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Flashcards in Perinatal infections Deck (140)
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1

What is the leading cause of neonatal chorioretinitis?

a. CMV
b. Rubella
c. Syphilis

2

What percentage of pregnant women are IgG+ for HSV-2?

20-30%

3

What percentage of women HSV seroconvert during pregnancy?

2-4%

4

What percentage of HSV-2 infected people are not aware of having the infection?

75-90%

5

Symptoms of newly acquired HSV infection

Asymptomatic in 70% of pregnant women
30% - range from minimal lesions to widespread genital lesions, tender regional lymph node enlargement, fever, malaise, headache

6

HSV-1 causes what percentage of oral infections? genital?

90% oral
10% genital

7

HSV-2 causes what percentage of oral infections? genital?

10% oral
90% genital
(but among college-age populations, majority of new cases of genital HSV are HSV-1)

8

What percentage of neonatal HSV results from women who acquire HSV-1 or -2 near term?

50-80%

9

What is a "nonprimary first-episode HSV infection"?

HSV-2 confirmed in a person with prior HSV-1, or vice-versa. Symptoms are usually milder than a first-episode primary infection.

10

What is reactivation (recurrent) genital herpes?

-Caused by reactivation of latent HSV, usually HSV-2.
-Over 90% of HSV episodes in pregnancy are recurrent or non primary 1st
-Symptoms last 7-10 days, with low viral load shedding for 3-5 days.

11

What is the incidence of neonatal HSV after a vaginal delivery during a first episode primary infection?

25-50%

12

What is the incidence of neonatal HSV after a vaginal delivery during a recurrent infection?

<1%

13

Why is the incidence of neonatal HSV after a primary maternal infection higher?

The infant of the mother with primary HSV lacks the protection of transplacental type-specific antibodies. The major sites of intrapartum viral entry are the neonatal eys, nasopharynx, or a break in the skin. Transplacental infection is rare.

14

What is GBS?

Streptococcus agalactiaeAn encapsulated gram-positive coccus that colonizes the vaginal & GI tract

15

Manifestations of GBS in the mother

Urinary tract infectionChorioamnionitisEndometritisBacteremiaStillbirth

16

What are the 2 types of newborn GBS infection?

Early-onset - usually within first 24 hrs of life, up to 6 days after birthLate-onset - Usually at 3-4 weeks of age, can occur any time from 7 days - 3 months

17

Symptoms of neonatal GBS

Early-onset:Respiratory distressShockPneumoniaMeningitis (occasionally)Late-onset:Bacteremia (common)Meningitis (common)Poor feedingIrritabilityExtreme drowsinessListlessnessLocalized infection: middle ear, sinuses, bones, joints, skin

18

Prevalence of asymptomatic GBS anovaginal colonization in pregnant women

20%, can be transient or persistentA substantial portion of women colonized in one pregnancy will not have colonization during a subsequent pregnancy

19

Percentage of neonates born to mothers colonized with GBS that are colonized themselves

40-75%

20

Risk factors for early-onset GBS disease

Prolonged ROM (>/= 18 hrs)Preterm birth (but >80% GBS are term)Termp >/= 38 deg CMaternal GBS colonization btw 35-37wPrevious infant with invasive GBS diseaseMaternal choioBlack or HispanicGBS bacteriuria during pregnancyDM or GBS colonization in a previous pregnancy are not risk factors

21

Neonatal mortality due to GBS disease

5%25% if < 33w GA

22

Is there a vaccine for GBS?

accination against GBS is potentially the most effective method of preventing the morbidity and mortality caused by infection. GBS vaccines have been investigated as a tool to reduce maternal colonization and prevent transmission to the neonate; however, a licensed vaccine is not yet available.

23

What percentage of neonates with early-onset GBS sepsis are born to women without risk factors?

20.00%

24

How effective is a screening-based strategy compared to a risk factor-based strategy for GBS?

>50% more effective for early-onset GBS, but does not affect the incidence of late-onset GBS sepsis

25

For whom is intrapartum GBS prophylaxis indicated?

Previous infant with invasive GBS diseaseGBS bacteriuria during current pregnancy+GBS screening culture during current pregnancy (unless C/S prior to ROM)Unknown GBS status and: /= 18 hrs Intrapartum temp >38 deg C Intrapartum NAAT GBS+

26

For whom is intrapartum GBS prophylaxis NOT indicated?

Previous pregnancy with a positive GBS screening culture (unless indication present during current pregnancy)C/S in absence of labor or ROM (regardless of culture status)Negative vaginal & rectal GBS screening culture 35-37w, regardless of intrapartum risk factors

27

What is the NPV of GBS cultures at 35-37w

95-98%, if prevalence 20%

28

Recommended regimen for GBS prophylaxis

Penicillin G, 5 million units IV x 1, then 2.5-3 million units IV q 4 hrs until delivery

29

Alternative GBS regimen

Amp 2 g IV x 1, then 1 g IV q 4 hrs until delivery

30

GBS prophylaxis - PCN allergic, but not at high risk for anaphylaxis

Cefazolin 2 g IV x 1, then 1 g IV q 8 hrs until delivery