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advanced antepartum exam 2
advanced antepartum exam 2
123
Nursing
Graduate
11/18/2014
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Term
Most common vaginal infection in women of childbearing age; common in pregnant women
 Definition
BV
Term
≈10-30% will have____ during pregnancy
 Definition
BV
Term
: No incubation period and is Not a sexually transmitted
 Definition
BV
Term
List risk factors for BV
 Definition
New partner or multiple sexual partners; smoking, chronic stress, frequent or recent douching, ethnic differences.
Term
Chronic BV can lead to
 Definition
PID
Term
What are some complications of BV
 Definition
SAB, PTL, LBW, PPROM, chorio, amniotic fluid infection
Term
vaginal discharge, odor, pain, pruritus or burning. Unique foul/“fishy” odor, particularly noted after intercourse. Discharge thin/grey-white are all s/s of
 Definition
BV
Term
BV increases the chances of getting
 Definition
STIs
Term
In regards to BV, what labs help with dx and what are the expected results?
 Definition
Wet prep: clue cells; pH > 4.5; positive “whiff” test
Term
Metronidazole or clindamycin are used for the treatment of
 Definition
BV
Term
Clindamycin, vaginally is associated with increased chances of
 Definition
ptb
Term
____ is the most common STI
 Definition
HPV
Term
What happens to genital warts during pregnancy?
 Definition
increase in size; may block birth canal
Term
During pregnancy, what is the tx for genital warts?
 Definition
not recommended and not needed
Term
Weak immune system; unprotected sexual activity; multiple sexual partners; change in sexual partner(s) are all risk factors for
 Definition
HPV
Term
if tx'd is given during pregnancy, genital warts typically
 Definition
do not respond well to tx
Term
what is the rare, neonatal complication associated with maternal genital warts?
 Definition
= respiratory papillomatosis; most nbn clear the virus spontaneously
Term
C/S is not needed to prevent transmission of
 Definition
genital warts
Term
 Incubation Period for HSV is
 Definition
≈ 2-10 days, initial sores heal in 2-4 wks.
Term
what is the most common mode of transmission of HSV?
 Definition
male to female
Term
once you have been infected with HSV, it remains in the
 Definition
cranial nerves or dorsal spinal ganglia indefinitely.
Term
If primary HSV outbreatk occurs late in pregnancy, the risk of neonatal transmission is
 Definition
50%
Term
because maternal antibodies are protective, recurrent outbreaks at delivery recurs a ___ neonatal transmission rate.
 Definition
1%
Term
 Most cases of neonatal HSV are born to
 Definition
 asymptomatic women with no history of genital HSV
Term
what are the three ways to dx HSV?
 Definition
blood draw, PCR swab; differentiates between type 1 and 2, cell swab of lesion and cervix
Term
 Acyclovir or valacyclovir for primary infection works to
 Definition
 Reduces symptoms and improves healing time and there are No contraindications to use in pregnancy.
Term
If active herpetic lesion or prodromal symptoms, cesarean delivery should be done, preferably within
 Definition
within 4 to 6 hours of ROM
Term
most common curable STI
 Definition
trichomonasis
Term
what is the incubation period for trich>
 Definition
: 4-28 days
Term
what are risk factors for contracting trich?
 Definition
Multiple sexual partners, U.S.-born, lower education, poverty, black race, douching, hx of prior STIs and coexistence infection with Neisseria gonorrhoeae
Term
Heavy yellow-green or grey vaginal discharge, can be “frothy”; pain or discomfort during sex; vaginal odor; painful urination are s/s of what STI?
 Definition
trich
Term
When dx trich, the cervix will appear____ and a ____ is completed to assess for _____cells.
 Definition
strawberry, wet prep,
Term
What is the tx for trich?
 Definition
Metronidazole or tinidazole PO. Easy to cure. High reinfection rates. Treatment does not reduce rate of PTB
Term
what is the incubation period for chlamydia?
 Definition
7-21 days, may be as long as 6 weeks
Term
what risk does chylamdia carry in the PP period?
