Obstetrics- Infections & Teratogens

Question 1

TMP-SMX in 3rd term

Answer 1

Avoided in near term gestation because of risk for neonatal kernicterus

Question 2

Pregnancy and acute pyelonephritis

Answer 2

Pregnancy related GU changes (urethral dilation) enable bacteria to ascend to kidney.

Pyelonephritis increases risk for preterm labor, ARDS, and low birth weight

Question 3

Initial Tx for pyelonephritis in pregnancy

Answer 3

Hospitalization
Urine Culture with sensitivity
Broad Spec IV abx (ceftriaxone)

Question 4

Out patient treatment for pyelonephritis in pregnancy

Answer 4

-Clinical improvement with IV abx –> oral abx based on sensitivities and fetal safety.

• Repeat Urine cultures
• Daily Abx prophylaxis remainder of pregnancy to prevent recurrence.

Question 5

Oral antibiotics safe in all trimesters

Answer 5

Penicillins
Cephalosporins
Fosfomycin

Question 6

Congenital rubella syndrome

Answer 6

viral transmission through the placenta especially in the first trimester can lead to spontaneous abortion or CRS

Question 7

S&S congenital rubella syndrome

Answer 7

Patent Ductus Arteriosus
Sensorineural Hearing loss
Leukocoria (white pupillary reflex) 
Cataracts 
Fetal growth restriction
Hepatosplenomegaly
Purpuric "blueberry muffin" rash

Question 8

Diagnosis congenital rubella syndrome

Answer 8

Serology. Positive infant IgM

Question 9

Maternal symptoms of Rubella

Answer 9

Fever
Arthralgia
Cephalocaudal spread of maculopapular rash

Question 10

S&S congenital toxoplasmosis

Answer 10

Chorioretinitis
Hydrocephalus
diffuse intracranial calcifications

Question 11

S&S congenital CMV

Answer 11

Chorioretinitis

Periventricular calcifications

Question 12

S&S congenital Listeria

Answer 12

Fetal Death
Premature birth

Newborn:
Fever
Dissiminated abscesses in multiple organs Skin lesions

Question 13

S&S congenital parvovirus infection

Answer 13

Fetal loss or hydrops fetalis

Abnormalities are rare in surviving infants

Question 14

Maternal symptoms of Parvo

Answer 14

Mild fertile illness followed by arthralgia or arthritis

Question 15

S&S congenital syphilis

Answer 15

Hepatomegaly
Nasal Discharge (snuffles)
Osteroarticular destruction
Maculopapular rash

Late sequela: sensorineural hearing loss

Question 16

Migraine Tx: Ergotamine

Answer 16

Contraindicated in pregnancy due to risk of hypertonic uterine contractions and vasoconstriction.

Adverse OB outcomes: Preterm labor, fetal growth restrictions

Question 17

Migraine Tx: Triptan s

Answer 17

Uteroplacental vasoconstriction, increased uterotonic activity, preterm delivery and low birth weight.

Question 18

NSAIDs in pregnancy

Answer 18

Avoided in 1st and 3rd trimester!

Spontaneous abortion
Premature ductus arteriosus closure
Oligohydramnios
Renal dysfunction

Question 19

Tx of bacterial vaginosis in pregnancy

Answer 19

metronidazole or clindamycin

SAFE in pregnancy