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H:\Infections In Pregnancy 2008 Cert Day 1[1]

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Infection & pregnancy

Infection & pregnancy


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  • 1. Infections in Pregnancy Chris Rust, RNC- OB, MSN Sandy Warner RNC-OB, MSN
  • 2. Acquired Immune Deficiency Syndrome
    • Organisms
    • - HTLV III– Human T- Cell Lymphotrophic
    • Virus
    • - HIV – Human Immune Deficiency Virus
    • Classes
    • I - Primary HIV
    • II - Asymptomatic /Latent HIV – months to yrs
    • III - Clinical Illness – life expectancy – 5 yrs.
    • IV - AIDS
  • 3. AIDS
    • Selectively targets and
    • destroys T-cells,
    • macrophages and
    • monocytes thereby
    • decreasing and
    • eventually eliminating
    • cellular immunity.
  • 4. Mode of Transmission
    • Direct contact with body fluid
    • Direct transmission to infant through vagina
    • Transplacentally
    • Breast milk
    • Rates
    • - 20 % HIV transmission in utero
    • - 80 % during L & D
  • 5. Risk Factors
    • Multiple sex partners
    • Infected with another STI
    • Illicit IV drug use
    • Emigrant from an HIV-endemic area such as Haiti or Africa
    • Prostitution
    • Received a blood transfusion between 1977 and 1985
    • Gilbert,E.S. (2007). Manual of high risk pregnancy & delivery . St. Louis: Mosby-Elsevier, p. 568.
  • 6. Detection
    • Two types of testing
    • - Rapid HIV tests
    • ▪ OraQuick Advance HIV-1 Antibody Test
    • ▪ Uni-Gold Recombigen HIV Test
    • ▪ Reveal Rapid HIV-1 Antibody Test
    • - Confirmatory tests
    • ▪ Western blot – most specific test
    • ▪ IFA – (immunoflourescence Assay)
  • 7. Maternal Effects
    • Initial symptoms -mono-like initial symptoms – fever, pharyngitis, lymphadenopathy, arthralgia, n&v, fatigue, weight loss
    • Erythematous maculopapular rash
    • Diffuse urticaria
    • Alopacia
    • Multiple infections
    • Disseminated Kaposi sarcoma
    • PTL, IUGR, PROM, postpartum endometritis
    • Susceptible to opportunistic infections
  • 8. Newborn Effects
    • All newborns will have + antibodies for HIV
    • 20-30% will remain positive by 15-18 months and will develop AIDS (300 per year in the US)
    • Increased risk of stillbirth, neonatal mortality
    • With treatment transmission risk < 2 %
  • 9. Treatment
    • Antepartum – ( > 28 wks) - ZDV 200 mg. po. TID or 300 mg. BID.
    • Intrapartum – IV ZDV and a single dose of NVA (nevirapine) or 3TC (lamivudine) at onset of labor.
    • - If the patient has a viral load of < 1000 copies/
    • ml c-section may not be required
    • Postpartum – ZDV po and protease inhibitors
    • Neonatal – ZDV syrup 2 mg/kg po Q 6 hrs from 12 hours of birth through 6 weeks of life (Term infants)
    • Gilbert,E.S. (2007). Manual of high risk pregnancy & delivery . St. Louis: Mosby-Elsevier, p.569.
  • 10. Other Factors
    • Total isolation
    • No scalp electrodes
    • Double glove
    • Vaginal delivery
    • No breastfeeding
    • If scheduled C/S drug administration 3 hours prior to surgery is optimal
  • 11. Other Factors for Infant
    • Mechanical suction of newborn
    • Minimize infant exposure to maternal fluids
    • Give infant a bath as soon as possible
    • No injections or eye ointment until bath is given
    • HIV DNA PCR blood test along with CBC as part of their admission lab work
    • (Infants become anemic when taking ZDV)
  • 12. Hepatitis
    • Hepatitis A - 40%
    • Hepatitis B - 45%
    • Hepatitis C - 5-10%
    • Hepatitis D - 5-10%
    • Hepatitis E - 5-10%
    • 136,000 new cases/yr.
