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natural childbirth II > Final-Infections During Pregnancy > Flashcards

Final-Infections During Pregnancy Flashcards

1
Q

Bartholin’s cyst

A

Blockage of bartholin’s gland due to congenital stenosis, thickened mucous at the outlet, mechanical trauma, neoplasm
-When fluid is infected an abcess will form

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2
Q

What should you expect if bartholin’s cysts are present bilaterally?

A

GC

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3
Q

DDx bartholin’s cyst

A

cyst, abcess, neoplasm, STI, sebaceous cyst

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4
Q

Management of bartholin’s cyst

A
  1. small asx = no tx
  2. draining abcess: culture and r/o STI and treat
  3. CBC if extended inflammation
  4. Uninfected bartholin’s cyst postpone tx in preg
  5. Refer to OB if rapid enlargement, increasing pain, abcess formation, hemorrhage into the cyst
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5
Q

Bartholin’s cyst tx

A
  1. sitz baths
  2. broad spectrum antibiotics
  3. surgical procedures
  4. excision (only recommended w/ a huge abcess, multiocular or recurrent abcess)
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6
Q

ND tx of bartholin’s cyst

A
  1. sitz baths w/ drawing herbs (echinacea, clay, charcoal)
  2. drawing poultice
  3. Hp hepar sulph to help ripen abcess
  4. NO GOLDENSEAL
  5. Iummune support
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7
Q

PID

A

Infxn of uterus, fallopia tube and adjacent pelvic structures not associated with pregnancy or abdominal surgery

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8
Q

Organisms associated with PID

A

Upper genital tract: usu GC or CT

G. vaginialis, H. influenzae, enteric gram- rods, strep agalactiae, CMV, mycoplasma hominis, urea urealyticum

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9
Q

Ssx PID

A

Variable, can include:

  1. lower abd pain
  2. adnexal tenderness
  3. Chandelier’s sign
  4. Fever
  5. purulent vaginal d/c
  6. possible palpable mass
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10
Q

Most serious complication of PID

A

TOA (Tubo-ovarian abcess)

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11
Q

PID complications

A
  1. hydrosalpinx
  2. TOA
  3. poor pregnancy outcome
  4. infant pneumonia
  5. neonatal death
  6. infertility
  7. chronic pelvic pain
  8. ectopic preg
  9. Increased risk of CA of reproductive tract
  10. Vulnerability to HIV
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12
Q

Predisposing factors to PID

A
  1. trichomonas
  2. douching
  3. STI exposure
  4. lower socioeconomic group
  5. no use of contraception
  6. multiple sex partners
  7. PID hx
  8. IUD use
  9. cigarette smoking
  10. sexual activity at a young age
  11. invasive genital medical procedures
  12. adolescence
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13
Q

PID dx

A
  1. clinical sxs and culture confirmed w/ rapid improvement w/ abx therapy
  2. wet prep >30 WBC/hpf
  3. elevated ESR, CRP
  4. endometritis w/ endometrial biopsy
  5. US or other imaging showing fluid-filled, thickened tubes, TOA, free pelvic fluid or laparoscopic evidence
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14
Q

Gold standard for PID dx

A

Laparoscopy

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15
Q

PID ddx

A
  1. ectopic preg
  2. endometritis
  3. ovarian cysts
  4. cancer
  5. myoma
  6. appendicitis
  7. pancreatitis
  8. septic abortion
  9. acute cholecystitis
  10. GC vs. nongonorrheal PID
  11. Mesenteric lymphadenitis
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16
Q

PID during pregnancy

A

High risk for maternal morbidity, fetal wastage, preterm delivery

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17
Q

HIV and PID

A

HIV + woman will respond to antibiotics but may have a more severe dz course and more likely to require surgical tx

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18
Q

PID management

A
  1. Pt education
  2. Hx, LMP, pregnancy
  3. Cultures and wet mount
  4. Tx sexual partners if sexual contact w/ woman within 60 days of sxs
  5. Instruct woman to complete tx
  6. Surgical tx
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19
Q

Toxoplasmosis sources

A
  1. cats who have eaten infected birds or rodents who have contacted the feces of infected cats
  2. humans can contract it from dirty sandboxes or playgrounds where cats have left feces
  3. raw meat of inadequately cooked esp pork or mutton
  4. water contaminated by cat feces
  5. milk from infected animals
  6. organ transplants or transfusions
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20
Q

Toxoplasmosis sxs

A
  1. usu subclinical

2. rash, lymphadenopathy, fever, malaise, generally mildly sick, can be similar to mono

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21
Q

Toxoplasmosis dx

A
  1. elevated IgG = past infxn
  2. elevated IgM = current or recent infxn
  3. infant: rising IgG titers
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22
Q

Toxoplasmosis tx

A

Toxic antimicrobials –> cannot use in preg

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23
Q

Toxoplasmosis prevention

A
  1. Avoid cat feces
  2. Cook meat well
  3. Wash hands after handling raw meat and cats
  4. Avoid raw milk and eggs
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24
Q

