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RGU 2 > Obstetric & Perinatal Infections > Flashcards

Obstetric & Perinatal Infections Flashcards

1
Q

What are perinatal and postnatal infections of the newborn?

A
  • acquired during birth

- acquired soon after birth

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2
Q

Why are pregnant women more susceptible to infection (also immediately following birth; puerperium)?

A
  • increased progesterone leads to decreased mobility of the ureter and the enlarged uterus obstructs the urethra, leading to incomplete bladder emptying and an increased risk for cystitis and UTIs.
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3
Q

What pathogens are more common in pregnancy?

A
  • salmonella
  • listeriosis
  • candidiasis
  • influenza
  • coccidiodomycosis
  • varicella
  • malaria
  • hepatitis E
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4
Q

In what trimester does pyelonephritis most often occur during pregnancy?

A
  • 2nd trimester, due to untreated cystitis.
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5
Q

What pathogens are associated with UTIs (in general, whether pregnant or not)?

A
  • E. coli (MOST)
  • Group B strep
  • Proteus mirabilis
  • Enterococci
  • Klebsiella pneumoniae
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6
Q

What is the concern with pyelonephritis?

A
  • sepsis, which is often associated with premature uterine contractions
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7
Q

*** What is chorioamnionitis?

A
  • ascending polymicrobial infection of the placenta, amniotic fluid, and fetal membranes, due to normal vaginal flora.
  • has high association with preterm birth and preterm premature RUPTURE of membranes.
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8
Q

*** What pathogens are associated with chorioamnionitis?

A
  • Gardnerella vaginalis
  • group B strep
  • E. coli
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9
Q

What are some risk factors for chorioamnionitis?

A
  • BV
  • STI (GC/Chlamydia)
  • GBS colonization
  • prolonged labor
  • frequent vaginal exams during labor
  • internal fetal monitoring
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10
Q

What are the signs of chorioamnionitis?

A
  • maternal fever
  • maternal or fetal tachycardia
  • uterine tenderness
  • leukocytosis
  • foul smelling amniotic fluid due to anaerobes (uncommon)
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11
Q

How do you diagnose chorioamnionitis?

A
  • culture of amniotic fluid
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12
Q

How do we treat chorioamnionitis?

A
  • induction of labor; delivery

- broad-spectrum antibiotics during labor, but aren’t needed after labor for the mother unless she remains febrile.

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13
Q

What can happen to the mother as a possible consequence of chorioamnionitis?

A
  • puerperal (intrapartum) fever
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14
Q

What pathogen is associated with more severe complications in chorioamnionitis?

A
  • clostridium perfringens (myonecrosis or gas gangrene)
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15
Q

What is puerperal fever?

A
  • fever that lasts more than 24 hours within the first 10 days post delivery due to ENDOMYOMETRITIS form postpartum infection of the uterus (at the placental site).
  • dissemination via blood or lymphatics could cause sepsis or peritonitis.
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16
Q

What are the major pathogens in postpartum endomyometritis?

A
  • E. coli
  • group B strep
  • anaerobes
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17
Q

What are the signs and treatment for postpartum endomyometritis?

A
  • fever, uterine tenderness, tachycardia, purulent vaginal discharge.
  • treat with broad-spectrum antibiotics
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18
Q

To what can postpartum endomyometritis lead?

A
  • thrombophlebitis and pelvic abscess
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19
Q

What causes most cases of neonatal herpes?

A
  • transmission of herpes virus during birth
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20
Q

** What NEONATAL infections are acquired during passage down an infected birth canal? (aka what is the baby getting, from the mother)

A
  • Group B strep= sepsis, pneumonia, meningitis.
  • E. coli= sepsis, pneumonia, meningitis.
  • Group A strep= sepsis, pneumonia, meningitis.
  • Enterococcus= UTI, sepsis.
  • Listeria monocytogenes= spsis, meningitis, diarrhea.
  • Neisseria gonorrhoeae= conjunctivitis
  • Chlamydia trachomatis= conjunctivitis
  • herpes simplex virus= herpes
  • genital papillomavirus (HPV)= laryneal warts
  • Candida albicans= oral thrush
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21
Q

How can EARLY-onset disease occur in the infant?

A
  • pathogen in blood transmitted to fetus across the placenta.
  • consequence of chorioamnionitis (aspiration of infected amniotic fluid).
  • pathogen in genital secretions transmitted during delivery in the birth canal.
22
Q

What can cause LATE-onset disease in the newborn?

A
  • nosocomial infection (mother or health care worker in nursery)
  • more often bacteremia, sepsis and meningitis
23
Q

What is a common site of entry to the newborn for systemic infection?

