Week 13 Perinatal Disorder

Question 1

Toxoplasmosis: Description and Epidemiology

Answer 1

Cat feces
Undercooked meat
Ingestion of contaminated soil

Question 2

Toxoplasmosis: Clinical findings

Answer 2

Prematurity and low Apgar scores
Jaundice
Anemia
Hepatosplenomegaly
Chorioretinitis
Microcephaly

Question 3

Toxoplasmosis: Diagnostic Studies

Answer 3

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

Question 4

Toxoplasmosis: Management, prognosis and prevention

Answer 4

Pyrimethamine, sulfadiazine with folic acid supplement

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

Prevention: gloves, and avoid contaminants

Question 5

Congenital Rubella: Description and Epidemiology:

Answer 5

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

Question 6

Congenital Rubella: Clinical Findings

Answer 6

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.

Question 7

Congenital Rubella: Diagnosis studies

Answer 7

nasopharyngeal secretions, conjunctiva, urine, stool, CSF

Measure serum immunoglobulins

Question 8

Congenital Rubella: Managment and Prevention

Answer 8

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

Question 9

CMV: Description and Epidemiology

Answer 9

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

Question 10

CMV: Clinical findings

Answer 10

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

Question 11

CMV: Diagnostic Studies

Answer 11

Viral cell cultures from urine, saliva, or other body fluids

Proof of congenital infection requires obtaining specimens within 3 weeks of birth

Question 12

CMV: Management, prognosis, and prevention

Answer 12

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.

Question 13

Group B Streptococcus: Description and epidemiology

Answer 13

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

Question 14

Group B Streptococcus: Clinical Findings

Answer 14

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

Question 15

Group B Streptococcus: Diagnostic studies

Answer 15

blood culture,

CSF or both

Question 16

Group B Streptococcus: Management, prognosis, and prevention

Answer 16

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

Question 17

Listeriosis: Description and Epidemiology

Answer 17

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

Question 18

Listeriosis: Clinical Findings

Answer 18

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

Question 19

Listeriosis: Diagnostic Studies:

Answer 19

Blood, CSF, meconium, and urine are cultures

CSF: high protein, decreased glucose, and high leukocyte account

Question 20

Listeriosis: Management and Prognosis

Answer 20

IV Ampicillin and aminoglycoside (gent) as initial therapy

Transplacentally acquired listeriosis usually results in SAB

Survivors on listeriosis: mental retardation, paralysis, and hydrocephalus

Question 21

Congenital Varicella: Description and Epidemiology

Answer 21

Herpes Virus

Question 22

Congenital Varicella: Clinical Findings

Answer 22

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

Question 23

Congenital Varicella: Diagnostic Studies

Answer 23

Immunofluorescent staining of vesicular scrapings

Question 24

Congenital Varicella: Management, Prognosis, Prevention

Answer 24

VZIG
Acyclovir
Vaccination of nonpregnant women

Question 25

Gonorrhea: Description and Epidemiology

Answer 25

Organism lives in exudate and secretions of infected mucous membranes Gonococcal infection of the newborn are primarily acquired during delivery

Question 26

Gonorrhea: Clinical Findings

Answer 26

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

Question 27

Gonorrhea: Diagnostic studies

Answer 27

a culture of eye exudate

Question 28

Gonorrhea: Management and prevention

Answer 28

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%

Question 29

Chlamydia: Description and Epidemiology

Answer 29

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

Question 30

Chlamydia: Clinical Findings

Answer 30

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

Question 31

Chlamydia: Diagnostic Studies

Answer 31

Cell cultures

Question 32

Chlamydia: Management and Prevention

Answer 32

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

Question 33

Syphilis: Description and Epidemiology

Answer 33

Routine maternal serological testing required in all states

Question 34

Syphilis: Clinical Findings

Answer 34

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

Question 35

Syphilis: Diagnostic Studies

Answer 35

Vernereal Disease Research Lab VDRL | Rapid Plasma Repair RPR

Question 36

Syphilis: Management and Prevention

Answer 36

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

Question 37

Herpes Simplex Virus: Description and Epidemiology

Answer 37

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

Question 38

Herpes Simplex Virus: Clinical Findings

Answer 38

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

Question 39

Herpes Simplex Virus: Diagnostic Studies

Answer 39

Tissue cultures from exudate 24-48 hours after birth Rapis ID tests: PCR, DNA from CSF

Question 40

Herpes Simplex Virus: Management, Prognosis, Prevention

Answer 40

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

Question 41

Cocaine: Infant Findings

Answer 41

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

Question 42

Cocaine: Management, complications and Prevention

Answer 42

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

Question 43

Heroin and Methadone exposure:

Answer 43

``` 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

Question 44

Heroin and Methadone Management, complications and Prevention

Answer 44

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

Question 45

Alcohol: Diagnostic Criteria

Answer 45

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

Question 46

Narcotics: Effects on Fetus and Newborn

Answer 46

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

Question 47

Narcotics: Management and Therapy

Answer 47

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

Question 48

Marijuana: Effects on fetus and newborn

Answer 48

Fetus: No clear effect Newborn: decreased visual responsiveness, increased tremors and startles Long-term: increased incidence of learning deficits and behavior problems

Question 49

Marijuana: Managment

Answer 49

Supportive care: swaddling, swinging, frequent feeding and low lights Breast feeding not contraindicated

Question 50

Tabacco: Effects on Fetus and newborn

Answer 50

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