 Definition
postpartum endometritis
Term
what are the risk to the neonate with maternal chlamydial infection?
 Definition
pneumonia and conjunctivitis
Term
vertical transmission occurs with chlamydial infection in what percentage of pregnancies?
 Definition
30-50-%
Term
Abnormal vaginal discharge or dysuria most common. 33% have urethral syndrome, urethritis or Bartholin’s gland infection are s/s of
 Definition
chlamydia
Term
what are the screening recommendations form the CDC?
 Definition
initial OB and in the 3rd trimester for at risk women
Term
what is the tx for chlamydia?
 Definition
: Azithromycin or doxycycline
Term
what is the incubation period for gonorrhea?
 Definition
Most often 2-5 days; up to 30 days
Term
list ways gonorrhea can enter the body
 Definition
May affect the genitals, anus, mouth, throat or eyes.
Term
what are risk factors associated with maternal gonorrheal infection?
 Definition
septic AB, PTB, PROM, chorio, postpartum infection
Term
what are the implications for the nbn born to a mother infected with gonorrhea?
 Definition
blindness, joint infection or a life-threatening blood infection.
Term
TOC is not necessary for women with gonorrhea if
 Definition
their symptoms resolve
Term
the incubation period for syphilis is
 Definition
: Averages 3 weeks; 3-90 days
Term
s/s of syphilis may go
 Definition
unrecognized for many years.
Term
 PTL, IUFD, neonatal infection, neonatal death
 Congenital anomalies
 Long term sequelae, neurological impairment, deafness are all consequences of
 Definition
syphilis
Term
Most commonly a single sore (chancre), but multiple sores possible. Sore(s) firm, round, small, raised, painless—on the spot where the infection entered. Lasts 3-6 wks, heals without tx.
 Definition
primary stage of syphilis
Term
Characterized by skin rash and mucous membrane lesions. Palms and soles of feet = common sites. Rash may appear as chancre is healing or weeks afterwards. May be faint and go unrecognized
 Definition
secondary stage of syphilis
Term
Begins when signs and symptoms of primary and secondary syphilis disappear. May last for years; disease process continues to progress
 Definition
latent syphilis
Term
: Develops in ≈ 15% of the untreated; occurs 15-20 yrs. post initial infection. Leads to central nervous system involvement, cardiovascular disease.
 Definition
late stage syphilis
Term
If pt has a positive RPR, then a treponemal test is completed to assess for
 Definition
antibodies to antigenic components of T. pallidum
Term
what is the incubation period for HIV
 Definition
Days to weeks. Most cases caused by HIV-1. Acute HIV infection, usually < 10 days.
Term
If an HIV infected mother has a viral load greater than 1000, what is the recommended mode of delivery?
 Definition
c/s
Term
Acute infection~ fever, night sweats, fatigue, rash, headache, lymphadenopathy, pharyngitis, myalgias, arthralgias, nausea, vomiting, diarrhea are s/s of
 Definition
HIV
Term
What are the ELISA and Western blot test in regards to HIV testing?
 Definition
Screening per ELISA test with a sensitivity of > 99.5%. Confirmed per Western blot or immunofluorescence assay (IFA
Term
what group of pregnant women are most at risk for UTIs?
 Definition
hx UTIs
diabetes
sickle cell trait
sickle cell disease
Term
• Asymptomatic Bacteriuria; what percentage will become symptomatic if left untreated?
 Definition
12%
Term
what UA results warrant obtaining a urine culture?
 Definition
o U/A per dipstick: + for WBCs, nitrates, &/or protein > trace
Term
In the tx of UTIs, what medications are contraindicated in women after 36wks? why?
 Definition
sulfa drugs and increased risk of kenicterus in neonate
Term
nitrofurantoin drugs for the tx of UTIs are contraindicated near term (≥ 38 wks GA), potential for induction of
 Definition
hemolytic anemia in the neonate
Term
UTI; when should a TOC be obtained?
 Definition
two weeks after tx
Term
What is the standard tx for women with asymptomatic bateriauria who have been resistant to two rounds of antibiotics?
