Infections of pregnancy, puerperium and neonate Flashcards Preview

Clinical Pathology > Infections of pregnancy, puerperium and neonate > Flashcards

Flashcards in Infections of pregnancy, puerperium and neonate Deck (42):
1

What is the definition of 'pregnancy'?

Conception to delivery

2

What is the puerperium?

- The puerperal state or period.
- Specifically - the few weeks following delivery during which the mother's tissues return to their non-pregnant state.
- Usually 6-8 weeks post partum

3

What is a neonate?

An infant less than 4 weeks old.

4

Which infections can be transmitted to the foetus during pregnancy (i.e. haematogenous spread via placenta)?

- CMV
- Parvovirus B19
- Toxoplasmosis
- Secondary/tertiatry syphilis
- VZV
- Zika virus

5

Which infections can be transmitted to the baby during delivery?

- Group B Strep
- HSV
- Gonorrhoea
- Chlamydia
- HIV
- Hep B

6

For which diseases is prophylaxis available and screening undertaken?

- HIV
- Hep B

7

Why does the handling of drugs differ during pregnancy?

- Increase of GFR results in increased renal excretion of many antimicrobials
- Serum levels of anti-microbials are generally lower during pregancy

8

What must be considered, with regards to the foetus, when prescribing in pregnancy?

- The potential to cause harm to the embryo/foetus/neonate must be considered
- All antimicrobials cross the placenta to some extent
- Virtually all antimicrobials appear in breast milk if given in therapeutic amounts to breast feeding women

9

Which antimicrobials are considered 'safe' in pregnancy?

- Penicillins
- Cephalosporins

10

Which antimicrobials are considered 'unsafe' in pregnancy?

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

11

Which primary viral infections cause mild symptoms/are asymptomatic?

- CMV
- Zika

12

Which primary viral infections are severe?

- VZV
- HSV
- measles
- influenza

13

What can be the consequences of foetal viral infections?

- Nothing
- Birth defects
- Stillbirth
- Spontaneous abortion

14

Which viruses are teratogenic?

- Rubella
- ?Zika

15

What is involved in the diagnosis of viral infections during pregnancy?

- serology
- and/or PCR relevant samples (blood, vesicle fluid, amniotic fluid)

16

Why is screening for bacteriuria indicated in pregnancy?

- Asymptomatic bacteriuria = no symptoms of UTI and 2 samples containing >10^5 same organism
- Bacteriuria can develop into symptomatic UTI if untreated
- Continuing bacteriuria is associated with premature delivery and increased perinatal mortality.

17

What is the recommended treatment for UTI in pregnancy?

- 7 days relatively non-toxic antibiotic e.g. amoxicillin or cefalexin (trimethoprim - give with folate, avoid 1st trimester)
- Repeat urine culture post treatment to confirm cure.

18

What percentage of term pregnancies have intra-amniotic infections?

1-2%

19

What percentage of pregnancies with pre-term labour are affected with intra-amniotic infections?

10-25%

Major cause of perinatal morbidity and mortality

20

What is chorioamnionitis?

Refers to inflammation of umbilical cord, amniotic membranes, placenta.

21

What are the clinical features of intra-amniotic infections?

- maternal fever
- uterine tenderness
- malodorous amniotic fluid
- maternal or foetal tachycardia
- raised white cell count

22

What are the risk factors for intra-amniotic infections?

- Prolonged rupture of membranes (most common)
- amniocentesis
- cordocentesis
- cervical cerclage
- multiple vaginal examinations
- BV

23

What is the pathogenesis of intra-amniotic infections?

- Bacteria present in the vagina cause infection by ascending through the cervix
- Haematogenous (via blood ) infection is rare e.g. Listeria monocytogenes

24

What are the common causative organisms in intra-amniotic infections?

- group B Streptococcus
- enterococci
- Escherichia coli

25

What is the management of intra-amniotic infections?

- antimicrobials and delivery of the foetus
- antimicrobials should be administered at the time of diagnosis (not after delivery)

26

What is purperal endometritis?

- infection of the womb during puerperium affects ~5% of pregnancies
- puerperal sepsis remains a major cause of maternal death

27

What are the risk factors for puerperal endometritis?

- caesarean section
- prolonged labour
- prolonged rupture of membranes
- multiple vaginal examinations

28

What are the clinical features of puerperal endometritis?

- fever (38.5C in first 24h post delivery or >38.0C for 4 hours, 24h+ after delivery)
- uterine tenderness
- purulent, foul-smelling lochia
- increased white cell count
- general malaise, - abdominal pain

29

What are the common causative organisms in puerperal endometritis?

- Escherichia coli
- Beta-haemolytic streptococci
- Anaerobes

30

What is invovled in the diagnosis of puerperal endometritis?

- The role of transvaginal endometrial swabs is controversial

31

What is the treatment for puerperal endometritis?

Broad-spectrum intravenous antimicrobials - continued until the patient has been apyrexial for 48 h

32

What are the clinical features of puerperal mastitis?

- mean onset 5.5 weeks post delivery
- abrupt onset fever, chills and breast soreness
- redness, warmth and tenderness of affected breast

33

What is the causative organism in puerperal mastitis?

S. aureus

34

How is puerperal mastitis diagnosed?

- clinical
- culture of pus

35

What is the management of purperal mastitis?

- continue nursing
- optimise nursing technique and breast care (also key to prevention)
- anti-staphylococcal antibiotics (e.g. flucloxacillin)
- incision/drainage if abscess present

36

What are the unusual causes of puerperal sepsis?

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

37

What is a common complication of neonatal sepsis?

Neonatal meningitis

38

When does early onset infection present?

2 weeks

39

What are the clinical features of neonatal sepsis/meningitis?

Temperature
- hypothermia or pyrexia

Respiratory
- dyspnoea
- apnoeas
- cyanosis

Cardiovascular
- tachycardia
- bradycardia
- hypotension

Hepatic
- hepatomegaly
- jaundice

Gastrointestinal
- anorexia
- vomiting
- abdominal distension
- diarrhoea

Haematological
- bleeding disorders

Central nervous system
- lethargy
- irritability
- seizure

40

What are the causitive organisms in neonatal sepsis/meningitis?

- Group B Streptococcus
- Escherichia coli
- (Listeria monocytogenes)

41

How is neonatal sepsis/meningitis diagnosed?

Blood, urine and CSF culture

42

How is neonatal sepsis/meningitis managed?

Broad spectrum antimicrobials active against the common causes e.g. amoxicillin plus gentamicin

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