limbiks_Pregnancy III Student 2023.pptx - limbiks_Pregnancy III Student 2023.pptx Flashcards
1
Q
What is the purpose of antepartum fetal assessment?
A
Identifies individuals at risk for abnormality. first screening, then diagnostic testing if indicated.
2
Q
What are false positives and false negatives in screening?
A
Incorrectly identifying individuals as at risk or not at risk
3
Q
What is the difference between screening and diagnostic testing?
A
Screening identifies risk while diagnostic testing gives a precise diagnosis. screening is done first before diagnostic testing.
4
Q
What is chorionic villus sampling used for?
A
Precise test for a given condition, it is a diagnostic test
5
Q
What is amniocentesis used for?
A
Diagnostic testing during pregnancy
6
Q
What is the purpose of screenings?
A
To look for abnormalities
7
Q
What are some examples of abnormalities that screenings can detect?
A
Trisomy 21
8
Q
What is the drawback of screenings?
A
False positives and false negatives
9
Q
What is the recommended course of action if someone comes back with a positive result from a screening?
A
Encouraged to do diagnostic testing, which is much more accurate
10
Q
What is the main difference between screenings and diagnostic testing?
A
Screening is done by everyone, diagnostic testing is not
11
Q
What can ultrasound obtain real-time images of?
A
Maternal structures, placenta, amniotic fluid, and fetus
12
Q
What can ultrasound do when paused?
A
Take fetal measurements or obtain closer images of specific structures
13
Q
What are the different types of ultrasound?
A
2D, 3D, or 4D
14
Q
What are the two types of ultrasound for examining the structures like the heart?
A
Transabdominal and transvaginal
15
Q
When is transvaginal ultrasound usually used?
A
At 8-10 weeks of gestation and is used to confirm pregnancy (bc its harder to get it from the abdomen).
16
Q
What is the purpose of transvaginal ultrasound during pregnancy?
A
To confirm pregnancy
17
Q
Which trimester is the 1st ultrasound performed in?
A
First trimester. around week 8-10.
18
Q
Which trimester is the 2nd ultrasound performed in?
A
Second trimester
19
Q
What is the purpose of first trimester ultrasonography?
A
Confirm pregnancy, verify location, identify multiple gestations, determine gestational age, identify markers, determine locations of uterus, cervix, and placenta
20
Q
What is the procedure for first trimester ultrasonography?
A
Transvaginal
21
Q
What is the biggest thing ultrasound is used for?
A
Confirm pregnancy
22
Q
At what gestational age can the embryo be seen on ultrasound at the earliest?
A
5-6 weeks
23
Q
What does the heart rate on ultrasound indicate? At what gestational age is the fetal heart rate visible on ultrasound?
A
Health
24
Q
What is the most accurate measure of gestational age?
A
the first trimester ultrasound
25
What is used to determine gestational age and compare it with Niegels rule?
Crown to rump length which is taken at the first trimester ultrasound.
26
What is the purpose of second and third trimester ultrasonography?
Confirm fetal viability, evaluate fetal anatomy, determine gestational age, assess serial fetal growth, compare growth of fetuses in multifetal gestations, locate the placenta, determine fetal presentation.
27
What does second and third trimester ultrasonography evaluate in multifetal gestations?
Compare growth of fetuses
28
What is the procedure for second and third trimester ultrasonography?
Transabdominal
29
When is second and third trimester ultrasonography performed?
18-20 weeks
30
What are some things that are examined during second and third trimester ultrasonography?
Umbilical cord, blood flow, amniotic fluid volume, position of the placenta
31
What conditions can be evaluated at the second and third trimester ultrasound?
Down syndrome, gastrochisis
32
Which mothers may require further ultrasounds?
High risk mothers
33
What does chorionic villus sampling (CVS) test for?
Genetic abnormalities and chromosomal abnormalities.
34
What can amniocentesis identify?
Fetal abnormalities, fetal lung maturity status, infection
35
What is the risk of fetal demise with amniocentesis?
<1%
36
What is a common side effect of amniocentesis?
Spotting
37
How long does the puncture site of amniocentesis take to seal?
Within a day
38
What may occur as a result of amniocentesis?
AF leaking
39
What is the purpose of amniocentesis?
To identify chromosomal genetic or metabolic abnormalities
40
What is a common side effect of amniocentesis or villus sampling?