  • 13. Hepatitis
    • Inflammation of the liver caused by a viral infection
    • Acute or chronic
    • Degeneration and necrosis of the liver
    • Inflammation and swelling blocks bile duct secretion
    • Incubation period 1-6 months
    • Affects 1 in 500-1,000 pregnancies
    • Bile backs up leading to jaundice
    •  ALT, Alk Phos,  Bilirubin
  • 14. Hepatitis B -Transmission
    • Sexual contact
    • Shared needles
    • Transplacental
    • Direct contact with secretions (blood, stool, semen, saliva, amniotic fluid, breast milk)
    • Shared personal items (toothbrush, razor, washcloth)
    • HBV can survive up to one week in dried blood or body secretions
  • 15. Detection
    • Hepatitis B virus is a double-stranded DNA virus consisting of:
    • - HBcAG – [core antigen] acute infection
    • only found in liver
    • - HBsAG –[surface antigen]- acute/chronic
    • first to appear
    • - HBeAG – [e antigen] HBV is active in serum and patient is highly infective
  • 16. Acute HBV infection:
    • HBsAg is elevated
    • HBeAg is elevated
    • Immunoglobulin M (IgM) anti-HBc is elevated
    • Gilbert,E.S. (2007). Manual of high risk pregnancy & delivery . St. Louis: Mosby-Elsevier, p.561.
  • 17. Chronic HBV Infection (Carrier state)
    • HBsAg remains elevated
    • IgG anti-HBc remains elevated
    • IgM anti-HBc is absent
    • If HBsAg is positive but HBeAg is negative this indicates a carrier state without active liver disease.
    • If HBsAg & HBeAg are both positive it indicates a carrier state with active liver disease.
    • Gilbert,,E.S. (2007). Manual of high risk pregnancy & delivery . St. Louis: Mosby-Elsevier , p.561.
  • 18. Maternal Effects
    • Pregnant patient with acute HBV :
    • - Chronic low grade fever
    • - Nausea and vomiting
    • - Anorexia
    • - Fatigue
    • - Skin rashes
    • - Arthralgia
    • Gilbert,E.S. (2007). Manual of high risk pregnancy & delivery . St. Louis: Mosby-Elsevier,p.561.
  • 19. Fetal /Newborn Effects
    • 70% chance of fetus being infected if acute onset is in 3 rd trimester
    • 70-90 % chance of being infected if mother is chronic carrier
    • Rarely develops symptoms
    • 90% chance of becoming chronic carrier
    • 25% chance of developing cirrhosis and/or liver cancer by age 50.
    • Also at risk if other family members are chronic carriers
  • 20. Treatment
    • Mother – If exposed during pregnancy and HBsAg (–) give HBIG, repeat HBIG in 1 month, followed by Hepatitis vaccine series.
    • If the Mother contracts HBV during pregnancy – can only treat symptoms (bedrest, diet high in protein, low in fat)
    • Infant –
    • If Mom is HBsAg (+) give HBV vaccine and
    • HBIG within 12 hrs. of delivery and at 1 & 6
    • months.
  • 21. High Risk Categories
    • Pregnant women from:
    • 1) China
    • 2) Southeast Asia
    • 3) Central Africa
    • 4) Middle Eastern
    • 5) Pacific Island
    • 6) Alaska
    • IV drug users
    • Prostitutes
    • Other STIs’ and/ or multiple partners
    • Recipients of multiple transfusions
    • Health care workers with blood and needlestick exposure
  • 22. Hepatitis A
    • Formerly known as infectious hepatitis
    • 1:1,000 pregnancies
    • Found in southeast Asia, Africa, Central America, Mexico, Middle East
    • Spread through fecal-oral route, person to person contact or ingestion of contaminated food or water – Not spread by blood
    • Incubation period 28 days
    • Transmission common in Day Cares
    • Acute Infection – IgM Anti-HAV
    • Not a chronic carrier
    • Immunization available
  • 23. Hepatitis C
    • Major cause of acute and chronic hepatitis
    • Asymptomatic in most people
    • Breastfeeding does not increase transmission rate
    • Transmission same as Hepatitis B but not as easy to spread through sexual intercourse
    • High rate of chronic disease
  • 24. Hepatitis C
    • C/S has not proved beneficial in lowering vertical transmission rates
    • Diagnosis – detecting the antibody to Hepatitis C through Enzyme Immune Assay (EIA). If positive the confirmative test is RIBA.
