Pregnancy Associated Disorders Flashcards

Question

Clinical features: HELLP syndrome

Answer 1

* Onset: most commonly \> 27 weeks gestation (30% occur postpartum) * Preeclampsia * RUQ pain (liver capsule pain; liver hematoma) * **Rapid clinical deterioration (DIC, pulmonary edema, acute renal failure, stroke, abruptio placentae)**

Answer 2

* Onset: the majority of cases occur in the **intrapartum and postpartum period** * Eclamptic seizures: generalized **tonic-clonic seizures** * Deterioration with headaches, RUQ pain, hyperreflexia, and visual changes are warning signs of a potential eclamptic seizure

Answer 3

1. blood pressure must be elevated on at least 2 occasions that are at least 4 hours apart 2. Urine tests to determine proteinuria * 24-hour urine collection (gold standard): ≥ 300 mg/24 h * Urine dipstick: 1–2 + protein 3. Laboratory analysis * CBC * Kidney function tests 4. HELLP syndrome is suspected: 1. Peripheral smear (assess for hemolysis) 2. coagulation studies are indicated if (i.e., thrombocytopenia and/or liver function)

Answer 4

* **Hypertension (\> 140/90 mmHg)** * **Proteinuria ≥ 300 mg/24 h** * If proteinuria is absent, at least one of the following must be present: * **Thrombocytopenia** * Impaired renal function * Impaired liver function * Visual or neurologic changes * Pulmonary edema

Answer 5

one or more * **Severe hypertension (\> 160 mmHg systolic or \> 110 mmHg diastolic)** * **Thrombocytopenia \< 100,000/μL** * Impaired renal function (serum creatinine \> **1.1 mg/dL** or doubling of serum creatinine) * Impaired liver function (**elevated transaminases**) * Pulmonary edema * Cerebral or visual symptoms

Answer 6

Primarily a clinical diagnosis: patient with preeclampsia presenting with **new-onset grand mal seizures**

Answer 7

1. Epilepsy 2. Encephalitis 3. Metabolic disorders (e.g., hypoglycemia, hyponatremia) 4. Hemorrhagic stroke 5. Ischemic stroke 6. Withdrawal syndromes

Answer 8

1. Throboticmicroangiopathy (TTP, HUS) 2. Fulminant VIral Hepatitis 3. Acute Fatty liver of preganancy 4. itrahepatic cholestatis of pregnancy

Answer 9

* a rare disease most common in the third trimester characterized by extensive fatty infiltration of the liver, which can result in acute liver failure * Pathophysiology: dysfunction of fatty acid β-oxidation

Answer 10

* Sudden onset of jaundice * RUQ pain, nausea, and vomiting * Coagulopathy * Hypoalbuminemia; ascites

Answer 11

* Acute liver failure * Acute renal failure * Encephalopathy

Answer 12

Laboratory analysis: * ↑ AST, ↑ALT * ↑ WBC, ↓ platelets * Hypoglycemia * Liver synthesis parameters: ↓↓ clotting factors , ↓↓ Cholinesterase Imaging: rule out other diagnoses

Answer 13

Therapy: immediate Cesarean (C)-section

Answer 14

rare disease most common in the third trimester that presents with pruritus, jaundice, and an elevation in serum bile acid concentrations

Answer 15

jaundice pruritis

Answer 16

Fetal growth restriction fetal mortality Premature labor; preterm birth **Recurrence in following pregnancies**

Answer 17

* ↑ Total serum bile acid levels (cholic acid and chenodeoxycholic acid) \> 10 micromol/L * ↑ ALP * ↑ ALT, AST * ↑ direct bilirubin * Hepatitis serology (to rule out viral hepatitis)

Answer 18

Therapy * First-line medication: ursodeoxycholic acid PO * An early therapy with ursodeoxycholic acid reduces the risk of preterm birth and stillbirth. Prognosis: fully reversible postpartum

Answer 19

* antepartum evaluation (Ultrasound, NST, BPP) Hospitalization and deilvery if: 1. greater than or 37 0/7 wks 2. suspected placental abption 3. Labor or rupture of membranes 4. Fetal weight \< 5th percentile 5. Oligohydramnios 6. Abnormal maternal or fetal test results if not outpatient with antihypertensives: **labetalol, hydralazine, nifedipine**