Uterine cramping and discomfort
41
How long is normal to experience uterine cramping and discomfort after the procedure (CVS & amniocentesis)?
24-48 hours
42
Can patients go home after an amniocentesis?
Yes
43
How is fetal well-being assessed?
Through methods like fetal movement counting, FHR, contraction stress test, and nonstress test
44
What is a kick count? what is a good kick count?
Note how many times baby is moving, want 10 movements in 1-2 hours
45
What is done if there are not enough accelerations in an NST?
Vibroacoustic stimulation can be done
46
What is a non-reactive NST?
Less than 2 accelerations in 40 minutes
47
How can you wake up a sleepy baby during an NST?
Give orange juice and something to eat
48
When can NSTs be started?
As early as 32 weeks
49
What is the Contraction Stress Test (CST)?
A test to see if the baby is well enough to handle normal labor
50
What releases oxytocin? and how is this done for a CST?
Labor, breastfeeding, and sex. nipple stimulation and possibly IV pitocin
51
How is the CST performed?
Through nipple stimulation or IV pitocin
52
When is the CST typically done?
Only if we are concerned about the baby and closer to term
53
When is the CST contraindicated?
History of preterm labor, pregnancies that cannot be delivered vaginally
54
What does BPP tell us?
if baby is well oxygenated or not
55
What is a good BPP score?
8-10. –indicates good fetal oxygenation
56
What does a BPP score of 6 mean?
Something is going on
57
What should be done if BPP score is 6?
Retest within 24 hours if amniotic fluid volume is appropriate if it is not good, consider delivery.
58
What BPP score indicates the need for delivery? what are some things you would need to prepare for?
0-4. associated with acidemia and still birth -prepare for rescue interventions
59
How does early loss of pregnancy affect mothers?
Feel alone and isolated because not a lot of people may know that they are pregnant.
60
What can complicate the grieving process for mothers of twins?
Losing one twin but not the other
61
What can be helpful for mothers experiencing perinatal loss?
validate feelings, Encouraging them to name the baby, respect their wishes.
62
How can previous loss impact a mother's anxiety during pregnancy?
They can feel anxious
63
What is the significance of the Cuddle Cot?
The Cuddle Cot provides families with more time to spend with their baby.
64
What does a cuddle cot do?
Keeps the baby cool.
65
What is an open adoption?
Biological mother is involved in the child's life
66
What is a closed adoption?
Maternal mom may not know the adoptive parents and they don't see the child again
67
Are adoptive parents always present for the birth?
It depends, they may or may not be present
68
Who do we need to care for in adoption?
Both the mom and the adoptive parents
69
What are the therapeutic management options for hyperemesis gravidarum?
Diphenhydramine, Histamine-receptor antagonists (pepcid/zantac), Gastric acid inhibitors (nexium/prilosec), Metoclopramide (reglan), Pyridoxine/doxylamine
70
What is Hyperemesis Gravidarum?
Severe pregnancy-related nausea and vomiting
71
How does Hyperemesis Gravidarum compare to morning sickness?
Approximately 10 times worse
72
How long does Hyperemesis Gravidarum typically last?
Throughout the entire pregnancy
73
What are the common symptoms of Hyperemesis Gravidarum?
Dehydration and electrolyte imbalances
74
What is the cause of Hyperemesis Gravidarum?
Unknown, but thought to be related to pregnancy hormones
75
How is Hyperemesis Gravidarum diagnosed?
By ruling out other causes of severe nausea and vomiting
76
What is the first line of treatment for Hyperemesis Gravidarum?
Medications that control nausea and vomiting
77
When might a pregnant woman with Hyperemesis Gravidarum be hospitalized?
If they are severely ill and require IV fluids and TPN
78
What medication is typically avoided during the first trimester in Hyperemesis Gravidarum?
Zofran, it can cause cleft palate and heart defects.
79
What should be monitored in Hyperemesis Gravidarum?
Intake and output
80
What conditions must exist for Rh incompatibility?
Mother is Rh-negative, and fetus is Rh-positive.
81
What are the potential negative effects of Rh incompatibility?
Negatively affects future pregnancies if not treated.
82
What is the treatment for Rh incompatibility?
Rhogam
83
At what time during pregnancy is Rhogam typically administered?
28 weeks
84
When is Rhogam typically administered after delivery?
