Perinatal Infections

Question 1

______ of women have asymptomatic vaginal colonization with GBS, with the majority having ________carrier status

Answer 1

Thirty percent

intermittent or transient

Question 2

Course of early onset GBS infection

Answer 2

This is usually vertical transmission from mother to neonate with a 30% mortality rate at or before
33 weeks but less than 5% at term.

Question 3

Late onset GBS is characterized as

Answer 3

Late-onset infection is less common, occurring after the first week of life, and is characterized by meningitis. This is usually hospital acquired, with a 5% mortality rate

Question 4

Intrapartum antibiotic prophylaxis of neonatal GBS sepsis is given with _______

Answer 4

IV penicillin

G

Question 5

T or F

All women with a positive GBS urine culture or a previous baby with GBS sepsis will receive intrapartum prophylaxis

Answer 5

T

Question 6

In GBS Infection

Third-trimester vaginal and rectal cultures are
obtained at_______ weeks gestational age, and intrapartum prophylaxis is administered only to those with positive GBS cultures

Answer 6

35–37

Question 7

GBS infection,

Intrapartum prophylaxis is given on the basis of risk factors being present:
1
2
3

Answer 7

preterm  gestation (<37 weeks), 
membranes ruptured >18 h, or maternal fever (>100.4°F) (38°C).

Question 8

Up to______of pregnant women are toxoplasmosis IgG seropositive

Answer 8

40%

Question 9

Toxoplasmosis

First-trimester infection risk is low (15%), but infections are _____ and _____

Answer 9

most serious, even lethal.

Question 10

Third-trimester infection risk is high (50%), but infections are mostly _______

Answer 10

asymptomatic.

Question 11

Tx of Toxo

_______ are used to treat a known infection.

______is used to prevent vertical transmission from the mother to the fetus.

Answer 11

Pyrimethamine and sulfadiazine

Spiramycin

Question 12

in VZV

The greatest neonatal risk is if maternal rash
appears between ______ and ________

Answer 12

5 days antepartum and 2 days postpartum.

Question 13

__________of patients with varicella will develop varicella pneumonia, which has a high maternal morbidity and mortality

Answer 13

10%

Question 14

________ to a susceptible gravida within 96 h of exposure.

Answer 14

Administer VZIG (varicella zoster immune globulin)

Question 15

T or F

Live-attenuated varicella virus (Varivax III) can be administered to nonpregnant or postpartum to varicella IgG-antibody–negative women.

Answer 15

T

Question 16

_______ is a highly contagious RNA virus that is spread by respiratory droplets.

Answer 16

Rubella

Question 17

Vertical transmission from mother to fetus or neonate can only occur during the _______because the result is residual lifelong immunity

Answer 17

viremia of a primary infection

Question 18

Manifestations may include symmetric IUGR, microcephaly,

or ventriculoseptal defect (VSD

Answer 18

fetal infection with rubella

Question 19

T or F

Rubella infection during pregnancy is generally a mild,
low-morbidity condition

Answer 19

T

Question 20

T or F

All pregnant women should undergo rubella IgG antibody screening

Answer 20

T

Question 21

Because rubella vaccine is made using a live attenuated virus, pregnancy should be avoided for_____

Answer 21

1 month after immunization

Question 22

______is a DNA herpes virus that is spread by infected body secretions

Answer 22

CMV

Question 23

Up to _____ of pregnant women are CMV IgG seropositive.

Answer 23

50%

Question 24

Manifestations of Fetal infection of CMV may include:

Answer 24

nonimmune hydrops, symmetric IUGR, microcephaly,

and cerebral calcifications in a periventricular distribution

Question 25

______ syndrome is the most common congenital viral syndrome in the United States

Answer 25

CMV

Question 26

Neonatal infection of CMV SSx

Answer 26

which includes petechiae, mulberry skin spots, meningoencephalitis, periventricular calcifications, hepatosplenomegaly, thrombocytopenia, and jaundice.

Question 27

CMV infection during pregnancy is generally a mild, | low-morbidity condition appearing as a ______

Answer 27

mononucleosis-like syndrome with hepatitis.

Question 28

_____ is a DNA herpes virus that is spread by intimate mucocutaneous contact.

Answer 28

HSV

Question 29

Up to ___ of pregnant women are HSV IgG seropositiv

Answer 29

50%

Question 30

The most common route of fetal infection is contact | with ______ during a recurrent HSV episode

Answer 30

maternal genital lesions

Question 31

Definitive Dx of HSV The definitive diagnosis is a positive HSV culture from fluid obtained from a________, but there is a 20% false-negative rate.

