Ch 10 Infections Diseases in Pregnancy Flashcards
asymptomatic bacteriuria is screened for as part of routine pregnant care and is associatd with significant risk in pregnancy
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prevalence of ASB >100,000 colonies in culture ranges from 2-11%
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women with abs are 20-30 fold increased risk of developing acute pyelonephritis during pregnancy \
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abs in pregnancy is further associated with low birth weight infants and PTL
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urinalysis might be positive for leukocyte esterase, nitrates, or hematuria, and the urine sediment will have elevated wbcs and bacteria.
nitrates are sensitive and specific to gram - negative bacteria.
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ecoli accounts for > 80% of all ASB and UTI
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treatment of ASB is usually with
amoxicillin, nitrofurantoin
trimethoprim/sulfamethoxazole
or cephalexint
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because ASB may persist, a test of cure culture should be obtained 2 weeks after completion of therapy
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wbc casts are highly associated with pyelonephritis. onset of symptoms is often abrupt and fever is universally present
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in adddition to treating infection, in patients with dysuria or bladder pain, pyridium which is concetrated in the urine acts as a local anesthetic to reduce the pain, is commonly used for symptomatic relief.
patients should be counseled that pyridium will cause the urine to turn bright orange
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most common complication of lower UTI is ascending infection to the kidneys, or pyelonephritis.
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pyelonephritis is characterized by fever, chills, flank pain, dysuria, urgency, and frequency. it is sometimes associated with nausea and vomiting. oh PE, fever and costovertebral angle tenderness are often present.
lab abnormalities:
pyuria
bacteriuria
elevated WBC
WBC casts (highly associated with pyelonephritis)
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pyelo a risk factor for preterm labor and particularly serious associated maternal complications including septic shock and ARDS. up to 20% of pregnant women with acute pyelonephritis develop multiorgan system involvement secondary to endotoxemia, resulting in sepsis.
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GBS refers to beta hemolygic gram-positive bacteria streptococcus agalactiae and is commonly responsible for UTIs, chorioamnionitis, and endomyometritis during pregnancy. it is also a major pathogen in neonatal sepsis which has severe implications.
mortality rate with GBS is 2-50%women with hx of GBS UTI or a history of previous infant with GBS disease should be treated independent of screening
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gbs only good for 5 weeks
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chorioamnionitis is infection of memebranes and amnioti fluid surrounding the fetus. frequently associated with preterm and prolonged ROM but can also occur without ROM
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herpes simplex virus serious infection with significant morbidity and mortality
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hsv2 clasically causes genital herpes,
primary infections are astymptomatic in 50% of patients and are responsible for approx 90% of neonatal herpes. risk of transmission to neonate with primary outbreak is 20-50%risk of transmission with recurrent herpes with active lesions is approx 1%.
latent infection occurs after a primary infection. virus resides in the dorsal root ganglion and peripheral nerves can shed virus symptomatically / asymptomatically
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ideal method of testing for genital herpes is through scraping of the lesions and sending for viral detection through PCR. virial culture is less sensitive than PCR, and additional assays are less specific.
antibody detection techniques include use of serologic tests to detect presence of antibodies to etiehr hsv2 or hsv1.
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varicella zoster virus -highly contagious dna herpes virus transmitted by respiratory droplets / close contact and causes the disease chicken pox
it can later reactive to cause herpes zoster / shingles
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vzv causes svereal symdromes relevant to pregnancy including
maternal varicella pneumonia
congenital varicella syndrome
neonatal varicella infection
vav pneumonia in pregnancy is a risk factor for maternal mortality
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congenital varicella predominantly when mothers are infected between 8-20 weeks of gestation. congenital varicella syndrome is characterized by
skin scarring limb hypoplasia chorioretinitis microcephaly 30% mortality in 1st year of life.
maternal infection in 3rd trimester, virus can cross the placenta and infant has insufficient cell-mediated immunity to prevent hematogenous dissemination of virus and cause neonatal varicella.
neonatal VZV is associated with high neonatal dealth rate.
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infants of mothers who develop varicella disease within 5 days before delivery or 2 days after should also receive varicella zoster immunoglobulin VZIG and / or treatment with antiviral agents such as acyclovir / valacyclovir
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maternal herpes zoster, recurrent VZV outbreaks is NOT associated with congenital anomalies / neonatal varicella
recurrent VZV outbreaks is NOT associated with congenital anomalies / neonatal varicella
if a susceptible pregnant patient is exposed to someone with varicella, she should be treated within 72-96 hours with one of two agents to prevent active infection
varicella zoster immune globulin variZIG is recommended for postexposure prophylaxis, and nay woman who has exposure without a history of chicken pox or history of vaccination should be treated ( up to 10 days after exposure)
alternative method of prophylaxis is to administer oral acyclovir 800mg five times daily x 7 days.
oral valtrex 1000mg tid x 7 days
patients with pneumonia, encephalitis, disseminated infection and immunsuppressed should be hospitalized and treated with IV acyclovir
parovirus b19 is a dna virus that causes erythema infectiosum (5th disease) a common childhood illness.
virus transmiteed by repiratory droplets and infected blood products. in pregnancy, virus transmitted transplacentally in about 35% of women.
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