Infections in Pregnancy Flashcards
What is gonorrhoea?
Gonorrhoea is a sexually transmitted infection (STI) caused by the bacterium Neisseria gonorrhoeae, which affects mucous membranes of the genital tract, rectum, and pharynx.
How common is gonorrhoea during pregnancy?
The incidence of gonorrhoea in pregnancy varies, but it is more common in women of younger age and those with high-risk sexual behavior.
How is gonorrhoea transmitted?
Sexual contact (vaginal, anal, or oral).
Vertical transmission during vaginal delivery from mother to baby.
Gonorrhoea is caused by the bacterium _____________.
Neisseria gonorrhoeae.
What are the symptoms of gonorrhoea in pregnancy?
Asymptomatic (common).
Vaginal discharge (thick, purulent).
Dysuria (painful urination).
Lower abdominal pain.
Dyspareunia (pain during intercourse).
What are the potential complications of untreated gonorrhoea in pregnancy?
Miscarriage.
Preterm birth.
Premature rupture of membranes (PROM).
Chorioamnionitis.
Postpartum endometritis.
Neonatal ophthalmia neonatorum or sepsis.
What are the neonatal risks associated with gonorrhoea?
Ophthalmia neonatorum (conjunctivitis).
Sepsis.
Meningitis.
Arthritis.
How is gonorrhoea diagnosed during pregnancy?
Nucleic acid amplification test (NAAT): First-line test.
Sample types: Vaginal swab, endocervical swab, or urine sample.
Microscopy and culture for antimicrobial sensitivity testing.
The first-line diagnostic test for gonorrhoea in pregnancy is _____________.
Nucleic acid amplification test (NAAT).
What is the management of gonorrhoea in pregnancy?
Antibiotic therapy:
First-line: Ceftriaxone (IM) + Azithromycin (oral).
Test of cure after 2 weeks to confirm eradication.
Partner notification and treatment.
Screening and retesting during pregnancy, particularly for high-risk groups.
What is the recommended antibiotic regimen for gonorrhoea in pregnancy?
Ceftriaxone 1 g intramuscularly (single dose).
Azithromycin 1 g orally (single dose).
Match the treatment to its purpose in gonorrhoea management:
Ceftriaxone
Azithromycin
Partner treatment
A: Covers gonorrhoea.
B: Covers co-infection with chlamydia.
C: Prevents reinfection.
1 → A
2 → B
3 → C
How can gonorrhoea be prevented in pregnancy?
Routine antenatal STI screening.
Practicing safe sex (condom use).
Screening and treatment of sexual partners.
Early prenatal care.
True/False
Q: Ophthalmia neonatorum caused by gonorrhoea can be prevented with routine application of prophylactic antibiotic eye ointment at birth.
True.
How is neonatal gonorrhoea managed?
Ophthalmia neonatorum:
Single dose of Ceftriaxone (IV or IM).
Irrigation of the eyes with saline.
Systemic infection: Ceftriaxone or Cefotaxime IV.
A 32-year-old pregnant woman is diagnosed with gonorrhoea at 28 weeks. She has a history of penicillin allergy (non-anaphylactic). What is the appropriate management?
Administer Ceftriaxone 1 g IM (safe for penicillin allergy if non-anaphylactic).
Add Azithromycin 1 g orally.
Conduct a test of cure after 2 weeks.
Why is a test of cure recommended for gonorrhoea in pregnancy?
To confirm eradication of the infection, especially given the risk of antibiotic resistance and the impact on maternal and neonatal outcomes.
Neonates exposed to gonorrhoea during delivery are at risk of developing _____________, a serious eye infection.
Ophthalmia neonatorum.
A pregnant woman is diagnosed with both gonorrhoea and chlamydia. How would her treatment plan differ?
Treat with Ceftriaxone for gonorrhoea and Azithromycin (already covers chlamydia).
Screen her partner(s) and treat as needed.
Should breastfeeding be avoided in women treated for gonorrhoea?
