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
How is puerperal endometritis diagnosed & treated?
D= transvaginal endometrial swab, blood culture T= broad spec IV antimicrobials continued until patient apyrexial for 48hours, co-amoxiclav
What is puerperal mastitis?
Infection of breast tissue via cracked/fissured nipples
What are clinical features of puerperal mastitis? What can present similarly?
- 5 weeks after delivery
- Rigor
- abrupt onset fever
- breast soreness
- redness, warmth, tenderness of breast
- blocked milk duct
What is the causative organism of puerperal mastitis?
-Staph aureus (treated with flucloxacillin)
What are clinical features of neonatal sepsis/meningitis?
- temperature: pyrexia/ hypothermia
- respiratory: dyspnoea, apnoeas, cyanosis
- CV: tachy/bradycardia, hypotension
- hepatic: jaundice, hepatomegaly
- GI: anorexia, vomiting, diarrhoea, abdo distension
- Haem: bleeding disorders
- CNS: lethargy, seizures, irritability
What are common causative organisms of neonatal sepsis? How is it treated?
- Group B strep
- E.coli
- Listeria
- Broad spec antimicrobials: amoxicillin w/gentamicin
How can infections be transmitted from mother to the foetus?
Haematogenous
What viral infections need to be considered during pregnancy?
- Zika virus, Rubella virus (teratogenic)
- Herpes simplex virus, influenza, measles, Varicella zoster virus (severe)
- Serology/PCR/amniotic fluid samples
What are common causes of puerperal sepsis?
- Pneumonia
- IV catheter related infection
- Wound infection (C-section)
