Module 3 Flashcards
1
Q
infections in pregnancy
A
- Development of microbial resistance to antibiotics
- routine antenatal screening is recommended for rubella, Hepatitis B, syphilis, HIV, varicella, and Group B Streptococcus (GBS) and urine culture should be included
2
Q
diagnosis
A
- Antibody screening
- Antibody testing for known or suspected infections
- Antigen detection or assays e.g. direct immunofluorescence or enzyme immunoassay
- Nucleic acid amplification e.g. polymerase chain reaction
- TORCH titres
- Viral cultures
- Wet mount (microscope)
3
Q
4 types of organisms
A
- Viral
- Bacterial
- Fungal
- Protozoan
4
Q
types of infections
A
- UTI (bacteriuria)
- Bacterial vaginosis
- Candidiasis thrush
- GBS
- Hep b and c
- Over 50 STIs are recognised that can affect health of woman and baby
5
Q
7 most common STIs
A
- Chlamydia
- Gonorrhea
- Herpes simplex virus type 2 (genital herpes)
- Human immunodeficiency virus (HIV)
- Human papillomavirus (HPV)
- Syphilis (Treponema pallidum)
- Trichomoniasis
6
Q
UTIs
A
- Bacteria from the GI tract contaminating the perineal area
- most common causative organisms are coliforms especially Escherichia coli, others are Klebsiella pneumoniae and Proteus species. Less frequently are Gram positive organisms such as GBS, enterococci and staphylococci=3-7% UTIs.
- Common when normal coliform organisms of the perineal flora are introduced into the urethra during poor perineal hygiene or during sexual intercourse. Bacteria may migrate from the urethra into the bladder and proliferate before the next urination
- Asymptomatic bacteriuria occurs in 2-10% of pregnant population – if untreated, 20-30% of women will develop symptoms of UTI
- Symptomatic bacteriuria occurs in another 1-1.5%. Women with a UTI history and current bacteriuria are 10 times more likely to develop symptoms during pregnancy than women without either feature
7
Q
signs and symptoms acute cystitis infection
A
frequency, dysuria, urgency
8
Q
kidney infection symptoms
A
- Pyelonephritis is usually present when fever, chills, nausea and vomiting, malaise and flank pain occur (CVAT)
- Incidence 1-2.5% with an increased risk of recurrence.
- Urine may be cloudy and infecting organism often found to be Escherichia.coli
9
Q
treatment and management of UTIs
A
Antibiotics as per organism sensitivity: 7-10 day course for an initial infection.
- Prophylaxis with nitrofurantoin (Macrobid) for women with recurrent UTI.
- Increase clear fluids 1.5-2 litres/day.
- Increase clear fluid intake and void before and after intercourse to decrease the risk of recurrent UTI.
- Education: hygiene measures - perineal hygiene, cotton underwear, avoidance of scented soaps, avoid tight fitting clothes.
- Reduce simple sugars in the diet.
- Eat yoghurt or drink milk containing acidophillus cultures and a probiotic when taking an antibiotic.
- Provide antenatal education to the woman to recognise and promptly report signs and symptoms of an infection
10
Q
bacterial vaginosis
A
- anaerobic bacteria such as Gardnerella vaginilis and Mycoplasma hominis which change the normal vaginal flora to a small amount of lactobacilli which would normally produce lactic acid and maintain an acid pH.
- BV is a vaginal infection and is the most common cause of vaginal discharge in women of childbearing age. It can arise and remit in both sexually active and non-sexually active women.
- Present in up to 20% of women during pregnancy and most are asymptomatic.
- Also contracted by swimming in contaminated water, using contaminated towels or sitting in contaminated hot tubs.
- Main symptom is thin, grey/white vaginal discharge, may have increased vaginal discharge and is characterised by a fishy odour after intercourse due to the release of amines by the alkaline semen. Does not cause vaginal itching or dysuria.
- Treatment: Antibiotics are highly effective. 7 day course of metronidazole (Flagyl) or oral clindamycin.
- Effect on pregnancy: increases the risk of spontaneous abortion, PROM, TPL and LBW infants. May cause intra-amniotic infection, neonatal septicaemia and postpartum endometritis.
