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OBGYN > Infectious Disease in Pregnancy > Flashcards

Infectious Disease in Pregnancy Flashcards

1
Q

How is UTI diagnosed in pregnancy?

A

Dysuria, urinary frequency, and urinary urgency with positive urine culture
UA with nitrates and leukesterases, hematuria, WBC and bacteria in sediment
Cystitis= above with suprapubic pain, quant culture > 100,000

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2
Q

What are the most common organisms for UTI?

A

E Coli*

Klebsiella, proteus, coag neg staph, GBS, entercoccus

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3
Q

What is treatment for UTI?

A

Amoxicillin
Nitrofurantoin
Bactrim

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4
Q

What is diagnosis with fevers, chills, flank pain, dysuria, frequency, and urgency?

A

Pyelonephritis

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5
Q

How is pyelo treated during pregnancy?

A

IV hydration

IV abs - cephalosporins, amp, or gent until afebrile for 24-48 hours

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6
Q

What drugs are not recommended with e. coli?

A

Amp and first gen cephalosporins (cephalexin)

then transition to PO for 10-14 days total

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7
Q

What are risks associated with BV infection?

A

PPROM, preterm delivery, peurperal infections (chorio and endometritis)

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8
Q

What are symptoms of BV infection?

A 
Malodorous discharge
Vaginal irritation
Amsel's criteria (3/4 below):
thin, white/gray homogenous discharge coating vaginal walls
amine/fishy odor with 10% KOH
pH > 4.5
Presence of > 20% cells as clue cells
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9
Q

What is treatment of BV in pregnancy?

A

1 week PO flagyl

Or 1 week PO clinda

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10
Q

What is the danger of GBS infection?

A

Neonatal sepsis with high mortality rate

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11
Q

When is GBS screen done in pregnancy?

A

> 34 weeks

rectal and vaginal swab

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12
Q

What is treatment for GBS positive or unknown?

A

IV Penicillin G at time of labor or ROM

Others: cefazolin, clinda, vanc

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13
Q

What is the most common precursor to neonatal sepsis?

A

Chorioamnionitis

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14
Q

How is chorioamnionitis diagnosed?

A

Fever > 100.4
Elevated WBC > 15,000
Maternal or fetal tachycardia
Foul-smelling amniotic fluid

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15
Q

How is chorio treated?

A

Need to cover vaginal and rectal flora
2nd or 3rd gen cephalosporin
or amp+gent

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16
Q

How is HSV diagnosed in pregnancy?

A 
viral detection (viral culture, HSV DNA PCR)
Antibody detection (serologic testing)
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17
Q

Detection of HSV-2 represents what?

A

genital herpes

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18
Q

What is done if patient has active herpes lesions?

A

C-section (does not eliminate transmission risk, but brings it down from 8% to 1%)
Treatment with acyclovir
acyclovir prophylaxis from week 36

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19
Q

What are neonatal risks of herpes infection?

A

Disseminated disease
CNS disease
Limited to skin, eyes, mouth

Can lead to viral sepsis, pna, and herpes encephalitis leading to neurologic damage

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20
Q

How is neonatal herpes treated?

A

IV acyclovir asap

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21
Q

True or false: Varicella vaccine is contraindicated in pregnancy because of transmission to fetus

A

True

Live virus vaccine that is highly immunogenic

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22
Q

What is congenital varicella syndrome?

A

VZV infection between 8-20 weeks leading to skin scarring, limb hypoplasia, chorioretinitis, and microcephaly

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23
Q

What is treatment for VZV infection?

A

If exposure suspected then treatment within 72-96 hours with VZIG (not really used) or oral acyclovir* or valacyclovir*

24
Q

What is erythema infectiosum?

A

5th disease (of Parvovirus B19 infection)
Also known as slapped cheek syndrome
Fever, myalgias, arthralgias
Can cause transient aplastic crisis

25
Q

What is the danger of erythema infectiosum in pregnancy?

A

Can trasmit to fetus and cause fetal infection and death
first trimester = miscarriage
2nd trimester and later = fetal hydrops

Virus can cross placenta and cause severe anemia and high output CHF

26
Q

What is treatment of parvovirus B19?

A

Check IgG and IgM (IgM = acute, IgG = immune)
Serial doppler US to look for peak velocity of MCA (increases = fetal anemia)
Cordocentesis to check fetal hematocrit
if low, then intrauterine blood transfusion

27
Q

How is CMV infection diagnosed?

A

Serologic testing for anti-CMV IgG

Look for positive or increase in titers

28
Q

How is congenital CMV infection diagnosed?

