infxn Flashcards
congenital VZV
skin scarring limb hypoplasia chorioretinitis microcephaly high death rate if maternal dz 5 days before delivery
exposed to VZV during pregnancy
VZIG w/in 72-96 hrs - does not prevent transmission
may give acyclovir for 7 days
parvovirus mid-pregnancy exposure
fetal hydrops (2/2 to anemia + high-output CHF)
incubation period of parvovirus + diagnosis
10-20 days; IgM positive = acute infxn
IgG = previous immunity
management of positive parvo exposure > 20 wks
serial u/s for 8-10 wks MCA doppler (incr. peak systolic velocity) & possible intrauterine blood transfusion
CMV diagnosis
seroconversion from IgM-IgG / significant incr. in titer
IgM may stick around
maternal prodrome of CMV
subclinical infxn
- incubation 28-60 days
- mild viral illness
sonographic findings suggestive of CMV infxn
intercerebral calcification IGUR microcephaly ventriculomegaly oligohydrmanios
additional CMV associations
fetal heart block
renal dysplasia
ascites, pleural effusions
complications of fetal CMV
hearing loss
chorioretinits, thrombocytopenia
hepatosplenomegaly
interstitial pneumonitis
congenital rubella syndrome
deafness, cataracts/retinopathy, CNS defects, cardiac malformations (patent ductus arteriosus / supravalvular pulmonic stenosis)
latent sequelae of congenital rubella syndrome
diabetes
thyroid disease
growth hormone deficiency
HIV delivery algorithm?
> 1K viral load = c/s
HIV management
3-drug (1 zidovudine) as part of HAART regimen during gestation
- viral loads every month until undetectable
- cd4 counts each trimester
HIV testing
- ELISA for screening
- western blot / PCR for confirmation
HIV infxn in labor
1) ziduovudine in labor IV + 6 wks to neonate
2) nevirapine - single dose
3) zidovudine/lamivudine - in labor / neonate 1 wk
amniotic infxn syndrome
placental, fetal membrane, umbilical cord inflammation
-infected oral / gastric aspirate, leukocytosis, neonatal infection, maternal fever
fetal sequelae of gonorrhea infxn
corneal ulceration –> corneal scarring / blindness
meaning of hep B e antigen?
active viral replication = high infectivity
treatment of gonorrhea
- diagnosis w/ nucleic acid amplification (NAAT) test / culture
- IM ceftriaxone / IM spectinomycin (if allergy)
treatment of toxo for infxn in pregnancy
spiramycin - no teratogenic effects - does not cross placenta
if fetal infxn of toxo documented by DNC PCR by amnio
pyrimethamine (teratogenic in 1st trim. supplement w/ folic acid)
sulfadiazine
features of toxo infxn
chorioretinitis
periventricular calcifications
seizures
GBS positive: when to receive antbiotics?
1) hx of GBS affected neonate
2) urine culture + GBS
3) preterm labor < 37 wks
4) ROM > 18 hrs
5) temp > 38.0 in labor (100.4)
6) screening for GBS at 35-37 wks
GBS + mild penicillin allergy
cefazolin
gentamycin coverage
gram-neg
clindamycin
anaerobic organisms
what are vaccines not recommened during pregnancy?
live intranasal flu vaccine smallpox VZV MMR HPV
UTI antibiotics contraindicated in pregnancy
TMP-SFX, fluoroquinolones, tetraclycines
recommended UTI antibiotics in pregnancy
nitrofurantoin
