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19 Cards in this Set
- Front
- Back
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Toxoplasmosis
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TORCH
-Transmitted my consumption of contaminated water, shellfish, fruit, unpasturized milk, uncooked meat and eggs; contact with cat feces -Highest risk of maternal-fetal infection: 10-24 weeks. 80% will present with severe problems -Testing: Skin test- very accurate for chronic infection Serologic: specific to parasite Amnio: fetal testing Neonatal: Capture IgM ELISA -Disease: generalized sepsis, neurological, preterm birth/ low birth weight -Requires transfer of care |
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Rubella
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TORCH
aka German Measles Transmission: usually childhood infection- permanent immunity. Transmitted by coughing/sneezing secretions; these symptoms last 7-10 days to produce symptoms. Immunization does not always produce permanent immunity. Other s/s include: swollen glands, throat, eyes and joints. In pregnancy: primary infection is devastating to fetus. 50% malformations, if exposed < 8 weeks. 30% malformations if exposed 9-12 weeks. Risk declines after 12 weeks. Testing: Routine screen for every woman. > 1:10 = immunity >1:64 = active or reccent infection <1:8 = non-immune (at risk for infection) Fetus can be diagnosed with cordocentesis, amnio, CVS, US Maternal re-infection rarely a risk to fetus Vaccination contraindicated prenatally |
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Cytomegalovirus
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TORCH
DNA herpes virus Transmission: sexual, all body fluid Risk: low maternal age, poor, many partners Prevention: hand washing, protected sex Symptoms: like mono. Fever, lymph nodes, joints, throat. Risk to fetus: Primary infection in the 1st half of pregnancy. reactivation of virus rarely a risk to fetus. Testing: Screening not recommended. Primary infection detected by antibody test, but most people are asymptomatic in primary infection Fetal Diagnosis: US, amnio, cordo <20 weeks 10% infected present with s/s: low birth weight, enlarged spleen, liver, jaundice, low platelets No treatment, nursing ok |
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Herpes Simplex Virus type 2
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TORCH
Routine screening not indicated 22% adults in general population infected- mostly genital. Most have mild or unrecognized infections Primary HSV2: Only 33% present with s/s S/S: vague discomfort, fever, swollen groin lymph glands, itching and burning @ outbreak site. Outbreak: blister - ulcer - crusting up - heals w/o scarring. Virus travels to sacral ganglia- permanent. Recurrent infections: less severe, brought on by diminished immune response. Triggers: menstruation, stress, poor nutrition, infection, sunlight, Care: thorough history, education about prevention, refer for Rx- acyclovir Birth: If lesions or prodromal s/s present after 36 weeks, surgical delivery indicated Treatment: Zinc 300mg L-lyseine 2000mg (prevent) L-lyseine 5000mg (outbreak) avoid nuts, seeds, chocolate, caffeine supplement echinacea, calcium lactate, eliminate stress and triggers |
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Varicella
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Torch
Chickenpox 75% of population immune- routine screening not recommended Transmission: lesion fluid, respiratory droplets. contagious for ~15 days S/s: slight fever, headache, backache, rash, pruritis Tx: oatmeal bath, calomine lotion, homeopathic Rhus-Tox Fetal Risk: 1-2% @ 7-20 weeks. Pigmented skin, short limbs, short fingers/toes, eye and CNS abnormalities, preterm labor, stillbirth PN Diagnosis: Maternal Ab titer, US @ 18-20 weeks Biggest risk for neonatal infection when mom has primary infection just before or after birth- baby has not received immunity yet. Neonatal infection is usually mild. V2IG vaccine NOT recommended during pregnancy Varivax (live virus) contraindicated before and during pregnancy |
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Hepatitis B Virus
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HBV
-Routine HBsAg titer for all pregnant women -Transmitted by contact with infected blood, birth, nursing with cracked nipples -Incidence in pregnancy 0.1-0.2% -Neonatal risk- usually asymptomatic, 80% chronically infected, 10% develop jaundice -HBV vaccine is routine for neonates. Recommended for known maternal infection. |
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Human Papilloma Virus
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HPV (Genital Warts)
5-15% women infected, 90% of those are types 6 & 11. Usually unrecognized, asymptomatic, clears up spontaneously S/s: overgrowth of roughly textured tissue. cervical lesions Types 6 & 11 can cause eye, nasal, oral, throat warts Types 16 & 18 can cause genital lesions and cancer Overgrowth around vulva may lead to excessive tearing during birth Screening: pap smear. If +, colposcopy, biopsy HPV vaccine contraindicated Neonatal risk: usually not a problem. Xmission of types 6&11 may cause laryngeal warts, blocking airway. incidence low. |
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Chlamydia
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Most common STI
