OBSTETRICS 2

o Infected lesions in between fingers, toes, and sacral areas

F.07 STD AND INFECTIONS IN PREGNANCY (PART 2)  Mode of transmission:
Dr. Jandoc | MAY 3, 2019 o Sexual intercourse
o Close personal contact
 Management:
A. GENITAL WARTS/ CONDYLOMA ACUMINATA a) Permethrin cream 5%: apply from neck down then wash off
 Generally caused by HPV 6 and 11 (Does not cause cervical in 8-14 hours
cancer. Causative agents for cervical cancers are HPV 16, 18- b) Lindane 1% lotion or 30 g cream: apply from neck down then
strains common in European countries.) wash off in 8 hours
 Gardsil 9: Cervical Cancer Vaccine should be given at 9 years c) Ivermectin (Category C): single low dose of 200mcg/kg or
old 0.8% topical solution
 Advantage of giving the vaccine at a young age is you only have
to give 2 doses. Adult dose would be 3 doses. They say that at 9- D. MOLLUSCUM CONTAGIOSUM
12 years old this is the time when the immune system of the child  Etiologic agent: Pox virus
is at its highest, therefore you only need 2 doses to protect the  Characteristics:
child. o Spread by close contact
 IP: one week to many months o Maybe acquired by non-sexual contact
 Clinical features:  IP: 2 to 7 weeks and may results from autoinoculation
o Painless, flesh papillary growth in the genital area  Umbilicated papule or small nodule called “water wart”
o Most common feature is pruritus. DDx: fungal infection. o Inside this nodule is a white, waxy material seen as
So if you treat a patient with Candidiasis and still has intracytoplasmic molluscum bodies when subjected with
pruritus, probably you are dealing with a viral infection. Wright’s or Giemsa stain under the microscope
o Variable in size from pinhead to cauliflower like lesions  Treatment:
 Management: o Excision then treat base of papule with chemicals - Ferric
1. Patient applied therapies subculfate (Monsel’s solution) or 85% Trichloro Acetic acid
a) Podofilox 0.5% sol’n or gel: BID for 3 days (TCA)
b) Imiquimod (Aldara) 5% cream: 3x a week for 16
weeks. Under Category B. E. HUMAN IMMUNODEFICIENCY VIRUS (HIV) INFECTION
2. Provider administered therapies  Window period: 2-6 months
a) Cryotherapy  Incubation Period: 5-12 years
b) Podophylin  Asymptomatic stage
c) Surgical removal: electrocautery -next option if  Mode of transmission:
Imiquimod cream fails. Requires sedation; curettage o Infected semen and vaginal fluid through sexual contacts
d) Alternative treatment whether vaginal, anal, or oral
i. Intralesional interferon o Blood transfusion
ii. Laser surgery o Organ transplant
o Sharing of contaminated needles and syringes
B. PEDICULOSIS PUBIS (BODY LOUSE) o Perinatal transmission
 Causative organism: Phthirus pubis  During pregnancy
 Mode of Transmission:  During delivery
o Sexual intercourse  During breastfeeding
o Close physical contact
o Through clothing and bedding A. CLASSIFICATION OF AIDS *skipped slides
 Clinical features: 1. Category A – initial viremic period
o Severe pruritus  CD4 count >200 cells/microliter
o Elevated red and pink lesions  Acute illness similar to viral syndromes lasting for 10 days
 Factors that affect transmission:  Viral Ag p24 and viral RNA (+) but antibody (-)
o Poor personal hygiene  After 4-6 weeks: HIV Ab levels begin to rise and viral Ag
o Overcrowding declines, entering the latency period which lasts for 10
o Poor environmental sanitation years
 Diagnosis: Adult lice/nits can be seen hanging on the hair shaft
 Management: 2. Category B
o Disinfection of clothing and beddings  Symptomatic individuals not from initial viremia and not
o Personal hygiene with full-blown AIDS
o Environmental sanitation  Manifest with cervical dysplasia, chronic diarrhea, pelvic
1. Permethrin Cream 1% apply for 10 mins (Category B) inflammatory disease (PID), immune thrombocytopenic
2. Lindane (Kwell) 1% shampoo applied for 4 mins – (Category purpura (ITP)
C)  CD4 count >200 cells/microliter

* Re-evaluate in 7 days, if still with symptoms: repeat 3. Category C

treatment  Clinical AIDS with CD4 count of <200 cells/microliter

C. SCABIES B. TREATMENT *skipped slides

 Causative organism: Sarcoptes scabiei 1. Prevention
 Clinical features: 2. Chemotherapy:
o Intense pruritus especially at night  Zidovudine (Category C)
o Rash or scratch mark in between the fingers, toes, forearms  Nucleosides reverse transcriptase inhibitor
and anogenital areas (and sacral areas)  Non-nucleoside reverse transcriptase inhibitor
o Rashes  Protease inhibitor