No, breastfeeding can continue. The antibiotics used (e.g., ceftriaxone and azithromycin) are safe during breastfeeding.
What is Group B Streptococcus (GBS)?
GBS is a bacterial infection caused by the Streptococcus agalactiae bacterium, commonly found in the gastrointestinal and genitourinary tract. It can cause severe infections in neonates and pregnant women.
Where is GBS commonly found in the body?
GBS is often found in the vagina, rectum, and intestines without causing symptoms (asymptomatic colonization).
The bacterium responsible for Group B Streptococcus infection is _________
Streptococcus agalactiae.
What percentage of pregnant women are colonized with GBS?
About 20-30% of pregnant women are colonized with GBS.
How is GBS transmitted to neonates?
Vertical transmission during labour and delivery.
Transmission from the maternal genital tract to the neonate.
What are the risks of GBS infection for neonates?
Early-onset sepsis (within 7 days of birth).
Pneumonia.
Meningitis.
Mortality or long-term neurological complications.
What are the signs of GBS infection in neonates?
Lethargy.
Poor feeding.
Irritability.
Respiratory distress.
Fever or hypothermia.
What are the risks of GBS for the mother?
Chorioamnionitis.
Urinary tract infection (UTI).
Endometritis.
Bacteremia or sepsis (rare).
When is routine GBS screening performed during pregnancy in the UK?
Routine screening is not recommended in the UK, but risk-based strategies are used.
In the USA, routine GBS screening is performed at __________ weeks of gestation.
35–37 weeks.
What are the maternal risk factors for GBS transmission to the neonate?
Preterm labour (<37 weeks).
Prolonged rupture of membranes (>18 hours).
Maternal fever during labour.
Previous baby with GBS infection.
Maternal GBS bacteriuria during pregnancy.
True/False
Q: Women with a previous baby affected by GBS require intrapartum antibiotic prophylaxis in future pregnancies.
True.
What is the management of GBS colonization in pregnancy?
Intrapartum antibiotic prophylaxis (IAP) for high-risk cases.
First-line: IV benzylpenicillin.
Alternative: Clindamycin (if penicillin allergy).
What is the standard IAP regimen for GBS?
Benzylpenicillin IV, administered:
Initial dose: 3 g.
Maintenance dose: 1.5 g every 4 hours until delivery.
A 28-year-old pregnant woman in preterm labour (36 weeks) has a history of GBS bacteriuria earlier in pregnancy. What management is required during labour?
Start intrapartum IV benzylpenicillin.
Monitor for neonatal signs of GBS infection postpartum.
The first-line antibiotic for intrapartum prophylaxis of GBS is _____________.
Benzylpenicillin.
How is a neonate exposed to GBS during delivery managed?
Observation for 12–24 hours for signs of infection.
If symptomatic: Start IV antibiotics (e.g., benzylpenicillin + gentamicin).
Match the GBS-related term with its description:
Early-onset GBS disease
Late-onset GBS disease
Intrapartum prophylaxis
A: Occurs within 7 days of birth.
B: Occurs between 7 days and 3 months of age.
C: Reduces the risk of neonatal infection during delivery.
1 → A
2 → B
3 → C
How can GBS infections in neonates be prevented?
IAP for high-risk pregnancies.
Early identification of maternal risk factors.
Adequate neonatal monitoring post-delivery.
A woman declines GBS screening but develops fever and prolonged rupture of membranes during labour. What is the next step?
Administer IV benzylpenicillin for presumed GBS infection risk.
True/False)
Q: Neonates with GBS infection always present with fever.
False. Neonates can also present with hypothermia.
What is the prognosis for neonates with early-onset GBS treated promptly?
With prompt antibiotic treatment, most neonates recover fully, but there is a risk of long-term complications like neurological impairment if untreated.
What is chlamydia?
Chlamydia is a sexually transmitted infection (STI) caused by the bacterium Chlamydia trachomatis, which can infect the cervix, urethra, rectum, and throat.
How common is chlamydia in pregnancy?
Chlamydia is one of the most common bacterial STIs in pregnancy, particularly in young women under 25 years.
