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maternal exam 1 > Reproductive Infections > Flashcards

Reproductive Infections Flashcards

1
Q

What causes a UTI? What do they treat uti’s with?

What can a UTI lead to?

How can this affect PG?

A

Bacteria present in urine culture treated with antibiotics

Could lead to cystitis or a kidney infection.

That would cause premature birth and intrauterine growth restriction.

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2
Q

How to prevent cystitis/uti

contraception:

Avoid:

Do:

A

Change diaphragm method for contraception

Avoid bladder irritants such as alcohol or caffeine or carbonated beverages
Avoid holding pee in
Avoid sex

Do drink water
Do drinkn cranberry juice to help relieve UTI symptoms
Do wipe front to back
Do take all of your antibiotics for UTI infections

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3
Q

Vaginitis or Vaginosis types (3)

A

Vulvovaginal Candidiasis

Bacterial vaginosis/gardnerella

Trichomoniasis

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4
Q

Name for yeast infection

How is it spread?

General mucus appearance?

treatment meds?

risk in pregnancy?
treatment for newborn?

A

Vulva Candidiasis which is considered to be a vaginitis subtype

spread by contact

cottage cheese like mucus

tx: antifungals like miconazole
pill, creams, suppositories

If present for labor, newborn could be at risk for thrush or diaper dermatitis
but just give them antifungals

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5
Q

Bacterial vaginosis/ Gardnerella

Mucus appearance
Smell

How is it dx

Howo is it tx

A

Vaginosis is gray/yellow milky discharge
Smells like fish

dx by clue cells on slide of discharge

treated with metronadozaole or flagyl

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6
Q

Bacterial vaginosis/Gardnerella

risk to pregnancy?

A

PROM - pre-term rupture, PTC - preterm labor, and postpartum infections

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7
Q

Trichomoniasis

appearance

symptoms

Dx:

tx:

education for sex & substances:

A

green white frothy discharge

can have urinary symptoms or strawberries on cervix

Saline slide reveals a motile flagellated tail organism
Rapid test
Affirm test

Metronidazole (again) 2 grams

BUT you need to avoid coitus until infection is gone
Avoid alcohol

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8
Q

Chlamydia

bacteria

how common is this?

transmission

symptoms? in men?

what if it isn’t treated?

newborn risks
- treatment?

adult tx

A

chlamydia trachomatis

most common sti in us

sexual contact transmission

no symptoms or may have purulent discharge or dysuria . men may think they have uti

if not treated, then could lead to
PID, ectopic PG, tubal infertility in women

newborn risks include eye and lung infection
- need to do prophylaxis treatment with erythromycin

adults treated with Azithromycin or Doxycycline orally

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9
Q

Syphillis bacteria?

incubation?

transmission?

A

Syphillis caused by spirochete treponema pallidum

Incubation is 10-90 days meaning you can have it not know

sex, open wound, blood, or transplacentally during PG

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10
Q

Syphillis early signs

A

Chancre at site of organism entry (disappears after 4 weeks)
Fever
Wt loss
Malaise

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11
Q

Syphillis secondary signs

A 
condylomata late (warts)
rash
arthritis 
hepatosplenamegaly 
tender lymph nodes
iritis 
chronic ST with hoarseness
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12
Q

Blood test for syphillis

A

VDRL (less sensitive )
RPR
FTA-ABS (most effective but costly)

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13
Q

At what gestational week age will syphillis begin to affect the fetus

A

14 weeks

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14
Q

treatment if you’ve had syphillis symptoms for less than a year if pregnant

for unknown duration or more than year if pregnant

what if someone is allergic to pcn?

A
  1. 4 million u. PCN x3weeks IM
  2. 4 million PCN x3weeks

just have to desensitize them to it

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15
Q

treatment for syphillis if not pregnant

A

doxycycline or tetracycline

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16
Q

How long will the mom be positive for syphillis for after treatment

A

8 months for mom

3 months for baby

But it is ok as long as you see the load decrease. do titer.