Answer 31

ruptured vesicle or debrided ulcer

Question 32

Fetal infection with HSV

Answer 32

Manifestations may include spontaneous abortions, symmetric IUGR, microcephaly, and cerebral calcifications.

Question 33

With passage through an HSV-infected birth canal, the neonatal attack rate is ____ with a primary infection, but ______ with a recurrent infection

Answer 33

50% <5%

Question 34

HSV Neonatal infection SSx

Answer 34

meningoencephalitis, mental retardation, pneumonia, hepatosplenomegaly, jaundice, and petechiae.

Question 35

A cesarean section should be performed in the presence of genital HSV lesions at the time of labor. If membranes have been ruptured______ the virus may already have infected the fetus and cesarean delivery would be of no value

Answer 35

>8–12 h,

Question 36

______is an RNA retrovirus that is spread by infected body secretions.

Answer 36

HIV

Question 37

HIV Transplacental infection occurs, but the major route of vertical transmission is _________

Answer 37

contact with infected genital secretions at the time of vaginal delivery

Question 38

Without maternal azidothymidine (AZT) prophylaxis, the vertical transmission rate is ____, but with AZT the infection rate is lowered to _____ with vaginal delivery

Answer 38

30% 10%

Question 39

In HIV, With elective cesarean section without labor and before membrane rupture, the perinatal infection rate may be ________

Answer 39

<5%.

Question 40

The greatest benefit to the fetus of cesarean delivery is | probably in women with ______ and ____, making infection through a vaginal delivery much more likely.

Answer 40

low CD4 counts and high RNA viral loads

Question 41

At birth neonates of HIV-positive women will have positive HIV tests from_______

Answer 41

transplacental passive IgG passage

Question 42

T or F HIV-infected breast milk can potentially transmit the disease to the newborn

Answer 42

T

Question 43

T or F Progression from HIV to AIDS in infants is more rapid than in adults

Answer 43

T

Question 44

T or F Pregnancy in an HIV-positive woman enhances progression to AIDS.

Answer 44

F Pregnancy in an HIV-positive woman does not enhance progression to AIDS.

Question 45

HIV Infected pregnant women should take________as part of their drug regimen, starting at 14 weeks and continuing throughout pregnancy, intrapartum, and after delivery

Answer 45

triple-drug therapy including the drug zidovudine | ZDV

Question 46

Example of triple therapy in HIV

Answer 46

This includes 2 nucelotide reverse transcriptase inhibitors (NRTIs) with either an NNRTI or a protease inhibitor. An example would be zidovudine, lamivudine, or ritonavir

Question 47

_____ is caused by Treponema pallidum, a motile anaerobic spirochete that cannot be cultured

Answer 47

Syphilis

Question 48

Transplacental infection is common with vertical transmission rates of ____ in primary and secondary syphilis

Answer 48

60%

Question 49

What Syphilis stage Papules become painless ulcers with rolled edges (chancres) which appear 2–3 weeks after contact at the site of infection, most commonly the vulva, vagina, or cervix

Answer 49

Primary

Question 50

What Syphilis stage? Two to three months after contact, fever, malaise, general adenopathy, and a maculopapular skin rash (“money spots”) are seen. Broad exophytic excrescences (condyloma lata) appear on the vulva.

Answer 50

Secondary

Question 51

What stage? Darkfield microscopy of lesion exudate is positive for the spirochete, but the nonspecific serologic tests VDRL or rapid plasma reagin [RPR] test) are not yet positive

Answer 51

Primary

Question 52

______is characterized by absence of symptoms or physical findings. One third of cases proceed to tertiary disease. The nonspecific and treponema-specific tests remain positive

Answer 52

Latent syphilis

Question 53

______ is a symptomatic stage with symptoms dependent on which organ system is affected by the classic necrotic, ulcerative nodules (gummas

Answer 53

Tertiary syphilis

Question 54

Tx of Syphilis

Answer 54

Benzathine penicillin 2.4 million units IM × 1 is given in pregnancy to ensure adequate antibiotic levels in the fetus.

Question 55

How to ff-up serology in pts with syphilis

Answer 55

Follow serology titers at 1, 3, 6, 12, and 24 months. Titers should be decreased fourfold by 6 months, and should be negative in 12-24 months

Question 56

In Syphilis Tx, The _______ is associated with treatment and occurs in half of pregnant women. It starts in 1-2 hours, peaks in 8 hours, and resolves in 24-48 hours

Answer 56

Jarisch-Herxheimer reaction