Week 13 Perinatal Disorder Flashcards Preview

Simmons NURP 501 Exam 3 Weeks 12 and 13 > Week 13 Perinatal Disorder > Flashcards

Flashcards in Week 13 Perinatal Disorder Deck (50):
1

Toxoplasmosis: Description and Epidemiology

Cat feces
Undercooked meat
Ingestion of contaminated soil

2

Toxoplasmosis: Clinical findings

Prematurity and low Apgar scores
Jaundice
Anemia
Hepatosplenomegaly
Chorioretinitis
Microcephaly

3

Toxoplasmosis: Diagnostic Studies

CT brain: Calcification or hydrocephalus
CSF: high protein, low glucose and evidence of T. Gondii
Serum Immunoglobulins: Antibodies against Toxoplasmosis

4

Toxoplasmosis: Management, prognosis and prevention

Pyrimethamine, sulfadiazine with folic acid supplement

Infants with severe involvement at birth have impaired: vision, hearing, cognitive function

Prevention: gloves, and avoid contaminants

5

Congenital Rubella: Description and Epidemiology:

RNA virus. Contact transmission. Virus infects the placenta and is transmitted to the fetus

6

Congenital Rubella: Clinical Findings

Maternal infection before 16 weeks gestation, negative rubella titers in mother, 50% of infected women are asymptomatic

PE: Hearing loss, congenital heart disease, mental retardation, cataract or glaucoma, microcephaly and "blue berry muffin" skin lesion.

7

Congenital Rubella: Diagnosis studies

nasopharyngeal secretions, conjunctiva, urine, stool, CSF
Measure serum immunoglobulins

8

Congenital Rubella: Managment and Prevention

Monitoring and intervention for developmental, hearing, vision and medical needs
Women of all child bearing age need to immunized

9

CMV: Description and Epidemiology

Member of the herpes virus. Transmitted with virus containing secretions and blood

10

CMV: Clinical findings

H & P: maternal infection, SGA/IUGR, hepatosplenomegaly, jaundice, petechial rash, chorioretinitis, cerebral calcifications, microcephaly

11

CMV: Diagnostic Studies

Viral cell cultures from urine, saliva, or other body fluids
Proof of congenital infection requires obtaining specimens within 3 weeks of birth

12

CMV: Management, prognosis, and prevention

Greatest risk are susceptible pregnant women exposed to urine and saliva from CMV infected children at daycares

Handwashing!

Ganivclovir to decrease progression of hearing impairment

Monitor urine for 18-24 months

The outcome of congenital CMV infection is poor (high morbidity rate): psychomotor retardation, microcephaly, hearing loss, seizures, chorioretinitis, optic atrophy, mental retardation, learning disabilities.

13

Group B Streptococcus: Description and epidemiology

Leading cause of sepsis in infants from birth to 3 months

Gram-positive diplococcus that forms colonies in maternal GU GI tract

GBS acquired by infants through vertical transmission

14

Group B Streptococcus: Clinical Findings

History: infants < 37 weeks gestation, ROM >18 hours, maternal fever during labor >100.4 F, previous delivery of a sibling with invasive GBS, maternal chorioamnionitis

PE: Poor feeding, temp instability, cyanosis, apnea, tachypnea, grunting, flaring, retractions, seizures, lethargy, bulging fontanelle, rapid onset deterioration

15

Group B Streptococcus: Diagnostic studies

blood culture,
CSF or both

16

Group B Streptococcus: Management, prognosis, and prevention

PCN and aminoglycoside until GBS differentiated from E. coli or Listeria sepsis or meningitis

Screen all pregnant women at 35-37 week OB. GBS + women need IV PCN or ampicillin at onset of labor and every 4 hours until birth

17

Listeriosis: Description and Epidemiology

Gram positive Rod
Soil, streams, sewage, certain foods, silage, dust and slaughterhouses

Mexican cheese, whole and 2% milk, uncooked hotdogs, undercooked meat, raw veggies, shellfish

18

Listeriosis: Clinical Findings

H & P: brown-stained amniotic fluid, generalized sx of sepsis, whitish posterior pharyngeal and cutaneous granulomas, disseminated erythematous papules on skin

19

Listeriosis: Diagnostic Studies:

Blood, CSF, meconium, and urine are cultures
CSF: high protein, decreased glucose, and high leukocyte account

20

Listeriosis: Management and Prognosis

IV Ampicillin and aminoglycoside (gent) as initial therapy

Transplacentally acquired listeriosis usually results in SAB

Survivors on listeriosis: mental retardation, paralysis, and hydrocephalus

21

Congenital Varicella: Description and Epidemiology

Herpes Virus

22

Congenital Varicella: Clinical Findings

H & P: Hx of maternal chickenpox infection, limb atrophy, scarring of the skin, eye manifestation

23

Congenital Varicella: Diagnostic Studies

Immunofluorescent staining of vesicular scrapings

24

Congenital Varicella: Management, Prognosis, Prevention

VZIG
Acyclovir
Vaccination of nonpregnant women

25

Gonorrhea: Description and Epidemiology

Organism lives in exudate and secretions of infected mucous membranes

Gonococcal infection of the newborn are primarily acquired during delivery

26

Gonorrhea: Clinical Findings

H & P: History of maternal gonococcal infections: Finding of conjunctivitis

27

Gonorrhea: Diagnostic studies

a culture of eye exudate

28

Gonorrhea: Management and prevention

Single dose of IM ceftriaxone 25-50 mg/kg not exceeding 125 mg) for prophylaxis of infants born to mothers with active infection

