Infectious Disease In Pregnancy

1. A 19 year old primigravida comes into triage at 36 wks gestation with premature rupture of membranes. She has received limited prenatal care and Group B Strep status is unknown. What should your next step be?

Rectovaginal GBS swab and culture, and prophylactic penicillin

C/S to avoid exposing fetus to unknown vaginal flora

IV Clindamycin 9mg every 8 hours until delivery

GBS status does not play a role at this time

The next step should be to perform a rectovaginal GBS swab and culture, and administer prophylactic penicillin. This is because GBS (Group B Streptococcus) status is unknown, and GBS is a common cause of neonatal sepsis and pneumonia. Administering prophylactic penicillin can help prevent the transmission of GBS to the fetus during delivery.

Explanation

The next step should be to perform a rectovaginal GBS swab and culture, and administer prophylactic penicillin. This is because GBS (Group B Streptococcus) status is unknown, and GBS is a common cause of neonatal sepsis and pneumonia. Administering prophylactic penicillin can help prevent the transmission of GBS to the fetus during delivery.

2. Which is NOT typical of congenital rubella syndrome?

Deafness

Retinopathy

Congenital heart disease

Macrosomia

Macrosomia refers to a condition where a baby is born with excessive birth weight. This is not typically associated with congenital rubella syndrome. Congenital rubella syndrome is a condition that occurs when a pregnant woman contracts rubella (German measles) and passes it on to her unborn baby. The syndrome is characterized by a range of symptoms including deafness, retinopathy (eye abnormalities), and congenital heart disease. However, excessive birth weight or macrosomia is not commonly observed in babies with congenital rubella syndrome.

Explanation

Macrosomia refers to a condition where a baby is born with excessive birth weight. This is not typically associated with congenital rubella syndrome. Congenital rubella syndrome is a condition that occurs when a pregnant woman contracts rubella (German measles) and passes it on to her unborn baby. The syndrome is characterized by a range of symptoms including deafness, retinopathy (eye abnormalities), and congenital heart disease. However, excessive birth weight or macrosomia is not commonly observed in babies with congenital rubella syndrome.

3. A 32 year old G3P2 expresses concern after reading about Parvovirus B-19 on the internet. Which of the following is true about this disease?

Mothers should not be routinely screened for Parvovirus B-19.

If an infected fetus does not develop hydrops, long-term outcomes are generally good.

There is no specific treatment for parvovirus infection.

>60% of adolescents and adults are seropositive for exposure.

ALL of the above are TRUE.

The correct answer is that ALL of the above statements are true. Mothers should not be routinely screened for Parvovirus B-19, as it is generally a mild and self-limiting infection in healthy individuals. If an infected fetus does not develop hydrops, which is a serious condition characterized by abnormal fluid accumulation, the long-term outcomes are generally good. There is no specific treatment for parvovirus infection, as it typically resolves on its own. Additionally, 60% of adolescents and adults are seropositive for exposure, meaning they have antibodies against the virus in their blood.

Explanation

The correct answer is that ALL of the above statements are true. Mothers should not be routinely screened for Parvovirus B-19, as it is generally a mild and self-limiting infection in healthy individuals. If an infected fetus does not develop hydrops, which is a serious condition characterized by abnormal fluid accumulation, the long-term outcomes are generally good. There is no specific treatment for parvovirus infection, as it typically resolves on its own. Additionally, 60% of adolescents and adults are seropositive for exposure, meaning they have antibodies against the virus in their blood.

4. Which of the following is true in regards to Toxoplasmosis?

Indoor cats are not reservoirs for Toxoplasmosis.

Only HIV positive women should be screened for Toxoplasma.

15% of reproductive age women have antibodies to Toxoplasmosis.

Spiramycin may reduce risk of fetal transmission.

ALL of the above are TRUE

Toxoplasmosis is a parasitic infection caused by the Toxoplasma gondii parasite. Indoor cats are not reservoirs for Toxoplasmosis because they usually do not have contact with the parasite. Only HIV positive women should be screened for Toxoplasma because their weakened immune system puts them at a higher risk. 15% of reproductive age women have antibodies to Toxoplasmosis, indicating that they have been exposed to the parasite. Spiramycin, an antibiotic, may reduce the risk of fetal transmission by treating the infection in pregnant women. Therefore, all of the statements mentioned are true.