Answer 20

DELIVERY if * Pregnancy is ≥ 34 0/7 weeks gestation * Pregnancy is \< 34 0/7 weeks gestation with maternal or fetal instability * Immediate delivery after stabilization (IV magnesium sulfate prophylaxis, antihypertensive drugs, corticosteroids ) If mom is stable: * monitor in patient * treat severe hypertension * **magnesium sulfate** * corticosteroids

Answer 21

Stabilization * **Magnesium sulfate** IV (first-line) * Antidote: **calcium gluconate IV** if early signs of magnesium toxicity (**decreased deep tendon reflexes)** * Position patient on left lateral decubitus position → prevent placental hypoperfusion through compression of the inferior vena cava Delivery: once the mother is stable and seizures have stopped

Answer 22

Stabilization * Blood transfusions * Antihypertensive agents (labetalol, hydralazine) * Magnesium sulfate Delivery: if ≥ 34 weeks gestation or at any gestational age with deteriorating maternal or fetal status

Answer 23

1. Placental abruption 2. Cerebral hemorrhage, stroke 3. DIC 4. Acute respiratory distress syndrome (ARDS) 5. Maternal death ARDS and cerebral hemorrhage are the most common causes of death.

Answer 24

* Fetal growth restriction * Preterm birth * Seizure-induced fetal hypoxia * Fetal death

Answer 25

Prophylactic low-dose ASA PO from 12–14 weeks gestation for patients with a high risk

Answer 26

Risk factors * Nulliparity Clinical features * Nausea and/or vomiting * Normal vital signs, lab findings, and normal physical examination

Answer 27

* Rehydration * Nonpharmacologic options * Adapt diet and avoid triggers. * Ginger tea/capsules * Antiemetic (add in a stepwise manner) 1. Pyridoxine (vitamin B6) and/or doxylamine 2. For refractory symptoms, add one of the following: * Diphenhydramine * Dimenhydrinate 3. Last resort; methylprednisolone

Answer 28

severe, persistent nausea and vomiting associated with a \> 5% loss of pre-pregnancy weight and ketonuria

Answer 29

* nausea, vomiting, * physical signs of dehydration, * hypersalivation, * orthostatic hypotension, * malnourishment

Answer 30

* Antiemetic therapy: * May require glucocorticoid therapy * IV fluid resuscitation/replacement * Electrolyte and thiamine repletion

Answer 31

* painless cervical dilation, in the absence of uterine contractions; * second trimester of pregnancy Clinical features * Painless cervical dilation with or without prolapsed membranes

Answer 32

* Clinical diagnosis typically before 24 weeks' (may be up to 28 weeks') gestation * history of ≥ 2 previous mid-trimester pregnancy losses * history ≥ 3 preterm births not explained by any other cause * transvaginal ultrasound cervical length \< 25 mm before 24 weeks' gestation * A shortened cervical length alone is not sufficient to diagnose must have history.

Answer 33

* Serial cervical ultrasound monitoring should be commenced in high-risk women (i.e., previous preterm birth) between 16–24 weeks' gestation. * Cervical cerclage * Progesterone supplementation (vaginal or intramuscular): indicated for a short cervical length at \< 24 weeks' gestation

Answer 34

* Definition: placement of a supportive suture in the cervicovaginal junction to prevent early pregnancy loss or preterm birth * Indications: only in singleton pregnancies

Answer 35

Compression of the vena cava and pelvic veins by the uterus may occur during the third trimester of pregnancy as a result of the mother lying in a supine position.