    • (Anti-HCV). Specimen obtained by liver biopsy
    • No cure
  • 25. Hepatitis D (Delta)
    • Occurs with Hepatitis B
    • Incubation 2-8 weeks
    • More common in the Mediterranean Sea
    • Identify antibody to Hepatitis D Anti-HDV or liver biopsy
    • Highly infectious
    • Obtained from multiple transfusions, IV drug abuse, hemophilia
    • Covered by Hepatitis B vaccine
    • Diminished liver function, increased jaundice, altered mental status
  • 26. Hepatitis E (HEV)
    • Obtained through sewage contaminated food or water
    • Increased during times of floods, hurricanes or rainy season
    • Similar to Hepatitis A
    • Found in India, Southeast Asia, Africa, South America
    • Usually affects people of childbearing age (15-40 years old)
    • Does not exist as a chronic carrier
    • IgG anti-HEV shows immunity
  • 27. Hepatitis E (HEV)
    • Characterized by mild illness – high mortality rate if infection is acute in third trimester due to liver failure
    • Neonates die from HEV infection more than from any other type of viral hepatitis
    • Vertical transmission has been reported
    • Acute infection diagnosed by a positive serum test for IgM anti-HEV antibody. This test is not available in most labs.
  • 28. Gonorrhea
    • Agent - Neisseria Gonorrhea (gram negative)
    • Mode of Transmission – Oral, rectal, genital.vertical transmission to fetus
    • Incubation – 10 days – Does not cross the placenta
    • 0.5 to 7 % in pregnancy
    • Screen for chlamydia and trich
    • PID in 40% if untreated
    • Symptoms – Chills, fever, vaginal discharge/ bleeding
  • 29. Gonorrhea
    • Detection
    • - Endocervical /Urethral /rectal/ throat culture
    • - ELISA Immunoassays
    • - If asymptomatic do DNA culture
    • Treatment
    • - Fetus – Erythromycin eye ointment
    • - Mother – Ceftriaxone 125 mg IM
    • and Cefixime 400 mg PO
    • - Treat all sexual partners
  • 30. Maternal Effects
    • 70-80% asymptomatic
    • Endocervicitis causes weakening of the fetal membranes and leads to PROM /PTL
    • Associated with septic abortions
    • GU infections with dysuria, pyuria
    • Often seen with chlamydia
    • Postpartum endometritis, decreased fertility
    • Yellow purulent discharge
    • Tenderness of Skein/ Bartholin glands
    • May cause sever disseminated infection – arthritis, perciarditis, meningitis, dematitis
  • 31. Maternal Effects
    • Postpartum endometritis, decreased fertility
    • Yellow purulent discharge
    • Tenderness of Skein/ Bartholin glands
    • May cause sever disseminated infection – arthritis, pericarditis, meningitis, dematitis
  • 32. Fetal Effects
    • PROM
    • Chorioamnionitis
    • Purulent conjunctivitis
    • Sepsis/meningitis
    • May breastfeed after antibiotic treatment – frequent handwashing extremely important
  • 33. Syphilis
    • Agent – Spirochete - Treponema Pallidium
    • Incubation – 10 - 90 days (average 21 days)
    • Mode of transmission – Sexual, oral, anal, vaginal, direct contact with lesion, placental transmission, through vagina during birth
  • 34. Congenital Syphilis
  • 35. Syphilis
    • Detection
    • - RPR (Rapid Plasma Reagin)
    • VDRL ( Venereal Disease Research Laboratory) > 1:32 = reactive
    • FTA-ABS – Flourescent treponeum
    • antibody absorption – Confirmatory test
    • Must have 2 positive tests for confirmation
    • Will have positive test within 4 wks of exposure
  • 36. Maternal Effects
    • Primary chancre – painless ulcer on lips, genitalia, oral cavity
    • Secondary- flu-like symptoms, red macules on soles and palms, generalized lymphadenopathy, patchy hair loss, neuromuscular and cardiovascular symptoms
    • Latent – can lay dormant for many years
    • Tertiary-involves heart, blood vessels, nervous system, muscle movement, dementia
  • 37. Fetal Effects
    • Varies depending on gestation
    • IUGR, anomalies, IUFD, PTL,stillborn
    • Absent nasal bridge, pneumonia, hepatitis, jaundice, skin lesions, hydrops, seizures
    • Placenta large and pale with club-like, thick villi
    • 25% die in utero, 30 % die post delivery, 40% develop tertiary syphllis
  • 38. Treatment
    • Prevention
    • Primary, secondary and early latent – PCN G 2.4 mil units IM x 1 dose
    • Latent & tertiary - PCN G 2.4 mil units IM q weekly x 3 weeks
    • < 1 yr old - PCN G 2.4 million units IM x 1 dose
  • 39. Group Beta Strep
    • Agent
    • - Beta Hemolytic Streptococcus (Gram +
    • cocci) – contains 5 subtypes
    • Mode of transmission – 10 - 30 % maternal carriage (Colonizes in rectum, vagina, cervix & urethra
    • - Ascending infection - 50%
