Infections in Pregnancy Lecture Powerpoint Flashcards
Most common bacterial infection in pregnancy
UTI
Asymptomatic bacteriuria is more common in ____ women, and these are also at higher risk for progression to upper UTI or pyelonephritis (predisposed to retention, stasis, vesicoureteral reflux, etc)
pregnant
Upper genital tract vs lower
Uterus, tubes, ovaries, pelvic peritoneum compose the upper and are all normally sterile while cervix and vagina are lower and are an infection waiting to happen
All pregnant women should be screened with a clean catch urine culture and sensitivity as well as a urine dipstick at….
….first prenatal visit (12-16 weeks gestation)
Function of urine dipstick at first prenatal visit vs urine and culture
Do both, the dipstick has low sensitivty but can help screen for presence of protein, blood, or glucosuria, hwile clean catch culture and sensitivity has high accuracy and if negative risk of subsequent UTI is low but if positive then needs close follow up
Most common causative organism of UTI’s in pregnancy (1)
-E coli
Asymptomatic bacteriuria
Pregnancy disease significant bacterial colonization of the bladder without symptoms, as little as 100CFU/mL can indicate active infection, risk of pyelonephritis is already increased in pregnancy
Risk factors of asymptomatic bacteruria (4)
- prior history of UTI
- anatomic abnormalities
- sexual behavior (poop in the vag hole)
- immunocompromised (DM, HIV)
Cystitis in pregnancy
Pregnancy disease symptomatic infection fo bladder with significant number of organisms >100organisms/mL with accompanying pyuria, dysuria being the most significant symptom and may be difficult to distinguish from pregnancy related complains, pelvic exam considered for all symptomatic patients
UTI in pregnancy treatment (4) and what should you NOT use and why? (3)
- nitrofurantoin 100mg oral (1st-early 3rd trimesters only)
- augmentin
- fofsomycin
- test for cure after treatment and repeat each trimester for recurrent infection (do this in ANY infection of pregnancy actually)
- sulfa drugs (inhibits folate and bilirubin kernicterus)
- fluorquinolones (fetal arthropathy)
- tetracyclines (detect fetal bones and teeth)
Pyelonephritis in pregnancy
Most common UTI complication in pregnant women most often occurring in 2nd trimester, frequently associated with septicemia, marked fetal/maternal morbidity and mortality, fetal bloodstream infection is rare so few direct fetal sequalae, but issue of hypoperfusion to placental vasculature and potential fetal cerebral hypoperfusion
Pyelonephritis signs and symptoms (7)
- fever
- flank pain
- cva tenderness
- significant bacteruria
- rigors
- urgency and frequency
- risk for dehydration
Pyelonephritis diagnostic studies (5)
- UA
- Urine culture and sensitivity (even having to catheterize if neccessary)
- blood cultures
- CBC
- BMP
Pyelonephritis in pregnancy treatment options (3)
- IV fluids
- ceftrioxone
- fetal monitoring (risk for progressing to preterm labor)
Most common cause of neonatal sepsis, gold standard for diagnosis
GBS, culture with vaginal and rectal swab routinely done at 35-37 weeks gestation
Neonatal GBS presentation (4)
- septicemia
- pneumonia
- meningitis
- potential infant mortality
Treatment of maternal GBS (2)
- treat at least 4 hours before delivery
- intrapartum prophylaxis using empiric treatment if culture results unknown
TORCHES viruses
Toxoplasmosis
Other (hep B, coxsakie, west nile, measles, HIV, zika)
Rubella
Cytomegalovirus
Herpes simplex
Erythema infectiosum (parvovirus B19 5th disease)
Syphilis
Infections developing intrauterine or during birth process
Toxoplasmosis risk factors in pregnancy (3), signs and symptoms, and treatment (1)
- raw or undercooked meat
- cat litter
- contaminated soil
- asymptomatic to mild fatigue and myalgias, congenital toxo in fetus causing blindness, microcphaly, etc.
