Infections in Pregnancy
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| Group B Strep | number one cause of neonatal sepsis. Number 2 reason is E.coli. If positive, tx prior and at labor and delivery
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| Early GBS | first 6 days of life (75% of cases).
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| Late GBS | “Late”onset after first week of life, nosocomial or community acquired cases documented
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| 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
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| GBS specimens are viable in transport media up to | 4 days
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| If pts asks: How did I get group B Strep? you can explain that | 30% of pts are colonized. (depends on your community)
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| Grow GBS on | 5% sheep blood agar plate
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| DOC for GBS | Penicillin G. If PCN allergic: Cefazolin
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| 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
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| 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
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| clue cell | bacteria surrounding epithelial cell
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| 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
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| USPSTF recommendation for BV | insufficient evidence to recommend routine screen and RX. Pursue and Rx for SXS!
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| 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
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| Acute Hep infxn with recovery | Constant presence of HBsAg and Total anti-HBc
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| 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
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| Can Hep B woman breast feed? | Yes, after infant receives Hep B vaccine and HBIg
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| 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
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| 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
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| Offer C-section in HIV pts when | Viral Load>1000.
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| TORCHES: Acronym for infections in pregnancy with teratogenic potential for fetus | TOxoplasmosis, Rubella, CMV, HErpes Simplex
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| 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.
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| Rubella vaccination | Live attenuated vaccine- administer post partum to avoid conception. Recommend 3 month delay though no cases of CRS reported after vaccine.
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| Neonatal herpes | no strategy eliminates the risk of neonatal herpes. Acyclovir is category C
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| In a woman who has no antibodies to varicella | Plan to vaccinate postnatally. 2 dose regimen. Little data on lactation but generally given
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| 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
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| 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
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| T/F? GBS bacteruria is indicative of heavy colonization and need for rx in labor | T
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| T/F? Pregnant women who are Hep B s ag positive should undergo cesarean to prevent vertical transmission and should avoid breast feeding. | F
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| Which vaccines cannot be given in pregnancy? | varicella and rubella (they are live). Can give Hep B, influenza, tetanus
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| Which abx/antivirals are best avoided in pregnancy | Doxy, Cipro, Interferon. (AZT (ZDV), Cephalexin, azithromycin is okay)
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| T/F? All pregnant women should be screened and treated for bacterial vaginosis | F
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| T/F? “Herd Immunity” is our best approach for avoiding congenital rubella syndrome. | F
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| Number one intrauterine infection | CMV; higher risk of transmission
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| Presence of ____ indicates an acute (6 months or less) Hep B infection | IgM anti-HBc
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| Greatest time frame risk of vertical transmission of HIV | Most transmission is intrapartum
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| 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.
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