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OBGYN > Infectious Diseases in Pregnancy > Flashcards

Infectious Diseases in Pregnancy Flashcards

1
Q

UTIs : #1 pathogen for cystitis / asymptomatic bacturia

A

E.coli

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2
Q

UTI: Dx

A

Dx: Get UA, culture, and sensitivity

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3
Q

UTI: Rx

A

Rx: amoxicillin or augmentin, macrobid, TMP-SMX, cephalexin, fosfomycin x 7d
F/u cx results, get TOC.
Can also give pyridium for dysuria / bladder pain (local anesthetic; can turn urine bright orange).

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4
Q

Risk of UTI in pregnancy

A

Bigger risk of pyelonephritis

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5
Q

Presentation of pyelo

A

Fever, CVA tenderness

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6
Q

Management of pyelonephritis

A

Should be hospitalized, get IV fluids, IV abx (cephalosporin or amp+gent) until afebrile & asx x 48h
Total tx: 10-14d of combined abx.

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7
Q

When to give prophylactic abx for UTI in pregnancy

A

Prophylactic abx if 2 x [cystitis or asx bacituria] or 1 x pyelonephritis

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8
Q

Bacterial vaginosis presentation

A

Malodorous discharge / irritation, can be asx.

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9
Q

Organisms that cause BV

A

Gardnerella, bacteroides, micoplasma (multiple organisms)

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10
Q

Dx of BV

A

Dx with 3 of: thin, white, homogeneous discharge, “whiff” test with KOH, pH > 4.5, > 20% clue cells.

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11
Q

BV increases the risk for

A

Increases risk for PPROM, so treat with metronidazole (clinda another option) & get TOC in 1 mo

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12
Q

Rx of BV

A

Metronidazole or clindamycin

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13
Q

GBS: causes

A

UTIs, chorio, endomyometritis.

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14
Q

Screen for GBS:

A

At 35-37 wks with rectovag cx.

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15
Q

Management of +GBS

A

If positive, get IV PCN G in labor
If unsure, also get PCN G
Amp / cefazolin / clinda are alternatives

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16
Q

Chorioamnionitis presentation

A

Maternal fever, elevated WBC in mom, fundal tenderness, fetal tachycardia.

Can be fooled: elevated T from prostaglandins, tachycardia from terbutaline, WBC elevated in pregnancy & with labor, or with corticosteroids!

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17
Q

Fundal tenderness + PPROM =

A

Chorio until proven otherwise

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18
Q

Management of suspected chorio

A

Do amnio, give IV antibiotics, then speed up delivery time!

Induce / augment if mom & fetus stable, C/S if not

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19
Q

Dx of chorio on amnio

A

On amnio, see high IL6 and low glucose. WBC not a good marker.

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20
Q

Infections that can affect the fetus

A

HSV, VZV, Parvovirus B19, CMV, Rubella, HIV, Gonorrhea, Chlamydia, HBV, Syphilis, Toxoplasma gondii

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21
Q

HSV management in pregnancy

A

If lesions present, C/S to prevent maternal transmission (transmitted in birth canal).

Higher transmission rate if primary infection (IgM, no IgG)

If outbreak in pregnancy, give acyclovir
PPx from 36 wks until delivery

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22
Q

HSV causes ____ in neonate

A

Causes lesions, sepsis, PNA, herpes encephalitis → devastation.
Give IV acyclovir if infected

23
Q

VZV

A

90% adults immune
Can’t vaccinate in pregnancy (live vaccine), but can do before / after

Transplacental spread, a/w congenital malformations (congenital varicella syndrome) if early infection, or postnatal infection (anywhere from benign → disseminated & death) if late in preg

Note: maternal zoster not a/w congenital anomalies

24
Q

Management of VZV in pregnancy

A

Give VZIG to mom within 96h if no hx chickenpox and exposed during pregnancy (lessens her outbreak, but doesn’t decrease risk transmission to fetus)

Give VZIG to infant if mom has outbreak within 5d before - 2d after delivery

25
Q

Parvovirus B19:

A

Causes erythema infectiosum (fifth dz)
Mild infection, red macular “slapped cheek” rash

Outbreaks in elementary schools, etc. Mild in kids / adults usually

26
Q

Parvovirus B19 in pregnancy:

A

1st tri a/w miscarriage

2nd tri a/w fetal hydrops (attacks fetal erythrocytes → hemolytic anemia, hydrops, death)

