A Physician Assistant Review of Some Infectious Complications of Pregnancy and Podcast Episode 002
Summary: Group B Strep This is probably the most often discussed infection in pregnant women. As high as 30% of pregnant women are asymptomatic carriers. An active Group B strep infection at the time of delivery can be very bad for both the mother and the baby whether the child is delivered vaginally or by C-section. The mother can develop endometritis and the newborn may develop sepsis. This is rare but in a term infant can be fatal in nearly 25% of those affected. All women are recommended to have vaginal cultures taken for group B strep at 35-37 weeks. If these cultures are positive or the results are unknown patients are to receive antibiotic treatment during labor. Penicillin G is recommended and cefazolin or vancomycin if the patient is allergic. Urinary Tract Infection The urinary tract is very susceptible to infection during pregnancy. A urine culture is performed as part a routine prenatal care. This may increase the risk for preterm labor. Treatment of a positive culture would include ampicillin, cephalexin or nitrofurantoin. HIV/AIDS HIV/AIDS does not have any effect the ability to get pregnant nor does it alter the course of the pregnancy. On a similar note there is no evidence that pregnancy has any effect on the AIDS virus and its progression. The issue much like Rh incompatibility is the mixing of fluids between the mother and infant especially during the trauma of delivery. Before routine screening and the use of antiretrovirals at the time of delivery as many as 25% of babies born to mothers with HIV were infected. This number has dropped down to between 1 and 8% with proper treatment. Mom is on an antiretroviral regiment throughout her pregnancy and the newborn is treated for 6 weeks. Herpes Genitalis Women with a primary infection late in pregnancy may require acyclovir in order to decrease the possibility of active lesions at the time of delivery. A history of recurrent herpes infection should be monitored throughout the pregnancy. If there is an active infection a C-section is indicated. Typically acyclovir starting at 36 weeks decreases the rate of detectable virus. Syphilis Syphilis may cause still birth, late term abortions, transplacental infection and congenital syphilis.All women should be tested for syphilis during prenatal visits. Cholecystitis Cholecystitis and gallstones due occur during pregnancy. An U/S should be able to diagnose gallstones. If the case warrants surgery then surgery should be performed. It is safest to perform laparotomy or laparascopy in the second trimester. Appendicitis Right sided abdominal pain should be a red flag for appendicitis in a pregnant patient. Obviously the anatomy is all in different places, so tenderness over Mcburne’s point may not be helpful. Nausea and vomiting are difficult symptoms to use in pregnant patient. Appendicitis is often over looked and needs to be considered. As stated above surgery if indicated is perfectly appropriate. A ruptured appendicitis is far more dangerous and may cause premature labor or abortion. Mastitis I’m not sure where to put this so it’s going here.Presentation Usually within 3 months of delivery Typically only one breast is affected Red, tender and warm Lumpy breast Swelling Fever Nipple discharge cracked nipples TreatmentMost commonly this is a Staph. aureus infection. An antibiotic that is effective against penicillin resistant Staph is the treatment of choice. A cephalosprin for 5-7 days. The mother is encouraged to continue to breast feed as this will empty the breasts. If not continuing to nurse mechanical emptying is necessary. An abscess may form which would require I&D. Generally speaking the baby does just fine without being treated with antibiotics. ------------------------------------------------------------------------------------------------------------------------- If you are preparing for the PANRE/PANCE check back for weekly updates.
