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OB Infxn

Obstetrics

QuestionAnswer
__% of women are GBS vaginal/rectal colonized 10-30% (all PG women should be tested at 35-37 weeks)
What is the most common cause of neonatal sepsis GBS (Strep agalactiae)
GBS bacteruria indicates Heavy colonization
What is something you see in babies born to mothers on AZT for HIV Lower WBC counts & macrocytic anemia (will resolve over time)
Chronic intrauterine infection is responsible for __% of IUGR pregnancies 5-10
What is the most commonly identified pathogen responsible for IUGR CMV
What is the most common protozoan, acquired by eating raw meat, that is responsible for IUGR Toxoplasma gondii
Bacterial infections occur commonly in PG & frequently are implicated in PTD; but they are not commonly assoc w/IUGR; exception to this rule is chronic infx with: Listeria monocytogenes
What is the clinical picture of an infant born to a mother infected with chronic listeria monocytogenes Critically ill, encephalitis, pneumonitis, myocarditis, hepatosplenomegaly, jaundice, and petechiae
Early GBS = 1st 6 days of life; 75% of cases; in utero or during birth; RFs: PTL, PROM, PPROM
Late GBS = After 1st week of life; nosocomial or CA
BV adverse outcomes PTD/LBW; intraamniotic or placental infxn (ID & Rx did not improve outcomes); USPSTF: no routine screen; tx sx
If PG pt pos for HBSAg: check acute/chronic (HBcAb,LFT); test partner, if neg, vax
Hep E antigen = increased risk of infectivity (vertical trans in maternal chronic Hep B)
Hep B vertical transmission: tx Recombivax, HBIg to neonate after delivery (90% effective); mom can breastfeed after tx
Most common effects of rubella transmission Heart, eye, ear; risks are GA dependent
Acyclovir is Category: C
VZV: perinatal exposure: tx VZIg perinatally (5 days before - 2 days after delivery); acyclovir for maternal VZV
Which vax can be given during PG? Hep B, flu, tetanus (Tdap); DO NOT GIVE VZV or Rubella (live)
If active herpetic lesions/prodromal sxs: deliver by C-section (60% fetal mortality in vaginal delivery, 50% transmission). PPx PO acyclovir after 36 weeks
Cystitis tx in PG Ceph, nitrofurantoin, or sulfa x7-10 days
Pyelonephritis tx in PG Admit, IV Abx (ceph or PCN + AG). Tocolytic tx to halt contractions if preterm labor. Repeat cx for TOC
If positive for Herpes: C-section only if active lesions on vulva / vagina / cervix at time of labor
Tx if positive for gonorrhea CTX 125mg IM or Cipro 500mg PO. All neonates receive eye drops (erythro or tetracycline)
Surveillance in HIV+ women who are PG Viral load and CD4+ counts monthly
Chorioamnionitis bugs Bacteroides, Prevotella. E coli. Anaerobic streptococci. GBS.
Endometritis clinical features Usually presents on day 2-7 post partum. Usually polymicrobial. High fever, chills, purulent / foul lochia
Persistent fever, high WBC. Ruled out UTI, endometritis, Dx may be: septic pelvic vein thrombophlebitis
Created by: Abarnard
 

 



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