Infections in Pregancy Flashcards
This infection, usually due to Escherichia coli, is one
of the most common infective complications of
pregnancy
Acute pyelonephritis
Acute pyelonephritis, why the need to hospitalize?
The patient should
be hospitalised and usually requires intravenous
antibiotic therapy and possibly rehydration
Abx for Acute pyelo
amoxycillin 1 g IV 6 hourly for 48 hours, then
500 mg (o) 8 hourly (if bacteria sensitive) for
14 days
Alternatives to Amox
Alternatives: cephalosporins (e.g. ceftriaxone 1 g
IV and cephalexin 500 mg (o))
Patients with _______ typically have dysuria and
frequency. Treat for 10–14 days
acute cystitis
Tx for acute cystitis
cephalexin 250 mg (o) 6 hourly 2
or
amoxycillin/potassium clavulanate (500/125 mg)
(o) 12 hourly
or
nitrofurantoin 50 mg (o) 6 hourly, if a betalactam
antibiotic is contraindicated
_______ is contraindicated in
the third trimester of pregnancy as it may
lead to haemolytic diseases in the newborn
Nitrofurantoin
_________of pregnant asymptomatic women have
positive cultures during pregnancy
5–10%
Ideally all women should be screened for
___________at their first visit
bacteriuria
Puerpuerial infection
It especially involves the______ and ______
placental site in the uterus and laceration or incisions of the birth canal
____________is infection of the placenta and membranes usually from normal vaginal flora
(e.g. Group B Streptococcus (GBS), E. coli ).
Chorioamnionitis
It is worth recalling that ___________
infection was the outstanding cause of septic maternal
death before the introduction of penicillin
Lancefield group A Streptococcus
Routine testing for GBS is recommended
at 36 weeks because:
if antibiotics are not given to carriers (the
15–20% who carry GBS) in labour, 50% of babies
become colonised and _______ of these are severely
affected and often die
1%
if antibiotics are given in labour (at least _______
prior to delivery) fetal colonisation and infection
almost never occurs
2 hours
Intrapartum GBS prophylaxis is indicated for:
Indicated for GBS carrier in current pregnancy and
previous baby with early onset disease
Intrapartum GBS prophylaxis TX
benzylpenicillin 1.2 g IV statim then 600 mg IV
4 hourly until delivery (clindamycin 600 mg IV 8
hourly if hypersensitive to penicillin)
Maternal puerperal GBS infection usually has the following features: 1 2 3
- high fever >38 ° C on any 2 days from days 1 to 14
- tachycardia (maternal and fetal)
- endometritis—offensive or purulent discharge
Tx of uterine sepsis
amoxycillin 2 g IV 6 hourly plus gentamicin 4–6 mg/kg IV daily plus metronidazole 500 mg IV 12 hourly
___________is common in pregnancy since
pregnancy is a predisposing factor to the growth of
the fungus
Candida (thrush)
______ is a first-line treatment for vaginal candidiasis
Clotrimazole
Rubella _______ indicates recent infection, rises
7–10 days after infection, and a real risk if
pregnant
IgM:
Dx of rubella infection
Fourfold rise in ____________ If initial test –ve repeat in 2 weeks
IgG titres or rubella specific IgM
antibody.
• Greatest risk if infection for varicella is in______ and _______
first trimester and very late pregnancy
______________ is rare—includes limb
abnormalities, microcephaly, optic atrophy, mental
impairment, IUGR—but it appears to occur in 3% of
pregnancies where the mother contracts varicella
Fetal varicella syndrome
Maternal infection in early pregnancy: greatest
risk <20 weeks gestation. Give a course of_________________
an antiviral
(e.g. acyclovir, valaciclovir); consider ultrasound
Consider VZ-Ig for baby if _________ before delivery and up to 4 weeks after. Isolate mother from baby until not
contagious.
<7 days
What to screen if suspicious for Parvo
• Screen for immunity with parvovirus B19 IgG
antibodies (reassure if positive).
• Screen for infection with acute and convalescent
sera for IgM antibodies
Miscarriage rate for Parvo
Miscarriage rate is 4% <20 weeks
__________ is anaemia–hydrops
fetalis with cardiac failure and possibly death
Fetal parvovirus syndrome
___________ is the commonest cause of intra-uterine
infection
CMV
- Up to 30% of CMV-affected infants have ____
* In up to 50% the effects are restricted to ___
mental impairment.
hearing loss
- ve HBsAg indicates _______
- ve anti-HBs indicates ______
- ve HBeAg indicates_____
acute infection.
recovery and immunity.
high infectivity but low transmission in utero.
Infected infants have a ______ risk of becoming
chronic carriers with liver disease
90%
When to give passive hep b vaccine
At delivery or ASAP give newborn babies of carrier
mothers both hepatitis B vaccine and immunoglobulin
(HBIg). This gives efficacy of about 90–95%.
When to give booster of hep b
Follow
up with booster doses of vaccine at 2, 4 and 6 (or 12)
months.
HCV
If positive, the transmission rate to fetus is _____ and much higher if there is maternal infection during pregnancy.
5%
The risk from primary infection of genital herpes is greatest if it occurs after
28 weeks gestation.
Risk factors for intrapartum genital herpes infection include 1 2 3
primary infection, multiple lesions,
premature rupture of the membranes and premature
labour
When to give prophylactic antiviral therapy in herpes?
Consider prophylactic antiviral (e.g. acyclovir) for
mother from 38 weeks until time of delivery—to
try to prevent recurrent herpes in late pregnancy
When to do CS in herpes?
1
2
— there are active lesions present (cervix/vulva)
at time of delivery or within preceding 4 days
— membranes ruptured <4 hours
T or F
Genital herpes
If vaginal delivery, give acyclovir to the neonate
T
T or F
the risk of transmission of
the HPV virus from the maternal genital tract to the fetus
is very high
false (low)
What condition?
• Incidence 2:1000
• Usually transmitted in second trimester
• May cause fetal death; congenital infection with
mental handicap
Syphilis
What are the tests for Syphilis
VDRL, TPHA, FTA-Abs
Syph Tx
Acquired early syphilis including latent
<12 months: ______
benzathine penicillin 1.8 g IM as single dose
Syph Tx
• Late latent syphilis (incubation period
>12 months): _______
benzathine penicillin 1.8 g IM once each week for 3 doses
The fetal infection rate from an HIV-positive mother
is about ______ unless appropriate ART has been
given
15–25%,
If screening detects an HIV-positive mother, both
she and her newborn infant require ______
antiretroviral
therapy.
T or F
Breastfeeding is inadvisable in HIV because it doubles
the risk of vertical transmission
T
The risk of HIB transmission can be reduced to
<5%:
• by treatment with _____ prescribed for the
mother antenatally and during labour and to the
neonate for the first 6 weeks postpartum
• by _______, and
• by ________
zidovudine
elective caesarean
avoiding breastfeeding
Both gonorrhoea and chlamydia urethritis can
transmit infection to the fetus, causing ________, which develops in the first 2 weeks of
life
neonatal
conjunctivitis
Chlamydia can also cause neonatal pulmonary
infection such as pneumonia, which usually appears
at ________
2 or 3 months of age
• Acquired by close contact with infected cats or
eating uncooked or undercooked meat
• About 2:1000 maternal infection rate with about
30% passed to fetus
Toxoplasmosis
Well-proven transplacental vertically transmissible pathogens include 1 2 3 4 5
cytomegalovirus, rubella, syphilis, toxoplasmosis and varicella
The best serological evidence of recent infection is
________ so the first specimen should be
collected ASAP after the onset of symptoms
IgG seroconversion
