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OB > Self-paced module 1 > Flashcards

Self-paced module 1 Flashcards

1
Q

What is the leading cause of neonatal sepsis?

A

GBS

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2
Q

What organism causes GBS? Where does this organism live?

A

Gram positive beta hemolytic cocci
Lives in a reservoir like GI tract or GU tract

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3
Q

How is GBS colonized? What s/s can be associated with colonization?

A

Chronic, intermittent, transient

Colonization in women in generally asymptomatic but can cause maternal UTI, infection in endometrium after birth, or intraamniotic infections
Preterm labor and stillbirth as also associated w/ GBS colonization

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4
Q

How is GBS transmitted to newborns?

A

Vertically - direct exposure during birth or ascending form vagina

Horizontally - cross contamination like poor hand hygiene

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5
Q

What is the transmission rate (likelihood of giving it to baby) influenced by?

A

How heavily colonized the women is
Site of colonization
Chronic colonization
Risk factors: preterm status, prolonged rupture of membranes, low birth weight and prescence of intraamniotic infection

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6
Q

What are the CDC guidelines for universal screening? What is the purpose?

A

All pregnant women should be cultured between 36-37 weeks w/ vaginal rectal culture

Very accurate at predicting GBS status if birth occurs within 5 weeks of obtaining the culture (if negative at 36-37 weeks, then it will remain negative until 41 weeks)

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7
Q

What are the exemptions to universal screening?

A

GBS bacteria of any amount found in clean catch urine sample
History of infant with invasive GBS sepsis

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8
Q

If GBS bacteria of any amount found in clean catch urine sample what is the treatment?

A

Treat UTI at diagnosis
Women will be given antibiotics in labor to prevent transmission to newborn

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9
Q

If mom. has history of infant with invasive GBS sepsis what is the treatment?

A

Prophylactic antibiotics in labor d/t history

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10
Q

How is a vaginal culture preformed? Can the patient do it themselves? What is not recommended?

A

Swab inserted into outer third of vagina and swiped down into the perineum and inserted into the rectum just past anal sphincter

Not recommended to do a cervical culture

With good education, patient can do culture themselves

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11
Q

GBS is generally treated with PNC, what testing should be done r/t this?

A

Susceptibility testing for patients with PCN allergies

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12
Q

Who should be treated with intrapartum prophylactic antibiotics?

A

Any positive GBS vaginal-rectal culture in the current pregnancy OR
History of:
1. GBS bacteria at any time in the pregnancy
2. Infant affected by invasive neonatal GBS infection
3. Universal screening cultures are not done because of the high risk of transmission `

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13
Q

What if mom hasn’t had the universal screening or you don’t have results?

A

Antibiotics should be given for these factors:

  1. Gestation less than 37 weeks
  2. Preterm pre-labor rupture of membranes (PPROM)
  3. Ruptured membrane more than 18 hours
  4. Intrapartum temp over 100.4
  5. History of GBS colonization in previous pregnancy d/t 50% that mom is colonized with GBS again
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14
Q

What is the reasoning behind giving prophylactic treatment? When should treatment be started?

A

Prevention of early onset neonatal sepsis
This is not the same as giving newborn antibiotics for a GBS infection

On admission and continued until the baby is delivered

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15
Q

What are the differences for a schedule C-section? What if they have a positive GBS result?

A

Universal screening at 36-37 6/7 weeks
Positive GBS:
1. Not in labor and membranes in tract – no treatment
2. In labor or membranes ruptured - treat w/ antibiotics prior to delivery

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16
Q

What is the recommended treatment for GBS? Why? Initial dose? Maintenance dose?

A

Penicillin G

New spectrum agent, targets gram positive, and less likely to cause antibiotic resistance to other vaginal organisms

Initial dose: 5 million units IVPB

Then 3 million units IVPB every 4 hours until delivery

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17
Q

What is the acceptable alternative if PNC G is not an option? Initial dose? Maintenance dose?

A

Ampicillin

2 g IVPB load

Then 1 g every 4 hours until delivery

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18
Q

What is considered adequate treatment?

A

Highest effectiveness is obtained with there is at least 4 hours between initial antibiotics and birth of baby

Can be effective after 2 hours

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19
Q

How do antibiotics work against GBS?