Answer 36

* Very common, benign finding Management * Rule out DVT and preeclampsia * Monitoring; usually no treatment necessary

Answer 37

1. Lower back pain: increased lumbar lordosis caused by relaxation of the ligaments supporting the joints of the pelvic girdle in preparation for childbirth 2. **Carpal tunnel syndrome** (caused by peripheral edema; usually resolves after delivery)

Answer 38

* Spontaneous abortion/miscarriage: loss of pregnancy before 20 weeks' gestation * Stillbirth: loss of pregnancy after 20 weeks' gestation * Recurrent pregnancy loss: two or more miscarriages occurring before 20 weeks' gestation

Answer 39

Abnormalities of the reproductive organs * Septate uterus * Uterine leiomyomas * Uterine adhesions * Cervical incompetence Systemic diseases * diabetes mellitus, * hyperthyroidism, * hypothyroidism, * genetic disorders, * infections, * hypercoagulability (e.g., antiphospholipid syndrome

Answer 40

Fetoplacental * **Chromosomal abnormalities** account for up to half of all spontaneous abortions * Congenital anomalies Miscellaneous * Trauma * Iatrogenic * Environmental

Answer 41

1. Intrauterine growth restriction 2. Placental abnormalities 3. Infection 4. Chromosomal abnormalities 5. Congenital malformations 6. Umbilical cord complications (nuchal cord or knot) 7. Fetal hydrops

Answer 42

1. Fetal-maternal hemorrhage 2. Diabetes mellitus 3. Hypertensive pregnancy disorders 4. Uterine rupture 5. Advanced age 6. Heavy smoking

Answer 43

* vaginal bleeding * fetal activity * cervical os closed

Answer 44

* vaginal bleeding * visible/ palable products of conception * fetal activity may be present * cervical os dialated

Answer 45

* No bleeding * No expulsion of the products of conception * No fetal activity * cervical os closed

Answer 46

* Vaginal bleeding; * **products of conception within the cervical canal or uterus** * Usually occurs \> 12 weeks' gestation * cervical os dialated

Answer 47

* Vaginal bleeding; * **products of conception completely outside of the uterus** * Usually occurs \< 12 weeks' gestation * cervical os closed

Answer 48

* absence of fetal movements and cardiac activity * cervical os variable

Answer 49

* Absence of fetal cardiac activity * Pelvic examination should be performed; visualization of the cervix is necessary to confirm that the source of bleeding is uterine. * Transvaginal ultrasound is the best imaging test: * Absence of fetal cardiac motion * A downtrending β -hCG is consistent with a failed pregnancy

Answer 50

* Ultrasound examination is the best diagnostic modality to confirm loss of fetal heart activity * Fetal autopsy

Answer 51

1. Expectant management 2. Avoid strenuous physical activity 3. Weekly pelvic ultrasound 4. Rule out treatable causes of vaginal bleeding 5. Rh(D)-negative women should receive Rh(D)-immune globulin

Answer 52

* Expectant management (option for women \< 14 weeks gestation); * Medical evacuation * Misoprostol is used to induce cervical ripening and expulsion of the products of conception. * Pretreatment with mifepristone 24 hours prior is recommended. * Surgical evacuation is usually recommended if evacuation does not occur after 4 weeks * Preferred method in septic abortion or if there is heavy bleeding

Answer 53

* Definition: method for terminating unwanted pregnancy in an early stage * Treatment: combination of a progesterone antagonist (mifepristone) and a prostaglandin analog (e.g., misoprostol)

Answer 54

1. Spontaneous labor usually begins within **2 weeks** of intrauterine fetal death. 2. Labor may be induced with oxytocin if maternal disease develops or if the patient prefers induction. 3. Vaginal delivery is safer than cesarean section 4. Express empathy and acknowledge patient grief; provide privacy and emotional support. 5. Patients should be offered a fetal autopsy to determine the cause of death.

Answer 55

1. Septic abortion: retained products of conception become infected * Broad-spectrum antibiotics, D&C 2. Retained products of conception → release of thromboplastin into systemic circulation → **DIC** (disseminated intravascular coagulation) 3. Endometritis

Answer 56

Impaired glucose tolerance diagnosed during pregnancy; associated with an increased risk of maternal and fetal morbidity

Answer 57

1. In the first trimester, insulin sensitivity increases and there is a tendency towards hypoglycemia. 2. In the second and third trimesters, hormonal changes trigger progressive insulin resistance that results in hyperglycemia,

Answer 58

* Gestational diabetes in prior pregnancy * Recurrent pregnancy loss * At least one birth of a child diagnosed with fetal macrosomia