Gonorrheal conjunctivitis can lead to blindness

Eye ointment: 1% silver nitrate, 1 % tetracycline or erythromycin 0.5%

29

Chlamydia: Description and Epidemiology

Infection occurs in 50% of infants born vaginally to infected mothers

30

Chlamydia: Clinical Findings

H & P: History of maternal chlamydia infections, conjunctivitis within a few to several weeks after birth, infant commonly afebrile with normal activity level
Pneumonia 2-19 weeks after birth

31

Chlamydia: Diagnostic Studies

Cell cultures

32

Chlamydia: Management and Prevention

Oral erythromycin suspension 50 mg/kg/day divided by 4 doses for 10-14 days for conjunctivitis and pneumonia

Appropriately treat of the pregnant woman before delivery

33

Syphilis: Description and Epidemiology

Routine maternal serological testing required in all states

34

Syphilis: Clinical Findings

H & P: Maternal infection and positive serologic testing; majority of infants are asymptomatic at birth, hepatosplenomegaly; persistent rhinorrhea, maculopapular or bullous dermal lesions, FTT, restlessness, fever

35

Syphilis: Diagnostic Studies

Vernereal Disease Research Lab VDRL
Rapid Plasma Repair RPR

36

Syphilis: Management and Prevention

10 consecutive days of crystalline PCN 100-150,000 units/kg/day IV
Then Procain PCN G 50,000 units/ KG IM for 10 days
If more than 1 day missed entire course must be restarted
Untreated congenital syphilis can lead to multiorgan involvement

37

Herpes Simplex Virus: Description and Epidemiology

3 Categories:
Disseminated disease: Present with sx suggestive of bacterial sepsis plus hepatitis, encephalitis, pneumonitis, DIC
CNS disease: Seizures and encephalitis
Local: Disease restricted to skin, eyes and mouth

HSV transmitted with direct contact during birth

38

Herpes Simplex Virus: Clinical Findings

H&P: Mom has lesions and delivered vaginally. Vesicles in skin, eyes, and mouth are found.
S/S: Encephalitis, pneumonia or sepsis

39

Herpes Simplex Virus: Diagnostic Studies

Tissue cultures from exudate 24-48 hours after birth

Rapis ID tests: PCR, DNA from CSF

40

Herpes Simplex Virus: Management, Prognosis, Prevention

Antiviral therapy in final weeks of pregnancy for women with a hx of HSV
Acyclovir 20 mg/kg/dose IV every 8 hours for 14 days

Cesarean delivery before ROM in any woman with active infection

Acyclovir IV or ophthalmic drugs for the infected infant

41

Cocaine: Infant Findings

Low Birthweight,
IUGR,
prematurity,
fetal distress
meconium staining
Anomalies of GU and GI
Feeding difficulties
liability of mood

42

Cocaine: Management, complications and Prevention

Offer quiet environment with decreased stimuli
Mothers who use cocaine should not breastfeed
Prenatal cocaine exposure has been linked to:
changes in IQ
Neurobehavioral dysfunction
hyperactivity
aggression
short attention span

43

Heroin and Methadone exposure:

Tremors and hyperirritability
Limbs rigid and hyperreflexia
Skin abrasions secondary to hyperactivity
Tachypnea
Poor feeding
Diarrhea
Vomiting
High-pitched cry
Fist sucking
Low birth weight or SGA

Withdrawl begins 24-48 hours of life, withdrawal from methadone takes longer than with heroin

44

Heroin and Methadone Management, complications and Prevention

Supportive Management: Swaddling, frequent feedings, protection from external stimuli

increased risk of SIDS

Meds: phenobarbital, tincture of opium and methadone can be used in severe SX

45

Alcohol: Diagnostic Criteria

4 Digit Diagnostic Code

Growth Deficiency (Pre and postnatal despite adequate nutrition
Characteristic facial features: shortened palpebral fissures, thin upper lip, flattened philtrum and flat mid face
Evidence of brain dysfunction: microcephaly, structural abnormalities of the neurologic conditions such as seizures, behavioral and cognitive problems

Breast feeding should be avoided for 2-3 hours after consumption of alcohol

46

Narcotics: Effects on Fetus and Newborn

Fetus: Increased rate of SAB and still births, IUGR

Newborn: High-pitched cry, tremulousness, sleeplessness, difficulty feeding, sweating, nasal stuffiness, sneezing, vomiting, cramping and diarrhea

Onset: 48 hours to 4 days after birth

Long-term effect: Increase risk for learning and behavioral problems

47

Narcotics: Management and Therapy

Management: Neonatal Abstinence Scoring System

Abstinence Score <8: supportive measurements

Abstinence Score >8: and unresponsive to supportive measures: START phenobarbital

Other meds: tincture of opium, methadone, chlorpromazine. DO NOT paregoric

Breastfeeding ok while on methadone maintenance

48

Marijuana: Effects on fetus and newborn

Fetus: No clear effect

Newborn: decreased visual responsiveness, increased tremors and startles

Long-term: increased incidence of learning deficits and behavior problems

49

Marijuana: Managment

Supportive care: swaddling, swinging, frequent feeding and low lights

Breast feeding not contraindicated

50

Tabacco: Effects on Fetus and newborn

Fetus: Growth restrictions, increased mortality: abruption, placenta previa, prematurity, respiratory distress, SAB

Newborn: Passes through breast milk, but no effects have been described

Long-term: increased risk of SIDS, aggressive type behavioral problems