Infection in pregnancy Flashcards
Features of Group A Strep:
1- May be ascending (from Vagina)
2- May be descending (Respiratory)
3- Can lead to Toxic Schock Syndrome (60% mortality)
Tx GAS?
1- Aggressive fluid replacement
2- ABX (PCN-G and Clindamycin)
3- Source control (Hysterectomy may be life saving in GAS sepsis and should be the default management)
4- Give Immune Globulins to pt with TSS
Initial clinical signs and symptoms of GAS include:
fever (78 percent), hypotension (56 percent), abdominal pain (44 percent), and tachycardia (44 percent) [14]. A prodrome of sore throat or upper respiratory tract infection was reported in 56 percent of patients. GAS was cultured primarily from the blood (78 percent) and/or respiratory tract (44 percent).
DD GAS?
infection due to C. perfringens and Clostridium sordellii.
ACOG recommends GBS rectovaginal screening except for?
●Women with GBS bacteriuria during the current pregnancy
●Women who previously gave birth to an infant with invasive GBS disease
ACOG recommendations for penicillin dosing in GBS?
Penicillin G 5 million units IV, then 2.5 million U every 4 hours until delivery
ACOG recommendations for vancomycin dosing in GBS?
20 mg/kg (maximum single dose 2 g) intravenously every eight hours in patients with normal renal function
Diagnosis of intraamniotic infection is made when:
Maternal temperature is greater than or equal to 39.0°C or when the maternal temperature is 38.0–38.9°C and one additional clinical risk factor is present.
Suspected intraamniotic infection is based on clinical criteria, which include:
maternal intrapartum fever and at least one of:
●Maternal leukocytosis ●Maternal tachycardia >100/min ●Fetal tachycardia >160/min ●Uterine tenderness ●Bacteremia ●Purulent or malodorous amniotic fluid.
TX for intraamniotic infection?
Ampicillin 2g IV Q8
& Gentamicin 5mg/Kg IV Q24hrs
Who should receive GBS prophylaxis?
●Positive screening culture for GBS
●History of infant with early-onset GBS disease
●GBS bacteriuria (any colony count)
●Unknown antepartum culture status plus:
- Intrapartum fever (≥100.4°F) or
- Preterm labor (<37+0 weeks of gestation) or
- PPROM or
- Prolonged rupture of membranes (≥18 hours) or
- Intrapartum nucleic acid amplification test (NAAT) positive for GBS
DD Intraamniotic infection:
●Labor – can be associated with fever (if the patient has an epidural anesthetic), maternal tachycardia, leukocytosis, and uterine tenderness.
●Abruptio placentae – can cause uterine tenderness and maternal tachycardia, but is usually associated with vaginal bleeding and absence of fever.
●Extrauterine infections associated with fever and abdominal pain (with or without labor) include *pyelonephritis *influenza *appendicitis and *pneumonia. These infections can cause maternal tachycardia and leukocytosis, and fetal tachycardia;
Most common sequela of CMV?
Sensorineural hearing loss
Clinical manifestations of congenital CMV?
petechiae jaundice hepatosplenomegaly thrombocytopenia sga microcephaly, intracranial calcifications sensorineural hearing loss, chorioretinitis seizures.
