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Flashcards in Antepartum Complications Deck (102)
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1

TORCH

T: Toxoplasmosis
O: other like hepatitis
R: Rubella
C: CMV
H: Herpes Simplex

2

Symptoms of some infections may appear in mother as ____ and in baby as ____

flu-like, more serious

3

Herpes Simplex Virus

HSV

-1 in 6 americans
-1 and 2 with type 2 causing more outbreaks than 1

4

Following primary herpes infection clearing, ......

viral shedding continues for up to 3 months

subsequent outbreaks vary thereafter

5

_____ risk of fetal transmission with presence of lesion and primary infection of herpes

50%

6

__ to __ of herpes infections are truly asymptomatic or unrecognized

60 to 90%

7

Primary test for herpes

-viral culture in most clinics

-confirm diagnosis by PCR

8

Clinical Manifestations of Herpes

-lesions begin as small macules that progress to vesicles on an erythematous base that eventually ulcerate

-very painful

9

Tx of New onset HSV

-Acyclovir or a similar antiviral agent

-hygiene measures to avoid secondary infection

-pain management with an NSAIDs or a lidocaine based topical if needed

-diet rich in B vitamins, vitamin C, zinc and calcium

-education and emotional support

10

Greatest risk for transmitting to NB occurs...

when mother gets infected in the third trimester

11

Acyclovir

reduces length of time of outbreak and severity and asymptomatic viral shedding (ASV)

-use as suppressive Rx to reduce transmission and at 36 weeks gestation to protect fetus

12

When can herpes infected patient deliver vaginally?

-if no lesions visible

-on suppressive rx

13

Condoms and Herpes

-reduce spread but no full proof

14

HSV most important STD in enhancing _____

HIV transmission

15

Herpes effects on neonate

-infant may be asymptomatic at birth, but 2-12 days later may develop fever or hypothermia, jaundice, seizures, and poor feeding and half develop vesicular lesions

16

herpes encephalitis

untreated is fatal

17

Tx for infants infected with herpes

-anti-viral medications help tremendously

-best tx is primary prevention (tx mom when symptoms present and consider C/S, Acyclovir does not appear to harm fetus but best avoided in 1st trimester)

18

Can Lead to pre-term birth

-syphilis
-HIV
-chlamydia
-bacteria vaginosis

19

Fastest spreading STD in US women

Chlamydia

1 in 20 girls between 14-19 has had it

20

______ isn't technically isn't an STD

Bacteria Vaginosis (BV)

21

Effects of Syphilis on pregnant women

-25% will have stillbirth or neonatal death

-40-70% will have syphilis-infected baby if untreated

-if they survive, many of these babies have long term health problems even with aggressive therapy

22

Nursing care of Pregnant patient with syphilis

-screen all patients at first visit and later - VDRL and RPR

-tx pregnant women with parental PCN-G and if allergic to PCN try to desensitize. If this isn't possible, erythromycin and azithromycin

-PCN-G can be given throughout pregnancy, but best results with the least negative fetal outcomes occur if tx by 18 weeks

-assess NB for symptoms

23

When do babies have symptoms of congenital syphilis

-at birth or may take several weeks to develop

24

Symptoms of babies with congenital syphilis

-anemia
-fever
-rashes and skin sores
-moist sores of congenital syphilis are infectious
-liver and spleen and various deformities

25

HIV and AIDS in childbearing population

-end of 2012, an estimated 1.2 mil aged 13 and older living with HIV infection

-incidence of HIV in obstetrics: 1/1000

-90% of pediatric cases r/t perinatal transmission

-sero-conversion to HIV is 6-12 weeks after exposure

26

Factors that increase viral transmission

-previous child with HIV
-preterm birth
-decreased maternal CD4 counts
-firstborn twin
-SVD
-chorioamnioitis
-intrapartum blood exposure
-failure to tx mom and fetus/NB during perinatal period with zidovudine "AZT" aka "ZDV"

27

Bacterial Vaginosis

-whiff test

-very common in preg. pts

-interruption of normal vaginal bacterial flora

-tx as it can lead to preterm labor, PROM, or chorioamnionitis

28

chorioamnionitis

intra-amniotic infection (IAI) is an inflammation of the fetal membranes (amnion and chorion) due to a bacterial infection. It typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor.

29

Symptoms of BV

-50% of women with BV have no symptoms

-excessive, thin gray or white vaginal discharge that sticks to the vaginal walls

-fishy, musty, unpleasant vaginal odor, most noticeable after sexual intercourse

-vaginal itching and irritation

30

Tx of BV

Rx with metronidazole or clindamycin