Obstetric & Perinatal Infections Flashcards
(51 cards)
1
Q
What are perinatal and postnatal infections of the newborn?
A
- acquired during birth
- acquired soon after birth
2
Q
Why are pregnant women more susceptible to infection (also immediately following birth; puerperium)?
A
- increased progesterone leads to decreased mobility of the ureter and the enlarged uterus obstructs the urethra, leading to incomplete bladder emptying and an increased risk for cystitis and UTIs.
3
Q
What pathogens are more common in pregnancy?
A
- salmonella
- listeriosis
- candidiasis
- influenza
- coccidiodomycosis
- varicella
- malaria
- hepatitis E
4
Q
In what trimester does pyelonephritis most often occur during pregnancy?
A
- 2nd trimester, due to untreated cystitis.
5
Q
What pathogens are associated with UTIs (in general, whether pregnant or not)?
A
- E. coli (MOST)
- Group B strep
- Proteus mirabilis
- Enterococci
- Klebsiella pneumoniae
6
Q
What is the concern with pyelonephritis?
A
- sepsis, which is often associated with premature uterine contractions
7
Q
*** What is chorioamnionitis?
A
- ascending polymicrobial infection of the placenta, amniotic fluid, and fetal membranes, due to normal vaginal flora.
- has high association with preterm birth and preterm premature RUPTURE of membranes.
8
Q
*** What pathogens are associated with chorioamnionitis?
A
- Gardnerella vaginalis
- group B strep
- E. coli
9
Q
What are some risk factors for chorioamnionitis?
A
- BV
- STI (GC/Chlamydia)
- GBS colonization
- prolonged labor
- frequent vaginal exams during labor
- internal fetal monitoring
10
Q
What are the signs of chorioamnionitis?
A
- maternal fever
- maternal or fetal tachycardia
- uterine tenderness
- leukocytosis
- foul smelling amniotic fluid due to anaerobes (uncommon)
11
Q
How do you diagnose chorioamnionitis?
A
- culture of amniotic fluid
12
Q
How do we treat chorioamnionitis?
A
- induction of labor; delivery
- broad-spectrum antibiotics during labor, but aren’t needed after labor for the mother unless she remains febrile.
13
Q
What can happen to the mother as a possible consequence of chorioamnionitis?
A
- puerperal (intrapartum) fever
14
Q
What pathogen is associated with more severe complications in chorioamnionitis?
A
- clostridium perfringens (myonecrosis or gas gangrene)
15
Q
What is puerperal fever?
A
- fever that lasts more than 24 hours within the first 10 days post delivery due to ENDOMYOMETRITIS form postpartum infection of the uterus (at the placental site).
- dissemination via blood or lymphatics could cause sepsis or peritonitis.
16
Q
What are the major pathogens in postpartum endomyometritis?
A
- E. coli
- group B strep
- anaerobes
17
Q
What are the signs and treatment for postpartum endomyometritis?
A
- fever, uterine tenderness, tachycardia, purulent vaginal discharge.
- treat with broad-spectrum antibiotics
18
Q
To what can postpartum endomyometritis lead?
A
- thrombophlebitis and pelvic abscess
19
Q
What causes most cases of neonatal herpes?
A
- transmission of herpes virus during birth
20
Q
** What NEONATAL infections are acquired during passage down an infected birth canal? (aka what is the baby getting, from the mother)
A
- Group B strep= sepsis, pneumonia, meningitis.
- E. coli= sepsis, pneumonia, meningitis.
- Group A strep= sepsis, pneumonia, meningitis.
- Enterococcus= UTI, sepsis.
- Listeria monocytogenes= spsis, meningitis, diarrhea.
- Neisseria gonorrhoeae= conjunctivitis
- Chlamydia trachomatis= conjunctivitis
- herpes simplex virus= herpes
- genital papillomavirus (HPV)= laryneal warts
- Candida albicans= oral thrush
21
Q
How can EARLY-onset disease occur in the infant?
A
- pathogen in blood transmitted to fetus across the placenta.
- consequence of chorioamnionitis (aspiration of infected amniotic fluid).
- pathogen in genital secretions transmitted during delivery in the birth canal.
22
Q
What can cause LATE-onset disease in the newborn?
