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Infections during pregnancy Flashcards

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1
Q

TORCH infxns

A 
Toxoplasmosis
"Other"
-Syphilis
-HIV
-Hepatitis B
Rubella
CMV
Herpes
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2
Q

toxoplasmosis is what type of parasite

A

obligate intracellular parasite

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3
Q

what type parasite is transmitted thru raw/poorly cooked meat or contact w/ cat feces?

A

toxoplasmosis

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4
Q

prevention counseling for toxoplasmosis in pregnancy

A

thoroughly cook meats
careful handwashing after handling raw meats
wash fruits & vegetables
wear gloves when working in soil
keep cats indoors & fed only processed food

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5
Q

how is toxoplasmosis transmitted to the fetus?

A

transplacentally

vaginal delivery

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6
Q

severe sequelae usually occurs in newborn d/t infxn w/ toxoplasmosis occurring when in mother’s pregnancy?

A

infxn acquired in 1st trimester & goes untreated

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7
Q

sequelae in infant from toxoplasmosis that is mild or not apparent at birth usually d/t infxn when in mother’s pregnancy?

A

3rd trimester

went untreated

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8
Q

different rates of transmission of toxoplasmosis from mother to fetus depends on a few things

A

placental blood flow
virulence of virus
immune status

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9
Q

many infants infected w/ toxoplasmosis appear healthy at birth & have no S&S of infxn. If there are S&S, what are they?

A

chorioretinitis
intracranial calcifications
anemia, thrombocytopenia, jaundice at birth
microcephaly

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10
Q

toxoplasmosis affected survivors may have?

A 
MR
seizures
visual defects
spasticity
severe neurologic sequelae
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11
Q

routine screening of toxoplasmosis in pregnancy is NOT recommended except?

A

maternal HIV infxn

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12
Q

positive IgG titer in toxoplasmosis infxn indicates?

A

infxn at some point in time

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13
Q

negative IgM in toxoplasmosis infxn r/o?

A

recent infxn

+IgM may persist for long periods- not reliable in assessing duration of dz

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14
Q

other tests that may help Dx toxoplasmosis

A

PCR
skin tests
Ab levels in aqueous humor/ CSF
perform amniocentesis @ 20-24 weeks’ gestation if congenital dz suggested

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15
Q

what is the DOC for maternal/ fetal toxoplasmosis?

A

Spiramycin (Rovamycine)

does not prevent sequelae in fetus if infxn has occurred

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16
Q

DOC for toxoplasmosis infxn in other populations besides maternal/fetal

A

pyrimethamine

sulfadiazine

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17
Q

if toxo infxn has occurred in fetus, what drugs might decrease risk of congenital infxn & severity of manifestations

A

pyrimethamine

sulfadiazine

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18
Q

what systemic dz is caused by motile spirochete Trepone pallidum?

A

syphilis

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19
Q

typical presentation of primary syphilis

A

painless ulcer w/in 6 wks following exposure

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20
Q

secondary syphilis presentation

A

skin rash
maybe condyloma lata
usually 1-3 months later

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21
Q

syphilis generally crosses the placenta to fetus when?

A

after 16 weeks gestation

can occur any time, sometimes as early as 6 wks

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22
Q

untreated syphilis complications in pregnancy

A

SAB
stillbirth
neonatal death

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23
Q

when is neonatal infxn w/ syphilis more likely to occur?

A

during primary/secondary infxn vs. teritiary

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24
Q

infants infected w/ syphilis usually develp evidence of dz how many days after delivery?

