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OB > Infections during pregnancy > Flashcards

Infections during pregnancy Flashcards

1
Q

TORCH infxns

A 
Toxoplasmosis
"Other"
-Syphilis
-HIV
-Hepatitis B
Rubella
CMV
Herpes
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2
Q

toxoplasmosis is what type of parasite

A

obligate intracellular parasite

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3
Q

what type parasite is transmitted thru raw/poorly cooked meat or contact w/ cat feces?

A

toxoplasmosis

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4
Q

prevention counseling for toxoplasmosis in pregnancy

A

thoroughly cook meats
careful handwashing after handling raw meats
wash fruits & vegetables
wear gloves when working in soil
keep cats indoors & fed only processed food

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5
Q

how is toxoplasmosis transmitted to the fetus?

A

transplacentally

vaginal delivery

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6
Q

severe sequelae usually occurs in newborn d/t infxn w/ toxoplasmosis occurring when in mother’s pregnancy?

A

infxn acquired in 1st trimester & goes untreated

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7
Q

sequelae in infant from toxoplasmosis that is mild or not apparent at birth usually d/t infxn when in mother’s pregnancy?

A

3rd trimester

went untreated

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8
Q

different rates of transmission of toxoplasmosis from mother to fetus depends on a few things

A

placental blood flow
virulence of virus
immune status

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9
Q

many infants infected w/ toxoplasmosis appear healthy at birth & have no S&S of infxn. If there are S&S, what are they?

A

chorioretinitis
intracranial calcifications
anemia, thrombocytopenia, jaundice at birth
microcephaly

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10
Q

toxoplasmosis affected survivors may have?

A 
MR
seizures
visual defects
spasticity
severe neurologic sequelae
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11
Q

routine screening of toxoplasmosis in pregnancy is NOT recommended except?

A

maternal HIV infxn

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12
Q

positive IgG titer in toxoplasmosis infxn indicates?

A

infxn at some point in time

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13
Q

negative IgM in toxoplasmosis infxn r/o?

A

recent infxn

+IgM may persist for long periods- not reliable in assessing duration of dz

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14
Q

other tests that may help Dx toxoplasmosis

A

PCR
skin tests
Ab levels in aqueous humor/ CSF
perform amniocentesis @ 20-24 weeks’ gestation if congenital dz suggested

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15
Q

what is the DOC for maternal/ fetal toxoplasmosis?

A

Spiramycin (Rovamycine)

does not prevent sequelae in fetus if infxn has occurred

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16
Q

DOC for toxoplasmosis infxn in other populations besides maternal/fetal

A

pyrimethamine

sulfadiazine

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17
Q

if toxo infxn has occurred in fetus, what drugs might decrease risk of congenital infxn & severity of manifestations

A

pyrimethamine

sulfadiazine

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18
Q

what systemic dz is caused by motile spirochete Trepone pallidum?

A

syphilis

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19
Q

typical presentation of primary syphilis

A

painless ulcer w/in 6 wks following exposure

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20
Q

secondary syphilis presentation

A

skin rash
maybe condyloma lata
usually 1-3 months later

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21
Q

syphilis generally crosses the placenta to fetus when?

A

after 16 weeks gestation

can occur any time, sometimes as early as 6 wks

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22
Q

untreated syphilis complications in pregnancy

A

SAB
stillbirth
neonatal death

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23
Q

when is neonatal infxn w/ syphilis more likely to occur?

A

during primary/secondary infxn vs. teritiary

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24
Q

infants infected w/ syphilis usually develp evidence of dz how many days after delivery?

A

10-14

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25
Q

early evidence of syphilis dzy in infant?

A 
maculopapular rash
"snuffles"
mucous patches on oropharynx
hepatosplenomegaly
jaundice
lymphadenopathy
chorioretinitis
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26
Q

later signs of syphilis infxn

A

Hutchinson’s teeth
Mulberry molars
Saddle nose
Saber shins

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27
Q

is congenital syphilis readily preventable w/ prompt & appropriate maternal tx?

A

yes

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28
Q

serological testing for syphilis should be done when?

A

as early as possible
again at delivery
*serologic testing is mainstay of dx

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29
Q

nontreponemal testing

A

VDRL (Venereal dz Research lab)
RPR (rapid plasma reagin)
both sometimes falsely +

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30
Q

treponemal specific tests

A

FTA-ABS (flourescent treponemal Ab absorbed)
TP-PA (T. pallidum particle agglutination)
+ test results indicate active dz or past exposure. regardless of tx, + for life in most individuals

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31
Q

DOC for syphilis

A

PCN

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32
Q

Jarisch-Herxheimer rxn

A

occurs most often among pts w/ early syphilis. If pregnancy this may precipitate preterm labor/ cause fetal distress. Observe closely

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33
Q

RPR & VDRL can follow what?

A

post tx titers of syphilis

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34
Q

If syphilis is adequately tx’d, you should see what?

A

a 4 fold decrease in titers by six months

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35
Q

rubella

A

“German measles”

risk of congenital dz related to GA at time of infxn- highes in 1st month of pregnancy, decreases w/ increasing GA

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36
Q

defects d/t rubella are rare if infxn occurs after when?