72 hours if the mother is negative and baby is positive.
85
What can happen if there is Rh factor incompatibility between the mother and the baby?
Birth defects or abortion
86
What happens if the baby's blood type is negative?
No 72-hour follow-up is needed with rhogam
87
What happens if the baby's blood type is positive?
Rhogam is given within 72 hours
88
What is hypovolemia?
Decreased blood volume
89
How does hypovolemia affect the mother?
Can lead to decreased blood flow and oxygen delivery to organs
90
What does a complete abortion mean?
Abortion does everything and there is no retained tissue.
91
What does an incomplete abortion mean? What might be needed?
Something was left behind and a D&C may be needed.
92
What does a missed abortion mean?
Retains all the tissue and requires a D&C.
93
What does recurrent abortion mean?
Three or more occurrences of abortion, not necessarily successive.
94
What is the most important lab for abortion conditions?
CBC and H&H, but CBC is the most important.
95
How is an abortion (miscarriage) defined in terms of gestational age?
Less than 20 weeks
96
What is cerclage?
Procedure to stitch the cervix closed
97
When is cerclage recommended?
For women at risk of premature birth
98
How is cerclage performed?
Using stitches to secure the cervix or with the use of a band.
99
Is a cerclage considered a high risk pregnancy?
Yes
100
What is an ectopic pregnancy?
Implantation of a fertilized ovum outside of uterine cavity
101
Where do 97% of ectopic pregnancies occur?
Fallopian tube
102
What are the consequences of a ruptured ectopic pregnancy?
Severe pain, internal bleeding, and significant cause of maternal death
103
How is ectopic pregnancy diagnosed?
Via ultrasound
104
What are the treatment options for ectopic pregnancy?
Methotrexate, salpingectomy
105
What should be done if an ectopic pregnancy ruptures?
Prevent hypovolemic shock
106
When is an ectopic pregnancy usually found or caught?
usually caught on the first ultrasound. keep in mind that some people dont even know theyre pregnant though.
107
What treatment can be given for an ectopic pregnancy if caught early enough?
Methotrexate
108
What is the success rate of methotrexate in treating ectopic pregnancy?
90%
109
What is the latest stage an ectopic pregnancy needs to be caught before methotrexate cannot be given anymore?
Around 8-10 weeks
110
What is gestational trophoblastic disease?
tbh the thing that looks like a bunch of bubbles or cysts.
111
What is the difference between complete and partial hydatidiform mole?
Complete: no fetal tissue, Partial: fetal tissue present
112
What are the treatment options for hydatidiform mole?
D&C, oxytocin
113
What are the two types of hydatidiform mole?
Complete and partial
114
What is the biggest complication of a hydatidiform mole?
Bleeding leading to hypovolemia. prepare for hypovolemia.
115
What should moms avoid after a hydatidiform mole so that we can monitor for carcinoma?
Pregnancy for 6-12 months minimum
116
What can extremely high HcG levels indicate?
Presence of hydatidiform mole trophoblasts
117
What should be watched for in hydatidiform moles?
Malignant changes or cancer
118
What is placenta previa?
Implantation of the placenta in the lower uterus
119
What is the difference between placenta previa and low lying placenta?
Placenta previa involves implantation of the placenta in the lower uterus, while low lying placenta refers to a placenta that is near the cervix but not covering it. placenta previa is completely covering the cervix.
120
What is a common symptom of placenta previa?
PainLESS bright red bleeding
121
What are the delivery restrictions for placenta previa?
No vaginal delivery, no SVE (sterile vaginal examination), pelvic rest
122
How is placenta previa diagnosed?
Second ultrasound
123
What is the implantation location in placenta previa?
Lower part of the uterus
124
What is a low lying placenta?
Within 2 cm of the cervical opening
125
What is the hallmark sign of placenta previa?
Painless bright red bleeding
126
What should be avoided with placenta previa?
Vaginal delivery, sterile vaginal exam, sex, tampons, swimming, oxytocin
127
What should be done if bright red bleeding occurs?
Get an ultrasound to rule out placenta previa
128
What treatment is given for placenta previa before 34 weeks?
Corticosteroids to help mature the lungs
129
What can cause improper implantation in placenta previa?
Previous scar (fibroid removal, previous C-section)
130
What is abruptio placentae?