A

10-14

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25
early evidence of syphilis dzy in infant?
``` maculopapular rash "snuffles" mucous patches on oropharynx hepatosplenomegaly jaundice lymphadenopathy chorioretinitis ```
26
later signs of syphilis infxn
Hutchinson's teeth Mulberry molars Saddle nose Saber shins
27
is congenital syphilis readily preventable w/ prompt & appropriate maternal tx?
yes
28
serological testing for syphilis should be done when?
as early as possible again at delivery *serologic testing is mainstay of dx
29
nontreponemal testing
VDRL (Venereal dz Research lab) RPR (rapid plasma reagin) both sometimes falsely +
30
treponemal specific tests
FTA-ABS (flourescent treponemal Ab absorbed) TP-PA (T. pallidum particle agglutination) + test results indicate active dz or past exposure. regardless of tx, + for life in most individuals
31
DOC for syphilis
PCN
32
Jarisch-Herxheimer rxn
occurs most often among pts w/ early syphilis. If pregnancy this may precipitate preterm labor/ cause fetal distress. Observe closely
33
RPR & VDRL can follow what?
post tx titers of syphilis
34
If syphilis is adequately tx'd, you should see what?
a 4 fold decrease in titers by six months
35
rubella
"German measles" | risk of congenital dz related to GA at time of infxn- highes in 1st month of pregnancy, decreases w/ increasing GA
36
defects d/t rubella are rare if infxn occurs after when?
20th week of gestation
37
rubella fetal presentation in utero
SAB/ stillborn microcephaly IUGR
38
rubella fetal congenital presentation
deafness cataracts/Glaucoma neurologic: meningoencephalitis/ MR cardiac: PDA/ PA stenosis
39
rubella presentation in early CH
radiolucent bone dz blueberry muffin rash thrombocytopenia/ HSM
40
rubella presentation in late CH
thyroid abnormalities | panencephalitis
41
screening & testing for rubella
routine in pregnancy screen for IgM & IgG Ab's for primary infxn pregnant- do not vaccinate delay becoming pregnant for one month after vaccine is recommended
42
Rubella vaccination
- offer postpartum - breastfeeding NOT CI - IVIG may be given to infected woman but does not prevent fetal infxn - if rubella Dx during pregnancy, advise pt about fetal risks & counsel regarding continuing pregnancy
43
some S&S of HBV
``` jaundice joint pain fatigue nausea decrease in appetite ```
44
routine screening for HBV during pregnancy is done by looking for what?
hep B surfact antigen (HBsAg)
45
vertical transmission of HBV is related to the presence of what?
``` maternal HBeAg (indicates high viral load & active replication) fetus has 70-90% risk of becoming infected & most will become chronic carriers ```
46
tx of HBV
``` HBIG HBV vaccine (usually betwee 2 days & 2 months after birth) breastfeeding not CI in chronic carriers if infant has received both vaccinations & HBIG within 12 hrs of delivery ```
47
HIV infxn doesn't seem to have a direct effect on pregnancy, but may be associated w/ what?
pregnancy complications or perinatal infxn (BV, HSV, HPV, syphilis, CMV, toxo, HBV, HCV, etc)
48
what is more accurate in pregnancy- % of CD4+ cells or absolute #'s
% of CD4+ b/c the decline in absolute # is 2/2 hemodilution
49
HIV transmission can occur when?
antepartum intrapartum postpartum w/ breastfeeding most often occurs during/close to intrapartum period
50
initial screening for HIV
ELISA- enzyme-linked immunosorbent assay | most antibodies detectable by 3 months after infxn
51
if ELISA is +, confirm w/ what?
Western blot test
52
HIV screening in pregnancy is what?
standard, but voluntary | if they "opt out" make sure to document!
53
at risk population screening for HIV should be repeated when?
3rd trimester
54
HIV meds to avoid in pregnancy
Efavirenz during 1st triemester combo stavudine (d4T) & didanosine (ddI) nevirapine if CD4 count >250/mm3
55
when do start HIV meds during pregnancy
depends on immune status | may start after 1st trimester to avoid drug exposure
56
antiretroviral drug Zidovudine is known to reduce what?
risk of transmission
57
what type of ULS should be done in HIV + pt?
``` detailed ULS (level II) usually @ 18-20 weels ```
58
precautions during delivery to avoid transmission of HIV
chorioamnionitis prolonged rupture of membranes invasive fetal monitoring & mode of delivery are risk factors for vertical transmission
59
if HIV viral load >1000, what should be planned?
c-section at 38 weeks | if vaginal birth, avoid compromising fetal skin
60
HIV + mothers should avoid what after birth of baby?
breastfeeding
61
primary HSV poses the greatest risk to?
the fetus
62
how is the fetus infected w/ HSV?
ascending infxn 2/2 spontaneous rupture of membranes or passage thru infected lower genital tract
63
infants w/ localized herpes usually do well, but those w/________________dz do very poorly
disseminated
64
congenital HSV infxn presentation
microcephaly hydrocephalus chorioretinitis vesicular skin lesions
65
3 subtypes of acquired HSV infxn have been ID'd, what are they?
