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):

Toxoplasmosis: Description and Epidemiology

Cat feces
Undercooked meat
Ingestion of contaminated soil


Toxoplasmosis: Clinical findings

Prematurity and low Apgar scores


Toxoplasmosis: Diagnostic Studies

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


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


Congenital Rubella: Description and Epidemiology:

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


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.


Congenital Rubella: Diagnosis studies

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


Congenital Rubella: Managment and Prevention

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


CMV: Description and Epidemiology

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


CMV: Clinical findings

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


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


CMV: Management, prognosis, and prevention

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


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.


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


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


Group B Streptococcus: Diagnostic studies

blood culture,
CSF or both


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


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


Listeriosis: Clinical Findings

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


Listeriosis: Diagnostic Studies:

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


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


Congenital Varicella: Description and Epidemiology

Herpes Virus


Congenital Varicella: Clinical Findings

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


Congenital Varicella: Diagnostic Studies

Immunofluorescent staining of vesicular scrapings


Congenital Varicella: Management, Prognosis, Prevention

Vaccination of nonpregnant women


Gonorrhea: Description and Epidemiology

Organism lives in exudate and secretions of infected mucous membranes

Gonococcal infection of the newborn are primarily acquired during delivery


Gonorrhea: Clinical Findings

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


Gonorrhea: Diagnostic studies

a culture of eye exudate


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%


Chlamydia: Description and Epidemiology

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


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


Chlamydia: Diagnostic Studies

Cell cultures


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


Syphilis: Description and Epidemiology

Routine maternal serological testing required in all states


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


Syphilis: Diagnostic Studies

Vernereal Disease Research Lab VDRL
Rapid Plasma Repair RPR


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


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


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


Herpes Simplex Virus: Diagnostic Studies

Tissue cultures from exudate 24-48 hours after birth

Rapis ID tests: PCR, DNA from CSF


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


Cocaine: Infant Findings

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


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
short attention span


Heroin and Methadone exposure:

Tremors and hyperirritability
Limbs rigid and hyperreflexia
Skin abrasions secondary to hyperactivity
Poor feeding
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


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


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


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


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


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


Marijuana: Managment

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

Breast feeding not contraindicated


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