A
  • umbilical cord
24
Q

What is neonatal sepsis?

A
  • systemic illness with bacteremia that occurs in the 1st month of life
  • often includes PNEUMONIA and MENINGITIS.
25
Q

What is normally associated with HYPOthermia in neonatal sepsis?

A
  • bacteria
26
Q

What is normally associated with FEVER in neonatal sepsis?

A
  • viral agens (HSV)
27
Q

What should you look for in neonatal sepsis?

A
  • cyanosis, mottling, pallor, petchiae, rashes, jaundice, or respiratory distress
28
Q

With what is early onset neonatal sepsis most associated?

A
  • respiratory symptoms (group B strep most common, then E. coli).
29
Q

What is a common pathogen associated with LATE-onset disease of the newborn?

A
  • coagulase negative Staph epidermidis from skin of health care workers
30
Q

** What is important to know about Strep agalactiae (GBS)?

A
  • B-hemolytic
  • normal flora of GI and GU tract
  • transmission to neonate during birth
  • MOST COMMON cause of NEONATAL SEPSIS in the US
  • causes most cases of MATERNAL cystitis and higher incidence of premature rupture of membranes.
31
Q

What can happen to newborns that acquire EARLY-onset Strep agalactiae (GBS) infection?

A
  • respiratory distress and pneumonia.
  • meningitis (serotype III).
  • septicemia
  • death
32
Q

What is the most common LATE-onset Strep agalactiae (GBS) complication?

A
  • MENINGITIS (serotype III)
33
Q

When are pregnant mothers screened for GBS?

A
  • at 35 weeks gestation for vaginal and rectal colonization
34
Q

If a pregnant mother tests positive for GBS, what antibiotic is given during intrapartum?

A

penicillin
*does not have an effect on late onset disease (makes sense because the late onset comes from nosocomial infection later).

35
Q

What risks are associated with PRIMARY genital herpes of the mother?

A
  • spontaneous abortion
  • intrauterine growth retardation
  • preterm birth
36
Q

Does REACTIVATION herpes of the mother transfer often to the neonate?

A

NO because maternal antibodies will be present.

37
Q

When do most cases of neonatal herpes occur?

A
  • peripartum (during delivery)
38
Q

What are the clinical manifestations of neonatal herpes?

A
  • skin, eye and/or mouth

- disseminated= CNS (encephalitis or meningoencephalitis), pneumonitis, hepatitis, or CVS involvement.

39
Q

What is the leading cause of sporadic ENCEPHALITIS?

A
  • HSV type I

* in neonate it is HSV type II

40
Q

If the mother has an active HSV infection at time of birth, what should you do?

A
  • C-section
41
Q

How do you treat neonatal herpes?

A
  • acyclovir
42
Q

What happens if the mother gets a varicella zoster infection 6-21 days before delivery?

A
  • newborn will have mild, self-limiting infection due to maternal antibodies providing protection.
43
Q

What happens to the newborn if the mother gets a varicella zoster infection 5 days before to 2 days after delivery?

A
  • transplacental transmission places newborn at risk for severe morbidity.
  • no transplacental transfer of maternal antibodies
  • varicella (chicken pox)
  • disseminated infection
  • shingles (months to years after birth).
  • treat infant with varicella zoster immunoglobulin (VZIG)
44
Q

What does Listeria monocytogenes do the pregnant mother?

A
  • mild influenza-like illness
45
Q

What does Listeria monocytogenes do if transmitted to baby across the placenta or postnatally?

A
  • MENINGITIS
46
Q

How is acute HBV of the mother transmitted to the baby?

A
  • prenatal
  • during delivery (MOST COMMON)
  • postpartum
47
Q

*** How do you treat HBV in the neonate?

A
  • HBV immunoglobulin (HBIG) should be given to neonate of infected mother within 12 hours of birth, followed by HBV vaccine.
  • remember development of CHRONIC HBV is much higher in infants than in adults.
48
Q

What does an HBsAg + and HBeAg + mother mean as far as risk of transmission goes?

A
  • ACTIVE infection with a very high risk of infection.
49
Q

What does an HBsAG + and anti-HBe + mother mean as far as risk of transmission goes?

A
  • less likely because she has antibody to HBe (which is the marker for transmission).
50
Q

What if the neonate is HBeAg +?

A

very high likelihood of developing a CHRONIC infection in newborn.

51
Q

What is the chance of HCV transmission to a baby in an RNA + mother?

A

low (4-6%)

RGU 2 (24 decks)

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