STI's in pregnancy

Question 1

Does Chlamydia affect the pregnancy at all?

If so, what changes?

Answer 1

No, chlamydia does not change the course of a pregnancy.

Chlamydia does not cause preterm labor or preterm premature rupture of membranes. Gonorrhea does, however.

Question 2

What good do erythromycin drops do for the baby?

What does it not protect against?

Answer 2

It prevents the baby from getting bad conjunctivitis from gonorrhea infections.

It does not protect against chlamydial conjunctivitis. (or a chemical conjunctivitis?)

Question 3

What are the neonatal complications of a chlamydial infection?

Answer 3

Conjunctivitis and a pneumonia.

Question 4

What is the treatment of a baby with chlamydial conjunctivitis?

Answer 4

erithromycin for two weeks.

Question 5

What is treatment for a pregnant mother with incidental infection with chlamydia?

Answer 5

one day azithromycin.

Question 6

What are the three main sites of infection for chlamydia in a woman?

What conditions does infection of these sites cause?

Answer 6

Uterus, Endocervix, and the Urethra.

Endometritis, Mucopurulent Endocervicitis, and Urethritis.

Question 7

What is the most common culprit in conjunctivitis of a newborn within the first month?

Answer 7

Chlamydia trachomatis.

Question 8

What is the most common culprit in endometritis that occurs about 2-3 weeks after delivery?

Answer 8

Chlamydia.

Question 9

What two medications are contraindicated in pregnant women because of their tendency to turn babies’ teeth dastardly yellow?

Answer 9

Tetracycline and Doxycycline.

Question 10

If a pregnant woman in her first prenatal visit is found to have a chlamydial infection and is treated, when do we test her again for chlamydia?

Answer 10

During the third trimester b/c reinfection with chlamydia is common.

Question 11

What are pregnancy complications that can arise from gonorrhea infections?

Answer 11

-Chorioamnionitis
-Abortion
-Preterm labor
-Preterm premature rupture of membranes
-Neonatal sepsis
-Postpartum infection, endometritis vs conjunctivitis vs neonatal systemic infection

Question 12

If newborn has gonorrhea conjunctivitis that is left untreated, what happens?

Answer 12

Corneal scarring and blindness.

Question 13

What’s the clinical picture of a woman with a systemic gonorrheal infection?

Answer 13

She will have pustular skin rashes, arthralgias, and septic arthritis after aspiration of synovial fluid.

Question 14

How do we treat gonorrhea?

How do we treat Chlamydia?

Answer 14

Treat gonorrhea with ceftriaxone and azithromycin, b/c those infected with gonorrhea almost always have chlamydia.

Treat chlamydia only, usually with azithromycin.

Question 15

Should HIV women breastfeed?

Answer 15

No, because babies can be infected with HIV from breast milk.

Question 16

When can a pregnant HIV mother give birth vaginally?

Answer 16

Only if her Viral Load is under 1,000 - then it is an option to consider.

Question 17

When should a pregnant HIV mom only do a Cesarean section?

Answer 17

When her viral load is above 1,000. C section is the only choice then.

Question 18

If an HIV mom opts to give birth vaginally, what medication should she receive?

What about her baby?

Answer 18

IV zidovudin during labor.

Zidovudin syrup for the baby.

Question 19

How often should viral load be obtained in an HIV pregnant mother?

Answer 19

Every month, it should be ordered.

Question 20

With appropriate HAART and delivery mode, what is the incidence of vertical transmission of HIV from mother to child?

Answer 20

<2%.

Question 21

What are the components of HAART?

How many of these components must we use at any given time?

Answer 21

-Nucleoside Reverse Transcriptase Inhibitor (NRTI)
-Non-nucleoside Reverse Transcriptase Inhibitor (NNRTI) - helps whenever there is resistance to meds.
-Protease Inhibitors

2/3.

Question 22

What is an example of an NRTI that is preferred in pregnant pts?

Answer 22

Zidovudine.

Question 23

Is there any risk to using HAART in pregnancy?

Answer 23

No, just a slight increase in the risk of prematurity and also preeclampsia with the protease inhibitors - but risk is minimal.

The only exception is efavirenz - increases chance of neural tube defects.

Question 24

What treatment should a newborn of a mother with an active Hep B infection receive?

Answer 24

He should receive Hep B immunoglobulin at birth and a Hep B vaccine within 12 hours of birth.

Question 25

Is there a risk to treating mothers with Hep C during pregnancy?

Answer 25

Yes, ribavirin and interferon can cause birth defects.

Question 26

Can women with Hep B or Hep C breastfeed?

Answer 26

The answer is yes. They can, as long as there is no open wound or cut on the breast/cracked nipples.

Question 27

What is the mode of treatment of chlamydia with azithromycin?

Answer 27

Only oral. Not intramuscular.

Question 28

A pregnant mother in now in labor, though her membranes did not rupture yet. Her cervix is now 6 cm dilated, and she has untreated HIV. What mode of delivery should she take?

What should we avoid?

Answer 28

Continue the vaginal delivery, can’t stop what’s started unless baby is in emergent danger. Infuse mother with Zidovudine and then give the baby syruppy zidovudine.

Avoid giving mom fetal head electrodes or using vacuum-assisted suction or forceps - anything invasive.

Question 28

Does C section have an impact on vertical transmission of Hep B and Hep C?

Answer 28

Not at all.

Question 29

What is the best thing to do to prevent vertical transmission of Hep C during delivery?

Answer 29

Avoid invasive procedures.