The bacterium responsible for chlamydia is ________
Chlamydia trachomatis.
How is chlamydia transmitted?
Sexual contact (vaginal, oral, or anal).
Vertical transmission from mother to baby during vaginal delivery.
What are the symptoms of chlamydia in pregnant women?
Often asymptomatic.
If symptomatic:
Vaginal discharge.
Dysuria.
Lower abdominal pain.
Intermenstrual or postcoital bleeding.
What complications can chlamydia cause in neonates?
Neonatal conjunctivitis (ophthalmia neonatorum).
Neonatal pneumonia
What complications can untreated chlamydia cause in pregnant women?
Preterm labour.
Premature rupture of membranes (PROM).
Postpartum endometritis.
Who should be screened for chlamydia during pregnancy?
All high-risk women (e.g., aged <25 years or with multiple sexual partners).
Universal screening may occur in some countries, depending on guidelines.
The diagnostic test for chlamydia is a __________ or __________ swab analyzed by nucleic acid amplification testing (NAAT).
Vaginal; cervical.
How is chlamydia diagnosed in pregnancy?
Using a NAAT of a vaginal or cervical swab (or first-catch urine).
What is the first-line treatment for chlamydia in pregnancy?
Azithromycin 1 g as a single dose.
What is the alternative treatment for chlamydia in pregnancy?
Amoxicillin 500 mg three times daily for 7 days.
Erythromycin (less commonly used).
True/False
Q: Azithromycin is safe to use in pregnancy for treating chlamydia.
True.
Why is partner notification important in managing chlamydia?
To ensure partners are tested and treated to prevent reinfection and further transmission.
A 24-year-old pregnant woman tests positive for chlamydia at her first antenatal appointment. What is the management plan?
Prescribe azithromycin 1 g orally as a single dose.
Test and treat her sexual partner(s).
Repeat testing after 3–6 weeks to ensure clearance.
How are neonates exposed to chlamydia during delivery managed?
Monitor for conjunctivitis and respiratory symptoms.
Treat neonatal conjunctivitis with topical and systemic erythromycin.
Match the term with its description:
NAAT
Azithromycin
Neonatal conjunctivitis
Vertical transmission
A: Diagnostic test for chlamydia.
B: First-line antibiotic treatment in pregnancy.
C: Eye infection in neonates caused by chlamydia.
D: Transmission from mother to baby during birth.
1 → A
2 → B
3 → C
4 → D
How can chlamydia transmission be prevented in pregnancy?
Screening high-risk individuals.
Prompt antibiotic treatment for infected mothers.
Partner notification and treatment.
Education on safe sexual practices.
The most common complication of untreated chlamydia in neonates is _____________.
Neonatal conjunctivitis.
When should repeat testing be performed after treating chlamydia in pregnancy?
After 3–6 weeks to confirm eradication.
A pregnant woman treated for chlamydia with azithromycin asks if she needs follow-up. What advice should you give?
Yes, repeat a NAAT after 3–6 weeks to confirm eradication.
Ensure her partner(s) have been tested and treated.
What increases the risk of neonatal complications from chlamydia?
Vaginal delivery.
Untreated maternal infection during pregnancy
What is syphilis?
Syphilis is a sexually transmitted infection (STI) caused by the bacterium Treponema pallidum.
What are the stages of syphilis?
Primary syphilis: Painless chancre at the infection site.
Secondary syphilis: Systemic symptoms (rash, lymphadenopathy).
Latent syphilis: Asymptomatic period.
Tertiary syphilis: Severe complications affecting the cardiovascular and nervous systems.
The causative organism of syphilis is ___________
Treponema pallidum.
How can syphilis be transmitted to the fetus?
Via transplacental transmission, particularly in early syphilis stages.
What increases the risk of syphilis in pregnancy?
High-risk sexual behavior.
Lack of antenatal care.
Previous or concurrent STIs.
What are the symptoms of syphilis in pregnancy?
Primary: Painless genital ulcer (chancre).