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17
Q

PG effects of syphillis

A

small low birth weight of infant, preterm birth, or stillbirth

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18
Q

Gonorrhea

bacteria

transmission

dx

A

Gonorrhea

Neisseria gonorrhea

sexual contact transmission

swab culture

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19
Q

Gonorrhea

treatment

education

newborns?
- treatment

A

Ceftriaxone 250 mg IM

partner must be treated
Will have to retest in 3 months (both people)

Could have eye ophthalmia and pneumonia
- need eye ointment erythromycin but can do oral

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20
Q

What are TORCH infections?

A 
A group of infections represented by the TORCH acronym. 
Toxoplasmosis
Other such as Hep A ,B, C
Rubella
Cytomegalovirus
Herpes
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21
Q

What is Toxoplasmosis cause?

What do Toxoplasmosis symptoms look like?

A

Caused by protozoa parasites that can be found in cats

Can have no symptoms or could have mono signs with a fever

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22
Q

How to avoid getting Taxoplosmosis?

A

Avoid eating undercooked meats

Don’t allow PG women to scoop litter w cat feces

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23
Q

Complications in PG if you get Taxoplasmosis?

A

Lots

hydrocephaly
choriortenitis
cerebral calcifications
enlarged liver
rash
jaundice after birth
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24
Q

How to treatment Toxoplasmosis with meds

A

Pyrimethamine

sulfa and folic acid for 1 yr total

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25
Q

Why is an infection of Toxoplasmosis (or any infection) more worrisome if it occurs in the first trimester?

A

The younger the baby the more likely the infection will affect development

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26
Q

Rubella is what type of virus?

Rubella effects are greatest in which trimester? And to which systems?

A

It is the German measles virus but it has an immunization

First trimester
Hearing is main system but also the eyes, CNS, or cardiac

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27
Q

Cytomegalovirus is described as?

A

Cytomegalovirus is a transplacental infection due to active maternal infections going on

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28
Q

Neonate symptoms of cytomegalovirus?

A 
rash
liver is enlarged
jaundice 
microcephaly 
IGM will be elevated
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29
Q

Cytomegalovirus treatment for newborn and mother

A

Antiviral to newborn

PG mother will be given CMV or a specific immunoglobulin

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30
Q

List Torch infections again

A 
Toxoplasmosis
Other hep a, b, c
Rubella
Cytomegalovirus
Herpes
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31
Q

Different types of Herpes

A

1 - oral

2- genital

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32
Q

Herpes transmission

A

vaginal
anal
oral

generally any skin to skin contact with infected site

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33
Q

What do Herpes blisters feel , look, and act like?

When do blisters heel after they show up?

A

Painful vesicles that can last up to 20 days past exposure

Will heal in 2-4 weeks - but the virus isn’t gone. It remains dormant in nerve ganglia.

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34
Q

How can Herpes affect pregnancy?

A

May have to do C-section if there is an active break out at delivery.

Can also increase risk of spontaneous abortion , preterm labor, or IUGR ( slow growing fetus)

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35
Q

Treatment for PG mothers with herpes and when

A

antiviral therapy in the 3rd trimester to reduce fetal risks and c-section delivery

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36
Q

What will the symptoms be like for herpes during a primary outbreak?

How is herpes diagonsed?

A

Blisters or ruptured ulcers
Urination and urinary retention issues
Lymph nodes enlarged in groin
Flu symptoms and tingling of genitals.

Diagnosis requires a culture of the lesions

37
Q

Meds for herpes to suppress virus?

Meds for herpes pain symptoms?

How to care for lesions?

A

Oral acyclovir, zovirax, or Famvir

Topical Lidocaine

Keep lesion area clean & dry
Wear cotton underwear

38
Q

Is there a cure for herpes?

A

Nope but lesions do move internally and thus appear healed.

39
Q

Why should a women with herpes go in for regular pap smears?

A

It increases risk of cervical cancers as well.

40
Q

HPV is .. also known as

A

Genital warts or Condylomata Acuminata

41
Q

How is HPV transmitted

A

Transmitted through oral, vaginal, and anal sex

42
Q

How long can HPV be incubated

A

HPV can be incubated for 3 weeks to 3 years & so you won’t know who gave it to you

43
Q

How is HPV diagnosed

A

Hx, Pap, and HPV test by specialists

44
Q

Which HPV strains are responsible for genital warts

Which HPV strains are known to account for cervical cancers

A

6 & 11 for warts

16 & 18 for cancers

45
Q

Is there any treatment that erradicates HPV

How to get rid of warts

A

None

But you can do certain procedures to remove warts

cryosurgery
chloracetic acid
scissor excision
curettage
cautery
laser
prepared gels
46
Q

When is it recommended people get the HPV vaccines

How?

