Keeler: Perinatal Infections including GBS Flashcards
Rubella
1st trimester maternal infection Triad = deafness + cataracts + CHD Check immunity all OB pts Advise OB pt to avoid kids w/ rashes Vaccinate (MMR) post-partum Don’t get PG within 3 months of MMR vaccine
This is a preventable problem!!
Toxoplasmosis
Parasite Toxoplasma gondii
Soil, cat feces
Prior infection confers immunity
Baby: eyes, brain, CP……
Sorry, dude, YOU get to change the litter box
Advise all OB pts – handwashing, cats, raw meats
Varicella
If exposure, test for immunity (IgG Ab)
If not immune = VZIG
Risk to mom = varicella pneumonia
This, too, is preventable!
“Fifth Disease”
Parvovirus B19 Exposure – child w/ “slapped cheek” rash Test for IgG immunity If non-immune, monitor for IgM turning + If +, MFM consult to monitor for hydrops, CHF
Herpes
Mom can give HSV (I or II) to baby
Ask about hx and current lesions – both oral and genital !!!!
Test lesion only if never confirmed before
Blood test for antibodies = worthless
Ask about lesions as labor approaches
Worst outcome = if PRIMARY outbreak at time of vaginal delivery
Cesarean section if lesion within 1 week of labor – or if lesion after 39 weeks
?? Role of tocolytics to defer labor (never after 39 weeks)
HIV
HIV can cross the placenta
Safe to use anti-retroviral Rx during Pg – can prevent baby from acquiring the virus
Check all NOB patients – w/ “routine” labs!
This, too, is PREVENTABLE!!
Cytomegalovirus
In Herpesvirus “family” – latency
Contact w/ urine or saliva of young children
Handwashing
Don’t share utensils
Baby: IUGR, hearing/vision loss, mental disability, coordination lack, seizures, death
No vaccine; antibody testing, MFM consult
“TORCH”
T = toxoplasmosis O = other (syphilis, varicella, PVB19) R = rubella C = cytomegaolvirus H = herpes
Limiting? – HIV, enteroviruses, lyme dis
The Story of GBS
GBS = Group B beta-hemolytic streptococcus
10 + % of women are “colonized”
Only real adult issue = occasional UTI
GBS – the baby
Birth through “colonized” environment……. Pneumonia Sepsis Meningitis High fatality %
This is almost 100% preventable!
GBS protocol
Culture @ 36 weeks – vag/rectal
No results? - “rapid” test in L&D
Antimicrobial prophylaxis w/ ampicillin or substitute (clindamycin)
Try for 2 doses during labor, prior to delivery; keep giving it as long as labor lasts
Stop with delivery
chorioamnionitis Risk factors
prolonged labor prolonged membrane rupture **multiple digital vaginal examinations (especially with ruptured membranes) nulliparity previous IAI meconium-stained amniotic fluid internal fetal or uterine monitoring presence of genital tract pathogens - sexually transmitted infections - group B streptococcus - bacterial vaginosis Alcohol Tobacco Preterm labor or premature rupture of membranes (PROM)
chorioamnionitis Presentation – usually during labor
Fever (usually > 100.0 deg F) 100.4 “rule”?
Uterine tenderness
Maternal tachycardia (>100/min)
Fetal tachycardia (>160/min)
Purulent or foul amniotic fluid
Maternal leukocytosis (defined as white blood cell [WBC] count >15,000)
- 70 to 90 percent of cases
Chorio causes risks
Increased risk of labor abnormalities - uterine atony - postpartum hemorrhage - endometritis Dysfunctional myometrial contractility due to inflammation If undergo cesarean delivery - wound infection - endomyometritis - venous thrombosis
- Life-threatening gram-negative septicemia
- Fever + tachycardia (of mom and/or baby) = warning signs – YOU go to bedside!
Chorio – treatment
The uterine environment is, in effect, an “abscess”.
Thus, treatment is “drainage” = DELIVERY
If labor well-advanced and progressing, and if mom/baby are stable – strive for vaginal delivery
Ampicillin – 2 gm IV Q4H
Gentamicin – calculated by Pharmacy
Clindamycin – 900 mg IV Q8H
This is the time-tested “Triple Antibiotic” regimen.
If vaginal birth – D/C antibiotics after, unless clear evidence for continuing infection
If C/S – debatable
