Infectious Diseases

Vaccination -> C9 Prenatal care

Influenza	vaccination Oseltamivir: category C (48hr ?)
Toxoplasma	1st trimester??? 10%?? ??? ?? ‘In-utero infection’ IUGR, rash, ????, ??, ?? TRIAD: Hydrocephalus, intracranial calcifications, and chorioretinits Spiramycin, Pyrimethamine, Sulfadiazine
Rubella	IUGR? m/c. ??, ???, PDA, ??? ???? ??? ?? ?? ? maculopapule? ???? ???? ????. ??/?? ?? IgM+, IgG+? ??. ???? 3????? titer f/u IgG avidity high? ??? ?? ??? ??. avidity? ??? ???? ??. ?? ???? ??? vaccination ?? ???. ?? 3?? ?? ?????.
CMV	IgG? avidity? ??? ? ??? ???? ??.  ??? IgM+? ?? ??? ? ??? ??
Herpes	VZV? ?? ??? 96??? VariZIG. ?? ??? IV acyclovir PROM?? ????? ??? ???? ?? OK
Syphilis	?? ???? ??? ?? ??. + ???? ?? VDRL ????. Penicillin? TOC. Allergy ??? desensitization????. Erythromycin? ??? ?? ??? ???.
Parvovirus	Slapped cheek, nonimmune hydrops ??. But ??? ?? ?? x

Maternal and fetal immunology

Pregnancy induced immunological changes

Fetal and Newborn Immunology

Viral infections

Cytomegalovirus

Varicella-Zoster Virus

• Varicella
  • ???? ???? ??? ?? ??? ?? ?? ??
  • ??? Varicella-zoster IG ??
• Zoster
  • ??? ?? ?? (-)
  • ??? Acyclovir (????? ??) ??.

Influenza Virus

Mumps Virus

Measles Virus

Rubella Virus

Respiratory Viruses

Hantaviruses

Enteroviruses

Parvovirus

West Nile Virus

Coronavirus Infections

Ebola Virus

Zika virus

Bacterial infections

Group A Streptococcus

Group B Streptococcus

Methicillin-Resistant Staphylococcus aureus

Listeriosis

Salmonellosis

Shigellosis

Hansen disease

Lyme disease

Tuberculosis

Protozoal infections

Toxoplasmosis

Malaria

Amebiasis

Mycotic infections

Travel precautions during pregnancy

Bioterrorism

Smallpox

Anthrax

Other bioterrorism agents

STD

1. Pelvic inflammatory diseases (PID)
   a. Nisseria Gonorrhea
   b. Chlamydia Trachomatis
   i. m/c (10%), ?? ?? x
   ii. Non-gonorrheal ???
   iii. Urethritis, cervicitis
   iv. ??? ?? ??, ??? PID ? abscess
   v. Fitz-Hugh-Curtis ? ? ???? ???? ??
   vi. Conjunctivitis? silver nitrate? ??
   vii. ???? erythromycin base? (???? ??)
2. Vaginitis
   a. Yeast, trichomonas, bacterial vaginosis

Syphilis

• Clinical manifestations
  • ?? 18? ???? ??? ????? ?????? ?? ???? ??.
• Management
  • ?? 4?? ?? ??? 98% ?? ??.

Gonorrhea

Chlamydial infections

Herpes simplex virus

Adult disease

Clinical presentation

Vertical transmission

• 1/3? ?? ??. ??? ?? ?

Diagnosis

Management

• Active genital herpes
  • fetus?? ?? ? ??, C-sec
  • ??? Acyclovir ?. Breast feeding? ?? ??!
  • Internal electronic monitoring during labor is not recommended.
• No current outbreak
  • Can safely deliver vaginally.

Peripartum shedding prophylaxis

Pregnant women with a history of genital HSV infection should receive prophylactic acyclovir or valacyclovir beginning at 36 weeks of pregnancy

Chancroid

Human papillomavirus

Causes condyloma accuminata (warts). ?? subtype? cervical ca.? ??.
??? Podophyllin? ??!! Trichloroacetic acid
?? ? ???? ???? ?? ??? ??? ?? ??

Vaginitis

Human immunodeficiency virus

Etiopathogenesis and epidemiology

Clinical manifestations

Prenatal HIV screening

Vertical transmission

Antepartum care

• HIV RNA viral load at initial visit, every 2-4 weeks after initiation or change of therapy, monthly until undetectable, then every 3 months.
• CD4 cell count every 3-6 months
• Resistance testing if not previously performed
• ART initiation as early as possible
• Avoid amniocentesis unless viral load ?1,000 copies/mL

Delivery planning

• Avoid artificial ROM (rupture of membranes), fetal scalp electrode, operative vaginal delivery.
• Viral load ?1,000 copies/mL: ART + vaginal delivery
• Viral load >1,000 copies/mL: ART + zidovudine + cesarean delivery
• Reducing perinatal HIV transmission
  • Cesarean delivery: ~50% when viral load is >1,000 copies/mL

Postpartum care

• Mother: continue ART
• Infant
  • Maternal viral load ?1,000 copies/mL: zidovudine
  • Maternal viral load >1,000 copies/mL: multidrug ART