Explanation

Toxoplasmosis is a parasitic infection caused by the Toxoplasma gondii parasite. Indoor cats are not reservoirs for Toxoplasmosis because they usually do not have contact with the parasite. Only HIV positive women should be screened for Toxoplasma because their weakened immune system puts them at a higher risk. 15% of reproductive age women have antibodies to Toxoplasmosis, indicating that they have been exposed to the parasite. Spiramycin, an antibiotic, may reduce the risk of fetal transmission by treating the infection in pregnant women. Therefore, all of the statements mentioned are true.

5. Which is true of Hepatitis B in pregnancy?

Breastfeeding is always contraindicated in women who are chronic carriers of HBV.

Non-immune mothers should not be vaccinated after the second trimester.

The risk of fetal infection is higher if maternal infection occurs in the third trimester.

Only infants with HBV positive mothers should be vaccinated.

The risk of fetal infection is higher if maternal infection occurs in the third trimester. This is because the transmission of Hepatitis B from mother to fetus usually occurs during childbirth. If the maternal infection occurs earlier in pregnancy, the fetus has a longer duration of exposure to the virus, increasing the risk of transmission. However, if the infection occurs in the third trimester, the time for transmission is shorter, reducing the risk of fetal infection.

Explanation

The risk of fetal infection is higher if maternal infection occurs in the third trimester. This is because the transmission of Hepatitis B from mother to fetus usually occurs during childbirth. If the maternal infection occurs earlier in pregnancy, the fetus has a longer duration of exposure to the virus, increasing the risk of transmission. However, if the infection occurs in the third trimester, the time for transmission is shorter, reducing the risk of fetal infection.

6. Which of the following is NOT a recommended routine screening in pregnancy?

Chlamydia

Syphilis

HSV serologic screening

Hepatitis B surface antigen

HSV serologic screening is not a recommended routine screening in pregnancy because it is not considered to be cost-effective or beneficial in preventing adverse outcomes for the mother or the baby. Additionally, there is a lack of evidence to support routine screening for HSV in pregnant women who do not have symptoms or a history of genital herpes. Therefore, other screenings such as Chlamydia, Syphilis, and Hepatitis B surface antigen are recommended as part of routine prenatal care.

Explanation

HSV serologic screening is not a recommended routine screening in pregnancy because it is not considered to be cost-effective or beneficial in preventing adverse outcomes for the mother or the baby. Additionally, there is a lack of evidence to support routine screening for HSV in pregnant women who do not have symptoms or a history of genital herpes. Therefore, other screenings such as Chlamydia, Syphilis, and Hepatitis B surface antigen are recommended as part of routine prenatal care.

7. A 25 year old nulliparous patient with HIV wishes to become pregnant. Which of the following is true?

Even with appropriate antiretroviral therapy, neonatal infection occurs 20-25% of the time.

Fetal scalp electrode monitoring should be avoided.

With appropriate antiretroviral therapy, breastfeeding is safe in these patients.

If the mother is untreated and has a high viral load, pursue a vaginal delivery

Fetal scalp electrode monitoring should be avoided in a 25-year-old nulliparous patient with HIV who wishes to become pregnant. This is because the use of fetal scalp electrode monitoring increases the risk of vertical transmission of HIV from the mother to the fetus. Other options are not true or recommended.

Explanation

Fetal scalp electrode monitoring should be avoided in a 25-year-old nulliparous patient with HIV who wishes to become pregnant. This is because the use of fetal scalp electrode monitoring increases the risk of vertical transmission of HIV from the mother to the fetus. Other options are not true or recommended.

8. A 29 year old primigravida patient has a history significant for HSV-2. Which of the following is NOT true regarding her care?

If any vulvovaginal lesions are seen at the time of labor, Cesarean delivery is recommended.

Acyclovir should be avoided in the first trimester.

Acyclovir should be given starting at 36 weeks to reduce the risk of viral shedding.

There is a 3% risk of neonatal infection if the mother has recurrent infection at the time of delivery.

Acyclovir should be avoided in the first trimester because it is associated with a small risk of birth defects. However, it can be used in later trimesters to reduce the risk of viral shedding and transmission to the baby. If any vulvovaginal lesions are seen at the time of labor, a Cesarean delivery is recommended to prevent the baby from coming into contact with the lesions and reducing the risk of transmission. There is a 3% risk of neonatal infection if the mother has recurrent infection at the time of delivery.

Explanation

Acyclovir should be avoided in the first trimester because it is associated with a small risk of birth defects. However, it can be used in later trimesters to reduce the risk of viral shedding and transmission to the baby. If any vulvovaginal lesions are seen at the time of labor, a Cesarean delivery is recommended to prevent the baby from coming into contact with the lesions and reducing the risk of transmission. There is a 3% risk of neonatal infection if the mother has recurrent infection at the time of delivery.