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obstetric - gynecol STEP 2 > infections and vaccination in pregnancy > Flashcards

infections and vaccination in pregnancy Flashcards

1
Q

endometritis - definition/association

A

Inflammation associated with retained products of conception following delivery, miscarriage, abortion, or foreign body (IUD)

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2
Q

endometritis - mechanism

A

retained materials in uterus –> infection by bacterial flora from vagina or intestine tract

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3
Q

endometritis - treatment / etiology

A

gentamicin + clindamycin +/- ampicillin

- polymicrobial

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4
Q

postpartum endometritis - RF

A
  1. C-section
  2. corioamnionitis
  3. Group B strep
  4. prolonged rupture of membranes
  5. operative vaginal delivery
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5
Q

postpartum endometritis - clinical features

A
  1. fever for more than 24 h postpartum
  2. uterine fundal tenderness
  3. purulent lochia
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6
Q

pyelonephritis in pregnancy - treatment

A

ceftriaxone

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7
Q

chorioamnionitis presents with

A

maternal fever, maternal and fetal thacycardia, uterine tenderness

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8
Q

chorioamnionitis typically presents in

A

patietns with premature or prolonged rupture of membranes as maternal fever, maternal and fetal tachycarda, uterine fundal tenderness, maternal leukocytosis

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9
Q

chorioamnionitis - RF

A
  1. prolonged rupture of membranes (more than 18 h)
  2. preterm premature of membranes
  3. prolonged labor
  4. internal fetal/uterine monitoring devises
  5. repetitive vaginal examinations
  6. presence of genital tract pathogens
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10
Q

chorioamnionitis - diagnosis

A

Maternal fever plus 1 or more of the following:
1. fetal tachycardia (more than 160) for at least 10 mins
2. maternal leukocytosis
3, purulent amniotic fluid
4. maternal tachycardia (more than 100)
6. uterine fundal tenderness

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11
Q

chorioamnionitis - management

A

broad spectrum antib

delivery

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12
Q

chorioamnionitis - complications

A

maternal: postpartum hemorrhage, endometritis
neonatal: preterm birth, pneumonia, encephalopathy

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13
Q

Asymptomatic bacteriuria - definition

A

more than 100.000 bacteria

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14
Q

Asymptomatic bacteriuria - RF

A
  1. Pregesational DM
  2. multiparity
  3. history of UTIs
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15
Q

Asymptomatic bacteriuria - common pathogens

A
  1. E. coli (MC)
  2. enterobacter
  3. klebsiella
  4. Strep Bg
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16
Q

Asymptomatic bacteriuria - treatment

A
  1. augmentin
  2. nitrofurantoin
  3. cephalexin
  4. fosphomycin
17
Q

Preventing neonatal group B strep infection - universal screening

A

rectovaginal culture at 35-37 weeks gestation

18
Q

Preventing neonatal group B strep infection - indications

A
  1. prior delivery complicated by neonatal GBS infection2
  2. BGS bacteriuria or GBS UTI during current pregnancy (regardless of treatment)
  3. GBS positive rectovaginal culture
  4. Unknown GBS status PLUS any of: less then 37 weeks gestation, intrapartum fever, rupture of membranes for 18 or more hours
19
Q

Preventing neonatal group B strep infection - prophylaxis

A

1st line treatment: penicillin

20
Q

when to test toxo in pregnancy

A

not indicated

only in symptoms (fever, nodes, malaise)

21
Q

syphilis in pregnancy but penicillin allergy - next step

A

desensitisation

22
Q

treatment of vaginosis in pregnancy

A

metronidazole

23
Q

HCV in pregnancy - complications

A
  1. gestational DM
  2. Cholestasis of pregnancy
  3. preterm delivery
24
Q

HCV - maternal management

A
  1. Ribavirin is teratogenic (avoid)
  2. no indication for barrier protection in serodiscordant, nonogamous couples
  3. HAV + HBV vaccination
25
Q

HCV in pregnancy - prevention of vertical transmission

A
  1. vertical transmission strongly associated with maternal viral load (+ HIV coinfection)
  2. C- section is not protective
  3. Scalp electrodes should be avoideed
  4. Sbreastfeeding should be encouraged unless maternal blood present
26
Q

treatment of chronic HCV in non pregnant

A

inf-a and ribavirin

27
Q

HIV management during pregnancy - anterpartum

A
  1. HIV RNA viral load at initial visit, every 2-4 wks after initiation or change of therapy, monthly until undetectable, then every 3 months
  2. CD4 every 3-6 months
  3. Resistance testing if not previously performed
  4. ART initiation NOW
  5. avoid amniocentesis unless viral load less than 1000
28
Q

HIV management during pregnancy - intrapartum

A
  • avoid artificial rupture of membranes, fetal scalp electrode, operative vaginal delivery
  • viral load less than 1000: ART + vaginal delivery
  • viral load more than 1000: ART + zidovudine + c-section
29
Q

HIV management during pregnancy - postpartum

A

mother: continue ART
infant: maternal viral load less than 1000: zidovudine
more than 1000: multi-drug ART

30
Q

RF for neonatal HSV infection

A
  1. 1y maternal infection
  2. longer duration of rupture of membranes
  3. vaginal delivery with active lesions
  4. impaired skin barrier (eg. fetal scapl electrode)
  5. preterm birth
31
Q

HSV - vaginal delivery?

A

only if no active genital lesions at the time of delivery

- and receive prophylacticly antivirals from the 36 wk

32
Q

check HCV during pregnancy?

A

only for patients with RF (HIV +, IV drug use)

33
Q

contraindicated vaccines during pregnancy

A
  1. HPV
  2. MMR
  3. live attenuated infl
  4. VARICELLA
34
Q

recommended vaccines during pregnancy

A
  1. Tdap
  2. inactivated inf
  3. Rho (D) immunogl
35
Q

Vaccines during pregnancy - for high risk patients

A
  1. HBV
  2. HAV
  3. Pneumococcus
  4. H. infl
  5. Meningococ
  6. Varicella zoster immunogl
36
Q

All pregnant should receive screening for

A
  1. HIV
  2. HBV
  3. Chlamydia
  4. syphilis

obstetric - gynecol STEP 2 (22 decks)

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