Ch 10 Infections Diseases in Pregnancy

Question 1

asymptomatic bacteriuria is screened for as part of routine pregnant care and is associatd with significant risk in pregnancy

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Question 2

prevalence of ASB >100,000 colonies in culture ranges from 2-11%

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Question 3

women with abs are 20-30 fold increased risk of developing acute pyelonephritis during pregnancy \

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Question 4

abs in pregnancy is further associated with low birth weight infants and PTL

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Question 5

urinalysis might be positive for leukocyte esterase, nitrates, or hematuria, and the urine sediment will have elevated wbcs and bacteria.

nitrates are sensitive and specific to gram - negative bacteria.

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Question 6

ecoli accounts for > 80% of all ASB and UTI

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Question 7

treatment of ASB is usually with
amoxicillin, nitrofurantoin
trimethoprim/sulfamethoxazole
or cephalexint

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Question 8

because ASB may persist, a test of cure culture should be obtained 2 weeks after completion of therapy

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Question 9

wbc casts are highly associated with pyelonephritis. onset of symptoms is often abrupt and fever is universally present

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Question 10

in adddition to treating infection, in patients with dysuria or bladder pain, pyridium which is concetrated in the urine acts as a local anesthetic to reduce the pain, is commonly used for symptomatic relief.

patients should be counseled that pyridium will cause the urine to turn bright orange

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Question 11

most common complication of lower UTI is ascending infection to the kidneys, or pyelonephritis.

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Question 12

pyelonephritis is characterized by fever, chills, flank pain, dysuria, urgency, and frequency. it is sometimes associated with nausea and vomiting. oh PE, fever and costovertebral angle tenderness are often present.
lab abnormalities:
pyuria
bacteriuria
elevated WBC
WBC casts (highly associated with pyelonephritis)

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Question 13

pyelo a risk factor for preterm labor and particularly serious associated maternal complications including septic shock and ARDS. up to 20% of pregnant women with acute pyelonephritis develop multiorgan system involvement secondary to endotoxemia, resulting in sepsis.

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Question 14

GBS refers to beta hemolygic gram-positive bacteria streptococcus agalactiae and is commonly responsible for UTIs, chorioamnionitis, and endomyometritis during pregnancy. it is also a major pathogen in neonatal sepsis which has severe implications.
mortality rate with GBS is 2-50%women with hx of GBS UTI or a history of previous infant with GBS disease should be treated independent of screening

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Question 15

gbs only good for 5 weeks

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Question 16

chorioamnionitis is infection of memebranes and amnioti fluid surrounding the fetus. frequently associated with preterm and prolonged ROM but can also occur without ROM

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Question 17

herpes simplex virus serious infection with significant morbidity and mortality

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Question 18

hsv2 clasically causes genital herpes,

primary infections are astymptomatic in 50% of patients and are responsible for approx 90% of neonatal herpes. risk of transmission to neonate with primary outbreak is 20-50%risk of transmission with recurrent herpes with active lesions is approx 1%.

latent infection occurs after a primary infection. virus resides in the dorsal root ganglion and peripheral nerves can shed virus symptomatically / asymptomatically

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Question 19

ideal method of testing for genital herpes is through scraping of the lesions and sending for viral detection through PCR. virial culture is less sensitive than PCR, and additional assays are less specific.

antibody detection techniques include use of serologic tests to detect presence of antibodies to etiehr hsv2 or hsv1.

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Question 20

varicella zoster virus -highly contagious dna herpes virus transmitted by respiratory droplets / close contact and causes the disease chicken pox

it can later reactive to cause herpes zoster / shingles

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Question 21

vzv causes svereal symdromes relevant to pregnancy including

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maternal varicella pneumonia
congenital varicella syndrome
neonatal varicella infection

Question 22

vav pneumonia in pregnancy is a risk factor for maternal mortality

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Question 23

congenital varicella predominantly when mothers are infected between 8-20 weeks of gestation. congenital varicella syndrome is characterized by

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skin scarring
limb hypoplasia
chorioretinitis
microcephaly
30% mortality in 1st year of life.

Question 24

maternal infection in 3rd trimester, virus can cross the placenta and infant has insufficient cell-mediated immunity to prevent hematogenous dissemination of virus and cause neonatal varicella.
neonatal VZV is associated with high neonatal dealth rate.