Rubella sxs

A

Fine rash, posterior cervical or occipital lymph node enlargement, malaise, mild fever

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25
Q

Rubella dx

A

Rubella titer (elevated IgM = current or recent exposure)

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26
Q

Rubella risk to fetus

A
  1. Malformations: deafness, cardiac defects, cataracts
  2. Congenital rubella syndrome: low birth weight, bone marrow damage, hepatitis, myocarditis, pneumonitis, encephalitis, chromosomal abnormalities
  3. at 1-8 wks PG, 40-80% risk fetal defects
  4. 9-12 wks, 20% risk
  5. 13-16 wks 5% risk
  6. 17-20 wks, 1% risk
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27
Q

Rubella management

A
  1. consider TAB in 1st and 2nd trimesters

2. Immunize non-immune women immediately after delivery

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28
Q

CMV Transmission

A

Transplacentally, from cervix, from breast milk

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29
Q

CMV Risk to Infant

A
  1. Subclinical and mild maternal infxn: jaundic, petechiae, feeding difficulty, irritability, muscle weakness, hepatosplenomegaly
  2. Maternal severe infxn: SGA, microcephaly, meningoencephalitis, chorioretinits, mental retardation
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30
Q

Varicella Transmission

A

Transplacental

31
Q

Varicella risk to infant

A
  1. 1st trimester: congenital varicella syndrome

2. 2nd and 3rd trimester, few problems

32
Q

Varicella risk to mother

A
  1. pneumonia, premature labor, dehydration, fatal (from pneumonia esp 3rd trimester)
  2. mostly 3rd trimester risk for mother
  3. if exposed and not immune give IgG shots away; give IV fluids if dehydrated; if severely ill may be give acyclovir
33
Q

Varicella infxn at time of delivery

A
  1. can’t deliver baby while mother has chicken pox b/c virus can be transmitted
  2. mother gets chicken pox within 5 d of delivery: 30% chance baby will too
  3. if >5d before delivery: 18% chance infxn in baby
  4. baby gets rash within 5-10 days of being born 20% will die
  5. after 10 days fetus receives passive immunity from mother
34
Q

Mumps transmission

A

Transplacental

35
Q

Mumps risk to infant

A
  1. increased SAB
  2. Prematurity
  3. Still birth
  4. endocardofibroelastosis
36
Q

Mumps Tx

A

Immunoglobulin to expose susceptible women

37
Q

Rubeola risk to infant

A
  1. SBA
  2. SGA
  3. Rare malformations
  4. Most have no problems
38
Q

Rubeola transmision

A

Transplacental. A reportable dz!

39
Q

Parvovirus B19

A

Fifth dz. Common. “slapped cheek” appearance on face and “lace-like” erythematous rash on trunk and extremities

40
Q

Zika Virus

A

Ask all pregnant women about recent travel
women should be tx for virus if:
1. they have traveled to an area with zika
2. have 2 or more sxs consistent with dz: acute onset of fever, maculopapular rash, arthalgia or conjunctivits during or within 2 weeks of travel
3. US findings of fetal microcephaly or intracranial calcifications

41
Q

Chlamydia

A 
50% of infants contact it at delivery --> 30-40% will have conjunctivitis 
Risks:
1. premature labor
2. miscarriage
3. neonatal death
42
Q

Is tetracycline C/I in pregnancy?

A

YES! Can cause mottled teeth and bone changes

43
Q

AIDS

A

Reportable! HIV ab screen. High risk pg, refer to appropriate facility

44
Q

Syphillis

A

Reportable! State law required testing of all pregnant women within 10 days of 1st visit. repeat test in 3rd trimester if current or current hx of STD, prostitute, multiple sex partner, drug abuse

45
Q

Syphillis risk to fetus

A
  1. 30% die in utero
  2. congenital syphillis: may appear normal at birth or have rhinitis, hoarse cry, rash (palms and soles), hepatosplenomegaly, weight loss, bones and teeth changes, CNS lesions. Very contagious.
46
Q

Gonorrhea

A

Reportable! Concerned about eye infxn in the newborn.

sx: severly sticky eye, may lead to blindness.
prevention: erythromyocin ointment in both eyes at birth

47
Q

HPV risk to fetus

A

laryngeal papillomas, HPV genitally

48
Q

Tuberculosis Management

A

Reportable!
1. screen all pregnany women
2. consult or refer if positive PPD
R/O by chest xray

49
Q

Congenital TB

A

Rare. Only from fetal aspiration of infected amniotic fluid or by hematogenous spread

50
Q

Trichamonas Vaginalis risk to fetus

51
Q

Herpes Simplex: neonatal dz

A

Sx: develop after 3-15 days

  1. skin or mucousal vesicles
  2. lethargy
  3. poor feeding
  4. jaundice
  5. fever
  6. cyanosis
  7. can develop pneumonitis, encephalitis, hepatitis
52
Q

