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Clinical Pathology > Infections of pregnancy, puerperium and neonate > Flashcards

Infections of pregnancy, puerperium and neonate Flashcards

1
Q

What is the definition of puerperium?

A

Puerperal state where mothers tissue returns to non-pregnant state

  • 6-8 weeks post partum
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2
Q

What is the definition of a neonate?

A

Recently born individual who is less than 4 weeks old

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3
Q

What infections can be spread through haematogenous spread (mother -> baby)?

A 
CMV
Zika virus
Syphillis 
Parvovirus B19
Toxoplasmosis
VZV
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4
Q

What infection can be transmitted through delivery?

A 
HSV
Chlamydia
Gonorrhoea
HIV*
Hep B*
Group B strep

HIV and Hep B are screened - prophylaxis available

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5
Q

Why are women more prone to infections during pregnancy?

A

Physiological/immune changes predisposes women to some infections

Handling of drugs differ e.g. increased GFR/excretion - higher doses required

Serum levels of antibiotics are lower - underdose/treatment failure?

Immune suppression - symptoms might not manifest/dampened with pregnancy

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6
Q

Why consideration must we have for prescribing antimicrobials to pregnant/puerperium mothers?

A

Antimicrobials might be harmful to embryo/foetus/neonate

Crosses placenta to some extent and all cross in breast milk

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7
Q

What antibiotics are considered safe for use during pregnancy?

A

Penicillins
Cephlasporins

(provided no allergy)

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8
Q

What antibiotics new considered unsafe for use during pregnancy?

A
  • Trimethoprim-sulphamethoxazole
  • Tetracycline
  • Fluroquinolones
  • Chloramphenicol

(benefit:risk ratio)

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9
Q

What is primary infection and secondary infection?

A

Primary infection = first episode without immunity

Secondary - latent infection e.g. shingles

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10
Q

Name some primary infections which are asymptomatic or cause very little symptoms to mother

A

CMV

Pika virus

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11
Q

Name some primary infections which cause severe symptoms/infection to mother

A

VZV
Herpes
Measles
Influenza

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12
Q

What are the effects of infection to foetus

A

Spectrum - can range from no illness to serve, still birth or miscarriage, some can be tetranogenic e.g. rubella, toxoplasmosis, zika

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13
Q

What diagnostic procedures can be used?

A
  • Serology (IgG - prior exposure; IgM - current)
  • PCR

of relevant samples e.g. blood, vesicle fluid, amniotic fluid

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14
Q

Concerning maternal UTIs, why should asymptomatic bacteriuria be treated?

A

Can develop to symptomatic bacteria which is associated with premature delivery and perinatal mortality

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15
Q

What is the recommended process by which bacteriuria is diagnosed and treated?

A

2 samples containing 10^5 of same organism
(asymptomatic bacteriuria)

7 days on non-toxic antibiotics e.g. amoxycillin, cefalexin, even if asymptomatic

Test again to test cure

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16
Q

What can intraamniotic infections cause?

A

Uncommon but can cause early delivery and perinatal morbidity/mortality

17
Q

What infection does choropamniotitis cause?

A

Inflammation of umbilical cord, placenta, amniotic membranes

18
Q

What are the symptoms of intraamniotic infections?

A

Maternal fever (>38 degrees)

Malodorous amniotic fluid*

Uterine tenderness

Foetal/maternal tachycardia

Leukocytosis

19
Q

What are the risk factors for intraamniotic infections?

A

Premature/rupture of membranes**

Amniocentesis/cordocentesis (i.e. injections)

Cervical cerclage (man made material)

Multiple vaginal examination

BV

20
Q

What is the pathogenesis for intraamniotic infections?

A

Vaginal bacteria ascend into cervix

Haematogenous spread is rare eg. listeria

21
Q

What are the causative organisms for intraamniotic infections?

A

E coli (GI tract)
Enterococci (GI tract)
Group B strep

Endogenous flora going to wrong place

22
Q

What is puerperal endometritis?

A

Infection of the womb (puerperium - after birth)

Major cause of maternal death

23
Q

What are the risk factors for puerperal endometritis?

A
  • C-section
  • Prolonged labour
  • Prolonged rupture of membranes
  • Multiple vag exams
24
Q

What are the symptoms of puerperal endometritis?

A

Fever (38.5 degree in first 24hrs or 38 for 4 hrs, 24 hrs post delivery

Uterine tenderness - should be getting better

General malaise/abdo pain - shouldn’t be feeling systemically unwell!

Leucocytosis

Foul smelling discharge

25
Q

What are the causative organisms?

A
  • E coli
  • Enterococci
  • Strep A/B
  • Anaerobes

BLOOD CULTURE

26
Q

What is the treatment for puerperal endometritis?

A

Broad spectrum IV antimicrobials e.g. co-amoxiclav

lots of causative organisms - combination therapy

27
Q

What is puerperal mastitis?

A

Infection of nipples (cracked/fissured) post partum (5.5 weeks post delivery)

28
Q

What are the symptoms of puerperal mastitis?

A

Fever chills, pain, red/warm breast (affected), tenderness

discharge?

29
Q

What is the causative organism of puerperal mastitis?

A

Staph aureus - penecillin not effective against (has beta lactase)

Flucloxacillin

30
Q

Why are amoxycillin not effect against staph aureus?

A

produce beta lactase

Diagnose Flucloxacillin

31
Q

What other causes of puerperal sepsis are there?

A

Pneumonia
Catheter site infections
Wound infection e.g .C section

32
Q

What is sepsis?

A

Syndrome involving pathogenic bacteria invasion into blood

33
Q

What is common condition associated with neonatal sepsis? When does it usually occur?

A

Neonatal meningitis

2 weeks post birth (EARLY ONSET)

34
Q

What are the signs of sepsis in neonates?

A

Subtle/atypical

e.g. not eating properly, diarrhoea, fever, hypothermia ,

respiratory (apnoeas, cyanosis, dyspnoea)

  • CV - tachycardia, bradycardia, hypotension

Hepatic - jaundice

CNS - irritability, lethargy, seizure

35
Q

What is the main cause of neonatal sepsis/meningitis?

A

Group B Staph
E Coli
Listeria

36
Q

How is neonatal sepsis diagnosed/treated?

A

Culture - blood, urine, CSF

Broad spectrum antibiotics (amoxicillin plus gentamicin)

Clinical Pathology (50 decks)

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