    • - Vaginal tract infection– 25%
    • - Other – 25%
    • Detection
    • - Urine culture
    • - Anogenital culture
  • 40. GBS
    • Most common cause of neonatal sepsis
    • - Early – within 24 hours – 80%
    • - Late – within a week
    • Greatest risk to preterm infants
    • Screen all patients at 35-37 weeks, earlier if past hx PTL
    • Risk of GBS transmission:
    • - Not treated -1:200
    • - Treated – 1:4000
    • All women who have been GBS + in the past should receive treatment
  • 41. Maternal Effects
    • Asymptomatic
    • UTIs’
    • Labor or postpartum infection with fever, tachycardia and abdominal distention
    • Duration of carrier unpredictable
    • Current research on vaccine to tx GBS
  • 42. Fetal Effects
    • Treatment at term eliminates 85 % of early onset GBS
    • PPROM
    • Infant with sepsis at delivery and GBS in CSF and /or blood
    • Symptoms – lethargy, jaundice, poor feeding , temperature instability, abdominal distention, pallor, tachycardia
    • 5-20% mortality rate – get sick quick
  • 43. Late Onset GBS
    • Usually meningitis
    • 15-30% will have permanent neurological damage, deafness, blindness, learning disabilities
    • Very rate – Only 25 % of these babies have moms that are GBS +
  • 44. Treatment
    • Maternal treatment
    • - In labor- PCN 5 million units initial dose and
    • then 2.5 mil. units q 4 hrs, or Ampicillin
    • 2 gm IVPB then 1 gm q 4 hrs – prefer at least two doses prior to delivery and the last dose to be at least 4 hours prior to delivery
    • - PPROM – Ampicillin 1 gm IVPB q 6 hrs
    • for 24 hrs then po when a prenatal patient
    • (Clindaycin if pt. allergic to PCN)
    • Ampicillin and Gentamycin for the infant after delivery
  • 45. Who should be treated?
    • Positive GBS in urine culture during pregnancy
    • Previous infant with GBS
    • Birth before 3 7 weeks(10-15 fold increase)
    • Rupture of membranes > 18 hrs.
    • Temperature > 100.4
  • 46. Chlamydia
    • Agent – Chlamydia Trachomatis (Gram negative)
    • Mode of transmission – Genital
    • Most common bacterial STI – especially high in teens
    • 5-30% carriage by pregnant women
    • Commonly seen with GC and Trich
    • Pregnant mother colonizes infant
  • 47. Chlamydia
    • May be asymptomatic (75%)
    • Detection –
    • - Endocervical / urethral / tissue culture
    • - ELISA (Enzyme-linked immunosorbent assay)-
    • rapid detection test
    • - Direct smear using flourescent antibody
    • Treatment
    • - Mother – Erythromycin 500 mg po qid x 7 days
    • in pregnancy or Amoxicilliin 500 mg po tid x 7
    • days
    • - Infant – Erythromycin opthalmic ointment at
    • birth
  • 48. Maternal Effects
    • If not treated – PID, infertility, tubal pregnancy, chronic pelvic pain
    • Dysuria, yellow purulent discharge, cervicitis, bleeding, postpartum endometritis up to 2 weeks after delivery
    • Associated with other STIs’
    • Treat sexual partner
  • 49. Fetal Effects
    • PTL/PROM
    • IUGR
    • Chorioamnionitis
    • 10% infants develop pneumonia
    • 50% develop conjunctivitis,10% develop pneumonia– usually 5-12 days after deliver
    • 2/3 of infants born vaginally to mothers with Chlamydial infection become infected during delivery
    • May breastfeed after treatment
  • 50. Bacterial Vaginosis
    • Agent - Non-specific vaginitis - Hemopilus, Gardnerella vaginalis or Candidiasis
    • Anerobic gram negative rods or fungal organism
    • Mode of transmission – Sexual transmission or tissue trauma
  • 51. Bacterial Vaginosis
    • Due to sexual intercourse, hormonal changes, antibiotics, spermicidal products, pregnancy, douching– very contagious vaginosis
    • Cause – Overgrowth of one or more types of normal bacteria present in 15-25% of pregnancies
  • 52. BV
    • Detection – positive diagnosis if 3 of 4 characteristics below are present:
    • - Clue cells (wet prep)
    • - pH > 4.5
    • - Fishy odor when discharge
    • mixed with KOH
    • - Thin, grayish-white discharge
    • or white curdy, cottage cheese discharge
  • 53. Maternal /Fetal Effects
    • Risk increased by douching, using intrauterine devices (IUDs), and smoking
    • Associated with ectopic pregnancies, spontaneous abortions, PID, PROM, PTL, postpartum endometritis
    • May cause neonatal septicemia
  • 54. Treatment
    • First trimester - Clindamycin vaginal cream 5 gm hs x 7 days or Flagyl gel 0.75%
    • (5 gm) vaginal cream twice daily x 5 days
    • Second trimester – Flagyl 250 mg po tid x 7 days or Clindamycin 300 mg po tid x 7 days
    • If breastfeeding – Flagyl 2 gm po x 1 and discard milk for 24 hrs.