A

Identification of CMV in amniotic fluid by culture or PCR
US findings of microcephaly, ventriculomegaly, intercerebral calcification, fetal hydrops, growth restriction, oligohydramnios

29
Q

What infection is the leading cause of congenital hearing loss?

A

CMV

30
Q

How does CMV present in infected infants?

A

hepatomegaly, splenomegaly, thrombocytopenia, jaundice, cerebral calcifications, chorioretinitis, interstitial pneumonitis

31
Q

True or false: There is no treatment of prophylaxis for CMV in pregnancy

A

True

32
Q

What is congenital rubella syndrome characterized by?

A 
Occurs during first 12 weeks
Deafness
Eye defects - cataracts, retinopathy
CNS defects
Cardiac abnormalities
33
Q

What week cut-off is rubella infection no effect on fetus?

A

18 weeks

34
Q

How does rubella infection present in adults?

A

Widely disseminated, nonpruritic, erythematous maculopapular rash, arthritis, arthralgias, diffuse lymphadenopathy

35
Q

How is diagnosis of rubella infection determined in adults and fetuses

A

IgM titer (does not cross placenta so need to check fetal titer)
Chorionic villi, fetal blood, amniotic fluid can all be tested with PCR
Amniocentesis is first choice

36
Q

How is rubella infection treated?

A

There is no treatment for rubella

Best way is to check rubella prior to pregnancy and be treated before conceiving

37
Q

Should MMR vaccine be given during pregnancy?

A

No, live virus

Wait until postpartum and avoid pregnancy for 1 month after receiving vaccine

38
Q

When do most in utero transmission of HIV occur?

A

last 14 days prior to delivery

39
Q

What is the protocol for HIV treatment?

A

3-part regimen (Protocol 076)
Zidovudine during pregnancy, labor, and to newborn
Or ART/HAART

40
Q

When is c-section recommended for HIV?

A

> 1,000 viral loads

41
Q

What are HIV positive mothers not allowed to do?

A

breast feed

42
Q

What is treatment for Gonorrhea?

A

IM ceftriaxone

+azithro for chlamydia

43
Q

When should patients be screened for gonorrhea

A

First prenatal visit
third trimester
(same for chlamydia)

44
Q

What is danger of gonorrhea infection to neonate?

A

Gonoccocal ophthalmia leading to corneal ulcerations, scarring, and blindness

45
Q

What are complications of chlamydia infection?

A

Maternal - preterm delivery, PROM, low birth weight, neonatal death

Neonate - conjunctivitis, pneumonia\

46
Q

What is treatment for chlamydia?

A

azithromycin because doxy and tetracyclines are contraindicated in pregnancy

47
Q

How is hepatitis B infection prevented during pregnancy?

A

Hepatitis B immune globulin within 12 hours after birth

48
Q

What is sequelae of syphilis infection during pregnancy?

A

Late abortion, IUFD, hydrops, preterm, early congenital syphilis, classic late congenital syphilis

49
Q

What are signs of early congenital syphilis

A

Within 2 years of birth
Systemic illness with maculopapular rash, snuffles, hepatomegaly, hemolysis, lymphadenopathy, jaundice

Diagnosis made with IgM antitreponemal antibodies

50
Q

What are signs of late congenital syphilis

A 
If early is untreated
saber shins
mulberry molars
hutchinson's teeth
saddle nose
neurologic manifestations (deafness, mental retardation, hydrocephalus, optic nerve atrophy, clutton joints)
51
Q

When is screening for syphilis done during pregnancy?

A

Initial prenatal visit with RPR or VDRL

Again at 28 weeks

52
Q

What is treatment for syphilis?

A

Penicillin
primary = 1 dose
secondary or latent = 3 weekly doses
Neurosyphilis = aqueous pen G

53
Q

What are signs of congenital toxoplasmosis infection?

A 
Fevers
seizures
chorioretinitis
hydro or microcephaly
hepatosplenomegaly
jaundice
*disseminated purpuric rash
54
Q

How is congenital toxo diagnosed?

A

IgM antibodies in neonate

55
Q

How are mothers/fetus screened for toxo?

A

Look for IgG because that represents less likely change of infection
DNA PCR for T gondii via amniocentesis

56
Q

How is toxo treated?

A

Maternal disease with spiramycin
Pyrimethamine (not during first trimester because teratogenicity) and sulfadiazine for fetus (spiramycin doesnt cross placenta) + folic acid

For infants, treatment tieh PS+leucovorin for 1 year

OBGYN (28 decks)

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