Answer 59

* Mothers are usually asymptomatic * May present with edema; * **warning signs include polyhydramnios or large-for-gestational age infants (\> 90th percentile)**

Answer 60

First and second trimester: * confirmed with two independent measurements ≥ 126 mg/dL and 92–125 mg/dL respectively Third trimester (at 24–28 weeks) * Initial screening: 50-g, one-hour oral glucose challenge test * blood glucose level should be \< 135 mg/dl * Confirmation test: 100-g, three-hour oral glucose tolerance test(oGTT) * blood glucose level should be \< 140 mg/dl

Answer 61

* **Glycemic control** * Dietary modifications and regular exercise (walking) * Strict blood glucose monitoring (4x daily) * _Insulin therapy_ if insufficient with dietary modifications * Regular ultrasound to evaluate fetal development * Consider inducing delivery at week 39–40 if glycemic control is poor or if complications occur

Answer 62

Maternal * Gestational hypertension * Preeclampsia, eclampsia, and HELLP syndrome * Urinary tract infection Fetal: * Diabetic fetopathy

Answer 63

A constellation of features that can develop due to fetal hyperinsulinemia during gestation which include: * macrosomia, * postnatal * hypoglycemia, * polycythemia .

Answer 64

1. In most cases, gestational diabetes resolves after pregnancy. 2. Increased risk of gestational diabetes recurring in subsequent pregnancies (∼ 50%) 3. Increased risk of developing type 2 diabetes mellitus (up to 50% over 10 years)→ screen for DM 6–12 weeks postpartum (75 g 2-hourGTT); repeat every 3 years

Answer 65

Diabetes mellitus (type 1 or type 2) that is present prior to pregnancy, which is associated with a significantly increased risk for maternal complications during pregnancy and delivery, and congenital malformations

Answer 66

Maternal 1. Diabetic ketoacidosis (in type 1), hyperosmolar hyperglycemic nonketotic coma (in type 2) 2. hypertensive disorder 3. Urinary tract infection 4. **Increased risk of premature birth** 5. **Spontaneous abortions** 6. **Postpartum hemorrhage** Fetal 1. Diabetic embryopathy (first trimester) 2. Diabetic fetopathy (second and third trimester)

Answer 67

* transposition of the great vessels; ventricular septal defect; truncus arteriosus * Neural tube defects * Caudal regression syndrome * aplasia or hypoplasia of the sacrum or lumbosacral spine Clinical features * paralysis; bladder incontinence * Anorectal malformations and sacral agenesis * Lower limb or foot deformities

Answer 68

* include hydatidiform moles (both complete and partial), invasive moles, and choriocarcinoma. * arise from the abnormal fertilization of the ovum

Answer 69

* Benign trophoblastic disease * complete or partial moles * May develop malignant traits and become an invasive mole

Answer 70

1. No histologic signs of malignancy in the primary tumor 2. Trophoblasts infiltrate the myometrium and gain access to the vascular system. 3. Hematogenic dissemination leads to metastatic growth in different organs (brain, lungs, liver).

Answer 71

* Prior molar pregnancy * History of miscarriage * Patients ≤ 15 and ≥ 35 years

Answer 72

**Complete** does NOT contain any fetal or embryonic parts **Partial** contains fetal or embryonic parts in addition to trophoblastic tissue

Answer 73

**Complete:** * fertilizationof an empty egg that does not carry any chromosomes. The physiological haploid chromosome set contributed by the sprem is subsequently duplicated. * result of paternal disomy **Partial:** * Fertilization of an egg containing a haploid set of chromosomes with two sperms * result of triploidy

Answer 74

**Complete:** 46XX (90%) 46XY (10%) **Partial:** 69(xx,xxy,xyy)

Answer 75

**Hydropic degeneration of chorionic villi** with concomitant **proliferation of cytotrophoblasts and syncytiotrophoblasts** → death of embryo

Answer 76

* trophoblasts invade the myometrium → increased risk of bleeding and hematogenous spread * Metastases without histological signs of malignancy

