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Obstetrics > Infections in Preg > Flashcards

Infections in Preg Flashcards

1
Q

Most common fetal sequelae of congenital varicella syndrome?

A

Growth restriction

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2
Q

TORCH infection associated with skin scarring/changing?

A

Varicella

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3
Q

When are fetal/neonatal complication risks the highest for varicella?

A

When the mother contracts it 5 days before or 2 days after birth

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4
Q

TORCH infection:
FGR
Limb atresia/hypoplasiaSkin Skin Scarring
Microcephaly/Microphthalmia
Hydrocephalus
Chorioretinitis

A

Varicella

*If maternal infection occurs before 20 weeks gestation, fetus can risk of acquiring congenital varicella syndrome

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5
Q

What virus causes Erythema Infectiousum?

A

Parvo B19

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6
Q

Single stranded DNA virus that can cause aplastic anemia in fetus after vertical transmission?

A

Parvo B19

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7
Q

If mother is confirmed to have Parvo B19 infection, what are next steps?

A

Serial US to assess for hydrops and to measure MCA (every 1-2 weeks) to assess for fetal anemia

Aplastic anemia and hydrops fatalis can occur in 1% of fetuses

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8
Q

When is the most dangerous time for a mother to contract Parvo B19?

A

13-16 weeks during development of hepatic hematopoietic system (most active during this time)

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9
Q

TORCH US Findings:
Hepatosplenomegaly
Placentomegaly
Hydrops Fetalis

A

Parvo B19

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10
Q

The risk of congential varicella syndrome is greatest when exposure occurs before what gestation?

A

20 weeks

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11
Q

TORCH US Findings:
Microcephaly
Hydrocephalus
Intracranial Calcifications

A

Toxoplasmosis

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12
Q

Painless Chancre
Presenting 3 weeks after unprotected intercourse

What is treatment?

A

Primary Syphilis

Treatment: 2.4 million units PCN G IM x 1 dose

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13
Q

Rash on palms and soles
Presenting 6 weeks after ulcer on genitals

What is treatment?

A

Secondary Syphilis

Treatment: 2.4 million units PCN G IM x 1 dose

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14
Q

General TORCH infection principles?

A

Maternal immunity almost always eliminates risk to fetus

If a woman exposed during pregnancy, the earlier in pregnancy it is less likely vertically transmission, but worse disease in infant

The later in pregnancy- higher chance of vertical transmission but milder disease in infant

FETAL EFFECTS (in general): most born without symptoms but 90% will develop them
- Chorioretinitis
- Intracranial calcifications
- Hydrocephalus
- Hearing loss

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15
Q

CMV Serology Testing

A

IgM is NOT reliable!

IgG Avidity testing to identify risk of recent infection

Low avidity means < 2-4 months

High avidity > 6 months

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16
Q

How do you diagnose someone with Varicella in pregnancy?

A

Classic pruritic vesicular rash

PCR of vesicular fluid

ELISA of VAV IgM and IgG

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17
Q

Treatment for rubella/varicella in pregnancy?

A

Post exposure PPx in non-immune pregnant pt:
- Varicella Zoster immune globulin
- 1 vial/10 kg body weight up to 5 vials
- Give ASAP, most effective within 96 hours

If immune globulin not available:
- Acyclovir 800 mg PO 5x daily for 7 days

18
Q

Treatment for asymptomatic listeria exposure in pregnancy?

A

Observe for 8 weeks for symptoms

19
Q

Treatment for listeria exposure w/ GI symptoms present?

A
  1. Obtain blood culture
  2. Treat w/ Amoxicillin for 14 days
  3. If blood culture positive - needs IV Amp/Gent 14-21 days AND ID consult
20
Q

Treatment for listeria exposure w/ fever or serious illness?

A
  1. Blood culture
  2. EMPERIC TREATMENT w/ IV Amp/Gent 14 days
  3. ID consult
21
Q

HBsAg Neg
HBcAb Pos
HBsAb Pos

A

Immune from prior infection

22
Q

HBsAg Neg
HBcAb Neg
HBsAb Pos

A

Immune from vaccination

23
Q

HBsAg Pos
HBcAb IgM pos/ IgG Neg
HBsAb Neg

A

ACUTE Hep B

24
Q

HBsAg Pos
HBcAb IgM Neg/ IgG Pos
HBsAb Neg

A

CHRONIC Hep B

25
Q

Who needs tripe screen panel for Hep B?

A

(HBsAg, Anti-HBs, Anti-HBc)

  • Uncompleted Hep B series OR
  • > 18 and do not have a documented negative triple screen result
26
Q

What Hep B Titer warrants treatment in the third trimester no matter what?

A

> 200 K

27
Q

Treatment for Hep B in pregnancy?

A

Tenofovir 300 mg PO daily

28
Q

Infant management for Hep B positive mother?

A

HBIG at birth
Hep B Vaccine within 24 hours

29
Q

Can you treat Hep C during pregnancy?

A

No! Treatments not approved in pregnancy

30
Q

Risks of Hep C in pregnancy?

A
  1. Preterm Birth
  2. Fetal Growth Restrictions
  3. Cholestasis in pregnancy
31
Q

When is CS delivered recommended for HIV Pos mother?

A

If viral load is > 1,000 (or uknown)

32
Q

Treatment for HIV Pos mother prior to CD?

A

Zidovudine IV
2 mg/kg load over 1 hour
Start 3 hours before surgery
Maintenance 1 mg/kg/hr until delivery

**ZDV not given if viral load < 1000 AND patient is on treatment AND no concern for compliance

33
Q

Timing for CD for HIV Pos mother?

A

CD at 38 weeks

Prior to onset of labor
Prior SROM
Viral load > 1000

34
Q

HSV Suppression in pregnnacy?

A

Start at 36 wks
Valacyclovir 500 mg BID

If genital lesions or prodomal symptoms present = CESAREAN

Consider cesarean if primary outbreak in third trimestser

35
Q

Treatment of primary HSV outbreak in Pregnancy?

A

Valtrex 1,000 mg BID for 10 days

36
Q

How do you screen/test for HIV in pregnancy?

A

Screen at NOB visit
High risk sexual practices
Screening test: ELISA
Confirmatory: Westernblot

If both screening + confrimatory are positive
Get viral load

Could screen again prior to 36 wks if high risk

37
Q

What do you do if someone presents in labor with unknown HIV status?

A

Rapid HIV testing (still takes awhile to get back)
Negative result is definitive
Positive results requires a westernblot

If positive rapid testing:
Treat for HIV without waiting for confirmation
CS if labor hasnt started and is not ruptured
Postpone BF until confirmation rules out HIV

38
Q

Treatment of HIV in pregnancy?

A

HAART
Highly active anti retro viral therapy
Usually 3 medications from 2 different classes
Monitor viral load

39
Q

Risk of vertical transmission of HIV in pregnancy?

A

25% if no treatment
With Zidovudine 8%
With Zidovudine + CS 2%
If pt on HAART + viral load < 1,000 copies and no CS < 2%

40
Q

Zidovudine management intrapartum

A

Give 2 mg/kg IV loading dose followed by 1 mg/kg/hr until delivery

Start 3 hours prior to scheduled CS

41
Q

When would an HIV Pos pt NOT need Zidouvdine at time of delivery?

A

On HAART
COMPLIANT
Viral load consistently < 1,000 copies/mL

Give patient their regular PO meds
**Don’t give methergine with protease inhibitors!

Obstetrics (26 decks)

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