A

Before becoming sexually active

Will need 2 or 3 IM injections over 6 months for aged 9 and older

47
Q

What contraceptive can help reduce hpv risk

Best prevention of hpv turning into cervical cancer

A

condoms

Need to do pap smears

48
Q

How common are congenital herpes infections in newborns

How common are herpes infections when spread through labor?

A

rare

More common. 85% of newborn herpes infections happen during vaginal births (maybe from mom being unaware or not telling the provider)

49
Q

Herpes symptoms and locations of lesions in newborns?

A 
CNS issues
oral 
eyes
skin lesions 
It can be deadly to the newborn

Will culture them to make sure. BUT always make sure to wear gloves when handling a newborn

50
Q

Med used to treat a newborn with a herpes infection?

A

Acyclovir (it won’t cure them but it will suppress it)

51
Q

What is PID?

A

A syndrome that can occur due to stds and stis - and can occur with or without absess formation but ultimately causes inflammation

(Hense the name - P Inflammatory D)

52
Q

PID endometritis

A

When the uterine lining is involved

endometrium of uterus

53
Q

PID salpingitis

A

Involved fallopian tubes

54
Q

PID Oophoritis

A

Has to do with ovaries

55
Q

PID peritonitis

A

Means of thee peritoneum

56
Q

Highest risk groups of PID

A

Teens and young adults

Low income & education

Smokers w multiple sex partners

Those who participate in early sexual activity

IUD users

Those who douche

57
Q

Main organisms responsible for PID

A

Chlamydia

Gonorrhea

58
Q

T/F

Women w PID can often still have children

A

Somewhat false.
PID is one of the main reasons women become infertile.
(A woman may still be able to have a child but this is in the minority)

59
Q

PID symptoms

A 
Pelvic pain
Fever 
Chills
Discharge
Bleeding 
malaise
NV
60
Q

How to diagnose PID

How to check for abscesses?

How to confirm results?

A

Do exam

Check for adnexal tenderness
(tender tubes and ovaries)

Chandelier cervix sign (reaching up in pain when cervix is touched)

Might do sonogram for any abscesses

Results confirmed with Laparoscopy after culture is obtained

61
Q

Treating PID

Education?

What if osmeone ahs an IUD?

A

Antibiotics for both partners
- Rocephin, Doxycycline, Clindamycin, Flagyl

Need to follow up & teach about prevention of Sti’s but also make sure they know early treatment is always best since late treatment is what caused the PID

Will need to remove IUD

62
Q

What is GBS or Group B Streptococci

A

It is a certain bacteria of Streptococci that can be harmful to a fetus during pregnancy

63
Q

What risks can happen if a PG mom develops GBS?

A

Chorioamnionitis
PROM or membrane rupture
UTI
PTL

Neonatal sepsis
Neonatal meningitis
Post partum infection

64
Q

Dx for GBS

A

at 35-37 weeks need to screen w swab

65
Q

Tx for GBS with antibiotics procedure?

What if the newborn ends up with GBS afterall?

A

IV antibiotics at early onset of active labor before the amniotic sac ruptures to reduce fetal effects

treated w antibiotics and will have to stay longer

66
Q

What percent of PG women are recommended to screen for HIV 1&2?

A

All of them 100%

67
Q

Name high risk groups of HIV

A 
prostitutes
bisexuals
IV drug users
Hemophiliacs
W/ HIV + partners
Native Africans (due to high % origin rates)
African American women
68
Q

Percent of pediatric cases with HIV due to PG mothers

Can you reduce the odds of transferring to the fetus?

Should women feel embarassed to be tested for HIV?

A

84% - from PG moms

Yes, treatment during pregnancy can help. Lowers infection rate to 1-2%.

While it is understandable, anonymous testing is available.

69
Q

What are high risk HIV fluids?

