49 - infections of pregnancy, peurperium and neonates

Question 1

Puerperium definition

Answer 1

The puerperal state or pregnancy - the few weeks following delivery during which the mother’s tissues return to their non-pregnant state (6-8 weeks post-partum)

Question 2

Neonate goes up to how many weeks old?

Answer 2

less than 4

Question 3

why does infection warrent special treatment during pregnancy?

Answer 3

Often more severe + common

Can affect foetus

Question 4

Route of acquisition + route of transmission to baby - CMV

Answer 4

Resp. droplet

Haemato

Question 5

Route of acquisition + route of transmission to baby - parvovirus B19

Answer 5

resp.droplet

Haemato

Question 6

Route of acquisition + route of transmission to baby - toxoplasmosis

Answer 6

Ingestion of oocysts

Haemato

Question 7

Route of acquisition + route of transmission to baby - syphilis

Answer 7

Sexual

Haemato

Question 8

Route of acquisition + route of transmission to baby - VZV

Answer 8

Resp. droplet

Haemato

Question 9

Route of acquisition + route of transmission to baby - zika

Answer 9

mosquito bite

Haemato

Question 10

Infections to be transmitted from mother to baby during pregnancy

Answer 10

Group B strep
HSV
Gonorrhoea
Chlamydia
HIV and Hep B (prophylaxis can be used)

Question 11

Antimicrobial prescribing in pregnancy

Answer 11

Potential to cause harm to foetus/embryo/neonate must be considered

All antimicrobials cross the placenta to some extent

Virtually all antimicrobials appear in breast milk at therapeutic levels

Question 12

Safe antimicrobials

Answer 12

Penicillins

Cephalosporins

Question 13

Unsafe antimicrobials

Answer 13

Chloramphenicol
Tetracycline
Fluoroquinolones (e.g. ciprofloxacin)
Trimethoprim-sulphamethoxazole

Question 14

Viral diagnosis in pregnancy

Answer 14

Serology

PCR of relevant samples

Question 15

UTI during pregnancy

Answer 15

Screening for bacteriuria is indicated in pregnancy

Can be asymptomatic

Continuing bacteriuria is associated with premature delivery and increased perinatal mortality

Question 16

UTI treatment

Answer 16

Current recommendation is 7 days of relatively non-toxic antibiotic - amoxicillin or cefalexin

Repeat urine culture

Question 17

Intra-amniotic infections

Answer 17

20-25% pregnancies with pre-term labour

Major cause of perinatal morbidity and mortality

Chorioamnionitis

Question 18

Chorioamnionitis

Answer 18

Refers to inflammation of umbilical cord, amniotic membranes, placenta

Question 19

Intra-amniotic infections - clinical features

Answer 19

Maternal fever
Uterine tenderness
Malodorous amniotic fluid
Maternal or foetal tachycardia
Raised white cell count

Question 20

Intra-amniotic infections - risk factors

Answer 20

Most common after prolonged rupture of membranes

Amniocentesis, cordocentesis, cervical cerclage, multiple vaginal exam

Question 21

Intra-amniotic infections - pathogenesis

Answer 21

bacteria present in the vagina cause infection by ascending through the cervix

Haematogenous is rare

Question 22

Intra-amniotic infections - causative organisms

Answer 22

Group B strepto
Enterococci
E. coli

Question 23

Intra-amniotic infections - management

Answer 23

Antimicrobials and delivery of foetus

Antimicrobials should be administered at time of diagnosis

Question 24

Puerperal endometritis -

Answer 24

Infection of the womb during puerperium (5% of pregnancies)

Puerperal sepsis major cause of maternal death

Question 25

Puerperal endometritis - risk factors

Answer 25

Caesarean section Prolonged labour Prolonged rupture of membranes Multiple vaginal exams

Question 26

Puerperal endometritis - clinical features

Answer 26

``` Fever (24hrs after delivery) Uterine tenderness Purulent, foul-smelling lochia Increased WCC General malaise, ab pain ```

Question 27

Puerperal endometritis - causative organisms

Answer 27

E.Coli Beta-haemolytic streptococci Anaerobes

Question 28

Puerperal endometritis - diagnosis

Answer 28

The role of transvaginal endometrial swabs is controversial

Question 29

Puerperal endometritis - treatment

Answer 29

Broad-spec IV antimicrobials

Question 30

Puerperal mastitis -

Answer 30

Infection gains access via cracked/fissured nipples

Question 31

Puerperal mastitis - clinical features

Answer 31

Mean onset 5.5 weeks post delivery Abrupt onset fever, chills and breast soreness Redness, warmth and tenderness of affected breast

Question 32

Puerperal mastitis - causative mechanisms

Answer 32

Staph. aureus

Question 33

Puerperal mastitis - diagnosis

Answer 33

Clinical | Culture of pus

Question 34

Puerperal mastitis - management

Answer 34

Continue nursing Optimise nursing technique and breast care Anti-staph antibiotics Incision/drainage if abscess present

Question 35

Puerperal sepsis -

Answer 35

Pneumonia IV catheter-related infection Wound infection (caesarean section)

Question 36

Neonatal sepsis / meningitis

Answer 36

Sepsis is a syndrome resulting from invasion of pathogenic bacteria into the blood

Question 37

Neonatal sepsis - presentation after birth

Answer 37

early onset presents within 2 weeks of birth

Question 38

Neonatal sepsis - common causative diseases

Answer 38

Group B strep E.Coli Listeria monocytogenes

Question 39

Neonatal sepsis - diagnosis

Answer 39

Blood, urine and CSF culture

Question 40

Neonatal sepsis - management

Answer 40

Broad spectrum antimicrobials active against common causes