Infections in Preg Flashcards by Alisha Lindberg

Most common fetal sequelae of congenital varicella syndrome?

Growth restriction

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TORCH infection associated with skin scarring/changing?

Varicella

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

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

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

Varicella

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

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What virus causes Erythema Infectiousum?

Parvo B19

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

Parvo B19

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

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

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

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TORCH US Findings:
Hepatosplenomegaly
Placentomegaly
Hydrops Fetalis

Parvo B19

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

20 weeks

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TORCH US Findings:
Microcephaly
Hydrocephalus
Intracranial Calcifications

Toxoplasmosis

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Painless Chancre
Presenting 3 weeks after unprotected intercourse

What is treatment?

Primary Syphilis

Treatment: 2.4 million units PCN G IM x 1 dose

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

What is treatment?

Secondary Syphilis

Treatment: 2.4 million units PCN G IM x 1 dose

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General TORCH infection principles?

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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CMV Serology Testing

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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How do you diagnose someone with Varicella in pregnancy?

Classic pruritic vesicular rash

PCR of vesicular fluid

ELISA of VAV IgM and IgG

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Treatment for rubella/varicella in pregnancy?

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

Treatment for asymptomatic listeria exposure in pregnancy?

Observe for 8 weeks for symptoms

Treatment for listeria exposure w/ GI symptoms present?

Obtain blood culture
Treat w/ Amoxicillin for 14 days
If blood culture positive - needs IV Amp/Gent 14-21 days AND ID consult

Treatment for listeria exposure w/ fever or serious illness?

Blood culture
EMPERIC TREATMENT w/ IV Amp/Gent 14 days
ID consult

HBsAg Neg
HBcAb Pos
HBsAb Pos

Immune from prior infection

HBsAg Neg
HBcAb Neg
HBsAb Pos

Immune from vaccination

HBsAg Pos
HBcAb IgM pos/ IgG Neg
HBsAb Neg

ACUTE Hep B

HBsAg Pos
HBcAb IgM Neg/ IgG Pos
HBsAb Neg

CHRONIC Hep B

Who needs tripe screen panel for Hep B?

(HBsAg, Anti-HBs, Anti-HBc) - Uncompleted Hep B series OR - > 18 and do not have a documented negative triple screen result

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

> 200 K

Treatment for Hep B in pregnancy?

Tenofovir 300 mg PO daily

Infant management for Hep B positive mother?

HBIG at birth Hep B Vaccine within 24 hours

Can you treat Hep C during pregnancy?

No! Treatments not approved in pregnancy

Risks of Hep C in pregnancy?

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

When is CS delivered recommended for HIV Pos mother?

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

Treatment for HIV Pos mother prior to CD?

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

Timing for CD for HIV Pos mother?

CD at 38 weeks Prior to onset of labor Prior SROM Viral load > 1000

HSV Suppression in pregnnacy?

Start at 36 wks Valacyclovir 500 mg BID If genital lesions or prodomal symptoms present = CESAREAN Consider cesarean if primary outbreak in third trimestser

Treatment of primary HSV outbreak in Pregnancy?

Valtrex 1,000 mg BID for 10 days

How do you screen/test for HIV in pregnancy?

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

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

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

Treatment of HIV in pregnancy?

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

Risk of vertical transmission of HIV in pregnancy?

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

Zidovudine management intrapartum

Give 2 mg/kg IV loading dose followed by 1 mg/kg/hr until delivery Start 3 hours prior to scheduled CS

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

On HAART COMPLIANT Viral load consistently < 1,000 copies/mL Give patient their regular PO meds **Don't give methergine with protease inhibitors!