A

agents work by temporarily decreasing maternal vaginal GBS colony count, preventing fetal or newborn surface and membrane colonization and reaching levels in newborns blood stream to effectively kill B streptococcus

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20
Q

If patient states they have a PNC allergy what should you do?

A

Ask them what occurred during the time they took it to determine the type of reaction - high or low risk
Consider using a PNC allergy skin test

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21
Q

What is a high risk for anaphylaxis reaction to PNC? (9)

A

History of anaphylaxis
Angioedema
Respiratory distress
Urticaria after being given penicillin or cepalosporin
Recurrent reactions
Reactions to multiple beta-lactam antibiotics
Positive skin testing
Rare delayed reactions
SJS

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22
Q

What is a low risk for anaphylaxis reaction to PNC? (4)

A

Non-urticarial maculopapular rash without systemic symptoms
Family history of penicillin allergy but no personal history
Non-specific symptoms such as nausea, diarrhea, and yeast vaginitis
Patient reports a history but cannot recall the symptoms or treatments

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23
Q

If a patient is low risk for anaphylaxis, what alternative antibiotics can be given? Doses?

A

Cephazolin

2 g IVPB load, then 1 g IVPB every 8 hours until delivery

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24
Q

If a patient has a high risk for anaphylaxis and identified sensitivity of GBS isolate what alternative antibiotic can be given? Dose?

A

Clindamycin

900 mg IV then every 8 hours until delivery

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25
Q

If a patient has a high risk for anaphylaxis and GBS not sensitive to clindamycin what alternative antibiotic can be given? Dose? Considerations?

A

Vancomycin

20mg/kg every 8 hours
Max single dogs 2 g
Infuse over a minimum of 1 hours or 500mg/30 minutes a dose for a dose over 1 g

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26
Q

What is specific about treating GBS with clindamycin?

A

Need to do a culture and sensitivity of vaginal-rectal culture when there is a PNC allergy to determine which antibiotic to use instead to ensure it is effective against GBS

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27
Q

Why is screening and treating GBS so important?

A

Mortality: less than 10% of neonate affected by GBS sepsis
Morbidity: long term neuro complications are common

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28
Q

What is early onset neonatal sepsis? What are the s/s?

A

Occurs in first 7 days of life

Temperature instability, hypothermia, poor feeding, lethargy, respiratory distress, pneumonia, apnea, and shock

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29
Q

What is late onset neonatal sepsis? What are the s/s?

A

7 days – 3 months

Often results in meningitis

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30
Q

What are nursing considerations r/t GBS on admission of a patient in labor?

A

Review record on admission for GBS status
Prophylactic treatment if indicated
Communicate
Care of the neonate

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31
Q

When reviewing the record for GBS status what should you look for?

A

Include vaginal rectal culture results
History of GBS urinary infection at any time during pregnancy
Past history of delivering newborn who developed GBS sepsis

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32
Q

When caring for neonate what should you do r/t GBS?

A

Determine estimated risk of developing early onset sepsis using a neonatal sepsis calculator
Monitor s/s for neonatal infection and lab testing
Administer antibiotics if indicated – symptomatic

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33
Q

What puts an infant at increased risk of contracting GBS?

A

Neonate is at increased risk of developing GBS sepsis if treatment is inadequate (not enough time has gone by since being given antibiotics)

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34
Q

How is chlamydia transmitted? Causative agent?

A

Acending through sexual contact
Transmitted to fetus via birth cancel

Bacterium - chlamydia trachomatis

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35
Q

What are the s.s of chlamydia?

A

Asymptomatic
Abnormal vaginal discharge & painful urination (dysuria)

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36
Q

What are occurs if chlamydia goes untreated? Fetal effects? Neonatal effects?

A

If untreated: Lead to pelvic inflammatory disease, Infertility, and Increased risk of ectopic pregnancy

Fetal Effects: Risk of preterm labor and PROM

Neonatal effects: Ophthalmic neonatorum and Chlamydial pneumonia

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37
Q

How is ophthalmic neonatorum prevented?

A

E-mycin opthalmic ointment

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38
Q

What is the treatment for chlamydia?

A

Azithromycin
Partner co-treatment w/ azithromycin or doxycycline
Repeat test of cure 1-3 mths after treatment completion
Abstain from sex for 2 weeks

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39
Q

How is gonorrhea transmitted? Causative agent?