Secondary: Rash (including palms/soles), fever, malaise, and condylomata lata.
Latent/Tertiary: Asymptomatic or severe systemic complications.
What complications can syphilis cause in the fetus?
Stillbirth.
Intrauterine growth restriction (IUGR).
Preterm birth.
Congenital syphilis, presenting with:
Hepatosplenomegaly.
Skeletal abnormalities.
Rash.
Snuffles (nasal discharge).
When is screening for syphilis performed during pregnancy?
At the first antenatal visit, typically using serological testing.
What tests are used to diagnose syphilis?
Non-treponemal tests: Rapid plasma reagin (RPR) or Venereal Disease Research Laboratory (VDRL) tests.
Treponemal tests: Treponema pallidum particle agglutination (TPPA) or enzyme immunoassay (EIA).
The gold standard treatment for syphilis in pregnancy is ________
Benzathine penicillin G.
How is syphilis treated in pregnancy?
Benzathine penicillin G intramuscularly.
Early syphilis: Single dose.
Late latent syphilis: Weekly doses for 3 weeks.
What is the Jarisch-Herxheimer reaction, and why is it relevant in syphilis treatment during pregnancy?
Acute systemic reaction to penicillin treatment.
Symptoms: Fever, chills, myalgia.
Can cause uterine contractions and fetal distress but does not contraindicate treatment.
True/False
Q: Pregnant women allergic to penicillin can use doxycycline to treat syphilis.
False. Penicillin desensitization is required as it is the only safe treatment in pregnancy.
What complications can syphilis cause in pregnant women?
Preterm labor.
Placental insufficiency.
Stillbirth.
How are neonates exposed to syphilis managed?
Serological testing at birth.
Treat with penicillin if congenital syphilis is confirmed or suspected.
How can syphilis in pregnancy be prevented?
Universal antenatal screening.
Safe sexual practices.
Early treatment of infected mothers and their partners.
A pregnant woman tests positive for syphilis during her first antenatal visit. What is the management plan?
Treat with benzathine penicillin G.
Advise about the Jarisch-Herxheimer reaction.
Screen and treat her sexual partner(s).
Repeat serological tests to monitor treatment response.
A newborn presents with hepatosplenomegaly, persistent nasal discharge, and a maculopapular rash. What is the most likely diagnosis?
Congenital syphilis.
When should serological testing be repeated after syphilis treatment during pregnancy?
At 28 weeks and again at delivery to confirm serological response.
What is bacterial vaginosis (BV)?
BV is a condition caused by an imbalance of vaginal flora, leading to a decrease in lactobacilli and an overgrowth of anaerobic bacteria.
What is the main cause of bacterial vaginosis?
A decrease in lactobacilli reduces lactic acid production, increasing vaginal pH and allowing anaerobic bacteria to overgrow.
Name three risk factors for bacterial vaginosis.
Multiple or new sexual partners.
Use of douches or vaginal washes.
Recent antibiotic use.
What are the main symptoms of bacterial vaginosis?
Thin, white/grey vaginal discharge.
Fishy odor, especially after intercourse.
Often asymptomatic.
What are the Amsel criteria for diagnosing BV?
Thin, homogenous discharge.
Clue cells on microscopy.
Vaginal pH > 4.5.
Positive whiff test (fishy odor with potassium hydroxide).
What are clue cells?
Vaginal epithelial cells coated with bacteria, giving them a stippled appearance under microscopy.
The vaginal pH in bacterial vaginosis is typically ____________
Greater than 4.5.
True/False
Q: Bacterial vaginosis is an STI.
False. BV is not classified as an STI, although sexual activity can be a risk factor.
What is the first-line treatment for bacterial vaginosis?
Oral metronidazole (500 mg twice daily for 7 days).
Alternatively, intravaginal metronidazole gel or clindamycin cream.
What percentage of women experience recurrent BV after treatment?
Approximately 30% within 3 months and 50% within 6 months.
What are the key differential diagnoses for bacterial vaginosis?
Candidiasis (thick, white discharge).
