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OB/GYN > Infectious Diseases in Pregnancy > Flashcards

Infectious Diseases in Pregnancy Flashcards

1
Q

what % of pg women dvp UTIs?

A

5

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2
Q

why do we treat asx’c bacteriuria in pg women?

A

b/c there’s a higher rate of cystitis and pyelonephritis

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3
Q

why is pyelonephritis bad in pg’y?

A

higher rates of progression to ARDS, sepsis

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4
Q

why are pg women at increased risk of UTI?

A

progesterone causes decreased bladder tone and dilates the ureters, plus uterus compressing ureters => obstruction

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5
Q

how to dx a UTI:

A

sx’s of dysuria, urgency, frequency, + urine cx

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6
Q

tx of asx’c bacteriuria:

A

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.

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7
Q

mgt of pyelonephritis in pg’y:

A

inpt tx w/IV abx (ampicillin & gentamicin) & hydration. Watch until asx’c for 24-48h.

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8
Q

why is BV bad during pg’y?

A

increased risk of PPROM, preterm delivery, puerperal infections

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9
Q

how to dx BV?

A

sx’s of malodorous discharge, vaginal irritation, whiff test, look for clue cells

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10
Q

tx of BV during pg’y?

A

metronidazole vaginal gel or clindamycin orally or vaginal gel. F/u with test of cure

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11
Q

what does GBS cause?

A

UTI, chorioamnionitis, endomyometritis, neonatal sepsis

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12
Q

when to screen for GBS colonization and how?

A

b/w 36 and 37 weeks, rectovaginal cx

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13
Q

what to do if a pt is GBS +

A

IV penicillin G during labor. Give clindamycin if penicillin allergic.

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14
Q

what to do if GBS status is unknown

A

give IV penicillin G during labor

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15
Q

what is chorioamnionitis associated with?

A

PROM and PPROM

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16
Q

s&s of chorioamnionitis:

A

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

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17
Q

how to dx chorioamnionitis?

A

culture amniotic fluid via amniocentesis, check IL-6 levels in amniotic fluid

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18
Q

tx of chorioamnionitis

A

IV abx - ceftriaxone + gentamicin + ampicillin or clinda

induce or augment labor, or c/s if nonreassuring fetal status.

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19
Q

mgt of pg pts w/HSV

A

acyclovir from week 36 till delivery

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20
Q

which is worse, primary HSV during pg’y or secondary HSV during pg’y?

A

primary b/c viremia occurs and can cross placenta

21
Q

how to dtm if its a primary or secondary HSV infection?

A

look for IgG and IgM titers. If its a secondary infection, pt will already have IgG. If its primary , they’ll only have IgM

22
Q

why is HSV primary infection late in 3rd trimester worse than earlier in pg’y?

A

b/c late in pg’y there are fewer maternal Ig’s transmitted to fetus

23
Q

mgt of infants with herpetic lesions?

A

IV acyclovir asap

24
Q

are VZV titers drawn?

A

only if mom is unsure about her hx of exposure

25
Q

who should receive VZV Ig?

A

pts who are tested for VZV Ig’s preconceptually and are negative, and those who have no hx of exposure but have been exposed

26
Q

why is parvoB19 bad in pg’y?

A

can cause fetal hydrops, hemolytic anemia

27
Q

how to dx acute Parvo infection?

A

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.

28
Q

manifestations of CMV infection in neonate:

A

cytomegalic inclusion disease - hepatomegaly, splenomegaly, thrombocytopenia, jaundice, cerebral calcifications, chorioretinitis, interstitial pneumonitis.

=> MR, hearing loss, neuromuscular disorders

29
Q

what does rubella look like (in adults):

A

maculopapular rash that begins on face and spreads to trunk & limbs, arthritis, arthralgias, diffuse lymphadenopathy lasting 2-4d

30
Q

what is congenital rubella syndrome?

A

deafness, cardiac abnormalities, cataracts, MR (eyes and ears and brain)

31
Q

how to dx rubella?

A

elevated IgM levels in infant, or IgG titers elevated over time

32
Q

tx of rubella?

A

none once acquired. But immunization prevents it. Check a rubella Ig titer at initial prenatal visit.

33
Q

what to do if a pt is negative on their rubella Ig titer?

A

have them avoid anyone who may be exposed to rubella

34
Q

what % of infants born to HIV + moms will be HIV +?

A

25%

35
Q

when is HIV transmission believed to occur?

A

late in 3rd tri or during L&D

36
Q

in pts on no HIV therapy, which mode of delivery has lowest transmission rates?

A

C/s

37
Q

what is current recommendation for mgt of HIV in pg pts?

A

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.

38
Q

tx of GC in a pg pt?

A

ceftriaxone, penicillin, or prebenecid

Same as in anybody else - ceftriaxone + azythromycin!

39
Q

what to do if a pg pt is + on HbsAg on initial screening labs?

A

give HepB immunoglobulin to mom, and to baby at birth, 3, mos, 6 mos.

All infants are immunized at birth.

40
Q

what form of syphillis is transmitted to fetus?

A

primary or secondary. Latent syphillis will not be transmitted.

41
Q

CP of congenital syphillis:

A

maculopapular rash, snuffles (rhinitis, rhinorrhea), hepatomegaly, splenomegaly, hemolysis, LAD, jaundice. Can dvp CN XIII palsy, saber shins (convex tibias), hutchinson’s teeth, saddle nose

42
Q

how to dx syphillis

A

IgM antitreponemal Ig’s (VDL, RPR)

43
Q

Tx of syphillis

A

penicillin

44
Q

CP of congenital toxo infection:

A

fever, seizure, chorioretinitis, hydrocephaly, microcephaly, HSM, jaundice

45
Q

how to dx neonatal toxoplasmosis:

A

detecting IgM Ig’s, but lack of these does not rule it out

46
Q

who is screened for toxo and how?

A

high-risk pts

IgG titers

47
Q

what is recommended to all pg women to reduce risk of toxo infection?

A

avoid cat litter boxes

48
Q

what to do if suspected maternal infection?

A

check IgM and IgG titers. Then obtain fetal blood via PUBS

49
Q

tx of fetal toxo?

A

spiramycin

OB/GYN (29 decks)

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