Separation of a normally implanted placenta before the fetus is born
131
What are the causes of abruptio placentae?
cocaine, meth, trauma, hypertension, alcohol
132
What are the symptoms of abruptio placentae?
Bleeding, board-like abdomen, abdominal tenderness, tachycardia, late decels
133
What is the management approach for abruptio placentae?
Depends on severity: conservative (bedrest, medications) or aggressive (delivery, possible cesarean section, blood transfusion)
134
What is the hallmark sign of a board-like abdomen associated with?
abruptio placentae or placental abruption
135
What can happen with partial abruptio of the placenta?
Concealed bleeding that can seal back up
136
What needs to happen if there is a complete abruption of the placenta?
The patient needs to go into labor
137
For marginal or partial abruption, what intervention may be considered first instead of a c-section?
Tocolytics to stop the process of labor
138
What are some potential interventions or procedures for a placental abruption?
Blood transfusion, fluids, possible hysterectomy (if bleeding cannot be controlled).
139
What are some signs and symptoms of fluid volume deficit (FVD) that could be a result of placental abruption?
Pale, cool skin; low BP; tachycardia
140
What are some possible signs of placental abruption on a toco monitor?
High toco monitor readings
141
what is the leading cause of maternal morbidity and mortality?
hypertensive disorders of pregnancy
142
What is the prevalence of hypertensive disorders of pregnancy?
5-8% of all pregnancies
143
What are the preventive measures for preeclampsia?
Early and regular prenatal care, aspirin
144
What are the signs and symptoms of preeclampsia?
Hypertension, proteinuria, edema (sudden, pitting), headaches, visual disturbance
145
What are the components of therapeutic management for preeclampsia?
Activity restrictions, blood pressure monitoring, weight monitoring, fetal assessment
146
What are some of the diagnostic tests used for preeclampsia?
NST, BPP, CBC, CCUA, CMP, LDH, Uric Acid, 24-hr urine protein
147
What is one way to prevent the progression of preeclampsia?
Early and regular appointments
148
What medication can be used for prevention of preeclampsia?
Aspirin
149
How can proteinuria be detected?
Dip stick test showing 2+ or more protein
150
How much protein in the urine is considered abnormal in a 24-hour urine collection?
300 mg
151
What is the only cure for preeclampsia?
Delivery of the baby
152
When does preeclampsia resolve?
After delivery of the baby
153
Who should take low-dose aspirin after their first trimester?
Pregnant women at risk for preeclampsia
154
What is the purpose of taking low-dose aspirin during pregnancy?
To prevent preeclampsia
155
What are some factors that put pregnant women at high risk for preeclampsia?
Chronic high blood pressure, diabetes, kidney disease
156
What are the diagnostic criteria for preeclampsia with severe features?
Systolic > 160, Diastolic > 110, Platelets < 100,000
157
What signs and symptoms may indicate preeclampsia with severe features?
Pulmonary edema, headache unrelieved by meds, RUQ pain, epigastric pain, blurred vision, small amount of dark urine
158
What laboratory test results may be abnormal in preeclampsia with severe features?
Elevated AST, ALT
159
What medications are used to treat preeclampsia, what are their primary puspose?
Magnesium and labetalol, to prevent seizures.
160
What precautions should be taken for a patient with preeclampsia?
Left side lying, seizure precautions, decrease stimuli
161
What is the recommended management for hypertensive disorders of pregnancy?
PREVENT SEIZURES. Bed rest, fetal monitoring, antihypertensive medication, anticonvulsant medications, magnesium sulfate, you want to increase placental blood flow.
162
What medications are used for antihypertensive treatment?
Labetalol, Hydralazine, Nifedipine
163
What medication is used for preventing seizures?
Magnesium sulfate
164
What are the signs of recovery in a patient with hypertensive disorders of pregnancy?
Diuresis, decreased proteinuria, normal blood pressure and labs
165
What is the loading dose of magnesium sulfate?
4-6 g over 15-30 min
166
What is the maintenance dose of magnesium sulfate?
1-2 g per hour
167
What are the signs of magnesium toxicity?
Lethargy, absent reflexes, CNS depression, resp depression
168
What should be monitored in a patient on magnesium sulfate?
Strict I&O (at least 30mL/hr)
169
What is the antidote for magnesium toxicity?