Trichomoniasis (frothy, green discharge).
What are the complications of untreated BV?
Increased risk of preterm labor and miscarriage in pregnancy.
Higher susceptibility to STIs, including HIV.
Pelvic inflammatory disease (PID).
A woman presents with thin, fishy-smelling vaginal discharge and a pH of 5.2. Microscopy reveals clue cells. What is the most likely diagnosis and treatment?
Diagnosis: Bacterial vaginosis.
Treatment: Oral metronidazole for 7 days.
The overgrowth of anaerobic bacteria in BV is often caused by the reduction of ____________ in the vaginal flora.
Lactobacilli.
How is recurrent bacterial vaginosis managed?
Prolonged courses of metronidazole.
Consider lactobacilli vaginal suppositories or probiotics.
Why is intravaginal clindamycin cream not recommended during late pregnancy?
It may increase the risk of neonatal infections.
What advice can be given to prevent bacterial vaginosis?
Avoid douching or vaginal washes.
Practice safe sex.
Limit the number of sexual partners.
True/False
Q: BV is associated with pelvic inflammatory disease in non-pregnant women.
true.
A pregnant woman diagnosed with BV has no symptoms. Should she be treated?
Yes, to reduce the risk of pregnancy complications, such as preterm labor.
What is a puerperal infection?
A puerperal infection refers to any bacterial infection of the genital tract occurring within 6 weeks postpartum.
Name the most common site of puerperal infection.
Endometrium (leading to puerperal endometritis).
What are the key risk factors for puerperal infections?
Prolonged rupture of membranes.
Cesarean section (most significant risk factor).
Retained products of conception.
Prolonged labor.
Multiple vaginal examinations.
Poor hygiene.
Maternal anemia.
What are the key clinical features of puerperal infection?
Fever > 38°C.
Lower abdominal pain.
Foul-smelling lochia.
Uterine tenderness.
General malaise.
What temperature defines puerperal fever?
Fever of ≥ 38°C on two occasions 24 hours apart within the first 10 days postpartum (excluding the first 24 hours).
True/False
Q: Puerperal infections most commonly occur after a vaginal delivery.
False. Cesarean sections are the most significant risk factor.
The most common causative organisms for puerperal infections are __________ and __________.
Group A Streptococcus and Escherichia coli (E. coli).
What are the key investigations for puerperal infections?
Full blood count (FBC) – leukocytosis.
Blood cultures.
Vaginal swabs.
Urine culture (to rule out UTI).
Pelvic ultrasound if retained products are suspected.
What is the initial management of puerperal infection?
Broad-spectrum IV antibiotics (e.g., IV ceftriaxone and metronidazole).
Removal of any retained products.
Supportive measures: fluids and antipyretics.
What is the first-line antibiotic regimen for puerperal endometritis?
IV clindamycin + gentamicin.
Name three complications of untreated puerperal infection.
Sepsis.
Pelvic abscess.
Peritonitis.
What are the differential diagnoses for puerperal infection?
Mastitis.
Urinary tract infection (UTI).
Pulmonary infection.
Deep vein thrombosis (DVT).
A postpartum woman presents with fever, lower abdominal pain, and foul-smelling lochia. What is the most likely diagnosis and initial treatment?
Diagnosis: Puerperal endometritis.
Treatment: Broad-spectrum IV antibiotics.
Why is it important to rule out retained products of conception in puerperal infections?
Retained products can act as a nidus for infection, preventing resolution until removed.
Match the clinical feature with its likely cause in the puerperium:
Fever and uterine tenderness.
Dysuria and fever.
Cough and chest pain.
Unilateral leg swelling and tenderness.
A: Pulmonary embolism.
B: Endometritis.
C: Urinary tract infection.
D: Deep vein thrombosis.
1 → B
2 → C
3 → A
4 → D
How can puerperal infections be prevented?
Prophylactic antibiotics during cesarean section.
Good perineal hygiene.
Minimizing vaginal examinations during labor.
What is the key parameter to monitor in puerperal infections to detect sepsis early?
