perinatal infection Flashcards
what is group B strep
normal vaginal flora, benign colonization for mom
what can GBS to do baby?
preterm delivery, chorioamnionitis, endometritis, PROM, pneurmonia and sepsis.
how do we screen for GBS?
wk 10 and again at wk 35-36.
what if positive GBS at wk 10
treat with ABs at that appointment and at delivery
what if positive GBS at 35
treat with ABs
how do we screen for GBS
urinanalysis/urine cultures at wk10, swab at wk35.
what are the risk factors for GBS infections
any positive screen.
prolonged ROM,
intrapartem fever
should you treat mom with antibiotics if she has EVER had a positive GBS screen?
Yes.
what are the treatments for GBS
1) ampicillin
2) cefazolin
3) clindamycin
4) vancomycin
treatment course depends on allergy
when are the only times you do not need to treat for GBS
if planned C-section and no ROM.
or never been GBS and had a negative screen
Hep B treatment
C-section to reduce maternal-fetal blood mixing. at birth vaccine for baby and IVIG hepB.
Ideally, vaccine mom before pregnant
what does having a positive HepB surface antibody mean
that you are immune either from exposure or vaccination
what does having a positive HepB core anitbody mean?
immune from exposure
what does having a positive HepB surface antigen mean
that you are infected. Not necessarily infectious.
what does having a positive HepB e antigen mean?
that you are infected and infectious
can HIV cross the placenta
no
In the context of HIV, what does having a low CD4 count mean
you are at risk for opportunistic infections.
what does increased viral load of HIV mean
that you are more infectious
what is the normal workup for HIV
rapid ELIZA, confirmed with western blot, need viral load, CD4 count.
if viral load is <1000 and on HAART what is indicated for birth
normal vaginal birth
if viral load is > 1000 or no HAART then what is indicated for birthing
C-section.
if viral status and HAART are unknown what is indicated for birth
AZT.
what is HAART
highly active anti-reverse transcriptase therapy. 2 + 1
thats 2 nucleoside reverse transcriptase inhibitors and 1 nonnucleoside reverse transcriptase inhibitors or 1 protease inihibitor and redonivir
what are the drugs for HAART
B treatment: tenofovir and emticitabine with atazanavir
or
C treatment: zidovudine and lanivudine with neviraprine.
what is the goal of HIV therapyu
to get viral load down.
what is TORCH
toxoplasmosis, other(syphilis), rubella, CMV, herpes. these are infections that can cause congenital defects
what is Toxo and what does it cause?
toxoplasmosis gondii is a parasite that is found in cat feces and undercooked meat. also found in cystic soil. causes maternal illness and potentiall birth defects
what birth defects occur with toxoplasmosis infection
ventriculomegaly, seizures, brain calcifications.
what does mom experience with toxo infection
mono-like illness with fatigue, splenomegaly, lymphadenopathy, fever.
what do we do prenatally for mom for toxo
check immune status. if not immune, needs to avoid meats, cleaning cat litter and soils.
what is the causal organism for suyphilis
trempneum pallidum whcih is a schistocyte.
what are the three presentations of syphilis
1 - painless chancre on the genitals this is an ulceration
2 -targetoid lesions (that are infectious) on the soles and palms,
3 -neurosyphilis. elder that can longer feel their feet.
latent -positive test with no symptoms.
how to diagnose syphilis
1 - darkfield microscopy.
2 - RPR with screening for flora treponea ABs
3 - CSF studies –RPR/VDLR
latent –same as 2.
what happens if baby is exposed to syphilis during 1st trimester
dead baby
what happens if baby is exposed to syphilis during 2nd-3rd trimester
deformities.
saddle nose, hutchinson teeth, saber shins, rhinorea
what is the treatment for syphilis
PENICILLIN> always.
1, 2, IM X1
3 -IV every four hours 7-10 days
latent - IM for 3 wks.
can you give MMR during pregnancy
NO. attentuated virus will cause viremia
what happens if baby is exposed to rubella
1st trimester usally causes IUGR and death
blue berry muffin baby. purpura and petichae on swollen baby. cataracts, congenital heart defects, deafness.
hw do we prevent rubella
give vaccine 3 months prior to pregnancy.
if mom is not vaccinated, then avoid kids and sick people
what is CMV
DsDNA virus, presents as toxo, but is not toxo
what does herpes do in pregnancy?
has to be primary viremia to cause congenital defects, which are IUGR, preterm delivery, blindness,
want does secondary reactivation of herpes do to baby>?
puts them at risk for infection
how do we diagnose herpes
look for lesions which are vesicles on a erythematous base after painful and burning prodrome. PCR of lesion scraping.
what is the treatment of Herpes for mom
acyclovir or valacyclovir possible c-section to reduce the risk of exposure to baby