Answer 77

* Vaginal **bleeding during the first trimester** * **Uterus size greater** than normal for gestational age * Pelvic pressure or pain * Passage of vesicles * Endocrine symptoms (due to ↑ β-hCG level) * **Preeclampsia** (before the 20th week of gestation) * **Hyperemesis gravidarum** * **Ovarian theca lutein cysts**: bilateral, large, cystic, adnexal masses that are tender to the touch * Hyperthyroidism

Answer 78

* Less severe symptoms than in complete mole * **Vaginal bleeding** * Pelvic tenderness

Answer 79

* β-hCG level measurement (initial test of choice) * Markedly elevated (higher than expected for the gestational age) * Higher in complete mole compared to partial mole.

Answer 80

1. Theca lutein cysts 2. Echogenic mass interspersed with many hypoechogenic cystic spaces that represent hydropic villi (referred to as “swiss cheese”, “honeycomb”, “bunch of grapes”, or “snowstorm”) 3. No amniotic fluid 4. No fetal parts 5. Lack of fetal heart tones

Answer 81

1. Fetal parts 2. Fetal heart tones may be detectable 3. Amniotic fluid is present. 4. Increased placental thickness

Answer 82

1. Uterine evacuation by dilation and suction curettage 2. Monitor β-HCG levels 3. Chemotherapy (usually methotrexate) if unresolved, as indicated by any of the following: * β-HCG values do not decrease. * Histological features of malignant GTD are present. * Metastases are present on chest x-ray.

Answer 83

* Microscopy: partial occurrence of hydropic villi, minimal trophoblastic proliferation * Immunohistochemical staining: p57 positive

Answer 84

* Highly aggressive, malignant tumor consisting of trophoblastic tissue * tendency to metastasize early *

Answer 85

* develops after fertilization and implantation of the egg * Most cases of choriocarcinoma are preceded by * Hydatidiform mole (50%) * Normal pregnancy (25%) * Miscarriages or ectopic pregnancy (25%)

Answer 86

Destructive growth into myometrium **without** chorionic villi →risk of hemorrahage and early metastasis( **lung,** vagina, brain, liver)

Answer 87

* postpartum vaginal bleeding and **inadequate uterine regression after delivery** * multiple **theca lutin cysts** * addisionat symptoms depend on the size of the metastasis: * seizures from metastases in the brain * dyspnea/ hemoptysis from metastases in the lungs

Answer 88

* Labs: **very high HCG** * Ultrasound * mass of varying apperance * **hypercascular** on color doppler * **Uterine D&C** * diagnostic and therapeutic

Answer 89

chest Xray: cannonball metastases (heme spread → multiple nodules in the lung)

Answer 90

* methotrexate * Surgical treatment (e.g., hysterectomy): may be indicated to stop bleeding from cancerous lesions or to excise distant metastases * Monitor β-HCG levels for at least 12 months.

Answer 91

* serious complication of pregnancy occurring within the third trimester. It is associated with significant maternal and fetal morbidity and mortality * cases of severe hemorrhage, patients may present with signs of hypovolemic shock. * Common Causes: * bloody showassociated with labor, * placental previa, * placental abruption. * Rare Causes: * vasa previa * uterine rupture

Answer 92

* Partial or complete separation of the placeta from theuterus prior to delivery * hemorrahge from both maternal and fetal vessels * occures most oftern in the thrid trimester *

Answer 93

* Vascular changes * **Hypertension (most common cause)** * **Preeclampsia/eclampsia** * **(Abdominal) trauma**; car accidents * Previous abruption * \> 35 years * Alcohol and cigarette consumption, cocaine use

Answer 94

Following placental separation of more than 30%, sudden onset: * Continuous, **dark, vaginal bleeding** * Retroplacental hemorrhage (20%); vaginal bleeding does not occur (signs of hypovolemic shock) * **Abdominal pain** or back pain , **uterine tenderness** * Hypertonic contractions (rigid uterus), premature labor * **Fetal distress** (60% of cases) * **Decelerations** seen on fetal heart monitor