Calcium gluconate
170
When do half of eclamptic seizures occur?
During birth or 48 hours post delivery
171
what cures preeclampsia?
birth
172
Can a patient with thrombocytopenia have an epidural?
No
173
Why is a woman at increasing risk for poor placental perfusion with eclampsia?
blood volume severely reduced
174
What should be monitored in a woman with eclampsia?
Ruptured membranes, signs of labor, or abruptio placentae
175
How would you describe the seizures in eclampsia?
Tonic clonic, lasting for approximately 1 minute. breathing typically stops
176
What happens during the post stage of the seizures in eclampsia?
Transient muscle movements
177
What complications can occur in eclampsia?
Help syndrome and DIC
178
What fetal heart rate monitor findings are associated with eclampsia?
Bradycardia, decelerations, and possibly tachycardia
179
What diagnostic tests may be conducted for eclampsia?
Ultrasound and x-ray
180
What is the common management approach for eclampsia?
Delivery of the baby
181
What is HELLP Syndrome?
Hemolysis, Elevated Liver enzymes, Low Platelets
182
What does HELLP Syndrome involve?
Liver
183
What percentage of pregnancies does HELLP Syndrome complicate?
10%
184
What are the symptoms of HELLP Syndrome?
RUQ abdominal pain, n/v, severe edema, elevated AST & ALT, jaundice, thrombocytopenia
185
What are the therapeutic management options for HELLP Syndrome?
BP control, seizure prevention, corticosteroids, induction, IV therapy, blood replacement
186
What percentage of HELLP patients had preeclampsia?
50%
187
What should you avoid doing if a patient has HELLP syndrome?
Do not palpate the abdomen
188
What is a potential risk if you palpate the abdomen of a patient with HELLP syndrome?
Liver rupture
189
What will happen to the baby if the mother has HELLP syndrome?
Delivery will be necessary
190
What happens to insulin release in early pregnancy with diabetes mellitus? What may occur?
Insulin release accelerates, hypoglycemia.
191
What happens to fetal growth in late pregnancy?
Fetal growth accelerates, placental hormones increase and create resistance to insulin.
192
What are the potential glucose abnormalities that can occur during pregnancy both early and late with diabetes mellitus?
Early: Hypoglycemia, Late: Hyperglycemia
193
What symptoms might indicate hypoglycemia in pregnant women?
Nausea/Vomiting
194
Why is maintaining normal maternal glucose levels essential during birth with diabetes mellitus?
To reduce neonatal hypoglycemia
195
What happens to the need for additional insulin postpartum for diabetics?
It falls
196
What is encouraged postpartum for women with diabetes?
Breastfeeding
197
How does breastfeeding help women with types 1 and 2 diabetes mellitus?
It helps lower the amount of insulin needed
198
What happens to the need for insulin in women with gestational diabetes mellitus after birth?
They usually need no insulin
199
when does gestational diabetes typically go away?
after birth
200
what are women with gestational diabetes at risk for later in life?
type II diabetes
201
What is Type 1 diabetes?
Insulin deficient
202
What is Type 2 diabetes?
Insulin resistant
203
What is gestational diabetes (GDM)?
Glucose/insulin intolerance during pregnancy
204
When does gestational diabetes start and end?
During pregnancy and ends after delivery
205
Who is at an increased risk for developing gestational diabetes mellitus?
Minority groups, overweight, history of abnormal glucose tolerance, maternal age over 25, history of diabetes in a close relative, previous birth outcome often associated with GDM, GDM in previous pregnancy, history of prediabetes, history of PCOS.
206
What is the glucose challenge test used for?
to see if a challenge test for gestational diabetes needs to additionally be performed.
207
What is the recommended timing for the glucose challenge test?
24 to 28 weeks of pregnancy
208
What is the glucose solution dose used in the glucose challenge test?
50 g. FSBS checked in 1 hour
209
What is the cutoff value for an abnormal glucose challenge test result?
>140 mg/dL. proceed to a glucose tolerance test
210
What test is done if the glucose challenge test result is abnormal?
3-hour oral glucose tolerance test with 100 g glucose
211
What are the fasting and postprandial glucose cutoff values for gestational diabetes diagnosis in the oral glucose tolerance test? how often are they?
