perinatal infection

Question 1

what is group B strep

Answer 1

normal vaginal flora, benign colonization for mom

Question 2

what can GBS to do baby?

Answer 2

preterm delivery, chorioamnionitis, endometritis, PROM, pneurmonia and sepsis.

Question 3

how do we screen for GBS?

Answer 3

wk 10 and again at wk 35-36.

Question 4

what if positive GBS at wk 10

Answer 4

treat with ABs at that appointment and at delivery

Question 5

what if positive GBS at 35

Answer 5

treat with ABs

Question 6

how do we screen for GBS

Answer 6

urinanalysis/urine cultures at wk10, swab at wk35.

Question 7

what are the risk factors for GBS infections

Answer 7

any positive screen.
prolonged ROM,
intrapartem fever

Question 8

should you treat mom with antibiotics if she has EVER had a positive GBS screen?

Answer 8

Yes.

Question 9

what are the treatments for GBS

Answer 9

1) ampicillin
2) cefazolin
3) clindamycin
4) vancomycin
treatment course depends on allergy

Question 10

when are the only times you do not need to treat for GBS

Answer 10

if planned C-section and no ROM.

or never been GBS and had a negative screen

Question 11

Hep B treatment

Answer 11

C-section to reduce maternal-fetal blood mixing. at birth vaccine for baby and IVIG hepB.
Ideally, vaccine mom before pregnant

Question 12

what does having a positive HepB surface antibody mean

Answer 12

that you are immune either from exposure or vaccination

Question 13

what does having a positive HepB core anitbody mean?

Answer 13

immune from exposure

Question 14

what does having a positive HepB surface antigen mean

Answer 14

that you are infected. Not necessarily infectious.

Question 15

what does having a positive HepB e antigen mean?

Answer 15

that you are infected and infectious

Question 16

can HIV cross the placenta

Answer 16

no

Question 17

In the context of HIV, what does having a low CD4 count mean

Answer 17

you are at risk for opportunistic infections.

Question 18

what does increased viral load of HIV mean

Answer 18

that you are more infectious

Question 19

what is the normal workup for HIV

Answer 19

rapid ELIZA, confirmed with western blot, need viral load, CD4 count.

Question 20

if viral load is <1000 and on HAART what is indicated for birth

Answer 20

normal vaginal birth

Question 21

if viral load is > 1000 or no HAART then what is indicated for birthing

Answer 21

C-section.

Question 22

if viral status and HAART are unknown what is indicated for birth

Answer 22

AZT.

Question 23

what is HAART

Answer 23

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

Question 24

what are the drugs for HAART

Answer 24

B treatment: tenofovir and emticitabine with atazanavir
or
C treatment: zidovudine and lanivudine with neviraprine.

Question 25

what is the goal of HIV therapyu

Answer 25

to get viral load down.

Question 26

what is TORCH

Answer 26

toxoplasmosis, other(syphilis), rubella, CMV, herpes. these are infections that can cause congenital defects

Question 27

what is Toxo and what does it cause?

Answer 27

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

Question 28

what birth defects occur with toxoplasmosis infection

Answer 28

ventriculomegaly, seizures, brain calcifications.

Question 29

what does mom experience with toxo infection

Answer 29

mono-like illness with fatigue, splenomegaly, lymphadenopathy, fever.

Question 30

what do we do prenatally for mom for toxo

Answer 30

check immune status. if not immune, needs to avoid meats, cleaning cat litter and soils.

Question 31

what is the causal organism for suyphilis

Answer 31

trempneum pallidum whcih is a schistocyte.

Question 32

what are the three presentations of syphilis

Answer 32

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.

Question 33

how to diagnose syphilis

Answer 33

1 - darkfield microscopy.
2 - RPR with screening for flora treponea ABs
3 - CSF studies –RPR/VDLR
latent –same as 2.

Question 34

what happens if baby is exposed to syphilis during 1st trimester

Answer 34

dead baby

Question 35

what happens if baby is exposed to syphilis during 2nd-3rd trimester

Answer 35

deformities.

saddle nose, hutchinson teeth, saber shins, rhinorea

Question 36

what is the treatment for syphilis

Answer 36

PENICILLIN> always.
1, 2, IM X1
3 -IV every four hours 7-10 days
latent - IM for 3 wks.

Question 37

can you give MMR during pregnancy

Answer 37

NO. attentuated virus will cause viremia

Question 38

what happens if baby is exposed to rubella

Answer 38

1st trimester usally causes IUGR and death

blue berry muffin baby. purpura and petichae on swollen baby. cataracts, congenital heart defects, deafness.

Question 39

hw do we prevent rubella

Answer 39

give vaccine 3 months prior to pregnancy.

if mom is not vaccinated, then avoid kids and sick people

Question 40

what is CMV

Answer 40

DsDNA virus, presents as toxo, but is not toxo

Question 41

what does herpes do in pregnancy?

Answer 41

has to be primary viremia to cause congenital defects, which are IUGR, preterm delivery, blindness,

Question 42

want does secondary reactivation of herpes do to baby>?

Answer 42

puts them at risk for infection

Question 43

how do we diagnose herpes

Answer 43

look for lesions which are vesicles on a erythematous base after painful and burning prodrome. PCR of lesion scraping.

Question 44

what is the treatment of Herpes for mom

Answer 44

acyclovir or valacyclovir possible c-section to reduce the risk of exposure to baby