Answer 95

* Clinical DIagnosis! Rapid treatment vital for survival. * Vaginal exam contraindicated: may worsen bleeding! * Ultrasound * possible retroplacental hematoma * montoring vital signs of the fetus (distress) * Labs: * CBC * Coag Factors

Answer 96

General approach * Hemodynamic control: monitor vital signs, maintain airways, volume resuscitation, type and crossmatch blood * **RhD prophylaxis in RhD negative mothers** Up to the **34th week** of pregnancy * Fetal lung maturity induction with corticosteroids (e.g., betamethasone) * If necessary, tocolysis (e.g., nifedipine, β2-adrenergic agonist) * Aim for a normal delivery **34th to 36th week** * Active uterine contractions present: **vaginal delivery** * No contractions + no signs of fetal distress + bleeding has stopped: ex**pectant management** All pregnancies are delivered if acute abruption occurs **after 36th weeks.**

Answer 97

Live Fetus: * Emergency Cesarean sections independent of gestational age unless vaginval delivery is impanding. Intrauterine fetal death * induction of vaginal delivery through pharmacologic uterine contraction inducers and opening of the amniotic sac * Emergency C-section if maternal risk

Answer 98

* Intrauterine fetal death (12%) * Maternal DIC and hypovolemic shock * Couvelaire uterus

Answer 99

Definition: widespread extravasation of blood into the uterine musculature and beneath the serosa, especially at the cornua. * may extend through the uterus into the peritoneum. * The myometrium is weakened: uterine rupture during contractions

Answer 100

* Presence of the placenta in lower uterine segment, either over or very near the internal cervical os; * Leads to partial or full obstruction of the neck of the uterus with high risk of hemorrhage (rupture of placental vessels) and birth complications * the placenta goes before the fetus into the birth canal

Answer 101

* Maternal age \> 35 years, * multiparity, short intervals between pregnancies * Previous curettage or cesarean section * Previous placenta previa

Answer 102

* **Low-lying placenta:** placenta lies less than **2 cm** from the internal cervical os * **Marginal previa:** placenta reaches the internal cervical os * **Partial previa:** placenta partially covers the internal cervical os * **Complete previa** (total previa): placenta completely covers the internal cervical os

Answer 103

* **Sudden, painless, bright red vaginal bleeding** * Usually occurs during the 3rd trimester (**before rupture of the membranes)**, stops spontaneously after 1–2 hours, and recurs during birth * Soft, nontender uterus * Usually no fetal distress

Answer 104

* **Transvaginal ultrasound** to assess the position of the placenta * Digital vaginal examinations are CONTRAINDICATED in cases of hemorrhage of unknown cause

Answer 105

Gestational age \< 37 weeks * No active bleeding AND no evidence of fetal distress: expectant management * Severe, active bleeding OR evidence of fetal distress: stabilization and emergency cesarian section Gestational age \> 37 weeks: immediate delivery Expectant management * If gestational age is \< 34 weeks: fetal lung maturity induction with corticosteroids * If gestational age is between 34 and 37 weeks and delivery is likely within 7 days: fetal lung maturity induction with corticosteroids * If mild uterine contractions are present: tocolysis with magnesium sulfate

Answer 106

* **Lower segment cesarean section; ideally scheduled at 36–37 weeks gestation** * Vaginal delivery may be performed if placenta lies \> 2 cm away from the internal os on ultrasonography * Vaginal delivery should never be attempted outside the operating room in a patient with placenta previa

Answer 107

* The fetal vessels are located in the membranes near the internal os of the cervix * can be torn with cervical dilatation or membrane rupture, and laceration can lead to rapid fetal exsanguination. * vessels can also be compressed by a presenting fetal part.

