EXAM #2 infection/STI in pregnancy Flashcards
Cytomegalovirus
Presentations: most common perinatal infection, mononucleosis-like syndrome: fever, pharyngitis, lympadenopathy, and polyarthritis.
Spread: body fluids per nasopharyngeal secretions, urine saliva, semen, cervical secretions or blood- intimate contact required (generally not highly contagious
Risk factors: children in day care centers & classrooms
Fetal risks: first half of the pregnancy → FGR, microcephaly, intracranial calcifications, mental and motor deficit, hepatosplenomegaly, jaundice, hemolytic anemia, thrombocytopenic purpura
Late onset sequelae: hearing loss, neurological deficits, chorioretinitis, psychomotor deficits, learning disability.
Diagnostic tests: routine CMV serological screening not recommended (IgM may be present with primary, recurrent or CMV reactivation)
Toxoplasmosis
Presentation: severity of fetal infection greater if contacted late in first trimester
→ <20% presents pyrexia, fatigue, sore throat, muscle pain, posterior cervical lymph node enlargement, maculopapular rash
Spread : tissue cysts from infected meat animal ; oocytes shed in feces of infected felines; soil or water
Risk factors: associated with consumption of undercooked meat and meat products mutton/lamb meat, cured meats, and raw goat milk and milk products
Fetal risks: PTB, LBW infants
Long term sequelae including neurological anomalies not necessarily evident at birth
Diagnostic tests: DNA amplification techniques and sonographic evaluation; refer to management.
Listeriosis
Presentation: may be asymptomatic but symptoms may includes: muscle aches, diarrhea, stiff neck, HA or febrile illness confused w/ influenza, pyelo or meningitis.
Spread : unpasteurized milk and milk products include soft cheeses, melons coleslaw, apple cider, smoked seafood products, sliced deli meats, pate, hummus, wieners.
Risk factors: 27% pregnant women report case out of 3.1 million –placental trophoblasts susceptible to L.monocytogenes.
Fetal risks: PTB, fetal loss, neonatal sepsis, chorio, placental lesions
Diagnostic tests: positive blood culture
Parvovirus B19
Presentation: erythema infectiosum: slapped cheek disease or fifth disease
Spread : respiratory or hand-to-mouth ,
Risk factors: day care workers and women with school age children
Fetal risks: SAB, second and third trimester infection : fetal anemia, non-immune hydrops fetalis and fetal death.
Diagnostic tests: ELiSA and western Blot for IgG and IgM antibodies.
** IgM antibodies coincide with time of symptoms, disappear in 1-4 months IgG antibodies detectable approximately on day 7 remain for life
**if exposed & IgG negative, repeat in 2-4 weeks; if IgG positive then refer to medical management ASAP/STAT
Varicella
Presentation: one to two day prodrome then pruritic vesicular lesions, crust over 3-7 days
Spread : direct contact : incubation period 10-21 days
Risk factors: non-immune women has 60-90% risk of infection post exposure
Fetal risks: 25-40% exposes fetuses will have congenital varicella syndrome, greatest risk during the first 20 weeks, earlier in pregnancy the greater risk to fetus.
Diagnostic tests: varicella titers
GBS
- transmission : GBS ascends from the vagina to the amniotic fluid after onset of labor or rupture of membranes, although GBS also can invade through intact membranes.
- risk factors: 10-30% colonized with Group B strep in urinary tract, digestive, & reproductive tract. No way of knowing.
- diagnosis : it can come & go so test early doesn’t matter so test at the end of pregnancy.
- management: routine screening for GBS colonization is done with vaginal & rectal GBS cultures at 35-37 weeks for all pregnant women. Take 4 hours prior labor.
- treatment: penicillin
UTI
- transmission : d/t urinary stasis and vesicoureteral reflux associated with preterm or low birth weight infant.
- risk factors: African American, multiparas, sickle cell trait
- diagnosis : U/A per dipstick: + for WBC, nitrates, &/protein > trace = get culture
- management: first prenatal visit. Treat if 20,000-50,000
- treatment: empiric tx initiated pending U/C results in symptomatic women nitrofurantoin (macrobid) contraindicated near term >38 week potential for induction of hemolytic anemia in the neonate
sulfa drugs contraindicated after 36 weeks may contributed to kernicterus of the newborn
Pyelonephritis
transmission : most serious medical complication of pregnancy; leading cause of septic shock during pregnancy, common in second trimester
- risk factors: nulliparas, young
- diagnosis : unilateral & right side pain. fever chills and aching pain in one or both lumbar regions. Tenderness usually can elicited by percussion in one or both costovertebral angles.
- management: obtain blood & urine culture, IV hydration
- treatment: ampicillin PLUS gentamycin; cefazolin or cetriaxone or an extended spectrum antibiotic
Hep B
- transmission : blood transfusion, generalize infection by other viruses (Epstein-barr, hsv, measles) or nonviral causes (bacterial sepsis, syphilis)
can be chemically induced by chronic ETOH ingestion or by medication (ASA, acetaminophen, phenytoin, isoniazid, rifampin) - risk factors: blood transfusion or blood products/organs prior june 1992, previous hepatitis or jaundice
- exposure to someone who has hepatitis or is jaundiced, multiple sex partners, sexual activity with a bisexual male, IV drug use (even x1) immigration or travel from an region w/ endemic hepatitis, occupation exposure.