A

Blood
semen
vaginal fluids
breast milk (HIV + mothers cannot breastfeed whatsoever)

70
Q

What do most HIV tests screen for?

What is the test called? What does the test look for?

A

HIV antibodies - which are produced upon infection.

IFA - indirect fluorescent antibody test
- test looks for antigen or antibodies

71
Q

Which cells does HIV affect & inhibit ?

A

T cells which affects immune system response of any infection

72
Q

Where is HIV 1 geographically prominent

A

US & west europe

73
Q

Where is HIV 2 geographically found

A

West africa

74
Q

How many stages of HIv/AIDS

A

4

75
Q

Acute stage of HIV

A

mono like symptoms

seroconversion

76
Q

Asymptomatic stage of HIV

A

HIV for 5-10 years

  • Where most PG women are
77
Q

Symptomatic stage HIV infection

A

You begin to notice you have clinical manifestations

78
Q

Aids stage of HIV

A

end stage HIV infection where tumors and infections occur :

Wasting syndrome
Esophageal candidiasis
Herpes lesions
Kapasi's sarcoma
pneumocystitis
TN
toxopolasmosis (a torch infection)
79
Q

Vertical transmission of HIV

A

Transferring HIV from mom to baby

- either through labor or breastfeeding

80
Q

Patient asks which class of meds will be given to manage her HIV during delivery. And when she’ll begin taking them. Your response?

A

antiretrovirals

- must be given orally after 14 weeks until birth

81
Q

Is it safe to do an amniocentesis if mom has HIV?

A

No it is not safe.

82
Q

Can a PG mother infected with HIV have any possibility of vaginal delivery?

When is it appropriate do a C-Section?

A

If viral load is low and ruptured bag of water

CS needed if the viral load is high and there is no rupture yet

83
Q

Can an electrode fetal scalp monitor be used with HIV PG mom?
Vacuum extractor?
forceps?
External monitoring devices?

Should a PG HIV mom do frequent vaginal exams?

A

No
No
No
Yes - really just try to avoid anything internal if it can be helped.

No

84
Q

HIV mother is about to do a vaginal birth. It’s not working out and so they decide to a c-section. What was the med you gave before hand that is distributed for both types of deliveries? What route?

A

An antiviral!

Given IV.

85
Q

An HIV PG mom just gave birth to a healthy looking baby. What should you do immediately?

A

Bathe the baby.

86
Q

A HIV mom is asking if she can breastfeed her newborn. Your response?

She also asks how long she’ll have to take antivirals since she’s given birth. Your response?

A

No she cannot due to breastmilk containing HIV antibodies.

Antivirals should be continued as long as they’re prescribed.

87
Q

What complications can occur in a PG women postpartum due to HIV/AIDS?

Post partum considerations:

A

hemorrhage
infections
poor wound healing

Continue meds and labs
Parent child as condition allows

88
Q

When a baby is born with HIV - can you tell right away?
Will they receive meds immediatley?

What if they do end up being positive?

A

No. Need to wait a year for screening. If they’re 18 months and still negative , then they’re good.

Yes - they’ll be given AZT/ZDV po per weight.

Then switch meds to ART(antivirals) just like adults.

89
Q

General teachings concerning STI’s and STD’s

If you notice a sore or lesions anywhere near genitalia or mouth, should you abstain from sex?

You have sex and suddenly notice a change in discharge. Should you wait or go get it checked out?

You decide to wait to get treatment for sores on your genitalia but they end up going away. Should you still get tested?

Your sores go away before you finish all your meds. Now what?

Your providers notifies you that you are now the age able to have pap smears. You’ve been sexually active since you were 16 but feel fine. Should you avoid going in for your pap?

You are dx with HPV. Should you cancel your next screening if you want to go on vacation instead?

A

Yes - abstain if you are even the slightest bit suspicious.

Get it checked. Do not delay treatment anytime if ANY symptoms appear.

If sores go away, you still need to be tested.

Take ALL meds.

No, do not avoid a pap smear. HPV and cervical cancer often exhibit no symptoms. It is important women get pap smears when due. If you notice an infection, you should be making an appt with provider anyways.

Ideally, no. If you cancel make sure to reschedule and stay on top of your follow up appointments.

maternal exam 1 (9 decks)

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