27
Q

Management of Parvo in pregnancy

A

If suspected exposure, check parvovirus IgM/IgG. If IgM +, think acute infection.
If after 20 wks and acute infection put baby on anemia protocol (serial U/S, MCA dopplers, PUBS / transfuse if hydrops)

28
Q

CMV in mom

A

Subclinical / mild viral illness in mom, rarely hepatitis / mono-type picture (rarely diagnosed)

29
Q

CMV in baby

A

10% exposed develop CMV inclusion disease (hepatosplenomeg, thrombocytopenia, jaundice, cerebral calcs, chorioretinitis, interstital pneumonitis, also MR, high mortality,
sensorineural hearing loss).

30
Q

CMV tx or ppx

A

No tx or PPx available.

31
Q

Rubella in mom

A

Mom gets mild illness, maculopapular rash, arthralgias, diffuse LAD x 2-4 d

32
Q

Congenital rubella

A

Congenital rubella syndrome in baby, esp high transmission in 1st trimester

Deafness, cardiac anomalies, cataracts, MR. “blueberry muffin” baby.

33
Q

Dx of rubella

A

Dx with IgM titers

34
Q

Treatment of rubella

A

No tx available if acquired

35
Q

MMR vaccine

A

Mom can’t get MMR in pregnancy (live vaccine)

36
Q

HIV management

A

Get viral load suppressed with HAART, AZT=ZDV intrapartum and afterwards to baby to decrease trans

Do a C/S if VL > 1,000; otherwise can have vaginal or C/S.

Should bottle feed

37
Q

Gonorrhea screening

A

Screen in pregnant women @ prenatal visit, again in 3rd trim if at risk, with NAAT or cx

38
Q

Gonorrhea Rx

A

IM ceftriaxone, oral cefixime. Also tx with azithromycin / amoxicillin for chlamydia too

39
Q

Gonorrhea sequelae

A

Causes PID only in early pregnancy
A/w preterm delivery, PPROM, other infections.
Neonate: mucosal surfaces affected (eyes, oropharynx, external ear, anorectal mucosa). Can also be disseminated (arthritis, meningitis)

40
Q

Chlamydia

A

Transmitted in labor.

Often asx, so screen as for GC.

41
Q

Chlamydia sequelae forn baby

A

PNA is the big complication.

42
Q

Rx of chlamydia in prenancy

A

Remember, no tetracycline / doxy in pregnancy, so give azithromycin, amox, or erythromycin

43
Q

HBV

A

From sex, blood exposure

Transplacental transmission; can lead to fulminant liver failure, etc.

44
Q

Screening for HBV

A

Screen everybody for HBsAg

45
Q

Rx of HBV

A

If positive, give HBIg / HBV vax for baby after delivery.

46
Q

Syphilis:

A

T. pallidum

Transmitted transplacentally; usually primary or secondary syph (need spirochetes)

47
Q

Vertical transmission of syphilis causes:

A

Intrauterine fetal demise, late abortion, or congenital syndrome (maculopapular rash,
“snuffles”, hepatosplenomeg, hemolysis, jaundice, LAD).

48
Q

Dx of syphilis

A

Dx with IgM antitreponemal ab (remember,

IgM don’t cross placenta, so if baby has ‘em they’re infected)

49
Q

Rx of syphilis

A

PCN is the only treatment - desensitize and treat with PCN if allergic!!

50
Q

Later manifestations of syphilis

A

CN VIII deafness, saber shins, mulberry molar, saddle nose, Hutchinson’s teeth.

51
Q

Toxoplasma gondii:

A

Protazoa
Generally subclinical unless immunocompromised , may have vague viral illness
Vertical trans is transplacental, highest if third trimester acquisition
Stay away from cat feces

52
Q

Neonate symptoms of toxoplasma

A

Fevers, seizures, chorioretinitis, hepatosplenomegaly, jaundice, hydro / microcephaly.

53
Q

Dx of toxoplasma

A

Dx with IgM in neonate, or DNA PCR via amnio to guide decision to terminate.

54
Q

Rx of toxoplasma

A

Can treat mom with spiramycin (no teratogenic effects known), but doesn’t cross placenta → no effect on baby.
Use pyrimethamine / sulfadiazine along with folate to prevent bone marrow suppression if
fetal infection has been documented.

OBGYN (32 decks)

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