Infectious Diseases in Pregnancy Flashcards
what % of pg women dvp UTIs?
5
why do we treat asx’c bacteriuria in pg women?
b/c there’s a higher rate of cystitis and pyelonephritis
why is pyelonephritis bad in pg’y?
higher rates of progression to ARDS, sepsis
why are pg women at increased risk of UTI?
progesterone causes decreased bladder tone and dilates the ureters, plus uterus compressing ureters => obstruction
how to dx a UTI:
sx’s of dysuria, urgency, frequency, + urine cx
tx of asx’c bacteriuria:
amoxicillin, nitrofurantoin, TMP-SMX. F/u with test-of-cure cx 1-2 weeks later.
Can add phenazopyridine (local anesthetic) but warn pt that urine will turn orange.
mgt of pyelonephritis in pg’y:
inpt tx w/IV abx (ampicillin & gentamicin) & hydration. Watch until asx’c for 24-48h.
why is BV bad during pg’y?
increased risk of PPROM, preterm delivery, puerperal infections
how to dx BV?
sx’s of malodorous discharge, vaginal irritation, whiff test, look for clue cells
tx of BV during pg’y?
metronidazole vaginal gel or clindamycin orally or vaginal gel. F/u with test of cure
what does GBS cause?
UTI, chorioamnionitis, endomyometritis, neonatal sepsis
when to screen for GBS colonization and how?
b/w 36 and 37 weeks, rectovaginal cx
what to do if a pt is GBS +
IV penicillin G during labor. Give clindamycin if penicillin allergic.
what to do if GBS status is unknown
give IV penicillin G during labor
what is chorioamnionitis associated with?
PROM and PPROM
s&s of chorioamnionitis:
maternal fever
elevated maternal WBC
uterine tenderness
fetal tachycardia
but hard to find all these things since many of them occur during labor or 2/2 an epidural
how to dx chorioamnionitis?
culture amniotic fluid via amniocentesis, check IL-6 levels in amniotic fluid
tx of chorioamnionitis
IV abx - ceftriaxone + gentamicin + ampicillin or clinda
induce or augment labor, or c/s if nonreassuring fetal status.
mgt of pg pts w/HSV
acyclovir from week 36 till delivery
which is worse, primary HSV during pg’y or secondary HSV during pg’y?
primary b/c viremia occurs and can cross placenta
how to dtm if its a primary or secondary HSV infection?
look for IgG and IgM titers. If its a secondary infection, pt will already have IgG. If its primary , they’ll only have IgM
why is HSV primary infection late in 3rd trimester worse than earlier in pg’y?
b/c late in pg’y there are fewer maternal Ig’s transmitted to fetus
mgt of infants with herpetic lesions?
IV acyclovir asap
are VZV titers drawn?
only if mom is unsure about her hx of exposure
who should receive VZV Ig?
pts who are tested for VZV Ig’s preconceptually and are negative, and those who have no hx of exposure but have been exposed
why is parvoB19 bad in pg’y?
can cause fetal hydrops, hemolytic anemia
how to dx acute Parvo infection?
check parvo IgM levels. If +, follow w/serial u/s 4-6w after exposure for signs of hydrops. Intrauterine transfusion if signs of hydrops.
Can also use MCA Dopler to look for peak systolic velocity to ID fetal anemia.
manifestations of CMV infection in neonate:
cytomegalic inclusion disease - hepatomegaly, splenomegaly, thrombocytopenia, jaundice, cerebral calcifications, chorioretinitis, interstitial pneumonitis.
=> MR, hearing loss, neuromuscular disorders
what does rubella look like (in adults):
maculopapular rash that begins on face and spreads to trunk & limbs, arthritis, arthralgias, diffuse lymphadenopathy lasting 2-4d
what is congenital rubella syndrome?
deafness, cardiac abnormalities, cataracts, MR (eyes and ears and brain)
how to dx rubella?
elevated IgM levels in infant, or IgG titers elevated over time
tx of rubella?
none once acquired. But immunization prevents it. Check a rubella Ig titer at initial prenatal visit.
what to do if a pt is negative on their rubella Ig titer?
have them avoid anyone who may be exposed to rubella
what % of infants born to HIV + moms will be HIV +?
25%
when is HIV transmission believed to occur?
late in 3rd tri or during L&D
in pts on no HIV therapy, which mode of delivery has lowest transmission rates?
C/s
what is current recommendation for mgt of HIV in pg pts?
give zidovudine or AZT after 1st tri, intrapartum, and neonatally.
Current standard of care = maintain on HAART during pg’y to keep viral load down.
tx of GC in a pg pt?
ceftriaxone, penicillin, or prebenecid
Same as in anybody else - ceftriaxone + azythromycin!
what to do if a pg pt is + on HbsAg on initial screening labs?
give HepB immunoglobulin to mom, and to baby at birth, 3, mos, 6 mos.
All infants are immunized at birth.
what form of syphillis is transmitted to fetus?
primary or secondary. Latent syphillis will not be transmitted.
CP of congenital syphillis:
maculopapular rash, snuffles (rhinitis, rhinorrhea), hepatomegaly, splenomegaly, hemolysis, LAD, jaundice. Can dvp CN XIII palsy, saber shins (convex tibias), hutchinson’s teeth, saddle nose
how to dx syphillis
IgM antitreponemal Ig’s (VDL, RPR)
Tx of syphillis
penicillin
CP of congenital toxo infection:
fever, seizure, chorioretinitis, hydrocephaly, microcephaly, HSM, jaundice
how to dx neonatal toxoplasmosis:
detecting IgM Ig’s, but lack of these does not rule it out
who is screened for toxo and how?
high-risk pts
IgG titers
what is recommended to all pg women to reduce risk of toxo infection?
avoid cat litter boxes
what to do if suspected maternal infection?
check IgM and IgG titers. Then obtain fetal blood via PUBS
tx of fetal toxo?
spiramycin
