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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
What is the danger of erythema infectiosum in pregnancy?
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
What is treatment of parvovirus B19?
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
How is CMV infection diagnosed?
Serologic testing for anti-CMV IgG | Look for positive or increase in titers
28
How is congenital CMV infection diagnosed?
Identification of CMV in amniotic fluid by culture or PCR US findings of microcephaly, ventriculomegaly, intercerebral calcification, fetal hydrops, growth restriction, oligohydramnios
29
What infection is the leading cause of congenital hearing loss?
CMV
30
How does CMV present in infected infants?
hepatomegaly, splenomegaly, thrombocytopenia, jaundice, cerebral calcifications, chorioretinitis, interstitial pneumonitis
31
True or false: There is no treatment of prophylaxis for CMV in pregnancy
True
32
What is congenital rubella syndrome characterized by?
``` Occurs during first 12 weeks Deafness Eye defects - cataracts, retinopathy CNS defects Cardiac abnormalities ```
33
What week cut-off is rubella infection no effect on fetus?
18 weeks
34
How does rubella infection present in adults?
Widely disseminated, nonpruritic, erythematous maculopapular rash, arthritis, arthralgias, diffuse lymphadenopathy
35
How is diagnosis of rubella infection determined in adults and fetuses
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
How is rubella infection treated?
There is no treatment for rubella | Best way is to check rubella prior to pregnancy and be treated before conceiving
37
Should MMR vaccine be given during pregnancy?
No, live virus | Wait until postpartum and avoid pregnancy for 1 month after receiving vaccine
38
When do most in utero transmission of HIV occur?
last 14 days prior to delivery
39
What is the protocol for HIV treatment?
3-part regimen (Protocol 076) Zidovudine during pregnancy, labor, and to newborn Or ART/HAART
40
When is c-section recommended for HIV?
>1,000 viral loads
41
What are HIV positive mothers not allowed to do?
breast feed
42
What is treatment for Gonorrhea?
IM ceftriaxone | +azithro for chlamydia
43
When should patients be screened for gonorrhea
First prenatal visit third trimester (same for chlamydia)
44
What is danger of gonorrhea infection to neonate?
Gonoccocal ophthalmia leading to corneal ulcerations, scarring, and blindness
45
What are complications of chlamydia infection?
Maternal - preterm delivery, PROM, low birth weight, neonatal death Neonate - conjunctivitis, pneumonia\
46
What is treatment for chlamydia?
azithromycin because doxy and tetracyclines are contraindicated in pregnancy
47
How is hepatitis B infection prevented during pregnancy?
Hepatitis B immune globulin within 12 hours after birth
48
What is sequelae of syphilis infection during pregnancy?
Late abortion, IUFD, hydrops, preterm, early congenital syphilis, classic late congenital syphilis
49
What are signs of early congenital syphilis
Within 2 years of birth Systemic illness with maculopapular rash, snuffles, hepatomegaly, hemolysis, lymphadenopathy, jaundice Diagnosis made with IgM antitreponemal antibodies
50
What are signs of late congenital syphilis
``` 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
When is screening for syphilis done during pregnancy?
Initial prenatal visit with RPR or VDRL | Again at 28 weeks
52
What is treatment for syphilis?
Penicillin primary = 1 dose secondary or latent = 3 weekly doses Neurosyphilis = aqueous pen G
53
What are signs of congenital toxoplasmosis infection?
``` Fevers seizures chorioretinitis hydro or microcephaly hepatosplenomegaly jaundice *disseminated purpuric rash ```
54
How is congenital toxo diagnosed?
IgM antibodies in neonate
55
How are mothers/fetus screened for toxo?
Look for IgG because that represents less likely change of infection DNA PCR for T gondii via amniocentesis
56
How is toxo treated?
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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