    • Hydrogen peroxide douche
    • Condoms to prevent re-infection
  • 55. Human Papilloma Virus (HPV)
    • Agent – Condylomata Human Papilloma virus – > 200 types of HPV
    • Appears as genital warts
    • Incubation period –
    • 3-9 months prior to
    • appearance of warts
    • Most prevalent STI
  • 56. Human Papilloma Virus (HPV)
    • Mode of transmission –
    • 1) Sexual contact
    • 2) Pass on to the fetus during labor and
    • delivery
    • 3) If burned off they vaporize in the air and
    • begin to grow on human surfaces that they
    • land on.
    • Several strains of HPV cause cancer – (16, 18, 45, 56)
    • Strains 6 & 11 are found in newborn laryngeal papillomatosis
  • 57. Detection
    • 1) Visually – Dry, wart-like clusters that
    • resemble cauliflower. May be small or large.
    • Most often found on vagina, labia, cervix and
    • perineal area
    • 2) Microscopic pathology (cytology culture –
    • Hybrid II capture tubes containing anti-
    • RNA/DNA hybrid antibody – Light spectrum
    • is measured to determine one of 70 strains)
    • Important to have annual pap smears
  • 58. Maternal/Fetal Effects
    • Maternal – Warts, pruritis, bleeding, dysparunea, cervical dysplasia ( May enlarge in pregnancy)
    • Fetal/Newborn – Vaginal delivery unless lesions obstruct passage(.04% risk of exposure). C/S may decrease exposure risk
    • - Observe for laryngeal pappilomatosis – stridor, hoarseness, cough, abnormal cry, respiratory distress as late as 2-3 months
  • 59. Treatment
    • During pregnancy -Trichloracetic acid applications weekly
    • Post delivery -Laser, cryotherapy, Interferon injections (anti-neoplastic drug used in women over 18 who have not responded to other treatments)
    • Newborn treatment depends on size of warts
    • Treat partners
    • Use condoms
    • May breastfeed
  • 60. Trichimoniasis
    • Agent- Trichomoniasis Vaginalis
    • Mode of transmission – Multiple sexual contacts. It is not transmitted across the placenta
    • Lives for a varying amount of time I fresh water, semen, urine toilet tissue, toilet seats, damp wash cloths,
    • 50 % of women also have GC
    • PTL and LBW when associated with other STIs’.