 Definition
suppressive tx when two courses of tx have been completed without cure of asymptomatic bacteriuria or cystitis; monthly U/C for surveillance
Term
untreated uti's can progress to
 Definition
pyelonephritis
Term
o most common serious medical complication of pregnancy; leading cause of septic shock during pregnancy
 Definition
pyelonephritis
Term
what are the risk factors for pyelo
 Definition
o nulliparity
o young age
o diabetes
second trimester
untreated UTI
Term
what are complications of pyelo?
 Definition
: PTL/PTB, ARDS, hemolysis producing anemia, septic shock
Term
what are some potential problems associated with pyelonephritis?
 Definition
• chorio, endometritis,
• UTIs, wound infections;
• implicated in PTL/PTB, PROM
Term
incubation period is 6 weeks to 6 months and Approximately 50% of adults have symptoms within three months of exposure
 Definition
hep b
Term
fever, fatigue, anorexia, nausea, vomiting, abdominal pain, arthralgia, jaundice, dark urine, grey-colored stools are symptoms of
 Definition
hepatitis b
Term
Acute hepatitis can be self-limiting and can be cleared within
 Definition
First six months after infection. Self limited in those who can fight the infection and clear the virus. Others become chronic
Term
Chronic hep B may take _____to develop and many are______. 15-25% will develop_______
 Definition
30 years to develop. Many asymptomatic. 15-25% develop serious liver disease
Term
what things do you assess for during a physical exam of someone who you suspect has hepatitis
 Definition
 tender, enlarged liver
 enlarged spleen
 jaundice
Term
what medication should be given to the nbn to prevent hepatitis b transmission after birth? time frame?
 Definition
HBIG and first Hep B series within 12hrs
Term
• Hepatitis B surface antigen (HBsAg) indicates
 Definition
active disease; acute or chronic
Term
• Hepatitis B surface antibody (anti-HBs) indicates
 Definition
immunity from the virus; via vaccine or from previous infection
Term
• Total hepatitis B core antibody (anti-HBc) indicates
 Definition
o Positivity indicates recent infection with hepatitis B virus (<6 months). Its presence indicates acute infection.
Term
CMV is a member of the ___ family and is the most common ______
 Definition
o One of the herpes viruses: most common source of perinatal infection in the developed world
Term
List the ways CMV is transmitted
 Definition
: present in body fluids: transmission per nasopharyngeal secretions, urine saliva, semen, cervical secretions or blood—intimate contact required
Term
CMV is not highly
 Definition
contagious
Term
What are the most common ways CMV is spread?
 Definition
within households and among young children in day care centers and classrooms
Term
CMV infection does not equate to
 Definition
immunity; may become reactivated or reinfected
Term
fetal transmission occurs most often during the first half of pregnancy
 Definition
CMV; associated with high morbidity and mortality
Term
FGR, microcephaly, intracranial calcifications, mental and motor deficits, hepatosplenomegaly, jaundice, hemolytic anemia, and thrombocytopenic purpura may occur
 Definition
with CMV infection during the first half of pregnancy
Term
late pregnancy CMV infection is associated with
 Definition
: hearing loss, neurologic deficits, chorioretinitis, psychomotor deficits, learning disabilities
Term
primary way to prevent CMV is through
 Definition
hand washing
Term
review the first phase of human parvo virus
 Definition
: viremia and viral shedding; most asymptomatic, mild flu-like symptoms may occur; transmission rate high: 50% to household members, 30% school mates; infection from pregnant woman to fetus, 30%
Term
review the second phase of human parvo virus
 Definition
symmetrical “slapped cheek” rash in children that spreads to trunk and limbs, arthralgia occurs in adults; no transmission
Term
what is the dx test for human parvo virus? what does is look for?
 Definition
o Diagnosis: ELISA and Western blot for IgG and IgM antibodies
IgM antibodies coincide with time of symptoms, disappear in 1-4 months IgG antibodies detectable approximately on day 7, remain for life
Term
if pregnant woman has been exposed to parvo and test negative, seven days later, when should she retested?
