Maternal Child: Perinatal Infections
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- Vaccination - nearly elimated epidemics
- Unvaccinated women from other countries at risk
- Effects: mild in women, serious to fetus
- Teratogenic during 1st trimester: Congenital cataracts, sensorineural deafness, congenital heart defects, mental retardation, cerebral palsy.
- Infant born w/rubella syndrome: infectious 12 mos!
- Live attenuated vaccine, all children
- SX: maculopapular rash, lymphadenopathy, muscular achiness, joint pain.
- A herpes simplex virus: causes congenital and acquired disorders. May be asymptomatic
- Transmits: across the placenta to the fetus or by cervical rt during birth.
- Transmits in: urine, saliva, mucus, semen, breast milk.
- Usual innocuous in adults/children; fatal to fetus.
- Dx: blood test, amnio fluid, culture
- Tx: none
- Effects to fetus: all organs, retardation, SGA, bleeding, BLOOD/BRAIN/LIVER the most.
Herpes Simplex Virus
- 1 in 6 ppl have in US.
- >R/f spontaneous abort if in 1st 3mester, PTL, SGA
- Neonatal infection - asymptomatic at birth
- Sx Birth-4wks: fever, jaundice, seizures, < feeding, vesicular skin lesions, CNS symptoms.
- TX: Acyclovir
Group B Strep Infection
- Bact infection found in lower GI or urogenital tract.
- Leading infections cause of neonatal sepsis and mortality
- 10 - 30% pregnant women are carriers
- > AA women
- Stillbirths, Neonatal sepsis, respiratory distress, pneumonia, apnea, shock, meningitis, LT neuro complications.
- >risk group: Premature, maternal fever, membr rupt for >18 hr, bacteriuria in pregn, young maternal age, AA or Hisp race
- TX: Abx
Human B19 Parvovirus
- Causes erythema infectiosum or "fifth disease" in children. (Slapped cheek" rash)
- Sx: myalgia, coryza (inflammation of nasal membranes w/profuse nasal discharge), Ha, fever, nausea.
- In fetus: spontaneous abortion, fetal hydrops, stillbirth, fetal anemia.
Asymptomatic bacteriuria (ASB)
- Bacteria in urine / no symptoms
- Can cause systitis (lower UTI) or pyelonephritis w/o Tx.
- Tx: oral sulfonamides early in preg. ampicillin/nitrofurantoin later.
- (lower UTI) (bacteria)
- Sx: pain, frequency, urgency, LG fever
- If not treated, may ascend to pyelonephritis.
- Tx: as w/ASB - oral sulfonamides, ampicilli, furadantin
Pyelonephritis (from non-tx UTI)
- Sx: chills, fever, n/v, flank pain, dehydration, <low creatinine clearance, marked bacteremia in urine culture, WBC casts.
- Tx: hospital, IV ABX, cath if needed, supportive therapy for comfort, follow-up urine cultures.
- PG complic: <BW baby, preterm labor
- Yeast infection
- Cause: Candida Albicans
- Sx: Thick discharge, severe itching
- Tx: intravaginal miconazole or other topical azole,
- PG complic: NB thrush if born vaginally
- Gardnerella vaginalis
- Sx: thin yellow-gray fishy discharge, Clue cells on wet-mount slide
- Tx: Metronidazole (Flagyl), clindamycin
- PG complic: PROM - not teratogenic
- Cause: Tricomonas vaginalis
- Sx: may be asympt, frothy green gray disch, pruitus, urinary sx, strawberry patches vagina/cervix.
- Dx: wet-mount slide motile flagellated tricomonads
- Tx: Single 2g dose Flagyl, tx partner
- PG complic: r/f PROM, preterm birth, LBW
- Chlamydia trachomatis #1 STI
- Sx: may be asympt, thin or purulent disch, urinary burning, freq, low abd pain
- Dx: lab to detect antibodies for chlamydia
- Tx: Doxy, Roceph; if preg: azithromycin, amoxicillin
- Pg compl: conjunctivitis, premature labor, fetal death
- Cause: treponema pallidum (a spirochete)
- Sx: slight fever, malaise, chancre (4wks). Later: skin rash, arthritis, liver, eritis, sore throat w/hoarseness.
- Dx: bloodwork VDRL, RPR
- Tx: Penicillin, tx partner, also
- PG complic: w/Tx <14 wks, fetus unaffected, >14 wks, placental transfer
- Cause: Neisseria gonorrhoeae
- Sx: May not sx, may purulent disch, dysuria, freq, inflamm of vulva, erosion of cervix.
- Tx: IM Roceph + 1oral ceph
- Pg complic: eyes, lungs of NB if not Tx.
- Cause: Papiloma virus (warts)
- Sx: soft grayish pink lesions on the vulva, vagina, cervix or anus
- Tx: may remove warts to prevent friability during Pg. Chemical tx of warts contraindicated during Pg.
- Pg compl: effect of chemicals (fetal death), NO HPV vacc during Pg. Ok during breast feeding.
Measures to prevent cystitis
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