ch 7 + 35, substance abuse and infection Flashcards
examples transplacental organism infections
-HIV
-CMV
-rubella
examples organisms ascending into vagina to cause infection
-GBS
-E coli
examples organisms that cause infection from direct contact at birth
-herpes
perinatal infections risk factors
-h/o multiple sex partners
-previous h/x of STI or vaginal infections
-employment with high exposure to children
general S+S STI
*flu like S+S for mom, plus:
-vaginal discharge
-genital lesions
-dysuria
-painful intercourse
lab studies perinatal infections
-antibody titers
-TORCH
-VDRL
-RPR
-gonorrhea
-vaginal wet mount
which maternal immunoglobulin passes through the placenta? which does not?
passes: IgG
doesn’t: IgM
possible consequences of all infections
-abortion
-IUGR
-premature labor
-severe neonatal sepsis
-long-term carrier status
what is screened for on TORCH
Toxoplasmosis
Other (syphilis, gonorrhea, hepatitis, varicella, HIV)
Rubella
CMV
Herpes simplex
how is toxoplasmosis acquired
raw meat
unpasteurized milk
exposure to cat feces
classic triad in neonate presentation of toxoplasmosis
-hydrocephalus
-chorioretinitis (blindness)
-cerebral calcifications
possible maternal effects of syphilis
-chancere
-late abortion
-positive abx screen (VDRL, RPR)
possible fetal effects of syphilis
-stillbirth
-hydrocephaly
-cataracts
-**copper colored rash
-cracks around mouth
-hypothermia
Tx syphilis
-penicillin G
-erythromycin before 16 weeks
screens for syphilis
VDRL
RPR
S+S congenital rubella (severe anomalies if infection before 12 weeks EGA)
-blueberry muffin rash
-IUGR
-cardiac defects
-cataracts/glaucoma
-hearing loss
possible neonatal consequences of CMV
-IUGR
-microcephaly
-jaundice
-anemia
-deaf
-mental retardation
-rash
-hepatosplenomegaly
-cerebral palsy
possible consequence untreated hep b
preterm birth
what baby receives immunoglobulin for hep b after birth
mom had hep b surface antigen positive
possible consequences for fetus if mom has varicella zoster (chicken pox) before 20 weeks EGA (early transplacental transmission)
-limb atrophy
-neurologic anomalies
-IUGR
-eye abnormalities
high risk exposure time for fetus with varicella zoster? what can happen?
-last 3 weeks pregnancy (close to birth)
-neonatal varicella
-increased infant mortality rate
if women are exposed to varicella zoster when should they receive immunoglobulin (Vzig)? what about baby?
within 72 hrs
baby: 5 days before - 2 days after birth
S+S HPV
small or large wart like growths on vulva, vagina, cervix, or rectum
possible fetal effects of HPV
possible chronic resp papillomatosis
can herpes simplex virus be transmitted transplacentally
very rare
usually contracted during birth from lesions
optimal mode of delivery if mom has active lesions from herpes simplex virus
C/S
possible consequences for babies born with congenital herpes simplex virus
-neonatal viral sepsis
-herpetic lesions on eyes, skin
-pneumonia
-herpes enchephalitis
-neurological abnormality
-possible death
Tx babies born with congenital herpes simplex virus
acyclovir
maternal effects of gonorrhea
-dysuria
-purulent vaginal discharge
-PID
fetal effects of gonorrhea
-ophthalmia neonatorum (blindness)
-sepsis
Tx gonorrhea
-penicillin and/or erythromycin and ceftriaxone
Tx to avoid perinatal transmission of HIV
-antiretroviral meds
-C/S (can have vaginal birth if viral load <1000 at 36 weeks EGA)
-no breastfeeding
-no FSE or fetal scalp blood sampling
-avoid forceps and vaccuum
what must be done for fetus after birth (born to HIV+ mom) before he can receive shots
bath
maternal effects chlamydia trachomatis
-mucopurulent vaginal discharge
-dysuria
