EXAM #2 infection/STI in pregnancy Flashcards
Cytomegalovirus
Presentations: most common perinatal infection, mononucleosis-like syndrome: fever, pharyngitis, lympadenopathy, and polyarthritis.
Spread: body fluids per nasopharyngeal secretions, urine saliva, semen, cervical secretions or blood- intimate contact required (generally not highly contagious
Risk factors: children in day care centers & classrooms
Fetal risks: first half of the pregnancy → FGR, microcephaly, intracranial calcifications, mental and motor deficit, hepatosplenomegaly, jaundice, hemolytic anemia, thrombocytopenic purpura
Late onset sequelae: hearing loss, neurological deficits, chorioretinitis, psychomotor deficits, learning disability.
Diagnostic tests: routine CMV serological screening not recommended (IgM may be present with primary, recurrent or CMV reactivation)
Toxoplasmosis
Presentation: severity of fetal infection greater if contacted late in first trimester
→ <20% presents pyrexia, fatigue, sore throat, muscle pain, posterior cervical lymph node enlargement, maculopapular rash
Spread : tissue cysts from infected meat animal ; oocytes shed in feces of infected felines; soil or water
Risk factors: associated with consumption of undercooked meat and meat products mutton/lamb meat, cured meats, and raw goat milk and milk products
Fetal risks: PTB, LBW infants
Long term sequelae including neurological anomalies not necessarily evident at birth
Diagnostic tests: DNA amplification techniques and sonographic evaluation; refer to management.
Listeriosis
Presentation: may be asymptomatic but symptoms may includes: muscle aches, diarrhea, stiff neck, HA or febrile illness confused w/ influenza, pyelo or meningitis.
Spread : unpasteurized milk and milk products include soft cheeses, melons coleslaw, apple cider, smoked seafood products, sliced deli meats, pate, hummus, wieners.
Risk factors: 27% pregnant women report case out of 3.1 million –placental trophoblasts susceptible to L.monocytogenes.
Fetal risks: PTB, fetal loss, neonatal sepsis, chorio, placental lesions
Diagnostic tests: positive blood culture
Parvovirus B19
Presentation: erythema infectiosum: slapped cheek disease or fifth disease
Spread : respiratory or hand-to-mouth ,
Risk factors: day care workers and women with school age children
Fetal risks: SAB, second and third trimester infection : fetal anemia, non-immune hydrops fetalis and fetal death.
Diagnostic tests: ELiSA and western Blot for IgG and IgM antibodies.
** IgM antibodies coincide with time of symptoms, disappear in 1-4 months IgG antibodies detectable approximately on day 7 remain for life
**if exposed & IgG negative, repeat in 2-4 weeks; if IgG positive then refer to medical management ASAP/STAT
Varicella
Presentation: one to two day prodrome then pruritic vesicular lesions, crust over 3-7 days
Spread : direct contact : incubation period 10-21 days
Risk factors: non-immune women has 60-90% risk of infection post exposure
Fetal risks: 25-40% exposes fetuses will have congenital varicella syndrome, greatest risk during the first 20 weeks, earlier in pregnancy the greater risk to fetus.
Diagnostic tests: varicella titers
GBS
- transmission : GBS ascends from the vagina to the amniotic fluid after onset of labor or rupture of membranes, although GBS also can invade through intact membranes.
- risk factors: 10-30% colonized with Group B strep in urinary tract, digestive, & reproductive tract. No way of knowing.
- diagnosis : it can come & go so test early doesn’t matter so test at the end of pregnancy.
- management: routine screening for GBS colonization is done with vaginal & rectal GBS cultures at 35-37 weeks for all pregnant women. Take 4 hours prior labor.
- treatment: penicillin
UTI
- transmission : d/t urinary stasis and vesicoureteral reflux associated with preterm or low birth weight infant.