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Question 25

infants of mothers who develop varicella disease within 5 days before delivery or 2 days after should also receive varicella zoster immunoglobulin VZIG and / or treatment with antiviral agents such as acyclovir / valacyclovir

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Question 26

maternal herpes zoster, recurrent VZV outbreaks is NOT associated with congenital anomalies / neonatal varicella

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recurrent VZV outbreaks is NOT associated with congenital anomalies / neonatal varicella

Question 27

if a susceptible pregnant patient is exposed to someone with varicella, she should be treated within 72-96 hours with one of two agents to prevent active infection

Answer 27

varicella zoster immune globulin variZIG is recommended for postexposure prophylaxis, and nay woman who has exposure without a history of chicken pox or history of vaccination should be treated ( up to 10 days after exposure)

alternative method of prophylaxis is to administer oral acyclovir 800mg five times daily x 7 days.
oral valtrex 1000mg tid x 7 days

patients with pneumonia, encephalitis, disseminated infection and immunsuppressed should be hospitalized and treated with IV acyclovir

Question 28

parovirus b19 is a dna virus that causes erythema infectiosum (5th disease) a common childhood illness.

virus transmiteed by repiratory droplets and infected blood products. in pregnancy, virus transmitted transplacentally in about 35% of women.

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Question 29

low grade fever, malaise, myalgias, arthralgias, red macular “slapped cheek” facial rash.. in pregnancy, vertical transmission of virus is associated with severe sequelae and fetal death. 1st trimester infections have been associated with miscarriage, whereas emid trimester and later infections associated with fetal hydrops

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Question 30

if parovirus exposure suspected in the mother, acute infection can be diagnosed by check parovirus IGM and IgG levels. if IGM is negative and igG is positive, then patient has prior immunity and is protected against a second infection. If Igm and igg are both negative, patient does not have acute infection but is susceptible to future infections. in patients with strong exposure history and negative igm and igg, serum viral pcr should be considered because igm response takes 10 days.

if studies indicate acute paraovirus infection ( + igm and + or - igg), beyond 20 weeks, GA, fetus should undergo serial ultrasounds for 12 and up to 20 weeks after maternal infection

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Question 31

a more precise way to detect evolving fetal anemia is to use doppler velocimetry to examine the peak systolic velocity of the middle cerebral artery (“MCA).

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doppler velocimetry to examine the peak systolic velocity of the middle cerebral artery (“MCA).

Question 32

increases in peack systolic velocity are associated with

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fetal anemia

Question 33

cytomegalovirus most common cause of congenital viral infection.

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Question 34

most sensitive and specific test for diagnosing congenital cmv infection is the identification of CMV in amniotic fluid by either culture of PCR>

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Question 35

pricnipal sonographic findings suggestive of serious fetal injury are microcephaly, ventriculomegaly, intercerebral calcification, fetal hydrops, growth restriction , and oligohydramnios. less common findings include fetal heart block, echogenic bowel, meconium peritonitis, renal dysplasia, ascites, and pleural effusions. fetuses that demonstrate abnormalities, particularly if they involve cns, generally have a much poorer prognosis

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Question 36

CMV most common congenital infection, 1-2% of all neonates, and is the leading cause of congenital hearing loss.

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Question 37

infants who are symptomatic can develop cytomegalic inclusion disease manifested by a constellation of findings, including hepatomegaly, splenomegaly, thrombocytopenia, jaundice, cerebral calcifications, chorioretinitis, and interstitial pneumonitis. t

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Question 38

30% of severely infected infants die, and 80% of survivors have severe neurologic morbility such as mental retardation, sensorineural hearing loss, and neuromusclular disorder

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Question 39

currently there is no treatment or prophylaxis for the disease

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Question 40

Rubella “ german measles” rate of congenital infection sharpy declines with advancing GA, so that very few fetuses are affected if infection occurs after 18 weeks

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Question 41

4 most common amomalies associated with congeital rubella syndrome are deafness, eye defects, such as cataracts, or reinopathy CNS, and cardiac malformations

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Question 42

cd4 measurements, viral load measurements, baseline blood counts, liver and renal function tests, and drug resistance should be tested at the initial visit, and is recommended that tests repeated every 3 months during pregnancy

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Question 43

hiv + pregnant women should receive indicated vaccines if not previously faccinated including
hep a
hep b
pneumococcal vaccines.

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Question 44

gonococcal infections associated with pelvic inflammatory disease in early pregnancy, as well as preterm delivery, PPROM, and puerpal infections throughout pregnancy duration.

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Question 45

untreated endocervical gonorrhea and perinatal complcations includes:
PROM
preterm delivery
chorioamnionitis
neonatal sepsis
maternal postpartum sepsis

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Question 46

chlamydial infection during pregnancy associated with several adverse maternal outcomes, including preterm delivery, premature rupture of membranes, low birth weight, and neonatal death. untreated chlamydia include neonatal conjunctivitis or pneumonia or both.

