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OB Infxns in Preg.
Infections in Pregnancy
| Question | Answer |
|---|---|
| Group B Strep | number one cause of neonatal sepsis. Number 2 reason is E.coli. If positive, tx prior and at labor and delivery |
| Early GBS | first 6 days of life (75% of cases). |
| Late GBS | “Late”onset after first week of life, nosocomial or community acquired cases documented |
| Culture sites for GBS | vagina and rectum: single or two swabs through lower 1/3 of vagina & through anal sphincter. Incubate & test for GBS. Timing: 35-37 weeks. Collection: not by speculum, self-collection an option. Don't do in repeat C-sec. b/c pt will have abx in C-section |
| GBS specimens are viable in transport media up to | 4 days |
| If pts asks: How did I get group B Strep? you can explain that | 30% of pts are colonized. (depends on your community) |
| Grow GBS on | 5% sheep blood agar plate |
| DOC for GBS | Penicillin G. If PCN allergic: Cefazolin |
| GBS other issues | maternal endometritis can be caused by GBS, otehr pathogens (E.coli remain a threat to the neonate), Rapid strep tests lack sensitivity, GS vaccine is a potential alternative approach |
| Bacterial Vaginosis | Related to sexual activity, but not STD. Thin, watery, fishy discharge. Dx: clue cells on wet prep, basic pH, fishy odor with KOH |
| clue cell | bacteria surrounding epithelial cell |
| Bacterial Vaginosis Adverse Pregnancy Outcome | Preterm Birth/LBW or 1.4-6.9, Placental/Intraamniotic Infection or 1.5-6.8. Not all ppl with BV will have this outcome |
| USPSTF recommendation for BV | insufficient evidence to recommend routine screen and RX. Pursue and Rx for SXS! |
| Hep B | Sort out acute versus chronic infection- check LFTs, Hep B core antibody. Transmission to partner- check his surface antigen /antibody status. If both negative, then vaccinate |
| Acute Hep infxn with recovery | Constant presence of HBsAg and Total anti-HBc |
| Vertical Transmission of Hep B when | mom is a Hep B chronic carrier. Usually occurs in labor; E antigen suggests increased risk infectivity. Give Recombivax, HBIg to neonate after delivery to interrupt transmission, 90% effective |
| Can Hep B woman breast feed? | Yes, after infant receives Hep B vaccine and HBIg |
| HIV Testing in NC | Test early and late, if missed rapid screen in labor, if no testing newborn tested. heterosexual transmission biggest risk factor in Duke Population |
| HIV baby risk | No rx - 30% vertical transmission, AZT alone 6% with c/s 3%, Optimal rx - Viral Load undetectable <1%. Must get AZT during labor to decrease perinatal transmission |
| Offer C-section in HIV pts when | Viral Load>1000. |
| TORCHES: Acronym for infections in pregnancy with teratogenic potential for fetus | TOxoplasmosis, Rubella, CMV, HErpes Simplex |
| Risks of congential rubella syndrome are | gestational age dependent and cover a wide spectrum of disease and can be transient, permanent and/or progressive, Most common Heart, eye, ear, heart. |
| Rubella vaccination | Live attenuated vaccine- administer post partum to avoid conception. Recommend 3 month delay though no cases of CRS reported after vaccine. |
| Neonatal herpes | no strategy eliminates the risk of neonatal herpes. Acyclovir is category C |
| In a woman who has no antibodies to varicella | Plan to vaccinate postnatally. 2 dose regimen. Little data on lactation but generally given |
| Varcicella Perinatal exposure | Varicella Immune Globulin (VZIg) given may interrupt transmission. Fetal risk if pt contracts varicella depends on gestational age. Best application if pt has varicella: 5 days before or 2 days after delivery b/c mom hasn't made or passed on antibodies |
| T/F? The best test for gbs carriage in pregnancy is a cervical swab at 26 weeks directly plated to a sheep blood agar plate. | F |
| T/F? GBS bacteruria is indicative of heavy colonization and need for rx in labor | T |
| T/F? Pregnant women who are Hep B s ag positive should undergo cesarean to prevent vertical transmission and should avoid breast feeding. | F |
| Which vaccines cannot be given in pregnancy? | varicella and rubella (they are live). Can give Hep B, influenza, tetanus |
| Which abx/antivirals are best avoided in pregnancy | Doxy, Cipro, Interferon. (AZT (ZDV), Cephalexin, azithromycin is okay) |
| T/F? All pregnant women should be screened and treated for bacterial vaginosis | F |
| T/F? “Herd Immunity” is our best approach for avoiding congenital rubella syndrome. | F |
| Number one intrauterine infection | CMV; higher risk of transmission |
| Presence of ____ indicates an acute (6 months or less) Hep B infection | IgM anti-HBc |
| Greatest time frame risk of vertical transmission of HIV | Most transmission is intrapartum |
| If a woman claims to never have had chicken pox or varicella vaccination what should be your first step? | Order a varicella antibody. In US, 80% of those with no history of Ch Pox have antibodies to Varicella. |
Created by:
ltm12