Herpes Simplex: Neonatal Mortality

A
  1. 2-3% if lesions contained to skin
  2. 45% of babies have no skin lesions but have a brain infxn
  3. W/ disseminated infxn 15-50% die with therapy, 85% die without therapy
  4. 60% of survivors will have CNS damage, blindness, mental retardation.
  5. only 5% of babies with CNS infxn return to normal
53
Q

HSV Transmission

A
  1. birth canal (usu HSV 2)
  2. transplacental w/ or w/o primary outbreak
  3. nosocomial spread from one baby to another by hospital or family member in 15% of cases
54
Q

Management of a pt with hx of herpes

A
  1. establish dx
  2. c-section if prodrome or active lesion at time or ROM or labor
  3. if symptomatic, culture mom’s cervix and baby’s nasopharynx and skin
  4. if culture negative for 72 hours prior to ROM or labor onset, vaginal delivery safe
55
Q

Condyloma Accuminata (HPV) risk to fetus

A

Laryngeal papillomas

Genital HPV

56
Q

Bacterial Vaginosis (gardnerella) Risks

A
  1. premature labor
  2. PROM (bacteria weaken the sac)
  3. PP endometritis
  4. Pelvic dz (salpingitis)
57
Q

Candida

A

Common in PG due to increased estrogen

If asx may not treat but if close to term risk of infant developing thrush through birth canal

58
Q

Candida tx

A
  1. vinegar douche, acdiophilus caps as supp (pm) x 7d

2. Nystatin supp BID x 2 wks

59
Q

Beta step risks: PG women asx

A
  1. infxn of newborn, can be very serious! Infant can die within 8 hours, infected infants have decreased respirations and decreased temp
  2. premature labor
  3. PROM
  4. Uterine infxn
60
Q

Beta Strep Dx

A

Culture for organism and sensitivity

  1. aerobic culture of cervix at 36 weeks
  2. also culture with PROM
  3. culture in labor if hx of beta-strep
  4. culture after tx
61
Q

Beta strep Tx

A
  1. amoxicillin 500 mg TID x10 days
  2. Erythromycin 250 mg QID x10 days PO
  3. Clindomycin cream
  4. Echinacea to prevent early in PG
62
Q

UTI risks in preg

A 
Increased chance of asx bateria progressing to UTI
Possible sequelae:
1. premature labor and preterm birth
2. PROM
3. fetal death
4. low APGAR scored
5. mental retardation
6. IUGR
7. cerebral palsy (when UTI proresses to endotoxemia)
8. sepsis
9. chronic PN
63
Q

Urinalysis

A
  1. do complete UA early in PN care
  2. urine chemistry (dipstick) Q PN visit, midstream, clean catch
  3. bacteriuria is > 100,000 per ml
64
Q

Acute pyelonephritis

A

one of the most common medical conditions of pregnancy! most common in 2nd trimester

65
Q

Acute pyelonephritis ssx

A
  1. abrupt onset of fever and chills
  2. aching, lumbar pain
  3. N/V, headache, malaise, dehydration
    PE:
  4. temp >100 F
  5. CV angle tenderness
  6. dehydration
  7. tachycardia
  8. In preg may see fetal tachycardia, preterm labor
66
Q

URI incidence in preg

A

some women have increased resistance, some have decreased resistance

67
Q

Biggest risk of URI in preg

A

Pneumonia

–> decreased space, women cannot clear lungs as easily

68
Q

URI tx in preg

A
  1. rest!! preg already a challenge to immune system in preg
  2. increase fluids
  3. Vitamin C: 500 mg Q 2-4 hours
  4. Echinacea: 30-60 qtts Q 2-4 hours
  5. Ulmus fulva and Zn lozenges
  6. Homeopathy
  7. NO osha, goldenseal or OTC antihistamines in preg
  8. berberis in small quantities only
  9. hydro: nothing over abdomen, warming socks great
69
Q

Influenza risk

A
  1. women in 3rd trimester at risk for serious dz (pneumonia)

2. monitor mom’s temp (102 F PO or higher = risk to fetal well being)

70
Q

Hep A Risk

A

REPORTABLE DZ

  1. low birth weight
  2. maternal demise
71
Q

Hep B testing

A

REPORTABLE DZ

Testing of all PG women recommeded by CDC d/t risk of transmission

72
Q

Hep B risk to infant

A
  1. HbSag (surface antigen) (+) in mother: infant has 20-70% risk of infxn
  2. HbSag (+) and HbEag (+) in mother: infant has 90% risk of infxn but if mother has ab risk drops to 10%
  3. Of infected babies, 85-90% will become chronic carriers, 25% will die of hepatocellular CA or cirrhosis of liver
73
Q

test

natural childbirth II (13 decks)

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