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Question 47

prevalence of chlamydia 11%. many authorities recommend that all pregnant women be screened in the first prenatal visit. if high risk, recheck 3rd trimester.

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Question 48

in order to confirm an active hepatitis B infection, hepatitis B core antibody and hepatitis B surface antibody IgM and IgG should also be checked. patients with chronic hepatitis B are
+ for Hbsag and positive for IgM aB to the core antigen.
acutely/ chronically infection may or may not be positive for hepatitis B E antigen

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Question 49

approximately 90%of mothers who are positive for both surface antigen and the E antigen transmit infection.

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Question 50

syphilis
primary syphyilis is characterized by painless chancre.
2nd ary syphilis characterized by systemic rash, muscle sores, fatigue and myalgias.
tertiary / latent syphilis characterized by long dorman phase followed by systemic organ dysfunction including paralysis, blindness, and dementia.

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Question 51

all pregnant women screened for VDRL test or RPR test. if positive, a titer is sent.
all positive results must be confirmed with fluorescent treponemal antibody absorption FTA -ABS because there are false positives with both RPR and VDRL.
systemic lupus erythematosus and antiphospholipid antibody syndrome can cause false + rpr.

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Question 52

primary syphilis - one dose of 2.4units of benzathine penicillin G
however if
secondary syphilis/ latent syphilis, patient will require weekly treatments of 2.4million units of benzathine penicillin G for 3 consecutive weeks

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Question 53

toxoplasma gonddi is a common protozoan parasite that can be found in humans and domestic animals.
domestic cats are the only host for the oocyst.

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Question 54

symptomiatic BV associated with preterm delivery. treatment in pregnancy consists of oral metronidazole for 7 days

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Question 55

chorioamnionitis/ triple I is diagnosed by maternal fever with uterine tenderness, elevated maternal WBC count and fetal tachycardia.

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Question 56

ciprofloxacin has been associated with renal anomalies in the fetus, particularly in 1st trimester exposure

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renal anomalies.

this med is generally not given in pregnancy. amoxicillin and keflex are thought to be safe in pregnancy; both are category B which means there were no adverse outcomes in animal reproduction studies

Question 57

pyelonephritis has significant morbidity during pregnancy and is associated with high rates of ICU admission and acute respiratory distress syndrome (ARDS).

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Question 58

diagnosis of chorioamnionitis - maternal fever of greater than 39degrees C and at least one of the following signs:
elevated maternal WBC count
maternal tacycardia
uterine tenderness
fetal tachycardia
and foul smelling amniotic fluid.

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Question 59

gold standard for dx of chorioamnionitis is culture of amnioc fluid which can be obtained via amniocentesis.

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Question 60

most common organism that causes chorioamnionitis is polymicrobial infection of rectovaginal organisms

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Question 61

parovirus b19 causes erythema infectiosum 5th disease

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classified with low grade fever and red macular rash giving the “slapped cheek” appearance and usually resolves with minimal intervention.

Question 62

acute parovirus infections may be transmitted through placenta to fetus. 1s trimester infections habe been associated with miscarriage, but midtrimester and later infections are associated with fetal anemia and hydrops.

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Question 63

currently, doppler ultrasound to examine peak systolic velocity of the MCA is frequently used to identify fetal anemia

Answer 63

doppler ultrasound to examine peak systolic velocity of the MCA is frequently used to identify fetal anemia

Question 64

currently, doppler ultrasound to examine peak systolic velocity of the MCA is frequently used to identify fetal anemia

Answer 64

doppler ultrasound to examine peak systolic velocity of the MCA is frequently used to identify fetal anemia

Question 65

parovirus b19 causes fetal anemia by bone marrow suppression. severe anemia can lead to high output cardiac failure, hydrops and fetal death.

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Question 66

antiretroviral therapy recommended for all HIV + patients regardless of viral load of CD4 level.

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Question 67

currently, antiretroviral therapy in pregnancy includes a 3 drug regimen generally started preconception or at tim eof HIV diagnosis

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Question 68

3 drug cART regiment of zdv, lamivudine, and lopinavir/ritonavir

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Question 69

c/s delivery has been shown to lower transmission rates by 2/3 compared with vaginal delivery in patients on no therapy and particularly without onset of labor / rom in the setting of high viral load.

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Question 70

however, in women with VL < 1,000 copies/ mL there is no additional benefit of cs delivery vs vaginal delivery in hiv perinatal transmission. therefore, c/s delivery should be considered in HIV infected pregnant women with viral loads > 1,000 copies/ mL and without long standing onset of labor / rom

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