Monitor for hypotension, tachycardia, altered mental status, and oliguria.
Puerperal infection should be suspected in any postpartum woman with fever and __________ discharge.
Foul-smelling.
True/False
Q: Vaginal swabs are mandatory for all women suspected of puerperal infection.
True.
Why are broad-spectrum antibiotics essential for puerperal infection management?
To cover aerobic and anaerobic bacteria, which are common in polymicrobial infections.
What surgical procedure may be required if retained products are identified?
Evacuation of retained products of conception (ERPC).
When is puerperal infection most likely to occur postpartum?
Within the first 10 days, especially after cesarean delivery.
What are red flags for progression to sepsis in puerperal infection?
Tachycardia > 100 bpm.
Hypotension.
Confusion or altered mental status.
Oliguria.
What is the pathophysiology of puerperal infections?
It involves bacterial colonization of the endometrium or surrounding genital tissues postpartum, often due to ascending infection from the lower genital tract.
How can lochia be used to differentiate normal postpartum recovery from puerperal infection?
Normal: Gradually changes from red to yellow/white without foul odor.
Infected: Foul-smelling, purulent discharge with possible uterine tenderness.
List the common causative organisms in puerperal infections
Group A Streptococcus (GAS).
Escherichia coli.
Staphylococcus aureus.
Klebsiella.
Anaerobes (e.g., Bacteroides).
Which patient groups are at higher risk of developing puerperal infection?
Patients undergoing emergency cesarean.
Women with diabetes.
Women with poor prenatal care.
Those with prolonged ruptured membranes.
What are the key steps in managing sepsis from puerperal infection?
Immediate IV fluids.
Broad-spectrum IV antibiotics.
Blood cultures prior to antibiotics.
Monitor vital signs closely.
Consider admission to ICU if unstable.
__________ is a postpartum condition characterized by uterine tenderness, foul lochia, and fever.
Puerperal endometritis.
Match the symptom to the potential condition in postpartum women:
Uterine tenderness.
Breast redness and swelling.
Dysuria and frequency.
Fever and shortness of breath.
A: Mastitis.
B: UTI.
C: Endometritis.
D: Pulmonary embolism.
1 → C
2 → A
3 → B
4 → D
What is the management of surgical site infections after cesarean delivery?
Open and drain the wound.
Clean wound regularly.
Administer broad-spectrum antibiotics if infection is spreading.
How long should antibiotics be continued for puerperal infections?
Typically 7–10 days, but may be adjusted based on clinical response.
What are the signs of retained products of conception in puerperal infections?
Prolonged bleeding.
Persistent fever despite antibiotics.
Enlarged or tender uterus.
A patient presents 5 days postpartum with a fever of 39°C, uterine tenderness, and foul-smelling lochia. What is the next step in management?
Start broad-spectrum IV antibiotics and order blood cultures and a pelvic ultrasound.
Why is early treatment of puerperal infections crucial?
To prevent progression to sepsis, septic shock, and potential maternal mortality.
What are the key measures to prevent postpartum endometritis?
Prophylactic antibiotics for cesarean section.
Minimize vaginal examinations during labor.
Ensure aseptic technique during delivery.
How does breastfeeding reduce the risk of puerperal infection?
Breastfeeding promotes uterine contraction and helps in the expulsion of lochia, reducing the risk of infection.
What should women be counseled on regarding puerperal infection?
Warning signs of infection (fever, foul-smelling discharge).
The importance of seeking medical help early.
Maintaining good perineal hygiene.
When is pelvic ultrasound indicated in puerperal infections?
When there is suspicion of retained products of conception or pelvic abscess.
Puerperal infection typically presents with fever, uterine tenderness, and __________.
Foul-smelling lochia.
True/False
Q: Fever within the first 24 hours postpartum is always a sign of puerperal infection.
False. Mild fever in the first 24 hours can be due to breast engorgement or dehydration.
What are the indications for ICU admission in puerperal sepsis?
Hemodynamic instability.
Oxygen requirement.
Multi-organ dysfunction.
