CBL 5 – Teen Pregnancy, GBS bacteriuria, PPROM

Question 1

What is an emancipated minor?

Answer 1

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.

Question 2

Age of consent?

Answer 2

16 but some allowance if there is a 5 year age difference

Question 3

What is a mature minor?

Answer 3

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.

Question 3

Risk factors associated w teen pregnancy? (8)

Answer 3

PTL/PTB
PPROM
Alcohol and substance use
IPV
Mood disorders
Anemia
Congenital anomalies
Higher rates of BF discontinuation

Question 4

How many cases of chlamydia are asymptomatic?

Answer 4

75%

Question 4

If someone comes back with positive screen for BV but is asymptomatic should you treat?

Answer 4

YES

Question 5

BCCNM indications for teen preg?

Answer 5

Discussion with another HCP >17 yo
Consultation physician >14 yo

Question 6

Rate of teen pregnancy in Canada?

Answer 6

5.5 % ?

Question 7

Threshold CFU for Tx for GBS bacteriuria?

Answer 7

Greater/Equal 100,000 CFU/mL (reported sometimes as:
* 1 x 10^8 CFU/L
* 1 x 10^5 CFU/mL)

Question 7

Tx for chlamydia?

Answer 7

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

Question 8

Things to remember for chlamydia mgmgt?

Answer 8

Reportable to public health or BCCDC

Question 9

If G Tx fails?

Answer 9

Reported to local health authorities/consult with infectious disease specialist

Question 10

Partner reporting for C/G?

Answer 10

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)

Question 11

What approach should be taken to caring for pregnant teens?

Answer 11

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.

Question 11

What is often present with Chlamydia?

Answer 11

Gonorrhea and vice versa

Question 12

When is Tx for gonorrhea/chlamydia indicated? (3)

Answer 12

• Positive test result
• Presumed case before test results because of symptoms
• Partner diagnosed
• If positive for G or C

Question 12

What is the most common STI?

Answer 12

Chlamydia

Question 13

Care for newborns born to parent with untreated gonnorhea?

Answer 13

Tx

Question 14

Care for nb born to parent with untreated chlamydia?

Answer 14

Don’t Tx unless results positive

Question 15

What is GBS bacteriuria?

Answer 15

• 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)

Question 16

How is GBS bacteriuria managed in birth?

Answer 16

Anyone with documented bacteriuria should be treated as GBS positive at delivery and do not need routine GBS swabbing

Question 17

Risk factors of GBS bacteriuria? (3)

Answer 17

• History of UTI’s
• Pre-Existing Diabetes
• Low socioeconomic status

Question 18

Should PPROM do expectant mgmt.?

Answer 18

If everyone stable, expectant mgmt. may be reasonable

Question 19

Management of PPROM?

Answer 19

• 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)

Question 20

Abx and mgmt for PPROM if expectant mgmt.?

Answer 20

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

Question 21

Risks of GBS bacteriuria? (4)

Answer 21

• 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

Question 22

Positive GBS bacteriuria, but below 100x10^6 no symptoms?

Answer 22

No Tx
GBS pos for birth

Question 23

Postive GBS bacteriuria but below 100^6 symptoms?

Answer 23

Tx AND GBS + birth

Question 24

Positive GBS bacteriuria above 100^6 symptoms or none?

Answer 24

Tx AND GBS + birth

Question 25

Tx for GBS bacteriuria ?

Answer 25

Pen VK 300 mg QID 5-7 days, TOC