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Infectious Diseases of Pregnancy

This Prezi characterizes common infectious diseases of pregnancy, their clinical presentations, and treatment guidelines.
by

William Kethman

on 13 October 2011

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Transcript of Infectious Diseases of Pregnancy

Infectious Diseases of Pregnancy 133 million infants are born worldwide every year (7)
5.5 million of these infants die (4)
99% occur in developing countries
33% are due to mostly preventable infections Common Congenital Infections
T O R C H E S 22 year old G0 presenting for routine
prenatal care, LMP was 6 weeks ago,
at-home pregnancy test was positive.
Patient has had one episode of
Gonorrheal infection 2 years prior. What are the current infectious disease
screening recommendations? Prenatal screening recommendations (2):
HIV
Syphilis
Hepatitis B
Gonorrhea/Chlamydia
Rubella antibody
Group B Streptococcus - 35-37 weeks High risk screening recommendations (2):
HIV (Third trimester or at delivery if HIV status is unknown)
Syphillis (Third trimester and at delivery)
Hepatitis B (At delivery, consider vaccination)
Gonorrhea/Chlamydia (Third trimester)
Hepatitis C (Initial prenatal visit)

HSV/Bacterial Vaginosis/Trichomonas (Symptomatic only) Toxoplasmosis Rubella HIV Herpes Syphilis CMV Prevention:
Thoroughly cook all meats
Clean all fruits and vegetables
Wear gloves when working with soil
Avoid exposure to cats that are not fed processed foods
Spiramycin in HIV infected/high risk mothers
Complications/Findings:
Greatest risk - 3rd trimester/More severe - 1st trimester
Toxoplasmosis Antibody Titers - Radiologic
Severe mental retardation
Chorioretinitis, Blindness
Epilepsy, Intracranial calcifications
Hydrocephalus
Treatment:
Pyrimethamine + Sulfadiazine
Not proven to decrease transmission (6) http://www.tedmontgomery.com/the_eye/eyephotos/toxoplasmosischorioretinitis.html http://www.pathobio.sdu.edu.cn/sdjsc/engparabook/ch084.htm http://www.med.uc.edu/neurorad/webpage/bfa.html Prevention:
Screening and antibiotic prophylaxis
-High risk/Status Unknown (1)
Preterm labor (<37 weeks)
Preterm PROM
ROM >18 hours
Maternal fever
Complications:
-Early-onset (First week)/Late-onset (>3 Months)
Septic shock
Pneumonia
Meningitis
Treatment:
Penicillin, Ampicillin prophylaxis, primary treatment
Infant - [Third-generation Cephalosporin] or Aminoglycosides GBS http://richmondmidwife.com/GroupBStrepGBS.aspx Prevention:
Vaccination at least 1 month prior to conception (live attenuated virus)
Vaccination after delivery in pregnant women not immune
Complications/Findings:
Congenital heart disease - Patent ductus arteriosus
Mental Retardation
Deafness
Cataracts
Buzz phrase: "Blueberry muffin" rash
Treatment:
No treatment CDC CDC General:
Most common congenital infection
Primary maternal infection is highest risk
Complications/Findings:
Most are asymptomatic
Petechiae
Hepatosplenomegaly
Jaundice
Thrombocytopenia
Microcephaly, periventricular calcifications
Chorioretinitis
Hyrops fetalis
(MC) Long term - hearing loss and neurologic impairment
Treatment:
No treatment, ganciclovir and foscarnet (not proven effective, 1)
No vaccine available http://www.asm.org/Division/c/viruses.htm http://radiographics.rsna.org/content/30/7/1779/F2.expansion.html Prevention:
Screening: Dark-field microscopy, VDRL/RPR, FTA-ABS
Prophylaxis - Penicillin
Complications/Findings (10-14 days after delivery):
Maculopapular skin rash
Hepatomegaly
Osteitis
Mucopurulent rhinitis
Saber shins
Saddle nose
Hutchinson's triad - interstitial keratitis, peg-shaped incisors, deafness
Treatment:
Penicillin (G) (8) http://www.sciencephoto.com/media/295804/view CDC CDC General:
Infection occurs during or after delivery
Primary Infection - no evidence of prior infection, high risk
Recurrent - low risk to fetus
Complications:
Localized infections do well
Disseminated do poorly, encephalitis
Treatment:
Active vaginal lesions require C/S
Acyclovir - starting at 36 weeks (3) References
1. Beckman, Charles, et al. Obstetrics and Gynecology, Sixth Edition. Baltimore: Lippincott Williams and Wilkins, 2010.
2. Department of Health and Human Services, Centers for Disease Control and Prevention. "Sexually Transmitted Disease Treatment Guidelines, 2010." Morbidity and Mortality Weekly Report (2010): 8-10.
3. Hollier, Lisa M and George D Wendel. "Third trimester antiviral prophylaxis for preventing maternal genital herpes simplex virus (HSV) recurrences and neonatal infection." Cochrane Database of Systemic Reviews (2008).
4. Lawn, Joy E, Simon Cousens and Jelka Zupan. "4 million neonatal deaths: When? Where? Why?" The Lancet (2005): 891-900.
5. Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." 24 May 2010. AIDSinfo. 21 May 2011 <http://aidsinfo.nih.gov/ContentFiles/PerinatalGL.pdf>.
6. Peyron, Francois, et al. "Treatments for toxoplasmosis in pregnancy." Cochrane Database of Systemic Reviews (2010).
7. United States Central Intelligence Agency. "The World Factbook." 17 May 2011. Central Intelligency Agency. 21 May 2011 <https://www.cia.gov/library/publications/the-world-factbook/geos/xx.html>.
8. Walker, Godfrey. "Antibiotics for syphilis diagnosed during pregnancy." Cochrane Database of Systematic Reviews (2010). Prevention:
Screening and prophylaxis - ELISA (Confirmatory Western Blot)
Discourage breastfeeding - linked with transmission
Reduce time from ROM - Early C/S for >1000 copies/mL viral load
Complications:
Immunodeficiency
Treatment:
Combined antiretroviral therapy decreases transmission to 1% (5) - [Zidovudine], Neviparine, Lamivudine
Neonatal treatment (Ziduvidine for 6 weeks if ART, combined if not) http://www.articlesbase.com/diseases-and-conditions-articles/how-to-treat-genital-herpes-2407924.html
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