBS + birth
Tx for GBS bacteriuria ?
Pen VK 300 mg QID 5-7 days, TOC
