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OB Ch 7 - STI during pregnancy
AP-BSN Nursing program. OB review questions for test 1.
Terms in this set (47)
In general, we can treat all forms of sexually transmitted diseases, with the exception of which type?
What is always used to treat syphilis?
What is the most common STI?
What are 8 subtypes of HPV linked to causing?
What is the most painful STI?
Herpes simplex (Type 1 or 2)
-Type 2 is genital, but type 1 will grow on genitalia as well.
What STIs commonly present with no symptoms in the early stage?
Chlamydia and Gonorrhea
Pelvic Inflammatory Disease
Tables on 175 and 179
Group B Strep
Tested by vaginal culture
Treated with course of oral antibiotics
Tested again at 36 weeks, and treat again if present.
IV antibiotics are also started on the mother during labor.
Can cause neonatal sepsis, respiratory infections, and maternal fever. All this from a bacteria that is part of our normal flora
If a pregnant woman is diagnosed with chlamydia, should it be treated, and if so, how?
Yes, the infection should be treated because perinatal exposure to the disease can cause conjunctivitis or pneumonia. Additionally, chlamydia is the most common infectious cause of ophthalmia neonatorum. We can use erythromycin or amoxicillin to treat chlamydia in a pregnant woman
If a pregnant woman is diagnosed with gonorrhea, should it be treated, and if so, how?
Yes, the infection should be treated because the disease can cause numerous problems for the mother and the child. The mother can suffer from salpingitis in the first trimester. Additionally, perinatal complications include premature membrane rupture, preterm birth, chorioamnionitis, neonatal sepsis, intrauterine growth restrictions, and maternal sepsis postpartum. The child most commonly suffers from ophthalmia neonatorum. The treatment for pregnant women is ceftriaxone with treatment for chlamydia included due to the high percentage of dual infections
If a pregnant woman is diagnosed with syphilis, should it be treated, and if so, how?
Yes, syphilis should be treated because the disease can lead to serious systemic diseases and potentially death. Additionally, the disease can be transmitted transplacentally at any time during pregnancy. The recommended treatment is Benzathine penicillin G, with varying strength based on the stage of the disease. If a penicillin allergy, exists erythromycin can be used but it will not cross the placenta
PID can scar the pelvic viscera, including the fallopian tubes, which can render a woman infertile. Though it is often caused by STIs, there are other things that can cause it. What are those?
PID can be caused by both aerobic and anaerobic bacteria, which typically infect the woman after menses and ascend the vagina and endocervix to the upper genital tract
How could having an outbreak of primary herpes affect a woman's preferred method of delivery?
A primary outbreak of herpes changes the preferred method of delivery from vaginal to caesarian section as long as the C-section can be performed within four hours of labor initiation or rupture of membranes. If this is not possible, the newborn should be monitored and cultured
Which precaution should a mother with Hepatitis B take in order to breastfeed without transmitting the infection to the newborn?
There is no specific treatment for the mother, as the disease usually resolves spontaneously within four months. However, the child should be treated prophylactically at birth and should adhere to the CDC's recommended schedule of vaccinations.
Should moms with Hepatitis C breastfeed?
Yes, there are no current research findings that indicate that Hepatitis C is transmitted in breast milk
What are the most important two components of preventing vertical transmission from the mother to the fetus in the case of an HIV-positive mother?
The most important aspect of care for the HIV-positive mother is to adhere to the antiretroviral regiment that has been prescribed by the physician. Additionally, IV zidovudine will be administered during birth to further suppress that transmission. Outside of the drug regiment, it is important to avoid birth trauma to the infant and promptly wash the child after the delivery. This does not allow the virus access to and removes residual virus copies from the infant. The infant will also be treated with antiretroviral drugs for the first 6 months of life
Should mothers with HIV breastfeed?
No, the virus can be transmitted via breast milk and the risk does not outweigh the benefits of breastfeeding
What are two signs/symptoms that BV may be present?
Two findings that are indicative of BV are a fishy odor and copious thin vaginal discharge
Which medication is normally used to treat trichomoniasis?
Metronidazole or Tinidazole are the two preferred medications for the treatment of trichomoniasis
What two medications are used to treat GBS IV during labor?
Penicillin G or Ampicillin are the drugs of choice to treat GBS during labor.
To prevent getting toxoplasmosis, which two items should pregnant women avoid?
