Disease of Reproductive System - Part 2 Flashcards
What is pregnancy
conception to delivery
What is puerperium
The few weeks following delivery during which the mothers tissues return to their non pregnant state (6-8 weeks)
What are neonates
Newborns less than 4 weeks old
Diseases that can be transmitted from mother to baby during pregnanct
VZV, CMV, Parvovirus, Toxoplasmosis, Syphilis, Mosquito
Reach via haematogenous
How are VZV, CMV & Parvovirus spread
Respiratory/droplet secretions
How is tozoplasmosis spread
Ingestion of an oocyte
How it syphilis spread
Sexual
How is zika spread
Mosquito bites
What disease are transmitted from mother to baby during delivery
Group B streptococcus, HSV, gonorrhoea, chlamydia, HIV, Hep B
HSV Must be active to transmit
What does gonorrhoea require to be transmitted during delivery
Mucosal contact
E.g. eyes causing conjunctivitis
How does drugg handling differ in pregnancy
Increased GFR causes increased renal excretion of many antimicrobials - serum levels of antimicrobials generally lower hence many effectively underdosed
Do antimicrobials appear in the breast milk
Usually all do
What are 2 safe antimicrobials in pregnancy
Penicillin and cephalosporins
What antimicrobials aren’t safe in pregnancy
Choloramphenicol
Tetracylcine
Fluoroguinolones (ciprofloxacin)
Trimethoprim - sulphamethoxazole
2 teratogenic viruses
Rubella and zika
How do we test for viral infections
Serology and PCR (PCR more reliable)
Why do we treat asymptomatic bacteriruire
Can become sypmtomatic causing premature delivery and increased perinatal mortality
How do we treat UTI’s in pregancny
7 days non-toxic antibiotics (amoxicillin or cefalexin or trimethoprim)
Trimethoprim is a folate antagonist so give folate - and avoid in 1st trimester
What is chorioamnionitis
Inflammation of the umbilical cord, amniotic membrane, placents
Presents with a fever
Presentation of chorioamnionitis
Sustained maternal fever Uterine tenderness Malodorous amniotic fluid Maternal/foetal tachycardia Increased WBC's
Risk factors of chorioamnionitis
Prolonged rupture of membranes
Amniocentesis, cardiocentesis, cervical cirvlage, multivple vaginal examinatins, BV
Causative organisms of chorioamnionitis
Group B Streptococcus (normal vaginal flora)
Enteroccoi, E, Coli (normal in GI)
Rare haemoatogenous cause of chorioamnionitis
Listeria
Treatment of chorioamnionitis
Antimicrobials and delivery of foetus - treat at diagnosis
What is puerperal endometritis
Infection of womb during puerperium
Puerperium sepsis is a major cause of death
Risk factors of puerperal endometritis
Caesarean, prolonged labour, prolonged rupture of membranes, multiple vaginal examinations
Presentation of puerperal endometritis
Fever (over 38.5), uterine tenderness, purulent foul smelling lachia, High WCC, general malaise, ado pain, fl like sympotms
Causes of puerperal endometritis
E coli
Beta haemolytic Streptococi
Anarobes
Diagnose of puerperal endometritis
Blood cultures for systemic symptoms
Swabs not usefl
Treatment of puerperal endometritis
Broad spectrum IV - co-amoxiclav
Clinical features of puerperal mastitis
5.5 weeks post delivery Abrupt onset fever Chills Breast soreness Redness Warmth Breast tenderness
What causes puerperal masitics
Staphylcoccus aureus
How to diagnose puerperal mastitis
Clinical and pus culture
How do we treat puerperal mastitis
Flucloaxcillin (hs activity against B-lactamase producing organsims)
Other causes of puerperal sepsis
Pneumonia, IV related infection, C section/wound infection
What does treat staph aureus
Amoxicillin as staph aureus produces beta lactamase
What is sepsis
Syndrome resulting from invasion of pathogenic bacteria into blood
Early onset within 2 weeks after birth
Clinical features of sepsis in neonates
Hypothermia/pyrexia Dyspnoea, apnoea, cyanosis Tachycardia, bradychardia, hypotension Hepatomegaly, jaundice Anorexia, vomitig, abdo distention, diarrhoea Bleeding disorders Lethargy/irritable
VARYING PRESENTATION
Causes of neonatal spsis
Group B Streptococci
E coli
Listeria (but rare)
Treatment of neontala sepsis
Broad spectrum antibiotics:
Amoxicillin (against listeria in high doses)
Gentamicin (against in E. Coli)TI
What is an STI
transmitted person - person by sexual contact - may be asymptomatic
What is an STD
Have evidence of a disease
What is a genital infectious disease
Not always acquired by sexual transmittion - can be normal vaginal & GI flora
Organisms causing local infection
Gonorrheae, HSV, HPV, Trichomonas Vaginalis