-acute salpingitis (inflammation of fallopian tubes)
-PID
-sterility/infertility
fetal effects chlamydia trachomatis
-still birth/neonatal death
-preterm birth
-blindness
-pneumonia
Tx chlamydia
erythromycin
maternal effects bacterial vaginosis
-milklike discharge with fishy odor
-itching, burning, pain
-risk for PROM
-risk for PP endometritis
fetal effects bacterial vaginosis
-neonatal sepsis
-death
Tx bacterial vaginosis
-clindamycin
-ampicillin
-metronidazole
what med used to treat bacterial vaginosis (and some other vaginal infections) is contraindicated in the 1st (and sometimes 2nd) trimester of pregnancy because of its effects on the fetus
metronidazole (flagyl)
maternal effects yeast infections
-odorless, thick vaginal discharge
-cheesy appearance
-severe vaginal itching
-painful intercourse
fetal effects yeast infection (contracted at birth)
-oral yeast infection (thrush)
-perineal rash
what women are yeast infections more common in
-diabetics
-taking longterm antibiotics
Tx yeast infections
-miconazole nitrite cream or nystatin cream during pregnancy
-wear cotton underwear
-no sex until cured
Tx baby thrush/oral candidiasis
-topical application nystatin to mouth 4x/day for 14-21 days
-if breastfeeding: mom rubs some on nipples too
maternal effects trichomoniasis vaginalis
-profuse, frothy yellow discharge
-irritation
-itching
-dysuria
-painful intercourse
fetal effects trichomoniasis
none
Tx trichomoniasis
-vaginal suppositories to reduce S+S during 1st and 2nd tris
fetal effects GBS
-neonatal sepsis
-resp distress
risk factors transmission GBS
-PPROM
-preterm labor
-preterm birth
-chorio
when do pregnant women get rectovaginal culture to test for GBS
35-37 weeks EGA
prophylactic Tx pregnant woman with GBS
-intrapartum Tx ABX
what moms that are not tested for GBS would receive antibiotics for GBS intrapartum
-preterm labor
-h/x of preterm birth
-h/x of neonate with GBS
-prolonged ROM
-S+S GBS
-if untested, assumed +
neonatal Tx GBS
-ABX (ampicillin, penicillin, aminoglycoside)
2 categories neonatal sepsis
early onset: first 7 days life
late onset: day 7-30
risk factors early onset neonatal sepsis
-prematurity
-ROM >18hrs
-invasive procedures during L&D (FSE)
-resuscitation after birth
-maternal fever
-maternal GBS+
2 most common organisms causing early onset neonatal sepsis
-GBS
-E coli
S+S early onset neonatal sepsis
-lethargy
-poor feeding
-temperature instability
-subtle color changes (mottling, duskiness)
-resp distress, apnea
labs for babies at risk for early onset neonatal sepsis
-blood
-CSF
-urine
Tx neonatal sepsis
-ABX
-IV fluids
-encourage mother to breastfeed or pump
-emotional support (for mom
mom w/ untreated syphyilis: can baby room in and breastfeed
no rooming in
no breastfeeding
*until receives Tx
mom w/ untreated gonorrhea: can baby room in and breastfeed
no rooming in
no breastfeeding
*until receives Tx
mom w/ HIV/AIDS: can baby room in and breastfeed
can room in (strict handwashing)
no breastfeeding
mom w/ acute CMV: can baby room in and breastfeed
can room in
no breastfeeding
why is 1st tri sonogram helpful when mom has substance addiction
helps screen for fetal anomalies, measure growth
mom w/ chlamydia: can baby room in and breastfeed
yes breastfeeding
yes room in?
mom w/ gonorrhea treated for 24 hrs: can baby room in and breastfeed
yes breastfeeding
room in?
mom w/ hepatitis: can baby room in and breastfeed
yes breastfeeding
room in?
mom w/ herpes: can baby room in and breastfeed
yes breastfeeding unless lesion on breast/nipple
yes room in?
mom w/ syphilis treated for 24 hrs: can baby room in and breastfeed
yes breastfeeding after Tx unless lesion on breast/nipple
yes room in?