Answer 108

* Placental anomalies (e.g., **bilobate or succenturiate placenta, velamentous umbilical cord insertion**) * Placenta previa * **Multiparity**

Answer 109

* **Painless vaginal bleeding** (fetal blood) that occurs suddenly **after rupture of membranes** * Fetal distress * fetal bradycardia; * decelerations or sinusoidal pattern on fetal heart tracings

Answer 110

Transabdominal or transvaginal ultrasound with color Doppler shows fetal vessels overlying the internal os and decreased blood flow within fetal vessels

Answer 111

Emergency C-section if there are signs of fetal distress

Answer 112

intrauterine infection of the fetal membranes and amniotic fluid caused by bacteria ascending from the vagina

Answer 113

* Infection of the amniotic fluid, fetal membranes , and placenta * Causal Organisms * Ureaplasma urealyticum( 50%) * Mycoplasma hominis( 30%) * bacteroides; * group B Streptococcus; * E. coli

Answer 114

* Prolonged labor or premature rupture of membranes (PROM) * Pathological bacterial colonization of vaginal tract * multiple digital vaginal exams, invasive procedures

Answer 115

Maternal * **Fever (\> 38 °C)** * **Tachycardia \> 120/min** * **Uterine tenderness** * Malodorous and purulent amniotic fluid, vaginal discharge **Fetal tachycardia \> 160/min**

Answer 116

clinical diagnosis (fever plus ≥ 1 additional symptom) * Maternal blood tests * **Leukocytosis \> 15,000 cells/μL** * Bacterial cultures * Urogenital secretions * Amniotic fluid * **Group B Streptococcus screening**: cervicovaginal and rectal swabs

Answer 117

Maternal antibiotic therapy * Vaginal delivery: **IV ampicillin plus gentamicin** * Cesarean delivery: IV ampicillin and gentamicin, **plus clindamycin** Delivery * Swift delivery is generally indicated to minimize both maternal and fetal complications. * Cesarean delivery is not generally indicated, but is often necessary because of obstetrical complications

Answer 118

Maternal * endometritis * **Septic shock, DIC** Fetal/neonatal * premature birth * Asphyxia, intraventricular hemorrhage * **Neonatal infection**

Answer 119

* **≤ 72 hours** * chorioamnionitis, bacterial colonization * Common pathogens: * **group B Streptococcus** (GBS, Streptococcus agalactiae); * E. coli; * Listeria monocytogenes * Streptococcus agalactiae and Escherichia coli are the most common causes of both early- and late-onsetneonatal sepsis!

Answer 120

* **\> 72 hours** * nosocomial infection * Common pathogens: * **group B Streptococcus** * **coagulase-negative Staphylococcus** * Streptococcus agalactiae and Escherichia coli are the most common causes of both early- and late-onsetneonatal sepsis!

Answer 121

Maternal * PROM (premature rumpture of membranes) * premature labor * Infections Fetal * Premature birth, * low birth weight, * low Apgar score * Difficult delivery

Answer 122

1. Irritability, lethargy, poor feeding 2. Temperature changes (fever and hypothermia both possible) 3. Tachycardia, hypotension 4. Tachypnea, dyspnea; **expiratory grunting** 5. Skin tone: jaundiced and/or bluish-gray (indicates poor perfusion)

Answer 123

* Often no signs of meningism * Early phase: general symptoms and vomiting * Late phase: **bulging fontanelles, shrill crying, seizures, stupor**

Answer 124

1. **Tachypnea with intercostal/sternal retractions and nasal flaring** 2. Reduced oxygen saturation with cyanosis

Answer 125

1. Blood tests * Leukocytopenia or leukocytosis, thrombocytopenia * ↑ CRP 2. Lumbar puncture: test cerebrospinal fluid for meningitis 3. Chest x-ray: signs of pneumonia

Answer 126

Broad-spectrum antibiotics: IV ampicillin and gentamicin

Answer 127

Indication * Anytime GBS bacteriuria occurs during pregnancy or if a previous newborn had a GBS infection Medication * Intrapartum IV penicillin G or ampicillin

Answer 128

* Bacterial infection of the umbilical stump occurring 3–9 days after delivery * Pathogens: * Staphylococcus aureus, group A Streptococcus, E. coli, Klebsiella pneumoniae * Clostridium tetani: developing countries

Answer 129

1. Periumbilical redness, tenderness, swelling, and hardening 2. Purulent discharge 3. Signs of systemic infection

Answer 130

* Broad-spectrum IV antibiotics * Antistaphylococcal penicillin (e.g., ampicillin) plus * Aminoglycosides (e.g., gentamicin) * Surgery: * complete debridement if complications arise