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Infxn in Pregnancy Flashcards

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1
Q

% of pregnancy pts are GBS carriers?

Vertical transmission (if no abx)

A

~20%

50%

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2
Q

Top 3 bx risk factors for preterm birth

A
  1. BV <16w GA
  2. gonorrhea
  3. asx bx
  4. chlamydia (24w > 28w)
  5. trichomonas
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3
Q

Birth risks assoc w/ BV

A

PTB
chorio
postpartum endometritis
inc risk late miscarriage

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4
Q

Tx for flu?
Timing after sx?

in pregnancy

A

Oseltamivir
<48hrs after sx

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5
Q

Tx for asx BV in pregnancy

A

none unless hx preterm delivery

metronidazole or clinda

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6
Q

HIV: CI in breastfeeding?

A

yes (in USA)

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7
Q

HCV: CI in breastfeeding?

A

no

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8
Q

Which pts do we HCV screen in prengancy?

A

All!

Traditionally, high-risk (homeless, IVDU, transfusion before 1992)

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9
Q

Amsel Cx

how many cx to dx?

A

thin/grey discharge
+clue cells
+whiff when KOH applied
elev pH >4.5

@least 2

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10
Q

When do infants get flu vx?

A

> 6mo

prior to that, use passive immunity from mom

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11
Q

HepB Ag type for acute infxn?

A

surface antigen

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12
Q

HepB Ag tye for chronic infxn?

A

core Ag

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13
Q

Pneumococcal Vx in Pregnancy?

A

Yes, if indicated:
-chronic metabolic, liver, heart, lung, renal dz
-immunosuppression (malignancy, asplenia)

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14
Q

Most common congenital infxn worldwide

A

CMV

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15
Q

Congenital CMV Sx

A

ID, sensoneural hearing loss, visual impairment

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16
Q

Pregnancy impact on HIV d/z process

A

no change in course / opportunistic infxns

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17
Q

MMC maternal toxo (source)

A

undercooked lamb, pork

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18
Q

Varicella in Pregnancy Sx

A

chickenpox
(different “crops” age)

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19
Q

Congenital varicella findings

A

microcephaly
skin scarring
hydrocephalus
chorioretinitis / micropthalmia
limb abnormalities
GI: stenotic bowel

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20
Q

VZV contraction timing that confers highest risk for vertical transmission?

A

5days pre-delivery - 2days postpartum

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21
Q

Varicella ppx after exposure

A

immunoglobulin

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22
Q

Maternal tx for varicella

A

acyclovir
(PO for rash, IV for pneumonia)

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23
Q

Parvo B19
-type of virus
-sx
-fetal effects if acute maternal infxn

MoA of d/z

A

-ssDNA
-slapped cheeks, flu-like
-normal (more common)&raquo_space; hydrops, fetal death

suppress erythroid precursors -> aplastic crisis -> anemia

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24
Q

most specific sign for chorio?

A

+ amniotic fluid culture

but not often used (clinical dx)