- Diagnosis:LABS : CBC w/ platelets, liver test (AST, ALT, total bilirubin, alkaline phosphate, albumin) PT, & test for HBV replication (HBeAg, anti HBe, HBV DNA)
- management: consult/comanagement & report to state agency
- treatment: to reduce perinatal transmission in HBV positive mom→ administer to baby within 12 hours of birth (HBIG, HBvaccine series)
reassure women that HBIG reduce fetal transmission from 90% to 3%
Hep C
transmission : blood, HCV positve, RNA positive , sex (but inefficient) transmission at time of birth
- risk factors: drugs user blood transfusion
- diagnosis : antibody testing
- management: consult
- treatment: avoid ASA/Tylenol/alcohol
HPV
transmission : most common
- risk factors: sexually active.
- diagnosis : increase # and size during pregnancy making vaginal delivery or episiotomy difficulty.
- management: incomplete respone to tx during pregnancy but lesions commonly improve or regress rapidly following delivery. Consequently, eradication of warts during pregnancy is not always necessary.
- treatment: Trichloroacetic or bichloracetic acid some prefered cryotherapy, laser ablation, or surgical excision.
***podophyllin & interferon not recommend in pregnancy.
→ respiratory issue if infant infectef
HSV
transmission : interuterine 5%, peripartum 85%, postnatal 10%
- risk factors: adolescent
- diagnosis : PCR assay detection in spinal fluid.
- management: acyclovir (pregnancy)
- treatment: suppressive after 36 week until birth
HIV
incubation: from exposure to clinical disease is days to weeks
- s/x : fever night sweat fatigue rash headache lymphadenopathy pharyngitis myalgias arthralgias nausea vomiting and diarrhea.
- dx: ELISA (99.5% sensitivity) then confirmed with western blor or immunofluorescence assay (IFA) both have high specificity.
- transmission rate: 20% before 36 weeks, 50% in the days before delivery, 30% intrapartum, breastfeeding 30-40% … vertical transmission common in preterm birth and prolong membrane rupture.
- Antivirals: Highly active antiviral therapy HAART
GC
N. Gonorrhoea
Risk factors: 15-14, single, poverty, drug abuse, prostitution, lack of prenatal care, other STDs.
Dx: NAAT
TX: cetriaxone PLUS azithromycin/amoxicillin, erythromycin
Chlamydia
C. trachomatis
Risk: same as GC but screen will be at first AND at third because of recurrent 17% & high-risk behavior.
TX: azithromycin is first line ….(fluoroquinolones & doxycline are avoided in pregnancy)
Syphilis
incubation period 3-90days
-risk factors: substance abuse, especially crack cocaine, inadequate prenatal cares,.
- primary syphilis: chancre at site of inoculation –painless with raised red firm border and smooth base.
-secondary syphilis: spirochete disseminated and affects multiple organ system. → diffuse mascular rash, plantar & palmar target like lesion, patchy alopecia and or mucous patches may be seen. Codylomata lata are flesh colored papules and nodules found on the perineum and perianal area.
-late syphilis: slowly progressive disease affecting any organ system by is rarely seen in reproductive aged women.
Dx: darkfield examination & direct fluorescent antibody testing of lesion exudates.–> VDRL or RPR tesing is required by law in many state.
Tx: Penicillin G for all stages or benzathine penicillin G.
HSV
most common
Transmission : 85% peripartum
DX: PCR
TX: acyclovir (safe for pregnant women) , famiclovir, or valacyclovir for first episode
Suppressive thereapy: from 36 weeks until delivery (so they can have a vaginal birth)
BV
leukorrhea –maldistribution of normal flora. Number of bactobacilli decrease & overrepresented species are anaerobic bacteria
Treatment only for symptomatic women
S/x: smelly fishy discharge
Tx: metronidazole PO or gel. Or clindamycin cream
Trich
identified during prenatal examination
s/x : foamy leucorrhea with pruritis & irritation. Flagellated pear shaped motile organisms that are somewhat larger than leukocytes.
Tx: metronidazole
immunization recommended in pregnancy
safe to have during pregnancy: diphtheria, tetanus, influenza, & hep B. Other such as meningococcal & rabies, Hepatitis A may be considered.
immunization Contraindications in pregnancy
measles, mumps, & rubella; and varicella.
Live virus are generally contraindicated in pregnant women, however risk are theoretic.
H1N1 infections
pregnant women should get seasonal & H1N1 in any trimester to protect women from influenza
TB
S/x bad cough last for 3 weeks or longer Pain in the chest Coughing up blood or sputum Weakness or fatigue Weightloss No appetite Chills Fever Sweat at night
Mononucleosis
Extreme fatigue Fever Sore throat Head and body aches Swollen lymph nodes in the neck and armpits Swollen liver or spleen or both Rash Transmissions: kissing, sharing drinks/food, eating utensils or toothbrushes, contact with toys that children drooled on
Bronchitis.
chest cold, brochial tubes swell inflame produce mucus, cause cough soreness in the chest fatigue mild headache mild body aches low-grade fever watery eyes sore throat