Transcribers: LAPEÑA, LOREZCO, HIDALGO Page 1 of 3

 OBSTETRICS 2
 HAART (Highly Active Antiretroviral Treatment)  Antivirals in pregnancy
Combination therapy using multiple drug regimen 1. Oseltamivir (Tamiflu)- (Category C)
3. Education o Prophylaxis: 75 mg OD for 10 days
o Treatment: 75 mf BID for 5 days
C. HIV IN PREGNANCY 2. Zanamivir (Relenza) diskhaler- (Category C)
 HIV is associated with: o Prophylaxis: two 5 mg inhale OD for 10 days
o LBW o Treatment: two 5 mg inhale BID for 5 days
o Premature delivery
o Stillbirth **Recommended in pregnancy and renal impairment, people being
 Pregnancy does not seem to have an adverse effect on the health treated for HIV infection
of an HIV (+) woman or her long-term prognosis unless she has
AIDS or a concurrent infection such as TB G. VARICELLA
 Mother-to-child transmission w/o interventions during pregnancy is  Etiologic organism: VZV
15-30%, can be reduced to <1% by the following interventions  Transmitted by direct contact with an infected individual
during pregnancy:  Respiratory transmission has been reported
o Antiretroviral therapy for the mother: Zidovudine or  IP: 10-21 days
Nevirapine  1 to 2-day flu-like prodrome followed by pruritic vesicular lesions
o Elective cesarean section during delivery that crust over in 3 to 7 days
o Avoid breastfeeding. As much as possible avoid because of  Mortality predominately due to varicella pneumonia
the 15-30% chance of transmission. o More severe during adulthood and pregnancy
o Antiretroviral therapy for the neonate after delivery o Fever, tachypnea, dry cough, dyspnea, and pleuritic pain
o Scenario: If a patient is very poor, she cannot avoid BF how  CONGENITAL VARICELLA SYNDROME
can she feed her baby? Recommendation: Avoid BF as much o Corioretinitis
as possible, try to look for an alternative, formula milk, or o Microphthalmia
milk coming from other mothers that are not infected. But o Cerebral cortical atrophy
you have to look at the sustainability, meaning, this is o Growth restriction
possible for the next 6 mos. If this is not possible for the o Hydronephrosis
next 6 mos: You breastfeed, why? Because Breastmilk o Skin or bone defects
contains immunoglobulins, and Breastmilk coats the gut, it  Just before or during delivery (before maternal Ab has been
somehow protects the infant from having the transmission formed)
from mother to infant o Fetus: disseminated visceral and CNS disease, commonly fatal
o Varicella-zoster IG (VariZIG) given to neonates born to
F. INFLUENZA IN PREGNANCY mothers w/clinical evidence of varicella 5 days before and up
 In average flu season, an estimated 25/10,000 pregnant women in to 2 days after delivery
third trimester will require hospitalization
 Risks increase with each trimester, especially in women with *Exposed pregnant women who are susceptible should be given
coexisting morbidities (asthma, DM) and smokers VariZIG within 96 hours of exposure to prevent or attenuate
 Pneumonia increases the risk of preterm labor, pulmonary edema varicella infection
and LBW  Isolation
 CDC recommends pregnant women placed in high priority group  Supportive care
for H1N1 vaccine  IV fluids
 Symptoms: very similar to seasonal flu  If (+) pneumonia: Hospitalized
Fever Diarrhea  IV acyclovir therapy: 500 mg/m2 or 10 15 mg/kg every 8
Cough Vomiting hours
Sore throat Headache
Body malaise Fatigue H. MUMPS
Stuffy/ runny nose Chills  Caused by RNA paramyxovirus
(nasal congestion)  Primarily infects the salivary glands
 Morbidity is increased in pregnant women:  May involve the gonads, meninges, pancreas and other organs
o Altered immunity  Transmitted by: direct contact w/ respirator secretions, saliva, or
o Predisposition of pulmonary edema through fomites
o Increased O2 consumption  Treatment is symptomatic
o Increased cardiac output  Mumps in the 1st trimester: increased risk of spontaneous
 Acute Respiratory Distress Syndrome abortion
o Severe pneumonia  Infection in pregnancy: not associated with congenital
o Fetal distress malformations
o Preterm labor  MMR vaccine (live attenuated virus)
o Maternal death o Contraindicated in pregnancy
 Viral pneumonia o Pregnancy should be avoided for 30 days after mumps
 Secondary bacterial infections vaccination
 Myocarditis o May be given to susceptible women postpartum
 Worsening of underlying conditions o Not contraindicated in breastfeeding
 PREVENTION:
o Get a flu shot during the 2nd trimester of pregnancy. I. RUBEOLA
Similar to tetanus toxoid, but now we give Tdap  Etiologic organism: Rubeola virus
o Stay away from crowds  Characterized by fever, conjunctivitis, cough
o Wash hands often with soap and water  Characteristic rash: Koplik spots
o Isolate self from family members with influenza  initially in the face and neck; Spreading to the back, trunk, and
extremities