2-12% of women in U.S. (20% in high risk pop.) 40%- gonorrhea coexisting 85%- asymptomatic -S/s: prurlent yellowish dischargefrom cervix, inflammations Risk to mom: PID (fever, abdominal pain, urethral infection. Risk to baby: PROM, preterm labor, stillbirth, infection, death. S/s present 5-12 days after birth. Risk of conjunctivitis, blindness Testing: culture via speculum exam, urine culture Treatment: Mother and partner- refer for antibiotics Neonate: eye prophylaxis (with apparent maternal infection at birth- IV antibiotics) |
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Gonorrhea
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2nd most common STI
40% Chlamydia coeixisting 80% Asymptomatic -Pregnant women prone to disseminated infection S/s: Fever, joint pain, skin lesions, flu-like symptoms, genital inflammation -R/O when presenting with pelvic pain in 1st trimester -Reinfection common when immune response is poor -Testing: GC culture -Risk to fetus: preterm labor, prolonged ROM, chorio, PP infection -Treatment: Refer for antibiotic treatment -Neonatal s/s: conjunctivitis, blindness, loss of eye -NB treatment: Prophylactic eye ointment (if mother presents with apparent s/s at labor, NB should receive IV antibiotic therapy) |
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HIV
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Human Immunodeficiency Virus
Testing: Routine HIV-Ab blood test in pregnancy (ELISA). If reactive, repeat testing with Western Blot. Refer/ Transfer care required Maternal-child transmission 25-30% Treatment: antivirals |
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Syphilis
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Routine RPR for all pregnant women
Transmitted by contact with bodily fluids; maternal-fetal xmission. Primary Infection: chancres @ site of contact, Onset ~9-90 days after exposure, lasting 1-8 weeks Secondary infection: Onset ~3-6 months after chancres, presents with body rash and various systemic symptoms Latent infection: Untreated syphilis. Onset 10-30 years after primary infection, usually no symptoms. Late Stage: Tertiary Syphilis. Manifests 3-25y after primary infection. Neurological damage. Testing: routine RPR. If reactive, TP-PA test to confirm. Must refer/transfer care Neonatal risk: 70-100% with infected mom Defects, stillbirth, preterm labor, hydrops, rash or lesions. Placenta will look enlarged, pale, greasy. Treatment: IV Penicillin G long term |
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1st Trimester Bleeding
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May be due to:
Breakthrough bleeding (normal) Implantation (normal) Cervical erosion, polyps, cervical injury or cancer Ectopic/ molar pregnancy Threatened miscarriage Monitor FHT/ Refer for US RH negative moms: indirect Coombs, RhoGam |
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2nd Trimester Bleeding
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May be due to:
Vigorous sex Changing cervix Placental abruption Monitor FHT/ Refer for US RH negative moms: indirect Coombs, RhoGam Monitor for shock- refer/transfer |
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3rd Trimester Bleeding
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May be due to:
Cervical change- normal if term Placenta abruption Placenta previa Monitor FHT/ Refer for US RH negative moms: indirect Coombs, RhoGam Monitor for shock- refer/transfer |
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Pregnancy Induced Hypertension
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PIH
Usually presents after 20 weeks Not accompanied by s/s preeclampsia/ toxemia Diagnosed by 2 elevated BP readings at least 6 hours apart >140 systolic/ >90 diastolic Light exercise, rest, deep relaxation, hydrotherapy Brewer diet, adequate sodium intake, garlic, adequate hydration No stimulants- caffeine, nicotine, drugs, spicy foods Have mother assess BP at home Herbs: hops, skullcap, chamomile Supplements: Calcium, Magnesium, Potassium |
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Polyhydramnios
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Increased amniotic fluid
Associated with fetal urinary problems, IUGR, Gestational diabetes Refer for US/ physician consult |
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Gestational Diabetes
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Hyperglycemia, secondary to insufficient insulin action
Causes dysfunction of various organs Develops in later half of pregnancy Screen at 24-28 weeks: blood glucose, A1c >140 mg/dL blood glucose, collected 2 hours after consuming 50 g of sugary food/drink glucosuria, ketones May be controlled by dietary/ lifestyle changes Brewer diet/ eliminate grain carbs Retest Risk to fetus: macrosomia, polyhydramnios, hypoglycemia at birth, preterm labor, shoulder dystocia, fetal anomalies Mom at higher risk for toxemia, kidney problems |
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Preeclampsia
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Prevention: good diet
Develops after 20 weeks Hypertension- high bp on 2 separate occasions Proteinuria- 0.3g in 24 hrs -or- >+1 urine dipstick (clean catch, no UTI) Elevated serum creatinine >1.2mg/dL Low platelets <100,000/microliter Elevated liver enzymes ALT, AST, both Persistent headache, epigastric pain Eclampsia (seizures) May be superimposed on chronic hypertension if occuring <20 weeks |
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HELLP Syndrome
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Hemolysis
Elevated Liver enzymes Low Platelets increased bilirubin, low WBC also seen Usually hypertensive, but not a requirement diagnostically Contracted blood volume, high Hgb @ 28 weeks |