Fasting: 95 mg/dL, 1-hour: 180 mg/dL, 2-hour: 155 mg/dL, 3-hour: 140 mg/dL. every hour
212
Is fasting required for the glucose tolerance test?
yes
213
How can gestational diabetes make moms feel?
Awful
214
What is the recommended amount of exercise for individuals with gestational diabetes?
30 minutes/day, 5 days/week of moderate intensity exercise.
215
What are the target blood glucose levels for fasting and postprandial measurements?
Fasting: <95, Postprandial: <140 @ 1 hour, <120 @ 2 hours.
216
What are the two pharmacologic treatment options for gestational diabetes?
Insulin and metformin.
217
Which medication is preferred for treating gestational diabetes and why?
Insulin because it does not cross the placenta.
218
What fetal surveillance tests are commonly used for gestational diabetes?
BPP, NST, CST, kick counts.
219
What dietary advice should be given to the patient who has diabetes?
Avoid simple sugars, have high protein and small snacks throughout the day.
220
When will the patient come in for NST by?
32 weeks, sometimes twice a week for gestational diabetes.
221
What will be done if blood glucose levels are higher than monitoring levels?
Medication will be used
222
What are some maternal risks associated with obesity?
Obstructive sleep apnea, Gestational HTN, Preeclampsia, GDM, Preterm labor, Prolonged pregnancy, Induction of labor, Cesarean birth
223
What are some fetal risks associated with obesity?
Perinatal death, Macrosomia, Congenital malformations, NICU, childhood obesity, shoulder dystocia, hypoglycemia.
224
What is considered obese according to BMI?
BMI over 30.0
225
What percentage of patients are obese?
1/3 (33%)
226
t/f: pregnancy can exacerbate normal obesity comorbidities they may already have
TRUE
227
What are some risks associated with obesity during pregnancy?
Increased risk for infection, c-section, and induction of labor
228
What are some common types of anemia?
Iron-deficiency anemia, folic acid deficiency anemia (megaloblastic), sickle cell disease
229
What is the most common type of anemia?
Iron-deficiency anemia
230
What is the cause of sickle cell disease?
Genetic mutation
231
What is one of the most common problems of pregnancy?
Iron deficiency anemia
232
What can supplemental iron cause?
Constipation and black stools
233
What can pregnant women take to avoid constipation caused by iron supplements?
Stool softener
234
What are good sources of iron?
Meat, red meat, fish, green leafy vegetables
235
What is the role of folic acid in the body?
Essential for cell duplication and red blood cell development
236
Which types of food are good sources of folic acid?
Grains, beans, peanuts, green leafy vegetables
237
What happens to folic acid when cooked?
Mostly destroyed
238
What is the transmission rate of HIV without treatment from mother to baby?
25%
239
What is the transmission rate of HIV with treatment from mother to baby?
1-2%
240
Should all newborns be treated with antiretroviral therapy if their mother has HIV?
Yes
241
Is breastfeeding recommended for infants born to HIV-positive mothers?
No
242
What should be done for the infant immediately following birth if the mother has HIV?
Provide infant bath ASAP
243
What are the risks of COVID-19 during pregnancy?
Severe disease, preterm birth, fetal demise, preeclampsia
244
Is COVID-19 infection common in utero?
Rarely infected in utero
245
What is the recommendation for a pregnant woman with HIV and a viral load above 1000 copies/mL?
C-section at 38 weeks
246
Can mothers with low viral load with HIV have a vaginal birth?
Possibly
247
How should newborns of HIV-positive mothers be treated?
With antiretroviral therapy
248
What should HIV-positive mothers not do regarding feeding their baby?
Breastfeed
249
What can decrease transmission of HIV from mother to baby?
Bathing the infant as soon as possible
250
How can COVID-19 affect pregnancy?
It can cause preterm birth, labor, and preeclampsia
251
Are newborns typically infected in utero or after birth with covid?
after birth, not usually infected in utero.
252
What may high-risk newborns with COVID receive?
Monoclonal antibodies
253
Is breastfeeding and rooming in still encouraged if the mother has covid?
Yes
254
What is the leading cause of life-threatening perinatal infections in the US?
Group B streptococcus (GBS)
255
When is the vag/rectal swab performed?
At 36-37 weeks gestation
256
What is the first line treatment for GBS?
Penicillin
257
What is the name of the CAUSE OF LIFE TREATENING PERINATAL INFECTIONS?
group b strep
