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9: Complications of Pregnancy
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What is the likelihood of developing disease after neonatal hepatitis B exposure How is neonatal infection prevented
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Most infected neonates are asymptomatic; however, 85% become chronic carriers Through prenatal screening and administration of hepatitis B immune globulin as well as the hepatitis vaccination of newborns of infected mothers (vaccination is safe in pregnancy) There is a theoretic risk of transmission; however, hepatitis B immune globulin and neonatal vaccination should eliminate this risk
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Is breast-feeding safe in women with Hepatitis B
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What is hepatitis C and how is it transmitted What is the incidence of hepatitis C in pregnancy How is hepatitis C diagnosed A single-stranded Flaviviridae virus that is transmitted though exposure to blood and bodily fluids Depending on the population studied, it ranges from approximately 1 5% Serum antibody testing (those seropositive for anti-HCV have chronic hepatitis) It has no effect on pregnancy, although it may increase the risk of cholestatic jaundice Between 3% and 6% There are currently no known methods to prevent transmission at birth
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How does hepatitis C infection affect pregnancy What is the incidence of vertical transmission of hepatitis C How can vertical transmission be prevented
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What is hepatitis D A defective RNA virus that is only infectious if it coinfects with hepatitis B and is transmitted in a similar manner Approximately 25%
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What percentage of patients infected with hepatitis B are coinfected with hepatitis D
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Section III: Topics in Obstetrics
What are the sequelae of infection with hepatitis B and D
The same as hepatitis B, however the infection is more severe than infection with hepatitis B alone
Hepatitis E
What is hepatitis E What are the effects of hepatitis E infection in pregnancy An RNA virus transmitted via contaminated water There may be a high rate of vertical transmission and there is some evidence that infection is more severe in pregnancy
BACTERIAL INFECTIONS Group B Streptococcus
What is group B Streptococcus (GBS) Streptococcus agalactiae, a grampositive infection of the GI, upper respiratory and genital tracts It leads to severe disease in neonates if they are infected right before or during birth Approximately 15 30% Primarily in the rectum, with secondary infection in the bladder, vagina, and cervix Usually none Via routine screening with urine culture and rectovaginal swab A sample is swabbed from the vagina and rectum for culture and latex agglutination or ELISA Because of intrapartum chemoprophylaxis, the incidence of invasive disease is low GBS affects only approximately 1 in 4000 births in the United States 35 75% depending on the degree of infection UTI, chorioamnionitis, or postpartum wound infection, bacteremia, or endomyometritis
What percentage of women are asymptomatic carriers of GBS Where does colonization typically occur
What are the symptoms of GBS colonization in women How is GBS colonization diagnosed
What is the incidence of invasive GBS infection in pregnancy
What is the rate of maternal-neonatal transmission of GBS if left untreated How does symptomatic GBS infection manifest in pregnant women
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9: Complications of Pregnancy
What are the clinical manifestations of neonatal GBS infection
Bacteremia, sepsis, pneumonia, respiratory distress, meningitis, shock, or death can ensue If the neonate survives, 33% have longterm neurodevelopmental problems Early onset refers to infection before 7 days of age and it carries the highest mortality rate Late onset disease occurs from 1 week to 3 months after birth 5% 15% Preterm labor GBS bacteriuria during the pregnancy Prolonged ROM (>18 hours) Having a neonate affected by earlyonset GBS infection in a previous pregnancy Maternal fever >38 C during labor
What is the difference between early onset and late onset GBS disease
What is the mortality rate associated with neonatal GBS infection What are the major risk factors for neonatal GBS infection that necessitate treatment in a woman who has not been screened for GBS
What is the recommended treatment for GBS colonization What are the alternatives for patients allergic to penicillin
IV penicillin or ampicillin Cefazolin and vancomycin Clindamycin or erythromycin are acceptable alternatives only if culture and sensitivities have demonstrated the bacteria to be sensitive
Listeria Monocytogenes
What is Listeria A gram-positive, aerobic bacillus that is transmitted via fecal-oral transmission Infected foods such as raw vegetables, milk, smoked fish, soft cheeses, and some processed meats Can be asymptomatic or it can cause a flu-like illness Disseminated granulomatous lesions with microabscesses Chorioamnionitis Sepsis Sudden abortion or stillbirth
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What is commonly implicated in Listeria infection What are the clinical manifestations of listeriosis in adults What are the clinical manifestations of fetal infection with Listeria
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