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25
VZV virus type
ssDNA herpesvirus
26
Abx choice for laboring pt, ?GBS, w/ severe PCN allergy
Vancomycin | *clinda if know sensitivities
27
Complications of Pyelo in Pregnancy
1. sepsis* 2. ARDs 3. anemia 4. recurrent UTI 5. PTB 6. AKI 7. renal abscess | *most common (49%) vs ARDS (47%)
28
# Parvo B19 Dx Maternal? Fetal?
Maternal Infxn: serum IgG, IgM Fetal Infxn: amniotic fluid PCR
29
HSV Virus Type
dsDNA (HSV1, HSV2)
30
Maternal HSV Tx for recurrent infxn
acyclovir 400 TID 5d or acyclovir 800 BID 5d
31
Maternal HSV Tx: Daily suppression (and initiation)
acyclovir 400mg TID @36w0d
32
When to offer CS for HSV?
1. active lesions or prodromal sx 2. primary or nonprimary first-episode genital HSV during third trimester of pregnancy* | *due to prolonged viral shedding
33
Neonatal HSV Presentations (and %)
1. skin,eyes,mouth (45%) 2. CNS d/z (30%) 3. Disseminated (25%)
34
Neonatal HSV Tx
1. skin,eyes,mout :IV acyclovir 2wk 2. CNS, disseminated: acyclovir 3wk
35
Induction / Augmentation method assoc. w/ inc rate infxn
mechanical methods (compared to pharmacologic)
36
HBV Acquisition that most likely progresses to chronic infxn
acquired in perinatal /neonatal period | acquired during adulthood more likely to resolve after acute infxn
37
MCC valvular heart d/z in pregnancy worldwide? | Which valve most commonly affected?
rheumatic valve d/z | mitral valve > aortic valve
38
HCV Vertical Transmission Risk Factors (highest to lowest) | ?delivery route ## Footnote ?breastfeeding
1. high maternal HCV titer (HCV viremia) 2. PROM (>6hrs) 3. FSE use 4. HIV coinfection 5. maternal drug use | SVD vs CS (doesnt influence risk) ## Footnote breastfeeding ok
39
Most sensitive test for chorioamnionitis?
interleukin 6 (100%)
40
Most specific test for chorioamnioinitis?
gram stain
41
Neonatal HSV __% long-term sequelae
20%
42
Primary syphilis sx | timing
painless chancre | <1mo
43
Secondary Syphilis Sx | timing
-plantar/palmar target lesions -patchy alopecia -condylomata lata | 1-2mo after chancre appears
44
Tertiary Syphlis Sx
-neurosyphlis (variable presentation) -tabes dorsalis (balance, vision loss) -aortic valve d/z, aneurysms -gummas | years, decades
45
Give abx for repair of obstetric lac? | type, Timing, duration?
for OASIS (3rd, 4th degree) | cefotetan or cefoxitin; single dose @ repair
46
HIV mode of delivery (and timing)
viral load >1000: C/S @ 38w viral load <1000: trial of labor
47
Indications for pCS (%)
1. failure to progress (35%) 2. nonreassuring FHR (27%) 3. fetal malpresentation (18%)
48
Ancef dose for C/S
2g ancef <1hr prior to incision | 3g if >120kg
49
Listeria bx type
gram+ bacillus
50
Listeria bx infxn route
unpasteurized cheese processed foods
51
Listeriosis sx
flu-like sx (often asx)
52
Listeriosis impact on fetus
-stillbirth -abscesses -sepsis
53
Listeria Mgmt / Tx: 1. Asx 2. mild, afebrile 3. febrile pts
**Asx**: no test/tx **mild, afebrile**: expectant vs tx if blood cx positive **febrile**: tx on clinical suspicion; blood cx
54
Abx Tx for listeriosis ## Footnote allergy?
high-dose IV amp (6h/day) for 2wks | *+/-gent ## Footnote allergy to PCN -> TMP-SMX
55
HIV vertical transmission in VD if VL >1000c
25%
56
rompt: HIV vertical transmission in VD if VL <1000c (and on HAART)
1-2%
57
HSV2+ serology % rate among women
~26%
58
HIV unknown presenting in labor: What test to order? | sensitivity, specificity? ## Footnote Result time
Rapid test | >99% for chronic infxn ## Footnote results in 20min
59
Rapid HIV test MoA | downside
look for HIV Abs in blood | may take 1-3mo for Abs to form ("window period")
60
ELISA for HIV testing: in pregnancy? | downsides
screening only; takes 1-3 hrs | "third generation" rapid test; can miss acute infxn ## Footnote "old" version of rapid test; detects Ab only
61
4th gen immunoassay HIV test detects what? | How long to result? ## Footnote advantages / disadvantages?
1. HIV1, HIV2 Abs 2. p24 Ag | days ## Footnote detects 100% chronic infxn and 80% acute infxn; still screening and doesnt result qiuckly
62
HIV-1/HIV-2 differentiation immunoassay: what does it detect? | advantagse/disadvantage
TYPE of HIV (1 vs 2) based on RNA | confirmatory! takes 20mins
63
Ampicillin bx coverage
G+ cocci (strep), Gram neg bacilli | i.e. enterococcus (g_ cocci) ## Footnote no coverage MRSA, MS staph aureus
64
Clinda Bx coverage
Gram + cocci, anaerobes | i.e. staph aureus
65
gentamycin bx coverage
Gram neg. bacilli | i.e. e coli, proteus, klebsiella
66
% of HSV+ ppl who know they have it
15%
67
Hx HSV -> % recurrence in pregnancy?
75% (at least one recurrence during pregnancy)
68
fetal surveillance if maternal parvo
sonos q1-2w for 8-12w post-exposure
69
How to dx primary infxn of HSV | and why?
**Viral culture or PCR**: pos **IgG**: neg | b/c notes that hasnt had time for IgG (chronic) to form
70
What is better for HSV viral detection? culture vs PCR
PCR | 3-5x more likely positive than culture
71
urticaria rxn to PCN: desensitization?
yes | Type I rxn
72
maculopapular rash to PCN: desensitization?
no | Type V rxn
73
hypotension rxn to PCN: desensitization?
yes | Type I rxn (immediate)
74
bronchospasm rxn to PCN: desensitization?
yes | Type I rxn
75
Tx syphilis in pregnancy: primary secondary early latent late latent tertiary neurosyphilis
**primary, secondary, early latent**: PCN G 2.4mil IM x1w **late latent, tertiary**: PCN G 2.4mil IM x3 weekly **neurosyphilis**: PCN G 18-24mil IV q4 x2wk
76
timing early latent syphilis
<1yr infxn
77
timing late latent syphilis
infxn >1yr
78
timing neurosyphilis
any stage
79
dx neurosyphilis
**lab cx**: +VDRL in CSF **Clinical cx**: neuro sx (meningitis, Argyll Robertson pupils, tabes dorsalis
80
chronic Hep C in pregnancy: complication?
20x risk cholestasis

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