A

20th week of gestation

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37
Q

rubella fetal presentation in utero

A

SAB/ stillborn
microcephaly
IUGR

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38
Q

rubella fetal congenital presentation

A

deafness
cataracts/Glaucoma
neurologic: meningoencephalitis/ MR
cardiac: PDA/ PA stenosis

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39
Q

rubella presentation in early CH

A

radiolucent bone dz
blueberry muffin rash
thrombocytopenia/ HSM

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40
Q

rubella presentation in late CH

A

thyroid abnormalities

panencephalitis

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41
Q

screening & testing for rubella

A

routine in pregnancy
screen for IgM & IgG Ab’s for primary infxn
pregnant- do not vaccinate
delay becoming pregnant for one month after vaccine is recommended

42
Q

Rubella vaccination

A
  • offer postpartum
  • breastfeeding NOT CI
  • IVIG may be given to infected woman but does not prevent fetal infxn
  • if rubella Dx during pregnancy, advise pt about fetal risks & counsel regarding continuing pregnancy
43
Q

some S&S of HBV

A 
jaundice
joint pain
fatigue
nausea
decrease in appetite
44
Q

routine screening for HBV during pregnancy is done by looking for what?

A

hep B surfact antigen (HBsAg)

45
Q

vertical transmission of HBV is related to the presence of what?

A 
maternal HBeAg (indicates high viral load & active replication)
fetus has 70-90% risk of becoming infected & most will become chronic carriers
46
Q

tx of HBV

A 
HBIG
HBV vaccine (usually betwee 2 days & 2 months after birth)
breastfeeding not CI in chronic carriers if infant has received both vaccinations & HBIG within 12 hrs of delivery
47
Q

HIV infxn doesn’t seem to have a direct effect on pregnancy, but may be associated w/ what?

A

pregnancy complications or perinatal infxn (BV, HSV, HPV, syphilis, CMV, toxo, HBV, HCV, etc)

48
Q

what is more accurate in pregnancy- % of CD4+ cells or absolute #’s

A

% of CD4+ b/c the decline in absolute # is 2/2 hemodilution

49
Q

HIV transmission can occur when?

A

antepartum
intrapartum
postpartum w/ breastfeeding
most often occurs during/close to intrapartum period

50
Q

initial screening for HIV

A

ELISA- enzyme-linked immunosorbent assay

most antibodies detectable by 3 months after infxn

51
Q

if ELISA is +, confirm w/ what?

A

Western blot test

52
Q

HIV screening in pregnancy is what?

A

standard, but voluntary

if they “opt out” make sure to document!

53
Q

at risk population screening for HIV should be repeated when?

A

3rd trimester

54
Q

HIV meds to avoid in pregnancy

A

Efavirenz during 1st triemester
combo stavudine (d4T) & didanosine (ddI)
nevirapine if CD4 count >250/mm3

55
Q

when do start HIV meds during pregnancy

A

depends on immune status

may start after 1st trimester to avoid drug exposure

56
Q

antiretroviral drug Zidovudine is known to reduce what?

A

risk of transmission

57
Q

what type of ULS should be done in HIV + pt?

A 
detailed ULS (level II)
usually @ 18-20 weels
58
Q

precautions during delivery to avoid transmission of HIV

A

chorioamnionitis
prolonged rupture of membranes
invasive fetal monitoring & mode of delivery are risk factors for vertical transmission

59
Q

if HIV viral load >1000, what should be planned?

A

c-section at 38 weeks

if vaginal birth, avoid compromising fetal skin

60
Q

HIV + mothers should avoid what after birth of baby?

A

breastfeeding

61
Q

primary HSV poses the greatest risk to?

A

the fetus

62
Q

how is the fetus infected w/ HSV?

A

ascending infxn 2/2 spontaneous rupture of membranes or passage thru infected lower genital tract

63
Q

infants w/ localized herpes usually do well, but those w/________________dz do very poorly

A

disseminated

64
Q

congenital HSV infxn presentation

A

microcephaly
hydrocephalus
chorioretinitis
vesicular skin lesions

65
Q

3 subtypes of acquired HSV infxn have been ID’d, what are they?

A
  1. Dz localized to skin, eye, mouth (virtually no mortality)
  2. encephalitis w/ or w/o skin, eye, mouth involvement (mortality ~15%)
  3. disseminated infxn involving multiple sites, including the CNS, LU, LIV, adrenals, skin, eye, mouth (mortality ~ 57%)
66
Q

morbidity related to HSV related encephalitis or disseminated dz may include

A 
seizures
psychomotor retardation
spasticity
blindness
learning disabilities
67
Q

testing for HSV

A

clinical exam
confirm w/ viral cx
PCR testing (more sensitive than cx)
serologic testing

*routine screening for HSV not currently recommended

68
Q

mngt of HSV

A

Acyclovir (safe in pregnancy)
-for suppression begin at 36 weeks
-IV for severe maternal infxn
c-section if lesions ID’d

69
Q

acyclovir in pregnancy reduces the risk of?