A
- nosocomial infection (mother or health care worker in nursery)
- more often bacteremia, sepsis and meningitis
23
Q
What is a common site of entry to the newborn for systemic infection?
A
- umbilical cord
24
Q
What is neonatal sepsis?
A
- systemic illness with bacteremia that occurs in the 1st month of life
- often includes PNEUMONIA and MENINGITIS.
25
What is normally associated with HYPOthermia in neonatal sepsis?
- bacteria
26
What is normally associated with FEVER in neonatal sepsis?
- viral agens (HSV)
27
What should you look for in neonatal sepsis?
- cyanosis, mottling, pallor, petchiae, rashes, jaundice, or respiratory distress
28
With what is early onset neonatal sepsis most associated?
- respiratory symptoms (group B strep most common, then E. coli).
29
What is a common pathogen associated with LATE-onset disease of the newborn?
- coagulase negative Staph epidermidis from skin of health care workers
30
**** What is important to know about Strep agalactiae (GBS)?
- B-hemolytic
- normal flora of GI and GU tract
- transmission to neonate during birth
- MOST COMMON cause of NEONATAL SEPSIS in the US
- causes most cases of MATERNAL cystitis and higher incidence of premature rupture of membranes.
31
What can happen to newborns that acquire EARLY-onset Strep agalactiae (GBS) infection?
- respiratory distress and pneumonia.
- meningitis (serotype III).
- septicemia
- death
32
What is the most common LATE-onset Strep agalactiae (GBS) complication?
- MENINGITIS (serotype III)
33
When are pregnant mothers screened for GBS?
- at 35 weeks gestation for vaginal and rectal colonization
34
If a pregnant mother tests positive for GBS, what antibiotic is given during intrapartum?
penicillin
*does not have an effect on late onset disease (makes sense because the late onset comes from nosocomial infection later).
35
What risks are associated with PRIMARY genital herpes of the mother?
- spontaneous abortion
- intrauterine growth retardation
- preterm birth
36
Does REACTIVATION herpes of the mother transfer often to the neonate?
NO because maternal antibodies will be present.
37
When do most cases of neonatal herpes occur?
- peripartum (during delivery)
38
What are the clinical manifestations of neonatal herpes?
- skin, eye and/or mouth
| - disseminated= CNS (encephalitis or meningoencephalitis), pneumonitis, hepatitis, or CVS involvement.
39
What is the leading cause of sporadic ENCEPHALITIS?
- HSV type I
| * in neonate it is HSV type II
40
If the mother has an active HSV infection at time of birth, what should you do?
- C-section
41
How do you treat neonatal herpes?
- acyclovir
42
What happens if the mother gets a varicella zoster infection 6-21 days before delivery?
- newborn will have mild, self-limiting infection due to maternal antibodies providing protection.
43
What happens to the newborn if the mother gets a varicella zoster infection 5 days before to 2 days after delivery?
- transplacental transmission places newborn at risk for severe morbidity.
- no transplacental transfer of maternal antibodies
- varicella (chicken pox)
- disseminated infection
- shingles (months to years after birth).
* treat infant with varicella zoster immunoglobulin (VZIG)
44
What does Listeria monocytogenes do the pregnant mother?
- mild influenza-like illness
45
What does Listeria monocytogenes do if transmitted to baby across the placenta or postnatally?
- MENINGITIS
46
How is acute HBV of the mother transmitted to the baby?
- prenatal
- during delivery (MOST COMMON)
- postpartum
47
*** How do you treat HBV in the neonate?
- HBV immunoglobulin (HBIG) should be given to neonate of infected mother within 12 hours of birth, followed by HBV vaccine.
* remember development of CHRONIC HBV is much higher in infants than in adults.
48
What does an HBsAg + and HBeAg + mother mean as far as risk of transmission goes?
- ACTIVE infection with a very high risk of infection.
49
What does an HBsAG + and anti-HBe + mother mean as far as risk of transmission goes?
- less likely because she has antibody to HBe (which is the marker for transmission).
50
What if the neonate is HBeAg +?
very high likelihood of developing a CHRONIC infection in newborn.
51
What is the chance of HCV transmission to a baby in an RNA + mother?
low (4-6%)
