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 (36):
1

What is the definition of puerperium?

Puerperal state where mothers tissue returns to non-pregnant state

- 6-8 weeks post partum

2

What is the definition of a neonate?

Recently born individual who is less than 4 weeks old

3

What infections can be spread through haematogenous spread (mother -> baby)?

CMV
Zika virus
Syphillis
Parvovirus B19
Toxoplasmosis
VZV

4

What infection can be transmitted through delivery?

HSV
Chlamydia
Gonorrhoea
HIV*
Hep B*
Group B strep

HIV and Hep B are screened - prophylaxis available

5

Why are women more prone to infections during pregnancy?

Physiological/immune changes predisposes women to some infections

Handling of drugs differ e.g. increased GFR/excretion - higher doses required

Serum levels of antibiotics are lower - underdose/treatment failure?

Immune suppression - symptoms might not manifest/dampened with pregnancy

6

Why consideration must we have for prescribing antimicrobials to pregnant/puerperium mothers?

Antimicrobials might be harmful to embryo/foetus/neonate

Crosses placenta to some extent and all cross in breast milk

7

What antibiotics are considered safe for use during pregnancy?

Penicillins
Cephlasporins

(provided no allergy)

8

What antibiotics new considered unsafe for use during pregnancy?

-Trimethoprim-sulphamethoxazole
-Tetracycline
-Fluroquinolones
-Chloramphenicol

(benefit:risk ratio)

9

What is primary infection and secondary infection?

Primary infection = first episode without immunity

Secondary - latent infection e.g. shingles

10

Name some primary infections which are asymptomatic or cause very little symptoms to mother

CMV
Pika virus

11

Name some primary infections which cause severe symptoms/infection to mother

VZV
Herpes
Measles
Influenza

12

What are the effects of infection to foetus

Spectrum - can range from no illness to serve, still birth or miscarriage, some can be tetranogenic e.g. rubella, toxoplasmosis, zika

13

What diagnostic procedures can be used?

-Serology (IgG - prior exposure; IgM - current)

-PCR

of relevant samples e.g. blood, vesicle fluid, amniotic fluid

14

Concerning maternal UTIs, why should asymptomatic bacteriuria be treated?

Can develop to symptomatic bacteria which is associated with premature delivery and perinatal mortality

15

What is the recommended process by which bacteriuria is diagnosed and treated?

2 samples containing 10^5 of same organism
(asymptomatic bacteriuria)

7 days on non-toxic antibiotics e.g. amoxycillin, cefalexin, even if asymptomatic

Test again to test cure

16

What can intraamniotic infections cause?

Uncommon but can cause early delivery and perinatal morbidity/mortality

17

What infection does choropamniotitis cause?

Inflammation of umbilical cord, placenta, amniotic membranes

18

What are the symptoms of intraamniotic infections?

Maternal fever (>38 degrees)

Malodorous amniotic fluid*

Uterine tenderness

Foetal/maternal tachycardia

Leukocytosis

19

What are the risk factors for intraamniotic infections?

Premature/rupture of membranes**

Amniocentesis/cordocentesis (i.e. injections)

Cervical cerclage (man made material)

Multiple vaginal examination

BV

20

What is the pathogenesis for intraamniotic infections?

Vaginal bacteria ascend into cervix

Haematogenous spread is rare eg. listeria

21

What are the causative organisms for intraamniotic infections?

E coli (GI tract)
Enterococci (GI tract)
Group B strep

Endogenous flora going to wrong place

22

What is puerperal endometritis?

Infection of the womb (puerperium - after birth)

Major cause of maternal death

23

What are the risk factors for puerperal endometritis?

-C-section
-Prolonged labour
-Prolonged rupture of membranes
-Multiple vag exams

24

What are the symptoms of puerperal endometritis?

Fever (38.5 degree in first 24hrs or 38 for 4 hrs, 24 hrs post delivery

Uterine tenderness - should be getting better

General malaise/abdo pain - shouldn't be feeling systemically unwell!

Leucocytosis

Foul smelling discharge

25

What are the causative organisms?

-E coli
-Enterococci
-Strep A/B
-Anaerobes

BLOOD CULTURE

26

What is the treatment for puerperal endometritis?

Broad spectrum IV antimicrobials e.g. co-amoxiclav

(lots of causative organisms - combination therapy)

27

What is puerperal mastitis?

Infection of nipples (cracked/fissured) post partum (5.5 weeks post delivery)

28

What are the symptoms of puerperal mastitis?

Fever chills, pain, red/warm breast (affected), tenderness
discharge?

29

What is the causative organism of puerperal mastitis?

Staph aureus - penecillin not effective against (has beta lactase)

Flucloxacillin

30

Why are amoxycillin not effect against staph aureus?

produce beta lactase

Diagnose Flucloxacillin

31

What other causes of puerperal sepsis are there?

Pneumonia
Catheter site infections
Wound infection e.g .C section

32

What is sepsis?

Syndrome involving pathogenic bacteria invasion into blood

33

What is common condition associated with neonatal sepsis? When does it usually occur?

Neonatal meningitis

2 weeks post birth (EARLY ONSET)

34

What are the signs of sepsis in neonates?

Subtle/atypical

e.g. not eating properly, diarrhoea, fever, hypothermia ,

respiratory (apnoeas, cyanosis, dyspnoea)

- CV - tachycardia, bradycardia, hypotension

Hepatic - jaundice

CNS - irritability, lethargy, seizure

35

What is the main cause of neonatal sepsis/meningitis?

Group B Staph
E Coli
Listeria

36

How is neonatal sepsis diagnosed/treated?

Culture - blood, urine, CSF

Broad spectrum antibiotics (amoxicillin plus gentamicin)

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