In order to avoid contracting toxoplasmosis pregnant women should avoid eating raw or undercooked meats and contaminated cat litter
Rubella infection of the mother during pregnancy can cause birth defects in the fetus. Should we vaccinate a woman during pregnancy if her levels of antibodies against rubella turn out to be low?
If a woman has low rubella antibody levels during pregnancy, we should not vaccinate her due to the risk of developing a live infection from the vaccine.
What treatments are available to women who contract CMV (cytomegalovirus) during pregnancy?
At this time there are no available treatments for a woman who contracts CMV during pregnancy.
What are the potential effects of primary genital herpes on a pregnancy?
The potential side effects of primary genital herpes on pregnancy include miscarriage, preterm labor, and intrauterine growth restrictions.
Dyspareunia is one of the possible manifestations of STI. What is dyspareunia?
Dyspareunia is painful sexual intercourse for either sex
Medications used to treat Chlamydia in a pregnant woman?
erythromycin and amoxicillin
The effects of gonorrhea on mother and fetus
Chlamydia → premature labor / preterm birth, neonatal / maternal sepsis, growth restrictions leading to LBW. Most commonly the child has ophthalmia neonatorum
Medication used to treat gonorrhea?
**Treatment for gonorrhea is always paired with treatment for chlamydia as well, due to the high occurrence of these diseases presenting together.
What bacterial STI can cross the placenta at any time during pregnancy?
Possible effects of Syphilis
Serious systemic disease and possibly death.
Much less common than gonorrhea or chlamydia.
Medication for Syphilis
Benzathine penicillin G.
If allergic to penicillin, erythromycin will do
What sometimes happens following the treatment of Syphilis in pregnant women?
The Jerisch-Herxheimer reaction is an acute febrile reaction accompanied by headache, myalgia, and arthralgia within the first 24 hours. If this occurs in the second half of pregnancy, pre-term labor or pre-term birth can ensue
What is the only medication available to treat HPV in pregnancy?
The application of trichloracetic acid (TCA) or bichloracetic acid (BCA) 80-90% applied weekly. Cryotherapy at the time of birth can lower the probability of transmission.
Remember HPV --> genital worts.
TCA-treatment is very uncomfortable, and many women refuse treatment after the first application.
Complications of Herpes Simplex Virus during pregnancy?
If contracted during pregnancy, herpes can become viremic and infect the fetus.
Neonatal herpes is a severely disabling and possibly fatal condition. Mothers are encouraged to consider Cesarean section. Must be PERFORMED WITHIN 4 HOURS OF MEMBRANE-RUPTURE.
Info about Hepatitis B during pregnancy
- HBV is the most threatening virus to the fetus and neonate.
-HBsAG is the antigen typically screened for in pregnant women.
-Breast feeding is NOT contraindicated, as long as the infant received the standard Hep B vaccination at birth and is kept on the appropriate vaccination schedule.
Treatment of Hepatitis B?
There is no specific treatment of Hep B infection.
Usually resolves spontaneously in 3 - 16 weeks.
Should mothers with Hepatitis C (HCV) breastfeed?
There is no evidence to date that indicates that HCV can be transmitted via breast milk.
With an HIV-positive pregnant woman, as she goes into labor what precaution is taken?
IV zidovudine is administered to the mother during birth to suppress transmission of the virus. Also the child should be washed off immediately, and trauma should be avoided. Infant is also treated with Antiretroviral drugs for first 6 months.
What is BV?
- Most common type of vaginitis today.
- Associated with preterm labor and birth.
- Symptoms include "fishy odor,"
Profuse thin, white to grey or milky discharge
Decreased pH of vaginal discharge
Sometimes mild irritation and pruritus
Side effects and concerns with taking metronidazole
-Side effects of metronidazole are numerous, including sharp, unpleasant metallic taste in the mouth; furry tongue; central nervous system reactions; and urinary tract disturbances.
-When oral metronidazole is taken, the woman is advised not to drink alcoholic beverages, or she will experience the severe side effects of abdominal distress, nausea, vomiting, and headache. -Gastrointestinal symptoms are common whether alcohol is consumed or not.
What is GBS?
Group B streptococci.
- Considered part of a non-pregnant woman's normal vaginal flora, and present in 20%-30% of pregnant woman also.
- Problematic with pregnancy because can cause neonatal infection as neonate travels through the birth canal.
What are TORCH infections?
Infections that are capable of crossing the placenta and infecting the fetus.
- other (hepatitis)
- Rubella virus
- Cytomegalovirus (CMV)
- Herpes Simplex
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