Infections of Pregnancy Flashcards
What infections can be transmitted to baby during delivery? Which are screened for?
- Group B strep
- Herpes simplex virus
- Gonorrhoea
- HIV
- Hep B
- Chlamydia
- Hep B &HIV prophylaxis & screening given
Describe antimicrobial prescribing in pregnancy
- Inc in glomerular filtration rate results in inc renal excretion of many antimicrobials so lower serum levels, inc risk of treatment failure therefore higher doses needed
- to an extent all antimicrobials cross placenta
- all antimicrobials found in breast milk
What antibiotics are safe in pregnancy?
- penicillins
- cephalosporins
What antimicrobials are not safe to use in pregnancy?
- Chloramphenicol
- tetracycline
- fluoroquinolones (ciprofloxacin)
- trimethoprim
Describe UTIs during pregnancy
- screening for bacteriuria
- continuing bacteriuria associated with premature delivery & inc perinatal mortality
- treat if patient if asymptomatic (amoxicillin)
- pylonephritis & sepsis
Describe intra-amniotic infections
- infection of amniotic fluid, foetus, placenta
- major cause of perinatal morbidity & mortality
- chorioamnionitis= inflammation of umbilical cord, amniotic membranes, placenta
- lead to premature delivery
How do intra-amniotic infections present?
- maternal fever (sustained)
- uterine tenderness
- malodorous amniotic fluid (foul smelling)
- maternal/foetal tachycardia
- raised white cell count
What are risk factors for intra-amniotic infections?
- prolonged rupture of membranes
- amniocentesis
- cordocentesis
- multiple vaginal examinations
- cervical cerclage
What is the pathogenesis of intra-amniotic infections?
- bacteria present in vagina ascend through cervix
- haematogenous-rare listeria monocytogenes (salad, cheese)
What are common causative organisms of intra-amniotic infections?
- E.coli
- enterococci
- Group B strep
- normal flora get into the wrong place
How are intra-amniotic infections managed?
- delivery and antibiotic treatment
- antibiotics given at time of diagnosis
What is puerperal endometritis?
- infection of the womb during puerperium
- sepsis major cause of maternal death
What are clinical features of puerperal endometritis?
- fever (24hr after delivery)
- uterine tenderness
- purulent foul-smelling lochia (vaginal discharge)
- inc white cell count
- general malaise, abdo pain
What are risk factors for puerperal endometritis?
- Caesarian
- prolonged labour
- prolonged rupture of membranes
- multiple vaginal examinations
What are causative organisms of puerperal endometritis?
- E.coli
- Anaerobes
- beta-haemolytic strep
- Group A strep