 Definition
repeat in 2-4 wks
Term
s/s of toxoplasmosis
 Definition
: Often absent, < 20% have pyrexia, fatigue, sore throat, muscle pain, posterior cervical lymph node enlargement, maculopapular rash,
Term
associated with consumption of undercooked meat and meat products-- mutton/lamb meat, cured meats, and raw goat milk and milk products
 Definition
risk to getting toxoplasmosis
Term
review potential problems of the neonate born to mother infected with toxoplasmosis
 Definition
o PTB, LBW infant
o affected neonates at risk for significant long-tem sequelae including neurologic anomalies not necessarily evident at birth
Term
what is the dx test for toxoplasmosis
 Definition
: DNA amplification techniques and sonographic evaluation
Term
cooking meats to safe temperatures, cleaning cooking surfaces and utensils that contain raw animal products, wearing gloves while gardening outdoors, not changing cat litter of outdoor cats are all ways to
 Definition
ways to prevent toxoplasmosis
Term
review food sources of listeria
 Definition
: unpasteurized milk and milk products including soft cheeses, melons, coleslaw, apple cider, smoked seafood products, sliced deli meats, pâté, hummus, wieners
Term
what are the potential problems associated with listeria
 Definition
PTB, fetla loss, neonatal sepsis, chorio, placental lesions
Term
what is the tx for listeria
 Definition
Ampicillin and gentamycin are most often used antibiotics due to synergism
Term
o Double-stranded DNA herpesvirus; highly contagious; 95% of adults are immune
 Definition
varicella
Term
how is varicella transmitted; incubation period
 Definition
o Transmitted by direct contact; incubation period 10-21 days
Term
what part of pregnancy poses the highest risk to the fetus when a woman contracts chicken pox
 Definition
first 20wks; varicella syndrome
Term
Varicella passed to fetus six days prior to birth increases the risk of
 Definition
neonatal death; mother should be given VBIG
Term
when is varicella most contagious
 Definition
one day before onset of rash until lesions are crusted over
Term
what is the cause of maternal mortality in those who contract varicella
 Definition
varicella pneumonia
Term
Rubella infection is more likely to occur during what part of pregnancy?
 Definition
third trimester; less mobidity
Term
o Most common fetal problems with maternal rubella infection
 Definition
cataracts, cardiac defects, deafness
Term
Maternal rubella infection can lead to
 Definition
SABs, fetal anomalies, stillbirths
Term
review rubella immunity graph
 Definition
o antibody of 1:10 or > indicates immunity
o antibody < 1:10 indicates lack of immunity and should be noted
o antibody 1:64 or > indicates current disease
Term
what is the tx for UTI?
 Definition
Amoxicillin 500mg TID for 7-10 days
Term
Sulfa drugs in the 3rd trimester contriute to_____in the neonate
 Definition
hyperbilirubinemia; kernicterus
Term
Nitrofurantoin (macrobid) induces hemolytic anemiain the neonate due to
 Definition
G6PD deficiency
Term
Pyelo is treated with
 Definition
Ancef
Term
Hepatitis is not contraindicated in
 Definition
breastfeeding
Term
Hepatitis does not colonize in the ____ or ____.
 Definition
cord blood or amniotic fluid
Term
CMV is most often transferred during which trimester? Which trimester is more likely to be more serious?
 Definition
3rd trimester and 1st trimester
Term
CMV transplacental infection in the first half of pregnancy is more likely to lead to
 Definition
severe neonatel morbidity
Term
CMV symptoms are similar to mono symptoms. The triad usu includes
 Definition
pyrexia, pharyngitis, lymphadenopathy/polyarhritis
Term
IgG means
 Definition
you have permanent immunity
Term
IgM means
 Definition
you have an active infection
Term
review the symptoms of varicella syndrome
 Definition
chorioretinitis, micropthalmia, cerebral cortical atrophy, growth restriction, hydronephrosis, cicatricial skin lesions
Term
what is feature is noted in pts with BV?
 Definition
decreased lactobacilus
Term
list the suppressive therapy tx for HSV
 Definition
Acyclovir 400mg TID and
Valtrex 500mg BID
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