How is the response to treatment monitored in puerperal infection?
Improvement in fever and symptoms.
Monitoring vital signs.
Resolution of uterine tenderness.
What is Trichomonas vaginalis?
It is a sexually transmitted infection (STI) caused by the protozoan Trichomonas vaginalis.
How is Trichomonas vaginalis transmitted?
It is transmitted through unprotected sexual contact.
What are the common symptoms of Trichomonas vaginalis in pregnancy?
Greenish-yellow, frothy vaginal discharge.
Vaginal itching and irritation.
Dysuria (painful urination).
Strawberry cervix (punctate hemorrhages on the cervix).
True/False
Q: A strawberry cervix is a hallmark sign of Trichomonas vaginalis infection.
t
What are the diagnostic methods for Trichomonas vaginalis?
Microscopy of vaginal secretions (wet mount shows motile trichomonads).
Nucleic acid amplification test (NAAT).
Vaginal pH >4.5.
The most sensitive diagnostic test for Trichomonas vaginalis is ________
Nucleic acid amplification test (NAAT).
What are the potential complications of Trichomonas vaginalis in pregnancy?
Preterm labor.
Preterm rupture of membranes.
Low birth weight.
Trichomonas vaginalis in pregnancy is associated with an increased risk of __________ birth.
preterm .
What is the recommended treatment for Trichomonas vaginalis in pregnancy?
Metronidazole (2g single dose or 500mg twice daily for 7 days).
Is metronidazole safe in pregnancy?
Yes, it is considered safe in pregnancy, including the first trimester.
Why is partner treatment important in Trichomonas vaginalis?
To prevent reinfection and reduce transmission.
What should women with Trichomonas vaginalis be counseled on?
Partner notification and treatment.
Avoid unprotected sex until both partners are treated.
The importance of completing the course of treatment.
What increases the risk of reinfection with Trichomonas vaginalis?
Unprotected sexual contact with an untreated partner.
Lack of partner treatment.
What follow-up is recommended after treatment for Trichomonas vaginalis in pregnancy?
Retesting after 3 months.
Ensure symptom resolution.
A pregnant woman presents with frothy green discharge and vaginal itching. Microscopy confirms Trichomonas vaginalis. What is the next step?
Prescribe metronidazole.
Treat the partner.
Advise abstinence until treatment is complete
What preventive measures can reduce the risk of Trichomonas vaginalis infection?
Consistent condom use.
Routine STI screening.
Partner notification and treatment.
What is a UTI (Urinary Tract Infection)?
A bacterial infection of the urinary tract, which can occur as asymptomatic bacteriuria, cystitis, or pyelonephritis.
What are risk factors for UTIs in pregnancy?
Urinary stasis (due to uterine compression).
Hormonal changes (progesterone slows urinary flow).
Previous UTI.
Sexual activity.
Diabetes mellitus.
Hormonal changes in pregnancy cause urinary tract dilation due to elevated __________.
Progesterone.
What are the clinical features of cystitis?
Dysuria (painful urination).
Frequency and urgency.
Suprapubic pain.
Hematuria (blood in urine).
What are the clinical features of pyelonephritis?
Fever and rigors.
Flank pain.
Nausea and vomiting.
Dysuria and frequency.
May progress to sepsis.
How is a UTI diagnosed in pregnancy?
Urine dipstick (positive for nitrites and leukocytes).
Midstream urine culture (MSU confirms bacterial growth).
Urinalysis for pyuria and bacteriuria.
A urine dipstick positive for __________ and __________ suggests a UTI.
Nitrites, leukocytes.
What are the complications of untreated UTI in pregnancy?
Pyelonephritis.
Preterm labor.
Preterm rupture of membranes.
Low birth weight.
Sepsis.
What is the treatment for asymptomatic bacteriuria in pregnancy?
Antibiotics such as nitrofurantoin (avoid in the 3rd trimester) or cephalexin.
The first-line treatment for asymptomatic bacteriuria in pregnancy is __________ or __________.
Nitrofurantoin, cephalexin.