Transcribers: LAPEÑA, LOREZCO, HIDALGO Page 2 of 3

 OBSTETRICS 2
 Treatment is supportive  Not at high risk for anaphylaxis:
o Passive maternal immunization: immune serum gobulin – 0.25  Cefazolin, 2 g IV initial dose, then 1 g IV q
ml/kg  8hrs until delivery (Category B)
o Max dose of 15 ml, IM w/n 6 days of exposure  High risk for anaphylaxis
 Active vaccination not performed during pregnancy  Clindamycin, 900 mg IV every 8 hours until delivery (Category B)
 Susceptible women can be vaccinated routinely postpartum  Erythromycin, 500 mg IV every 6 hours until delivery
 High risk for anaphylaxis and resistant to clindamycin or erythromycin
 Breastfeeding not C/I with vaccination
 Vancomycin, 1 g IV q 12 hours until delivery
 Fetal effects:
o Does not appear to be teratogenic
CHECKPOINT
o Increased frequency of abortion, preterm delivery, LBW
1. T/F. HPV 6 and 11 cause cervical cancer.
neonates
2. Recommended age to give cervical cancer vaccine.
o Risk of serious infection especially in a preterm neonate in
3. Medical management for genital warts given for 16 weeks.
pregnant women developing measles shortly before birth
4. If your answer in no. 3 fails what is your next option?
5. T/F. MMR vaccine is contraindicated to pregnancy.
J. RUBELLA
6. T/F. MMR vaccine is contraindicated in breastfeeding.
 Etiologic organism: German measles 7. T/F. There is no CMV vaccine.
 IP: 12-23 days 8. T/F. Rubeola is teratogenic.
 Infection in the first trimester causes abortion and severe 9. T/F. Mumps is teratogenic.
congenital malformations 10. Morbidity is increased in pregnant women with influenza:
 Transmission: via nasopharyngeal secretions a. Altered immunity
b. Predisposition of pulmonary edema
 Generalized maculopapular rash beginning on the face and c. Increased O2 consumption
spreading to the trunk and extremities
d. Increased cardiac output
e. All of the above
CONGENITAL RUBELLA SYNDROME
o Eye defects: cataracts and congenital glaucoma Answers:
o Heart disease: PDA, Pulmonary artery stenosis 1. F
o Sensorineural deafness 2. 9-12
3. Imiquimod
o CNS defects: microcephaly, developmental delay, mental 4. Surgery
retardation, meningoencephalitis (Electrocautery)
o Pigmentary retinopathy 5. T
6. F
o Neonatal purpura 7. T
o Hepatosplenomegaly and jaundice 8. F
o Radiolucent bone disease 9. F
10. E
o Management and Prevention:
 MMR vaccine to non-pregnant women of childbearing age
vaccination should be avoided 1 month before or
during pregnancy
 Contains attenuated live virus

K. CYTOMEGALOVIRUS
 Person-to-person transmission by contact with infected
nasopharyngeal secretions, urine, saliva, semen, cervical
secretions, or blood
 Most infections are asymptomatic
Fever, Pharyngitis, LAD, Mental and motor
Polyarthritis retardation
Intracranial calcifications Growth restriction
Sensorineural deficits Hepatosplenomegaly
Jaundice Hemolytic anemia
TTP Microcephaly
Chorioretinitis
 Prevention of congenital infection relies on prevention of maternal
primary infection, especially in early pregnancy
 Treatment is symptomatic
 No CMV vaccine

L. GROUP B STREPTOCOCCUS not discussed

 S. agalactiae: major cause of neonatal morbidity and mortality
 Preterm labor, PROM, chorioamnionitis, fetal and neonatal infections
 Maternal bacteriuria, pyelonephritis, postpartum metritis, osteomyelitis,
postpartum mastitis
 Regimens for intrapartum antimicrobial prophylaxis for perinatal GBS
disease
o Penicillin G – 5 million units IV initial dose, then 2.5 million units IV
every 4 hours until delivery OR (Category B)
o Ampicillin, 2 g IV initial dose, then 1 g IV every 4 hours or 2 g
every 6 hours until delivery (Category B)
o If allergic to PCN

Transcribers: LAPEÑA, LOREZCO, HIDALGO Page 3 of 3