Mehl + UW BGstrep prophylaxis 03-25 (2) Flashcards
Mehl. what is adequate prophylaxis? abs + time of injection.
Adequate prophylaxis is considered to be IV penicillin or ampicillin administered within 4 hours of completion of Stage 2 (delivery of fetus; stages of delivery discussed later).
Mehl. what is wrong answer in 2CK?
Oral amoxicillin + clavulanate (Augmentin) is wrong. This is listed as wrong answer choice on 2CK form.
Mehl. we do not automatically give GBS prophylaxis in the current pregnancy just because the woman had a (+) culture in the PRIOR pregnancy.
When discussing indications for giving GBS prophylaxis, the first step is mentioning when you do not give it, which is when there is Hx of mere colonization with GBS in prior pregnancy.
Mehl. Knowing not to give it in this scenario is actually the highest yield point.
.
Mehl. Indications for giving GBS prophylaxis. what positive? when?
(+) Rectovaginal swab at 36 weeks.
Mehl. Indications for giving GBS prophylaxis. urine?
GBS bacteriuria at any point during the pregnancy, even if it was successfully treated.
if they say woman had 1st trimester GBS asymptomatic bacteriuria + she received ampicillin or penicillin + cultures are currently negative, we still give intrapartum prophylaxis.
Mehl. Indications for giving GBS prophylaxis. Hx of what?
Hx of early-onset GBS disease in prior pregnancy (i.e., meningitis, pneumonia, or sepsis) in NEONATE.
This is different from mere colonization in the mom while pregnant. In this scenario, the neonate actually went on to get a GBS infection.
Mehl. Indications for giving GBS prophylaxis.
- If mother’s GBS status is unknown or equivocal, we give it if any one of the following is present:? 3
1) Rupture of membranes (ROM) > 18 hours.
2) Maternal fever >38 C.
3) Preterm delivery (<37 weeks).
Mehl. 2CK Obgyn form, for instance, says that a pregnant woman is in labor at 40 weeks, her temperature is 37
C, and her GBS status is unknown. They ask which of the following is the best indication for prophylaxis in this patient –> answer = ROM > 18 hours.
.
Mehl. Another 2CK Obgyn Q asks for the Tx of GBS sepsis in the neonate –> answer = ampicillin + gentamicin;
vancomycin + ceftriaxone is wrong on the form.
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Mehl. Not GBS table.
Three most common bacteria causing infections in neonates are?
GBS, Ecoli, listeria
Mehl. Not GBS table.
If they say there is neonatal infection caused by gram-positive cocci, answer?
GBS
If they say there is neonatal infection caused by gram-negative rod, answer?
E coli
If they say there is neonatal infection caused by gram-positive rod, answer?
Listeria
Mehl. Not GBS table. listeria spread?
Listeria can be contracted by the pregnant female via soft cheeses and deli meats.
UW table. antenatal screenin, weeks?
new table tipo sako 36-38 weeks.
UW table. indications. urinary?
GBS bacteriuria or GBS urinary infection in current or prior pregnancy (regardless or treatment)
UW table. indications. culture?
GBS positive rectovaginal culture (mehl. said 36 weeks) in current pregnancy
UW table. indications. Unknown GBS status PLUS any of the following?3
<37 weeks gestation
Intrapartum fever
Rupture of membrane >= 18 hours
UW table. indications. Prior what disease?
Prior infant with early-onset neonatal GBS infection
UW table. intrapartum prophylaxis. What abs? what is allergy?
First line Iv penicillin or (ampicillin)
IF allergy –> give cefazolin
UW case.
First line Iv penicillin or (ampicillin)
because they reach high bactericidal concentrations in the amniotic fluid rapidly (eg, within 3-4 hours), have no fetal toxicity, and have a narrow spectrum of coverage, thereby minimizing bacterial resistance.
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UW case. Patient has penicillin allergy => what abs to give?
cefazolin (a first-generation cephalosporin).
Cephalosporins have a lower risk of cross-reactivity but achieve the same high bactericidal concentrations in the amniotic fluid without fetal toxicity.
UW case - was GBS erythromycin resistant. what other abs cannot be given?
erythromycin resistance is associated with inducible clindamycin resistance
UW case. GBS sensitive to erythromycin and clindamycin. which one to give?
clindamycin
UW case. Resistant to both erythromycin and clindamycin OR sensitivities are unavailable?
IAP is with vancomycin
UW case. vancomycin does not reach bactericidal concentrations in the amniotic fluid, infants of patients treated with vancomycin may require additional neonatal observation and evaluation.
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UW case. GBS and TMP-SMX?
Resistant, dont give. Also, forbidden in 1st and 3rd trimester
UW case. location of Streptococcus agalactiae, or group B Streptococcus (GBS)?
A common colonizer of the maternal gastrointestinal and genital tract.
UW case. Women screened at 36-38w -> positive -> give penicillin.
What if status unknown, eg did not get prenatal care?
Women with an unknown GBS status, such as this patient, are triaged based on risk factors. Most women at ≥37 weeks gestation do not require IAP as they are at low risk for vertical transmission, and indiscriminate antibiotic use can lead to bacterial resistance.
UW case. Status unknown, how to evaluate risk? 3
ROM for ≥18 hours because the extended time period allows for possible GBS proliferation, increased bacterial load, and prolonged fetal exposure to infected amniotic fluid—all of which increase the risk of vertical transmission and neonatal infection
Intrapartum fever, which indicates possible intraamniotic infection involving GBS
Delivery at <37 weeks gestation, as the immature fetal immune system is more susceptible to infection
UW case. Uknown status + meet 3 previously mentioned criteria (nereikia visu 3, uztenka bent vieno). What Mx?
intravenous penicillin
UW case. In case was GSB status unknown + green meconium fluid+ cervix 6 cm, contractions every 2-3 min. Fetal HR normal. Should we induce labor/cesarean?
NO!!!!
(in case) has a reassuring fetal heart rate tracing and is in active labor (6 cm dilated, contractions every 2-3 minutes). Therefore, neither cesarean delivery nor labor augmentation are indicated.
UW case. kitas variantas. Kada amnioinfusion?
used to decrease umbilical cord compression (as evidenced by variable decelerations) after rupture of membranes.
In case buvo active labor - early decelerations are caused by fetal head compression; they are normal and do not require treatment.