A

Sexually transmitted
Through contact with birth canal

Bacteria - neisseria gonorrheae

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40
Q

What are the s/s of gonorrhea?

A

Asymptomatic usually
Thin adherent discharge

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41
Q

What are the effects of gonorrhea on newborn?

A

Ophthalmia neonatorum
Sepsis
Joint infection

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42
Q

What is the treatment for gonorrhea?

A

Abstinence
Usually Ceftriaxone IM injection
Treat all partners
Test of cure 1-3 mths after treatment completion
Prevention: Safer sex and E-mycin ophthalmic ointment

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43
Q

How is HSV transmitted? Causative agent?

A

Direct contact with lesion during birth after membranes rupture
Sexual contact
Transplacental - rare

Viral HSV! or HSV2

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44
Q

What are the s/s of HSV?

A

Vaginal fullness, tingling, itching, burning or swelling
Blisters, ulcers, scabs

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45
Q

What is the neonatal risk with HSV?

A

50-60% mortality w/ exposure to primary lesion/infection
Neurological complications & sepsis

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46
Q

What is the treatment for HSV?

A

Zovirax (Acyclovir) 400 mg BID
Valacyclovir 500 mg BID orr 1000 mg daily
Prophylactic antiviral meds 35 -36 wks
Antivirals if 2-3 outbreaks during pregnancy

47
Q

HSV vaginally delivery or C-section? Will this affect mom forever?

A

Vaginal delivery no active lesions for 7 days
C-section if active lesions

Lifetime infection w/ individual variation on incidence & severity of lesions

48
Q

With HSV is the baby more likely to contract after first outbreak or recurrent outbreaks?

A

50% chance first will contract if moms first outbreak because first outbreak is more severe
1-5% if recurrent outbreak

49
Q

How is HPV transmitted? Causative agent?

A

Sexually
Transplacentally??

Viral

50
Q

What are the s/s of HPV? High risk/low risk?

A

Wart on vagina that are painless and flat

High risk –> cervical cancer
Low risk –> condyloma (warts)

51
Q

What is the neonatal risk with HPV?

A

Juvenile laryngeal papillomatosis
More a risk w/ initial outbreak HPV & direct contact

52
Q

What is the treatment for HPV?

A

TCA (Trichloroacetic acid), laser, or surgery
Often resolve without treatment
Prevention: HPV vaccine

53
Q

C-section or vaginal delivery with HPV?

A

Delivery: C-section not warranted
May impede vaginal delivery if warts are very large & obstruct vaginal canal

54
Q

How is syphilis transmitted? Causative agent?

A

Sexually
Transplacentally

Viral - treponema palidum

55
Q

What are the s/s of syphilis? What testing should be done?

A

Painless canker at site of transmission

Serologic testing recommended on all pregnant women

56
Q

What are the fetal-neonatal effects of syphilis?

A

2nd trimester loss
Stillbirth at term
Congenital infection
Live unaffected infant

57
Q

What is the treatment for syphilis?

A

PNC G
Screening and treat all partners
Immediately treat because critical to mom and baby

58
Q

How is trichomoniasis transmitted? Causative agent?

A

Sexually

Protozoan: trichomonas vaginalis

59
Q

What are the s/s of trichomoniasis?

A

Asymptomatic
Malodorous yellow-green discharge
Vulvar irritation (strawberry patches on cervix)
Preterm labor, birth, or PROM, SGA

60
Q

What is the treatment of trichomoniasis? What can the treatment cause?

A

Metronidazole (Flagyl)

Treatment can lead to preterm labor

61
Q

What is bacterial vaginosis? What is it caused by?

A

Bacterial imbalance in the vaginal canal

Can be caused by douching, detergents, hot tubs
Gardnarella vaginalis

62
Q

What are the s/s of BV? What could it cause for the fetus?

A

Asymptomatic
Fishy odor & discharge

Preterm labor/birth
PROM
Chorioamnionitis (infection)

63
Q

What is the treatment for BV?

A

Metronidazole (Flagyl)
Prevention measures

64
Q

How is toxoplasmosis transmitted? What is it caused from?