What is the treatment for cystitis in pregnancy?
Nitrofurantoin (avoid in the 3rd trimester), cephalexin, or amoxicillin.
What is the treatment for pyelonephritis in pregnancy?
Hospital admission.
IV antibiotics (e.g., cefuroxime or ceftriaxone).
Monitor for sepsis and complications.
What follow-up is recommended after treatment for UTI in pregnancy?
Repeat urine culture to ensure clearance of the infection.
True/False
Q: Nitrofurantoin is safe in the 3rd trimester of pregnancy.
False (due to the risk of neonatal hemolysis).
What preventive measures can reduce the risk of UTIs in pregnancy?
Adequate hydration.
Frequent urination (avoid holding urine).
Good perineal hygiene.
Cranberry supplements (may help prevent recurrence).
A pregnant woman at 20 weeks presents with dysuria and frequency. Urine dipstick is positive for nitrites and leukocytes. What is the next step?
Send midstream urine culture.
Start empirical antibiotics (e.g., nitrofurantoin or cephalexin).
Match the antibiotic to the correct UTI treatment in pregnancy:
Nitrofurantoin
Cephalexin
Ceftriaxone
A: Cystitis
B: Pyelonephritis
C: Asymptomatic bacteriuria
1 → C
2 → A
3 → B
What signs of worsening infection should be monitored for in pyelonephritis?
High fever and rigors.
Hypotension.
Tachycardia.
Reduced urine output (sign of sepsis)
What is Varicella zoster?
Varicella zoster is a herpes virus that causes chickenpox as a primary infection and can reactivate as shingles.
How is Varicella zoster transmitted?
Airborne droplets (from respiratory secretions).
Direct contact with skin lesions.
What are the risk factors for severe Varicella zoster infection in pregnancy?
Non-immune status.
Third trimester.
Smokers.
Pre-existing lung disease.
Immunocompromised patients.
What are the clinical features of Varicella zoster in pregnancy?
Fever and malaise.
Pruritic rash starting on the trunk, spreading to face and limbs.
Progression from macules → papules → vesicles → crusting.
What are maternal complications of Varicella zoster infection in pregnancy?
Varicella pneumonia.
Hepatitis.
Encephalitis.
Sepsis.
Premature labor.
What are potential fetal complications if Varicella occurs in pregnancy?
Congenital varicella syndrome.
Neonatal varicella.
Miscarriage or stillbirth.
Congenital varicella syndrome is characterized by __________, limb hypoplasia, cataracts, and neurological impairment.
Skin scarring.
What are the features of congenital varicella syndrome?
Skin scarring.
Limb hypoplasia.
Eye abnormalities (e.g., cataracts).
Neurological impairment (e.g., microcephaly).
When is the fetus at highest risk for congenital varicella syndrome?
Between 13-20 weeks gestation.
How is Varicella zoster diagnosed in pregnancy?
Clinical diagnosis based on characteristic rash.
Varicella zoster PCR from vesicular fluid.
Serology to check for IgG and IgM antibodies.
What is the management of a non-immune pregnant woman exposed to Varicella?
Varicella zoster immune globulin (VZIG) within 10 days of exposure.
Monitor for symptoms.
Varicella zoster immune globulin (VZIG) should be given within __________ days of exposure.
10
How is Varicella zoster treated in a pregnant woman with confirmed infection?
Oral acyclovir if presenting within 24 hours of rash onset.
Hospital admission for monitoring if severe infection or pneumonia.
What is neonatal varicella?
Severe varicella infection in newborns if the mother develops varicella 5 days before to 2 days after delivery.
How is neonatal varicella managed?
VZIG for exposed newborns.
Acyclovir if the baby develops symptoms.
How can Varicella zoster infection be prevented in pregnancy?
Pre-pregnancy vaccination for non-immune women.
Avoid contact with infected individuals during pregnancy.
A 24-week pregnant woman with no known immunity to Varicella is exposed to a child with chickenpox. What should be done?
Administer VZIG within 10 days of exposure.
