Infectious Diseases in Pregnancy

Question 1

what % of pg women dvp UTIs?

Answer 1

5

Question 2

why do we treat asx’c bacteriuria in pg women?

Answer 2

b/c there’s a higher rate of cystitis and pyelonephritis

Question 3

why is pyelonephritis bad in pg’y?

Answer 3

higher rates of progression to ARDS, sepsis

Question 4

why are pg women at increased risk of UTI?

Answer 4

progesterone causes decreased bladder tone and dilates the ureters, plus uterus compressing ureters => obstruction

Question 5

how to dx a UTI:

Answer 5

sx’s of dysuria, urgency, frequency, + urine cx

Question 6

tx of asx’c bacteriuria:

Answer 6

amoxicillin, nitrofurantoin, TMP-SMX. F/u with test-of-cure cx 1-2 weeks later.
Can add phenazopyridine (local anesthetic) but warn pt that urine will turn orange.

Question 7

mgt of pyelonephritis in pg’y:

Answer 7

inpt tx w/IV abx (ampicillin & gentamicin) & hydration. Watch until asx’c for 24-48h.

Question 8

why is BV bad during pg’y?

Answer 8

increased risk of PPROM, preterm delivery, puerperal infections

Question 9

how to dx BV?

Answer 9

sx’s of malodorous discharge, vaginal irritation, whiff test, look for clue cells

Question 10

tx of BV during pg’y?

Answer 10

metronidazole vaginal gel or clindamycin orally or vaginal gel. F/u with test of cure

Question 11

what does GBS cause?

Answer 11

UTI, chorioamnionitis, endomyometritis, neonatal sepsis

Question 12

when to screen for GBS colonization and how?

Answer 12

b/w 36 and 37 weeks, rectovaginal cx

Question 13

what to do if a pt is GBS +

Answer 13

IV penicillin G during labor. Give clindamycin if penicillin allergic.

Question 14

what to do if GBS status is unknown

Answer 14

give IV penicillin G during labor

Question 15

what is chorioamnionitis associated with?

Answer 15

PROM and PPROM

Question 16

s&s of chorioamnionitis:

Answer 16

maternal fever
elevated maternal WBC
uterine tenderness
fetal tachycardia

but hard to find all these things since many of them occur during labor or 2/2 an epidural

Question 17

how to dx chorioamnionitis?

Answer 17

culture amniotic fluid via amniocentesis, check IL-6 levels in amniotic fluid

Question 18

tx of chorioamnionitis

Answer 18

IV abx - ceftriaxone + gentamicin + ampicillin or clinda

induce or augment labor, or c/s if nonreassuring fetal status.

Question 19

mgt of pg pts w/HSV

Answer 19

acyclovir from week 36 till delivery

Question 20

which is worse, primary HSV during pg’y or secondary HSV during pg’y?

Answer 20

primary b/c viremia occurs and can cross placenta

Question 21

how to dtm if its a primary or secondary HSV infection?

Answer 21

look for IgG and IgM titers. If its a secondary infection, pt will already have IgG. If its primary , they’ll only have IgM

Question 22

why is HSV primary infection late in 3rd trimester worse than earlier in pg’y?

Answer 22

b/c late in pg’y there are fewer maternal Ig’s transmitted to fetus

Question 23

mgt of infants with herpetic lesions?

Answer 23

IV acyclovir asap

Question 24

are VZV titers drawn?

Answer 24

only if mom is unsure about her hx of exposure

Question 25

who should receive VZV Ig?

Answer 25

pts who are tested for VZV Ig's preconceptually and are negative, and those who have no hx of exposure but have been exposed

Question 26

why is parvoB19 bad in pg'y?

Answer 26

can cause fetal hydrops, hemolytic anemia

Question 27

how to dx acute Parvo infection?

Answer 27

check parvo IgM levels. If +, follow w/serial u/s 4-6w after exposure for signs of hydrops. Intrauterine transfusion if signs of hydrops. Can also use MCA Dopler to look for peak systolic velocity to ID fetal anemia.

Question 28

manifestations of CMV infection in neonate:

Answer 28

cytomegalic inclusion disease - hepatomegaly, splenomegaly, thrombocytopenia, jaundice, cerebral calcifications, chorioretinitis, interstitial pneumonitis. => MR, hearing loss, neuromuscular disorders

Question 29

what does rubella look like (in adults):

Answer 29

maculopapular rash that begins on face and spreads to trunk & limbs, arthritis, arthralgias, diffuse lymphadenopathy lasting 2-4d

Question 30

what is congenital rubella syndrome?

Answer 30

deafness, cardiac abnormalities, cataracts, MR (eyes and ears and brain)

Question 31

how to dx rubella?

Answer 31

elevated IgM levels in infant, or IgG titers elevated over time

Question 32

tx of rubella?

Answer 32

none once acquired. But immunization prevents it. Check a rubella Ig titer at initial prenatal visit.

Question 33

what to do if a pt is negative on their rubella Ig titer?

Answer 33

have them avoid anyone who may be exposed to rubella

Question 34

what % of infants born to HIV + moms will be HIV +?

Answer 34

25%

Question 35

when is HIV transmission believed to occur?

Answer 35

late in 3rd tri or during L&D

Question 36

in pts on no HIV therapy, which mode of delivery has lowest transmission rates?

Answer 36

C/s

Question 37

what is current recommendation for mgt of HIV in pg pts?

Answer 37

give zidovudine or AZT after 1st tri, intrapartum, and neonatally. Current standard of care = maintain on HAART during pg'y to keep viral load down.

Question 38

tx of GC in a pg pt?

Answer 38

ceftriaxone, penicillin, or prebenecid | Same as in anybody else - ceftriaxone + azythromycin!

Question 39

what to do if a pg pt is + on HbsAg on initial screening labs?

Answer 39

give HepB immunoglobulin to mom, and to baby at birth, 3, mos, 6 mos. All infants are immunized at birth.

Question 40

what form of syphillis is transmitted to fetus?

Answer 40

primary or secondary. Latent syphillis will not be transmitted.

Question 41

CP of congenital syphillis:

Answer 41

maculopapular rash, snuffles (rhinitis, rhinorrhea), hepatomegaly, splenomegaly, hemolysis, LAD, jaundice. Can dvp CN XIII palsy, saber shins (convex tibias), hutchinson's teeth, saddle nose

Question 42

how to dx syphillis

Answer 42

IgM antitreponemal Ig's (VDL, RPR)

Question 43

Tx of syphillis

Answer 43

penicillin

Question 44

CP of congenital toxo infection:

Answer 44

fever, seizure, chorioretinitis, hydrocephaly, microcephaly, HSM, jaundice

Question 45

how to dx neonatal toxoplasmosis:

Answer 45

detecting IgM Ig's, but lack of these does not rule it out

Question 46

who is screened for toxo and how?

Answer 46

high-risk pts | IgG titers

Question 47

what is recommended to all pg women to reduce risk of toxo infection?

Answer 47

avoid cat litter boxes

Question 48

what to do if suspected maternal infection?

Answer 48

check IgM and IgG titers. Then obtain fetal blood via PUBS

Question 49

tx of fetal toxo?

Answer 49

spiramycin