1. Dz localized to skin, eye, mouth (virtually no mortality) 2. encephalitis w/ or w/o skin, eye, mouth involvement (mortality ~15%) 3. disseminated infxn involving multiple sites, including the CNS, LU, LIV, adrenals, skin, eye, mouth (mortality ~ 57%)
66
morbidity related to HSV related encephalitis or disseminated dz may include
``` seizures psychomotor retardation spasticity blindness learning disabilities ```
67
testing for HSV
clinical exam confirm w/ viral cx PCR testing (more sensitive than cx) serologic testing *routine screening for HSV not currently recommended
68
mngt of HSV
Acyclovir (safe in pregnancy) -for suppression begin at 36 weeks -IV for severe maternal infxn c-section if lesions ID'd
69
acyclovir in pregnancy reduces the risk of?
clinical HSV recurrence at delivery c-section for recurrent lesions risk of viral shedding at delivery
70
what is the MC congenital viral infxn
CMV
71
CMV is transmitted via
``` saliva semen cervical secretions breast milk blood urine ```
72
CMV S&S
most infants asymptomatic | -petechiae hepatosplenomegaly, jaundice, thrombocytopenia, microcephaly, chorioretinitis, nonimmune hydrops fetalis
73
long term sequelae of CMV
severe neurologic impairment & hearing loss
74
CMV general
no effective vaccine/ tx routine screening NOT recommended stress prevention (i.e. good handwashing) test via PCR if testing antivirals have been used neonates, but still experimental
75
risk for congenital infxn of VZV limited to what?
maternal infxn occurring during first half of pregnancy
76
VariZIG
purified immune globulin from plasma containing high levels of antivaricella antibodies
77
VariZIG should be considered w/in______hrs of exposure of nonimmune pts
96 hrs
78
screening for VZV is?
routine
79
what are some maternal complications of VZV infxn?
varicella pneumonia & encephalitis | more common in adults than children
80
varicella pneumonia occurs more frequently during?
pregnancy related infxn assoc. w/ maternal mortality tx w/ acyclovir
81
VZV fetal infxn during 1st 1/2 of pregnancy may result in?
varicella embryopathy - limb atrophy - scarring of skin on extremities - CNS involvement - ocular manifestations
82
VZV can be fatal for infant if mother develops infxn w/in when?
5 days before or 2 days after delivery | administer variZIG
83
possible peripartum infxn caused by GBS
``` endometritis amnionitis UTI sepsis miningitis (rare) postpartum fever & tachy ```
84
clinical manifestations of GBS in newborn
early-onset infxn: 1st wk of life, respiratory distress, septicemia/ septic shock, pneumonia, meningitis late-onset infxn: reported beyond 3 months late-late onset infxn:very low birth wt preterm neonates
85
universal screening for GBS happens between?
35-37 weeks
86
GBS + women should receive Abx prophylaxis when?
in labor or w/ rupture of membranes
87
if cx status unknown then prophylaxis given in following situation
preterm labor (<37 wks) rupture of membranes 18 hrs+ maternal fever during labor (at/above 38 C) GBS bacteriuria during current pregnancy previously given birth to an infant w/ early-onset GBS dz
88
vulvovaginitis
spectrum of conditions causing vaginal/ vulvar sx's
89
diagnostic tests for vulvovaginitis
testing for vaginal pH saline "whiff" test saline wet mount 10% KOH microscopy
90
bacterial vaginosis presentation
c/o "fishy" odor, esp. post-coital gray-white/ yellow d/c mild vulvar irritation pH > 4.5
91
diagnosing BV
``` microscopic exam under saline wet mount increase in WBC's clumps of bacteria loss of normal lactobacilli characteristic "clue cells"- resemble ground glass ```
92
BV tx
oral/topical metronidazole or clindamycin | neither drug shown to have teratogenic effects
93
vulvovaginal candidiasis presentation
itching burning, external dysuria & dyspareunia common bright red excoriation in severe cases thick, adherent "cottage cheese" d/c, oderless pH usually 4-5
94
Dx vulvovaginal candidiasis
microscopic exam made under saline wet mount or 10% blastospores or pseudohyphae cx
95
Tx of vulvovaginal candidiasis
``` topical application synthetic imidazoles: miconazole clotrimazole butoconazole terconazole ```
96
trichomonas vulvovaginitis transmission
sexual contact fomites survive in swimming pools/ hot tubs
97
what is trich associated with?
``` PID endometritis infertility ectopic pregnancy preterm birth *been shown to facilitate HIV transmission ```
98
trich presentation
``` mild to severe vulvar itching/burning copious d/c w/ rancid odor- "frothy", thin & yellow-green to gray color pH>4.5 dysuria sypareunia edema/ erythema of vulva petechiae or "strawberry patches" upper vagina or cervix- "classic signs" ```
99
Dx of trich
microscopic exam made under saline wet mount large # if mature epithelial cells, WBCs trich organism
100
Tx of trich
oral metronidazole/ tinidazole partner notification & tx avoid unprotected sex during tx abstinence from EtOH- avoid disulfram like rxn assoc. w/ pre-term deliver, PROM , SGA tx may not prevent complications f/u for test of cure- absolute resistance rare, relative resistance may be as high as 5%

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