  • 61. Detection
    • Symptoms – frothy, thin, odorless, yellow-green discharge in copious amounts, pruritis, dysuria, strawberry cervix, painful intercourse, postpartum endometritis
    • Test – wet prep (saline solution) Look under microscope for white cells and erythrocytes
    • Ph> 4.5
  • 62. Treatment
    • Clotrimaxole vaginal cream @hs x 7 days for first trimester
    • Flagyl 2 gm po x 1 dose (Avoid alcohol)
    • May breastfeed
    • Use condoms and treat sexual partners
  • 63. Toxoplasmosis
    • Agent – Toxoplasmosis gondii (protozoan)
    • Mode of transmission –eating raw or undercooked meat, vegetables, fruit, drinking unpasteurized milk, ingesting cysts found in cat feces, transplacentally
    • Detection
    • - IFAT (Indirect Flourescent Antibody Test)-
    • from maternal tissue or serum for IgM or IgG
    • - ELISA
  • 64. Maternal/Fetal Effects
    • Fetal – congenital toxoplasmosis, IUGR, enlarged liver and spleen, anemia, jaundice, neurologic damage, microcephaly, hydrops, deafness, low IQ
    • * 10-24 wks highest risk period
    • Maternal – 90% asymptomatic, mono-like symptoms, lymph swelling , PTL, miscarriage, 15-30 % of pregnant women will have + antibodies from previous exposure
  • 65. Treatment
    • Spiramycin 1 gm q 8 hrs, Pyrimethamine 25 mg po qd, with sulfadiazine 1 gm po qid. Must be given with Folinic acid 6 mg IM or po 3 x per week
    • May reduce neonatal incidence by 50%
    • Watch maternal platelets
    • At birth infant is tx with Pyrimethamine and Sulfadiazine
    • May breastfeed
    • Isolate
  • 66. Prevention
    • Cook meats thoroughly
    • Wash kitchen utensils
    • Wash hands
    • Wash fruits and vegetables
    • Avoid contact with cat liter boxes, sand boxes, garden soil
  • 67. Rubella
    • RNA virus. Member of Togaviridae family
    • Incubation period – 10-14 days
    • Mode of transmission – Respiratory secretions, airborne, transplacentally
    • If infected in 1 st trimester 50 -90% of infants will have severe congenital anomalies or death
    • 2 nd or 3 rd trimester – subtle to no effects
  • 68. Rubella
    • Detection – HAA antibody test. If < 1:8 patient will be non-immune
    • 20 % of the population is not immune to rubella
    • Prevent pregnancy at lease 28 days post vaccination
    • ISG (immune serum globulin ) may be given to decrease fetal effects
    • Viral culture on infant
    • Strict isolation – no caretakers who are pregnant
  • 69. Maternal/Fetal Effects
    • Maternal – Maculopapular rash starting on the face and migrating downward. Rash lasts 3- 5 days, fever, malaise, post-auricular and occipital adenopathy
    • Viral shedding for 15 days
    • Spontaneous abortion, hydrops
    • Watch for sinusoidal FHR pattern
    • May breastfeed after viral shedding period
  • 70. Rubella
  • 71. Herpes Simplex Virus (HSV)
    • Type I (Oral) and Type II (Genital)
    • Transmitted by direct contact with lesion
    • – primary lesion occurs in 2-20 days
    • - vesicles rupture within 1-7 days and form ulcers that take an average of 12 days to heal
    • Routes of transmission - vaginal birth, ascending infection especially with ROM, transplacentally if primary infection
  • 72. HSV
    • Pregnant women infected with the virus for the first time can shed the virus for 8-100 days or for recurrent infection 6-40 days
    • 15-35 % women of childbearing age are HSV II +
    • Period of remission and occurrence
    • Oral sex can mix lesions
  • 73. Detection
    • Tissue (Viral) culture of open lesion for giant body cells (Znack prep)
    • ELISA
    • Positive PAP smear
    • Western blot
  • 74. Maternal Effects
    • Maternal – Painful papules that change to fluid filled vesicles/ulcers in clusters that crust over and heal. Located on vulva, vagina, cervix, labia, perineum
    • Severe pain, burning, itching, low grade fever malaise, numbness, tingling, enlarged lymph nodes or may be asymtomatic, predisposition to cervical cancer
    • Deliver within 4 hrs of ROM if active lesion – must do C/S
  • 75. Fetal Effects
    • Miscarriage if transplacental transmission,
    • Neonatal mortality 50-60 % if primary infection during pregnancy
    • Neurologic & opthalmic sequela
    • Microcephaly, bulging fontanels
    • Systemic infection in 70%
    • RDS, pneumonia
    • Intracranial calcifications, skin lesions,
    • Seizures, tremors, lethargy,
  • 76. Herpes Disease Progression
    • 500,000 people are infected with genital herpes each year and another 10 million have recurrent lesions
    • One in five pregnant women have had an HSV infection
    • Herpes can become dormant- once it gets into the dorsal root ganglia antiviral drugs are useless
    • Recurrent outbreaks are triggered by stress, illness, exposure to ultraviolet light, tissue damage or suppression of the immune system
  • 77. HSV
  • 78. Neonatal HSV
  • 79. Treatment
    • Mother – Acyclovir 800 mg bid x 5 days
    • or Valtrex 500 mg for 14 days in 3rd trimester
    • Infant – Acyclovir 30-60 mg / kg day for 10-21 days for neonates
    • Treat sexual partners
    • No AROM
    • NO FSE, vacuum extractor
    • May breastfeed as long as lesion is not on the breast. Must use excellent hand washing

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