11
Q
trichomoniasis
A
- caused by Trichomonas vaginalis, a flagellate protozoan that is most commonly sexually transmitted.
- Constant perineal itching, vaginal discharge may be profuse, frothy, yellow/green or grey and have a foul odour, dyspareunia, mild dysuria and lower abdominal pain.
- Treatment is for 5-7 days daily or in a large single dose of oral metrondiazole (Flagyl) and treat the partner(s) too.
- Implicated in PROM, LBW and preterm delivery.
- May be asymptomatic in 10-50% of women. May be acquired perinatally and occurs in 5% of babies born to infected mothers.
12
Q
candidiasis
A
- Candida albicans is a common fungal infection in pregnancy, causing vulvitis, vaginitis and vaginal discharge. Is a commensal and is found in the flora of the mouth, GIT and vagina.
- The vagina may be colonised from the lower intestinal tract or through sexual intercourse.
- Thrush results from a disturbance in normal vaginal flora and conditions that cause vaginal pH to be more alkaline e.g. using antibiotics, eating large amounts of simple sugars.
- May be found in the vagina, mouth or skin around the nipple.
- Clotrimazole most commonly in a vaginal suppository or cream is used for the full 7 days at night to relieve the maternal symptoms and avoid occurrence of neonatal thrush. Also treat the partner
13
Q
bacterial infections (chlamydia)
A
- Chlamydia is the most common, treatable and notifiable infectious disease in many countries and the most common STD especially among young people
- Is a leading cause of PID and is asymptomatic in 80% of cases. Called the “silent STI”.
- Chlamydia trachomatis is now classified as a Gramnegative intracellular bacterium based on its sensitivity to antibiotics and its reproductive cycle.
- Infection rates in pregnancy range from 2-30%
- The rate of chlamydia infection in the past ten years has tripled.
- Aboriginal and Torres Strait Islander people have about an eight-fold higher rate of diagnosis (per 100,000 population) than non-Aboriginal people
- easily diagnosed by self collected specimens including first pass urine and can be easily treated by erythromycin, clindamycin or single dose azithromycin.
- Can cause amnionitis and postpartum endometritis and 70% babies born to mothers with chlamydia become infected.
- Convincing evidence of the association between chlamydia infection and infertility. Long term consequences of infection experienced predominantly by women: chronic pelvic pain, ectopic pregnancy and infertility
14
Q
syphilis
A
- Caused by a motile spirochete bacterium Treponema pallidum.
- Most women who have syphilis have no symptoms and fortunately it is also now relatively uncommon in most of Australia except in the NT and QLD where rates are rising.
- Syphilis can present as a primary genital ulcer, a rash of secondary syphilis or as a large number of serious conditions as part of tertiary syphilis, if left untreated.
- It is particularly important in pregnancy because it may infect the fetus and can cause spontaneous abortion, preterm birth, death and can have serious life-long consequences. It also increases HIV transmission, particularly when a genital ulcer is present.
- Antenatal screening: VDRL at booking–in, repeated at 28 weeks and after birth if mum is high risk.
- Note: Testing is highly sensitive and non-specific and pregnancy may cause false positive results.
- Women who have a positive VDRL or RPR but no symptoms also need to be screened for lupus.
- Primary and secondary syphilis in pregnancy is effectively treated and most commonly by a single dose of 2.4 million units IMI benzyl penicillin. It crosses the placenta.
- If diagnosed after 20 weeks gestation, U/S performed to evaluate for fetal syphilis. Treatment failure is much higher in the presence of fetal hepatomegaly, ascites, hydrops polyhydramnios and placental thickening.
15
Q
GBS
A
- Streptococcus agalactiae is a naturally occurring Gram positive bacteria found in the rectovaginal flora of up to 25% of healthy women. Has the potential to cause infection and ongoing complications for the pregnant woman, the fetus and the neonate.
- NB: Screening issues and prophylaxis are very controversial. Know what happens in your own unit.
- Early onset neonatal GBS infection has high morbidity and mortality if not recognised and treated with antibiotics.
- 90% of neonates have onset of symptoms within 12 hours of birth and most cases occur in the first 72 hours. Late onset disease occurs on days 7-90.
- Incidence of early onset disease varies between 0.2- 1/1000 live births.
