infections and vaccination in pregnancy

Question 1

endometritis - definition/association

Answer 1

Inflammation associated with retained products of conception following delivery, miscarriage, abortion, or foreign body (IUD)

Question 2

endometritis - mechanism

Answer 2

retained materials in uterus –> infection by bacterial flora from vagina or intestine tract

Question 3

endometritis - treatment / etiology

Answer 3

gentamicin + clindamycin +/- ampicillin

- polymicrobial

Question 4

postpartum endometritis - RF

Answer 4

1. C-section
2. corioamnionitis
3. Group B strep
4. prolonged rupture of membranes
5. operative vaginal delivery

Question 5

postpartum endometritis - clinical features

Answer 5

1. fever for more than 24 h postpartum
2. uterine fundal tenderness
3. purulent lochia

Question 6

pyelonephritis in pregnancy - treatment

Answer 6

ceftriaxone

Question 7

chorioamnionitis presents with

Answer 7

maternal fever, maternal and fetal thacycardia, uterine tenderness

Question 8

chorioamnionitis typically presents in

Answer 8

patietns with premature or prolonged rupture of membranes as maternal fever, maternal and fetal tachycarda, uterine fundal tenderness, maternal leukocytosis

Question 9

chorioamnionitis - RF

Answer 9

1. prolonged rupture of membranes (more than 18 h)
2. preterm premature of membranes
3. prolonged labor
4. internal fetal/uterine monitoring devises
5. repetitive vaginal examinations
6. presence of genital tract pathogens

Question 10

chorioamnionitis - diagnosis

Answer 10

Maternal fever plus 1 or more of the following:
1. fetal tachycardia (more than 160) for at least 10 mins
2. maternal leukocytosis
3, purulent amniotic fluid
4. maternal tachycardia (more than 100)
6. uterine fundal tenderness

Question 11

chorioamnionitis - management

Answer 11

broad spectrum antib

delivery

Question 12

chorioamnionitis - complications

Answer 12

maternal: postpartum hemorrhage, endometritis
neonatal: preterm birth, pneumonia, encephalopathy

Question 13

Asymptomatic bacteriuria - definition

Answer 13

more than 100.000 bacteria

Question 14

Asymptomatic bacteriuria - RF

Answer 14

1. Pregesational DM
2. multiparity
3. history of UTIs

Question 15

Asymptomatic bacteriuria - common pathogens

Answer 15

1. E. coli (MC)
2. enterobacter
3. klebsiella
4. Strep Bg

Question 16

Asymptomatic bacteriuria - treatment

Answer 16

1. augmentin
2. nitrofurantoin
3. cephalexin
4. fosphomycin

Question 17

Preventing neonatal group B strep infection - universal screening

Answer 17

rectovaginal culture at 35-37 weeks gestation

Question 18

Preventing neonatal group B strep infection - indications

Answer 18

1. prior delivery complicated by neonatal GBS infection2
2. BGS bacteriuria or GBS UTI during current pregnancy (regardless of treatment)
3. GBS positive rectovaginal culture
4. Unknown GBS status PLUS any of: less then 37 weeks gestation, intrapartum fever, rupture of membranes for 18 or more hours

Question 19

Preventing neonatal group B strep infection - prophylaxis

Answer 19

1st line treatment: penicillin

Question 20

when to test toxo in pregnancy

Answer 20

not indicated

only in symptoms (fever, nodes, malaise)

Question 21

syphilis in pregnancy but penicillin allergy - next step

Answer 21

desensitisation

Question 22

treatment of vaginosis in pregnancy

Answer 22

metronidazole

Question 23

HCV in pregnancy - complications

Answer 23

1. gestational DM
2. Cholestasis of pregnancy
3. preterm delivery

Question 24

HCV - maternal management

Answer 24

1. Ribavirin is teratogenic (avoid)
2. no indication for barrier protection in serodiscordant, nonogamous couples
3. HAV + HBV vaccination

Question 25

HCV in pregnancy - prevention of vertical transmission

Answer 25

1. vertical transmission strongly associated with maternal viral load (+ HIV coinfection) 2. C- section is not protective 3. Scalp electrodes should be avoideed 4. Sbreastfeeding should be encouraged unless maternal blood present

Question 26

treatment of chronic HCV in non pregnant

Answer 26

inf-a and ribavirin

Question 27

HIV management during pregnancy - anterpartum

Answer 27

1. HIV RNA viral load at initial visit, every 2-4 wks after initiation or change of therapy, monthly until undetectable, then every 3 months 2. CD4 every 3-6 months 3. Resistance testing if not previously performed 4. ART initiation NOW 5. avoid amniocentesis unless viral load less than 1000

Question 28

HIV management during pregnancy - intrapartum

Answer 28

- avoid artificial rupture of membranes, fetal scalp electrode, operative vaginal delivery - viral load less than 1000: ART + vaginal delivery - viral load more than 1000: ART + zidovudine + c-section

Question 29

HIV management during pregnancy - postpartum

Answer 29

mother: continue ART infant: maternal viral load less than 1000: zidovudine more than 1000: multi-drug ART

Question 30

RF for neonatal HSV infection

Answer 30

1. 1y maternal infection 2. longer duration of rupture of membranes 3. vaginal delivery with active lesions 4. impaired skin barrier (eg. fetal scapl electrode) 5. preterm birth

Question 31

HSV - vaginal delivery?

Answer 31

only if no active genital lesions at the time of delivery | - and receive prophylacticly antivirals from the 36 wk

Question 32

check HCV during pregnancy?

Answer 32

only for patients with RF (HIV +, IV drug use)

Question 33

contraindicated vaccines during pregnancy

Answer 33

1. HPV 2. MMR 3. live attenuated infl 4. VARICELLA

Question 34

recommended vaccines during pregnancy

Answer 34

1. Tdap 2. inactivated inf 3. Rho (D) immunogl

Question 35

Vaccines during pregnancy - for high risk patients

Answer 35

1. HBV 2. HAV 3. Pneumococcus 4. H. infl 5. Meningococ 5. Varicella zoster immunogl

Question 36

All pregnant should receive screening for

Answer 36

1. HIV 2. HBV 3. Chlamydia 4. syphilis