A

Transplacentally

Eating raw or undercooked meat/game meats
Contact w/ feces of infected cats
In the soil (gardening)
Protozoan: Toxoplasma gondii

65
Q

What are the s/s of toxoplasmosis? When is mom at highest risk?

A

Mild flu like s/s

Highest risk in 3rd trimester

66
Q

What is the fetal risk with toxoplasmosis?

A

Severe neonatal disorders (blindness, development delays, seizures)
Severe fetal disease/death
Hydrocephalus, microcephaly

67
Q

What is the treatment for toxoplasmosis?

A

Recent infection: Spiramycin (↓ transmission
to fetus but does not cross placenta to treat fetus)

Suspected fetal infection: Sulfadiazine, Pyrimethamine & Folinic Acid (after 1 trimester)

Prevent: don’t eat raw meat or touch with bare hands, avoid infected cats, wash hands

68
Q

How is varicella transmitted? What is the causative agent?

A

Airborne
Direct contact
Saliva
Touching contaminated surfaces
Transplacentally

Viral

69
Q

What are the s/s of varicella?

A

Small red spots that turn into scabs, blisters, ulcers
Fatigue, fever loss of appetite

70
Q

What is the fetal risk with varicella? Maternal? Neonatal?

A

Maternal: High risk of death to pneumonia

Fetal: Lead to congenital varicella syndrom, Hypoplasia and contractures of limb, eye & CNS involvement

Neonatal: highest risk if maternal infection is within 5 days before and less than 2 days after delivery

71
Q

What is the treatment of varicella?

A

Treatment of active maternal infection: Acyclovir, Valcyclovir or Famcyclovir (reduce symptoms, duration, & intensity)

Prevention: Vaccination

72
Q

Should mom vaccinate while pregnant? Do antibodies from mom go to baby?

A

Maternal antibodies do not cross placental barrier

If not immune, pt should vaccinate postpartum (live attenuated vaccine, should avoid pregnancy for 30 days after receiving)

73
Q

How is parvovirus transmitted? Causative agent?

A

Transplacentally 1/3 of time

Human B19

74
Q

What are the s/s of parvo?

A

Slapped cheek appearance
Low grade fever
Nasal discharge
HA
Joint pain

75
Q

What is the fetal risk with parvo?

A

Fetal death 10% (4-12 weeks after infection) but normal development if fetus survives

Non-immune hydrops & marked fetal anemia (may need intrauterine transplant)

76
Q

What is the treatment of parvo? Does the fetus need to be monied?

A

Avoidance of exposure

Fetal surveillance w/ US evaluation of peak systolic velocity of middle cerebral artery

77
Q

How is listeria transmitted? Causative agent?

A

Transplcentally

Bacterium: Listeria Monocytogenes

78
Q

What are the s/s of listeria?

A

Fever
Muscle aches
HA
Stiff neck
Confusion
Loss of balance
Chills

79
Q

What are the fetal-neonatal effects of listeria?

A

Miscarriage; fetal death

Neonatal death related to pyogenic meningitis

80
Q

How is listeria treated?

A

Avoid eating high risk foods such as soft cheeses, deli meats, hot dogs, milk products, smoked seafood, sprouts, raw meat

81
Q

How is coxsackie transmitted? Causative agent?

A

Bodily fluids

Viral Infection (Hands, Foot, & Mouth)

82
Q

What are the s/s of coxsackie?

A

Blister like rash the develops on hands, feet, and mouth
Fever
Poor appetite
Runny nose
Sore throat

83
Q

What are the letal-neonatal effects of coxsackie?

A

Death
Chorioamnionitis
Placental infection
Myocarditis, encephalitis

84
Q

How is rubella transmitted? Causative agent? Diagnosis?

A

Transplacentally

Viral infection

85
Q

What are the effect of rubella on newborn?

A

Congenital heart congenital defects (PDA)
Congenital cataracts
Developmental delays
Cerebral palsy
Sensorineural deafnes

86
Q

What is the treatment for rubella?

A

MMR vaccine
Vaccination of all children & non-immune individuals
Childbearing women: vaccination prior to pregnancy or in postpartum period

87
Q

How long does rubella spread for? What should you do?

A

Can shed for 12 months
Isolate infants with rubella

88
Q

How is hep B transmitted? Causative agent?

