Maternal Child: Perinatal Infections

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Author:
sdelap
ID:
131272
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Maternal Child: Perinatal Infections
Updated:
2012-01-29 18:13:33
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Perinatal Infections
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Description:
Care of the Woman with a Perinatal Infection
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  1. Rubella (Virus)
    • 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.
  2. Cytomegalovirus
    • 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.
  3. 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
  4. 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
  5. 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.
  6. 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.
  7. Cystitis
    • (lower UTI) (bacteria)
    • Sx: pain, frequency, urgency, LG fever
    • If not treated, may ascend to pyelonephritis.
    • Tx: as w/ASB - oral sulfonamides, ampicilli, furadantin
  8. 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
  9. Vulvovaginal Candidiasis
    • Yeast infection
    • Cause: Candida Albicans
    • Sx: Thick discharge, severe itching
    • Tx: intravaginal miconazole or other topical azole,
    • PG complic: NB thrush if born vaginally
  10. Bacterial vaginosis
    • Gardnerella vaginalis
    • Sx: thin yellow-gray fishy discharge, Clue cells on wet-mount slide
    • Tx: Metronidazole (Flagyl), clindamycin
    • PG complic: PROM - not teratogenic
  11. Trichamoniasis (STI)
    • 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
  12. Clamydial infection
    • 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
  13. Syphilis
    • 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
  14. Gonorrhea
    • 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.
  15. Condylomata Acuminata
    • 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.
  16. Measures to prevent cystitis
  17. STI summary

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