- ID consult for intense meds
If mother infected with rubella in early pregnancy, __% of assing it to fetus (congeintal rubella syndrome)
90%
Congenital rubella syndrome presentation (5)
- blueberry muffin purpura
- small gestational age
- cataracts
- heart defects
- hearing defects
Congenital rubella syndrome is contagious for up to…
….1 year (isolate them)
CMV in pregnancy clinical presentation (2)
- majority asymptomatic
- congenital effects on the infant including sensorineural hearing loss***, IUGR, hepatosplenomegaly, etc
HSV passage from mother to child
Infected birth canal (HSV2 infection of pregnant woman), indication for c section if active visible vesicles, if mother doesn’t want to need informed consent documentation
Any septic neonate need to rule out this virus
HSV
A mom with primary or secondary syphilis during pregnancy is unlikely to have…
….normal infant (half will premature death other half will have congenital syphillis)
Syphilis presentation in neonates (3)
- maculopapular rash on palms and soles
- lymphadenopathy
- hearing loss
Syphilis treatment option in pregnant women (1)
-PCN is only one
Congenital varicella syndrome due to maternal acquiring infection between weeks 8-20 of pregnancy (4)
- muscle atrophy
- cutaneous scars as dermatomal pattern
- microcephaly
- mortality rate high
Sever disseminated varicella in the infant symptoms (3)
- hemorrhagic lesions
- sepsis, hepatitis, meningoencephalitis
- severe pneumonia
Severe disseminated varicella in the infant treatment options
- acyclovir
- varicella IG
Pregnancy infection with parvovirus B19 in weeks ____ has highest risk for fetal loss, hydrops fetalis, severe anemia, etc.
1st 20, 13-16 most critical
Only ___ (type of presentation of varicella zoster virus) has pregnancy concerns, not ___
varicella (chickenpox), herpes zoster (shingles)
Listeria monocytogenes infection in pregnancy treatment options
- ampicillin
- bactrim as backup (remember this isn’t good for the mother we want to avoid)
Chorioamnionitis and risk factors (4) and treatment (2)
Ascending infection of uterus and contents (palcenta, amniotic membranes/fluid, umbilical cord)
- prolonged rupture of membrane
- prolonged labor
- preterm labor
- meconnium staining of amniotic fluid
- Induction of delivery
- antibiotic treatment
After day 1 of a post partum fever, it should be considered..
….pelvic infection until proven otherwise
Risk factors for post partum endometritis (3) and causative agents(1) and treatment options (1)
- c section**
- Prolonged rupture of membrane
- prolonged labor
- multiple 2-3 organisms
- triple therapy, ampicillin gentamicin and clindamycin (post c section) or gent and clinda post vaginal
Episiotomy infection
Post partum wound infection, very rare and unlikely cause of post partum fever, risk factors include smoking and coagulation disorders and can be classified into different categories based on level of tissue involved and corresponding causative agent
Episiotomy infection clinical presentation (1) and treatment (2)
-painful dysuria discharge from site
- Surgical wide debridement
- adjunctive antibiotics clindamycin + B lactam
Post abortion infection presentation (5)
- 4 days post abortion
- fever
- chills
- tachycardia
- lower abdominal pain
Post abortion infection diagnostic studies (4) and causative agent (1) and treatment (2)
- positive pregnancy test 4-6 weeks post abortion indicates retention of fetal material
- gram stain
- C&S
- abdominal film
-polymicrobial infection
- amp and gent + clinda or metronidazole
- uterine suction curettage
Most common agent of mastitis in mother
-staph aureus
Treatment of mastitis (2)
- continuation of nursing (emptying breast)
- cephalexin to prevent abscess
Mastitis in a nonbreastfeeding woman could indicate….
…breast cancer
Chlamydia in pregnancy
Most common STI, can cause cervicitis or PID in mother or conjunctivits in newborn, screened at 1st visit and all at risk or younger than 25 should be rescreened in 3rd trimester
Chlamydia 1st line treatment and 2 backups
- azithromcin 1g po one time
- erythromycin
- amoxicillin
Gonorrhea 1st line treatment in mother and in newborn
- cephtriaxone + azithromycin
- erythromycin opthalmic ointment routine prophylaxis in newborns
Chlamydia often occurs alongside…
….gonorrhea
