infections in pregnancy

Question 1

vaccines during pregnancy

Answer 1

Recommended

• Tdap
• inactivated influenza
• Rho(D) immunoglobulin

Indicated for high risk patients

• Hep B
• Hep A
• Pneumococcus
• H flu
• Meningococcus
• VZV

Contraindicated

• HPV
• MMR
• Live attenuated flu
• varicella

Question 2

preventing neonatal GBS

Answer 2

Antenatal screening
-rectovaginal culture at 35-37 weeks gestation

indications for intrapartum prophylaxis

• prior infant with neonatal GBS
• GBS bacteriuris or UTI
• GBS positive culture
• unknown status plus intrapartum fever, rupture of membranes over 18 hours, gest <38 weeks

intrapartum prohphylaxis
-IV penicillin

Question 3

Cervicitis

Answer 3

CLINICAL

• postcoital bleeding
• thick, mucopurulent discharge
• dysuria
• dyspareunia,
• vulvovaginal pruritus

PATHOPHYS
-chlam and gonorr

DIAGNOSIS

• firable cervix
• NAT

TREAT
-azithromycin and ceftriaxone

Question 4

Hx of HSV

Answer 4

• if no outbreaks, prophylaxis starting at 36 weeks
• at time of delivery, if no prodromal symptoms, vaginal delivery is safe
• if active lesion or prodromal symptoms do a cesarean

Question 5

Congenital Zika syndrome

Answer 5

PATHOGEN

• ssRNA Flavivirus
• transplacental transmission to fetus
• targets neural progenitor cells

CLINICAL

• microcephaly, craniofacial disproportion
• neurologic abnormalities
• ocular abnormalities

DIANGOSIS

• neuroimaging: Calcifications, ventriculomegaly, cortical thinning
• Zika RNA detection