A

Blood exposure
Increased risk during delivery

Viral

89
Q

What is the treated of hepB?

A

Bathe ASAP
Hepatitis B vaccine
Hepatitis B immune globulin

Other family members should be screened and treated

Neonatal: HBIG and Hepatitis B vaccin

90
Q

How do you diagnose HepB?

A

Hep B surface antigen part of initial OB labs
Hep e antigen positive = diagnosis of active infection

91
Q

How is HepC transmitted? Causative agent?

A

Blood exposure
Increased risk during delivery

Viral

92
Q

Treatment of HepC?

A

Treatment controversial during pregnancy
All pregnant should be screened w/ each pregnancy for HCV antibodies at 1st prenatal visit in settings where HCV prevalence is >0.1%
Exposure usually w/ deliver

93
Q

How is HIV transmitted? Causative agent?

A

Blood products
Sexually
Breast feeding
Transplcentally

Viral: Human Immuno- deficiency Virus

94
Q

What are the s/s of HIV? Risk to child?

A

Flu like s/s
Usually asmyp until progresses to AIDS

Child may live to 10 years old with HIV

95
Q

How do you test for HIV?

A

Two methods of rapid testing blood or saliva:
OraQuick rapid HIV antibody test

96
Q

How do you treat HIV in pregnancy? Labor? Neonatal?

A

Pregnancy: AZT (ZVD)

Labor: IV Zidovudine

Neonatal: Highly active antiretroviral therapy and c-section/intact membranes decreases transmission

97
Q

What should you monitor mom for? What education should be given regarding HIV?

A

Monitor CD4 count
Encourage safer sex: mother can be REINFECTED & cause new viral load

98
Q

What should the neonatal care look like with HIV?

A

Wipe off secretions
Bathe ASAP
Use strict infection control techniques
Breastfeeding contraindicated
Neonatal med treatment
Observe other infections in mother

99
Q

How is TB transmitted? Causative agent?

A

Droplets in air

Bacterium: Mycobacterium tuberculosis

100
Q

How do you treat active TB? Inactive TB?

A

Active TB: Isoniazide, rifampin, ethambutol

Inactive: - May delay treatment until postpartum

Recommend TB skin or serum testing in high risk population

101
Q

Can you breastfeed with TB?

A

Inactive TB: may breastfeed & delay treatment until postpartum
Active: no direct contact w/ newborn until non-infectious

102
Q

How is Zika transmitted? Causative agent?

A

Through Aedes species of mosquito
Can be sexually contact up to 6 months after exposure
Transplacentally

Virus

103
Q

What are the maternal s/s of Zika virus?

A

Fever, rash, headache, arthralgias/myalgias, red eyes

104
Q

What are the fetal risks? What is congenital Zika syndrome?

A

10% risk with infected mother
Miscarriage, stillbirth, growth restriction

Congenital Zika Syndrome: microcephaly, ↓ brain tissue, ocular damage, limb/ joint defects hypertonia

105
Q

What is the treatment/prevention for Zika virus? Testing?

A

Avoid traveling to high risk areas (carribean, Latin America, India, Central America)

Testing: serum or urine testing

106
Q

fHow is COVID transmitted? Causative agent?

A

Droplets
Contact

Viral

107
Q

What are s/s of COVID?

A

fever, chills, loss of taste/smell, cough

108
Q

What is the treatment for covid?

A

Vaccinate prior to and during pregnancy
Daily low dose aspirin for all pregnanct patients with covid d/t hyper coagulability
Could need to be hospitalized and ventilated
Monoclonal antibodies recommended for patients w/ mild to moderate s/s and one or more risk factors (obese, CKD, DM, CVD)

109
Q

How does CMV transmit?

A

Across placenta
Cervical route during birth
Close contact with infected individual

110
Q

s/s of CMV?

A

asymptomatic

111
Q

What are the CMV fetal-neonatal effects?

A

Fetal death
SGA
Microcephaly/hydrocephaly
Cerebral palsy
Developmental delays
No damage

112
Q

Treatment of CMV? Diagnose?

A

no treatment

sero-conversion
Amniocentesis

113
Q

Where is transmission high? How long does viral shedding occur?

A

Viral shedding over many years
Most high in day care

OB (16 decks)

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