- risk factors: African American, multiparas, sickle cell trait
- diagnosis : U/A per dipstick: + for WBC, nitrates, &/protein > trace = get culture
- management: first prenatal visit. Treat if 20,000-50,000
- treatment: empiric tx initiated pending U/C results in symptomatic women nitrofurantoin (macrobid) contraindicated near term >38 week potential for induction of hemolytic anemia in the neonate
sulfa drugs contraindicated after 36 weeks may contributed to kernicterus of the newborn
Pyelonephritis
transmission : most serious medical complication of pregnancy; leading cause of septic shock during pregnancy, common in second trimester
- risk factors: nulliparas, young
- diagnosis : unilateral & right side pain. fever chills and aching pain in one or both lumbar regions. Tenderness usually can elicited by percussion in one or both costovertebral angles.
- management: obtain blood & urine culture, IV hydration
- treatment: ampicillin PLUS gentamycin; cefazolin or cetriaxone or an extended spectrum antibiotic
Hep B
- transmission : blood transfusion, generalize infection by other viruses (Epstein-barr, hsv, measles) or nonviral causes (bacterial sepsis, syphilis)
can be chemically induced by chronic ETOH ingestion or by medication (ASA, acetaminophen, phenytoin, isoniazid, rifampin) - risk factors: blood transfusion or blood products/organs prior june 1992, previous hepatitis or jaundice
- exposure to someone who has hepatitis or is jaundiced, multiple sex partners, sexual activity with a bisexual male, IV drug use (even x1) immigration or travel from an region w/ endemic hepatitis, occupation exposure.
- Diagnosis:LABS : CBC w/ platelets, liver test (AST, ALT, total bilirubin, alkaline phosphate, albumin) PT, & test for HBV replication (HBeAg, anti HBe, HBV DNA)
- management: consult/comanagement & report to state agency
- treatment: to reduce perinatal transmission in HBV positive mom→ administer to baby within 12 hours of birth (HBIG, HBvaccine series)
reassure women that HBIG reduce fetal transmission from 90% to 3%
Hep C
transmission : blood, HCV positve, RNA positive , sex (but inefficient) transmission at time of birth
- risk factors: drugs user blood transfusion
- diagnosis : antibody testing
- management: consult
- treatment: avoid ASA/Tylenol/alcohol
HPV
transmission : most common
- risk factors: sexually active.
- diagnosis : increase # and size during pregnancy making vaginal delivery or episiotomy difficulty.
- management: incomplete respone to tx during pregnancy but lesions commonly improve or regress rapidly following delivery. Consequently, eradication of warts during pregnancy is not always necessary.
- treatment: Trichloroacetic or bichloracetic acid some prefered cryotherapy, laser ablation, or surgical excision.
***podophyllin & interferon not recommend in pregnancy.
→ respiratory issue if infant infectef
HSV
transmission : interuterine 5%, peripartum 85%, postnatal 10%
- risk factors: adolescent
- diagnosis : PCR assay detection in spinal fluid.
- management: acyclovir (pregnancy)
- treatment: suppressive after 36 week until birth
HIV
incubation: from exposure to clinical disease is days to weeks
- s/x : fever night sweat fatigue rash headache lymphadenopathy pharyngitis myalgias arthralgias nausea vomiting and diarrhea.
- dx: ELISA (99.5% sensitivity) then confirmed with western blor or immunofluorescence assay (IFA) both have high specificity.
- transmission rate: 20% before 36 weeks, 50% in the days before delivery, 30% intrapartum, breastfeeding 30-40% … vertical transmission common in preterm birth and prolong membrane rupture.
- Antivirals: Highly active antiviral therapy HAART
GC
N. Gonorrhoea
Risk factors: 15-14, single, poverty, drug abuse, prostitution, lack of prenatal care, other STDs.
Dx: NAAT
TX: cetriaxone PLUS azithromycin/amoxicillin, erythromycin
Chlamydia
C. trachomatis
Risk: same as GC but screen will be at first AND at third because of recurrent 17% & high-risk behavior.
TX: azithromycin is first line ….(fluoroquinolones & doxycline are avoided in pregnancy)
