Pregnant Traveler

Question 1

Check immunity to which infectious disease ?

Answer 1

HA, HB, , rubella, varicella, measles, pertussis

Question 2

What should be included in their kits?

Answer 2

Blood pressure, hemoroid cream, antiemetic, prenatal vitam., meds for vaginitis, talcum powder,support hose

Question 3

When is it contraindicated to travel?

Answer 3

Less obvious one: incompetent cervix, suspected ectopic pregnancy
Threatened abortion
Vaginal bleeding
Toxemia past or present see page 563

Question 4

Which routine imm can be updated for pregnant traveller?

Answer 4

HA, HB, Tdap, flu, polio

Question 5

Who can be affected by hypoxemia during air travel?

Answer 5

Preexisting cardiovascular disease,
Sickle cell
Severe anemia ( hemoglobin

Question 6

DVT 5-10 greater in pregnancy what are some preventive measures?

Answer 6

Frequent stretching, walking, isometric leg exercise, graduated compression stockings

Question 7

What is the travel restriction for 1. Airline 2. Cruise ship?

Answer 7

1. 36 wks (9 months)

2. 28 wks (7 mos) or as early 24 wks

Question 8

Pregnant women should avoid high altitude activities because

Answer 8

Most common acute mountain sickness : insomnia, h/a, nausea

Prudent to recommend not stay at sleeping altitude > 12000ft (3658m)

Recommend slower ascent with adequate time to acclimatization

Question 9

Scuba in pregnancy?

Answer 9

No. Risk of fetal gas embolism during decompression

Question 10

More vulnerable to GI infection stress

Answer 10

• Strick hand hygiene
• Food water precaution
• Bottle water: iodine-containing compound should not be used to purify water , effect on fetal thyroid

Question 11

What is the treatment if choice for TD?

Answer 11

Vigorous ORL
Azithromax if clinically indicated

Pepto bismul: contraindicated

Question 12

What does HA & HE CAUSE?

Answer 12

HA: placental abruption & premature lab

HE: case-fatality 15-30% during 3 trimester

Question 13

Other food borne illness?

Answer 13

Toxiplasmosis , listeriosis cause spontanious abortion, stillbirth, congenital inf

Precaution: avoid unpasteurized cheeses & undercooked meat

Question 14

Parasitic disease and pregnancy

Answer 14

Little problem can be treated after delivery

Question 15

Which protozoan infection requires tx cause of gastroenteritis, chronic malabsorption (effect fetal growth)?

Answer 15

Giardia, entamoeba histolytica, cryptosporidium

Question 16

What helps to relieve morning sickness?

Answer 16

Ginger
Pyridoxine ( vit B 6)

Question 17

Which drugs are safe in pregnancy?

Answer 17

Tylenol
Laxative
Antihistamin: meclizine, dimenhydrinate

Question 18

When should Tdap be given?

Answer 18

After 20 wks (5 mos best at 7 mos)

Question 19

Inactivated influenza recommended at any trimester?

Answer 19

Yes

Question 20

Which vaccine can ve given during pregnancy based on risk?

Answer 20

MPSV4, IPV, HA, HB, rabies post exposure, rabies pre-exposure if substantial risk,

Live vaccine contraindicated except for YF precaution risk of virus exposure outweigh risk of vaccination

Question 21

What is the postexposure management of a nonimmune pregnant traveller exposed to measles or varicella?

Answer 21

Administration of IG within 6 days for measles or varicella-zoster IG within 10 days for varicella

Question 22

What are the drug of choice for anti malarial in pregnant woman who has to travel?

Answer 22

Chloroquine & mefloquine

Contraindications:
Doxy: teratogenic effects on fetus after 4 mos of pregnancy

Primaquine; unable to test fetus G6PD

Atovaquone-proguanil: lack of data