A

clinical HSV
recurrence at delivery
c-section for recurrent lesions
risk of viral shedding at delivery

70
Q

what is the MC congenital viral infxn

A

CMV

71
Q

CMV is transmitted via

A 
saliva
semen
cervical secretions
breast milk
blood
urine
72
Q

CMV S&S

A

most infants asymptomatic

-petechiae hepatosplenomegaly, jaundice, thrombocytopenia, microcephaly, chorioretinitis, nonimmune hydrops fetalis

73
Q

long term sequelae of CMV

A

severe neurologic impairment & hearing loss

74
Q

CMV general

A

no effective vaccine/ tx
routine screening NOT recommended
stress prevention (i.e. good handwashing)
test via PCR if testing
antivirals have been used neonates, but still experimental

75
Q

risk for congenital infxn of VZV limited to what?

A

maternal infxn occurring during first half of pregnancy

76
Q

VariZIG

A

purified immune globulin from plasma containing high levels of antivaricella antibodies

77
Q

VariZIG should be considered w/in______hrs of exposure of nonimmune pts

A

96 hrs

78
Q

screening for VZV is?

A

routine

79
Q

what are some maternal complications of VZV infxn?

A

varicella pneumonia & encephalitis

more common in adults than children

80
Q

varicella pneumonia occurs more frequently during?

A

pregnancy related infxn
assoc. w/ maternal mortality
tx w/ acyclovir

81
Q

VZV fetal infxn during 1st 1/2 of pregnancy may result in?

A

varicella embryopathy

  • limb atrophy
  • scarring of skin on extremities
  • CNS involvement
  • ocular manifestations
82
Q

VZV can be fatal for infant if mother develops infxn w/in when?

A

5 days before or 2 days after delivery

administer variZIG

83
Q

possible peripartum infxn caused by GBS

A 
endometritis
amnionitis
UTI
sepsis
miningitis (rare)
postpartum fever & tachy
84
Q

clinical manifestations of GBS in newborn

A

early-onset infxn: 1st wk of life, respiratory distress, septicemia/ septic shock, pneumonia, meningitis
late-onset infxn: reported beyond 3 months
late-late onset infxn:very low birth wt preterm neonates

85
Q

universal screening for GBS happens between?

A

35-37 weeks

86
Q

GBS + women should receive Abx prophylaxis when?

A

in labor or w/ rupture of membranes

87
Q

if cx status unknown then prophylaxis given in following situation

A

preterm labor (<37 wks)
rupture of membranes 18 hrs+
maternal fever during labor (at/above 38 C)
GBS bacteriuria during current pregnancy
previously given birth to an infant w/ early-onset GBS dz

88
Q

vulvovaginitis

A

spectrum of conditions causing vaginal/ vulvar sx’s

89
Q

diagnostic tests for vulvovaginitis

A

testing for vaginal pH
saline “whiff” test
saline wet mount
10% KOH microscopy

90
Q

bacterial vaginosis presentation

A

c/o “fishy” odor, esp. post-coital
gray-white/ yellow d/c
mild vulvar irritation
pH > 4.5

91
Q

diagnosing BV

A 
microscopic exam under saline wet mount
increase in WBC's
clumps of bacteria
loss of normal lactobacilli
characteristic "clue cells"- resemble ground glass
92
Q

BV tx

A

oral/topical metronidazole or clindamycin

neither drug shown to have teratogenic effects

93
Q

vulvovaginal candidiasis presentation

A

itching
burning, external dysuria & dyspareunia common
bright red
excoriation in severe cases
thick, adherent “cottage cheese” d/c, oderless
pH usually 4-5

94
Q

Dx vulvovaginal candidiasis

A

microscopic exam made under saline wet mount or 10%
blastospores or pseudohyphae
cx

95
Q

Tx of vulvovaginal candidiasis

A 
topical application synthetic imidazoles:
miconazole
clotrimazole
butoconazole
terconazole
96
Q

trichomonas vulvovaginitis transmission

A

sexual contact
fomites
survive in swimming pools/ hot tubs

97
Q

what is trich associated with?

A 
PID
endometritis
infertility
ectopic pregnancy
preterm birth
*been shown to facilitate HIV transmission
98
Q

trich presentation

A 
mild to severe
vulvar itching/burning
copious d/c w/ rancid odor- "frothy", thin & yellow-green to gray color
pH>4.5
dysuria
sypareunia
edema/ erythema of vulva
petechiae or "strawberry patches" upper vagina or cervix- "classic signs"
99
Q

Dx of trich

A

microscopic exam made under saline wet mount
large # if mature epithelial cells, WBCs
trich organism

100
Q

Tx of trich

A

oral metronidazole/ tinidazole
partner notification & tx
avoid unprotected sex during tx
abstinence from EtOH- avoid disulfram like rxn
assoc. w/ pre-term deliver, PROM , SGA
tx may not prevent complications
f/u for test of cure- absolute resistance rare, relative resistance may be as high as 5%

OB (13 decks)

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