Infections in Preg Flashcards
Most common fetal sequelae of congenital varicella syndrome?
Growth restriction
TORCH infection associated with skin scarring/changing?
Varicella
When are fetal/neonatal complication risks the highest for varicella?
When the mother contracts it 5 days before or 2 days after birth
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
What virus causes Erythema Infectiousum?
Parvo B19
Single stranded DNA virus that can cause aplastic anemia in fetus after vertical transmission?
Parvo B19
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
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)
TORCH US Findings:
Hepatosplenomegaly
Placentomegaly
Hydrops Fetalis
Parvo B19
The risk of congential varicella syndrome is greatest when exposure occurs before what gestation?
20 weeks
TORCH US Findings:
Microcephaly
Hydrocephalus
Intracranial Calcifications
Toxoplasmosis
Painless Chancre
Presenting 3 weeks after unprotected intercourse
What is treatment?
Primary Syphilis
Treatment: 2.4 million units PCN G IM x 1 dose
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
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
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
How do you diagnose someone with Varicella in pregnancy?
Classic pruritic vesicular rash
PCR of vesicular fluid
ELISA of VAV IgM and IgG
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?
- Preterm Birth
- Fetal Growth Restrictions
- 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!
