OB--Infections (TORCH)

What does TORCH stand for?

Toxoplasmosis, Other, Rubella, Cytomegalovirus, Herpes

How do we prevent/treat Chlamydia?

Treat disease with antibiotics. Instill erythromycin ointment in baby's eyes at birth. Don't use silver nitrate (only effective against gonorrhea, not chlamydia)

How do we treat/prevent Herpes?

Treat w/ the antiviral Acyclovir, provide supportive care. Prophylactic eye ointment (vidarabine). Deliver by C/S if cultures are positive at full term and membranes ruptured less tha 4-6 hrs prior. If later than 4-6 hrs after ROM, baby probably already infected. Vaginal delivery if mother has 2 negative cultures one week prior to delivery.

How do we prevent/treat HPV?

Vaccines Cervarix and Gardisil. Treat non-pregnancy women drugs like podophillin or podofilox (applied directly to wart; oral form is teratogenic). During pregnancy, lesions can be removed via cryotherapy, laser, surgery, local podophillin application. May have elective C-section delivery.

How do we prevent/treat GBS?

Vaginal culture on all pregnant women around 36wks; treat positive women w/ IV antibiotics. Receive 2 doses of antibiotics during labor.

What are the maternal s/s of Cytomegalovirus?

asymptomatic or mononucleosis-type symptoms: prolonged fever, mild hepatitis. Cells appear large

What are the maternal s/s of Syphilis?

s/s appear with 10-90 days after infection. Painless primary sores at site of infection. Skin rashes and/or sores in the mouth, vagina, or anus (also called mucous membrane lesions ) mark the secondary stage of symptoms. fever, swollen lymph glands, sore throat, patchy hair loss, headaches, weight loss, muscle aches, and fatigue. Latent stage in which there are no s/s of syphilis.

What are the fetal/newborn effects of Cytomegalovirus?

Abortion, stillbirth, death. Prematurity, IUGR, microcephaly. Severe mental and physical handicaps. Hearing loss.

What are the fetal/newborn effects of HIV/AIDS?

Asymptomatic at birth. If infected prenatally, develop s/s of HIV infection and die by 1-2 yrs of age. If infected during birth, develop s/s from btwn 1-10 yrs of age.

What are the Maternal s/s of Toxoplasmosis?

Asymptomatic, mild flu-like symptoms

What are the maternal s/s of Group B beta-hemolytic strept infection (GBS)?

Asymptomatic; part of normal flora in the vagina. Most don't know they are infected (silent carriers).

If a newborn is usually asymptomatic at birth, how do we know if they are HIV positive?

Babies of infected mothers usually will have maternal antibodies for 8-15 months. After that, the maternal antibodies disappear. If the baby is HIV negative, the baby won't produce antibodies. If it is positive, the baby will begin producing his own antibodies. Treat baby as HIV positive until proven otherwise.

How do we treat/prevent Cytomegalovirus?

CMV specific immunoglobins given to positive pregnant woman (passive immunity). Infected newborns treated with antiviral medications.

What are the fetal/newborn effects of Chlamydia?

Conjunctivitis, scarring of the conjunctiva. Pneumonia. Early/late pregnancy loss, stillbirth, premature birth.

How is Cytomegalovirus transmitted to the fetus?

Crosses placenta, ascends through cervix, contact w/ body fluids.

How is Rubella transmitted to the fetus?

Crosses the placenta

How is Toxoplasmosis transmitted to the fetus?

Crosses the placenta

How is Chlamydia transmitted to the fetus?

Crosses the placenta, direct contact in the birth canal

How is Hep B transmitted to the fetus?

Crosses the placenta. Direct contact during birth

How is HIV/AIDS transmitted to the fetus?

Crosses the placenta. Direct contact during birth. Contact with breast milk and other bodily fluids.

How is Syphilis transmitted to the fetus?

Crosses the placenta. Direct contact with a lesion during birth.

How is Herpes transmitted to the fetus?

Crosses the placenta; ascends through cervix; direct contact in birth canal; direct transmission from infected family or staff (cold sores)

How is GBS transmitted to the fetus?

Direct contact during birth (main cause), crosses placenta

How is HPV transmitted to the fetus?

Direct contact in birth canal

How is Gonorrhea transmitted to the fetus?

Direct contact in birth canal; postnatally via infected adult

What are the fetal/newborn effects of Herpes?

Disseminated Type: all organs affected, bacterial sepsis, shock, death. CNS Type: residual neurological deficits, blindness, death. Localized Type: skin lesions, eye damage, blindness. If untreated, can progress to Disseminated or CNS types.

What are the maternal s/s of Human Papillomavirus/Genital Warts (HPV)?

Dry wart-like growths on the vulva, vagina, cervix, rectum, and thighs. Vaginal discharge. Itching.

How do we prevent/treat newborn Hep B?

Dx via amniotic fluid culture--presence of Hep B antigens and IgM in fetal cord blood. Give baby Hep B vaccine and immunoglobins at birth if mom's HepB+.

What are the fetal/newborn effects of GBS?

Early onset (w/i 24 hrs): severe respiratory provlems, systematic infection, meningitis (4% mortality). Late onset (1wk-3 mos): meningitis w/ residual neurological deficits.

How do we prevent/treat Gonorrhea?

Eye prophylaxis treatment (erythromycin ointment, silver nitrate is effective against gonorrhea). IV antibiotics if systemic infection.

What are the maternal s/s of Hepatitis B?

General symptoms of viral infection: painful jointsl, n/v, HA, fever, abd pain. If chronic, may have liver cirrhosis or liver cancer.

How do we prevent/treat newborn HIV/AIDS?

HIV testing (recommended but not legally required). Treat HIV positive women with HAART antiviral therapy (may have teratrogenic effects during 1st trimester). Treat newborns with antivirals for six weeks. Depending on mother's viral load, may schedule C/S or allow vaginal birth. No fetal scalp monitoring. Avoid breastfeeding in developed countries.

What are the fetal/newborn effects of Toxoplasmosis?

Learning disabilities, mental retardation. Prematurity, IUGR. Hydrocephalus. Blindness. Death

What are the maternal s/s of Herpes Simplex and Herpes Simplex type II?

No symptoms. one or more blisters on or around the genitals, rectum or mouth that can break, leaving painful sores that may take two to four weeks to heal. The first time someone has an outbreak they may also experience flu-like symptoms such as fever, body aches and swollen glands.

If a mother is HepB+, is she allowed to breast feed.

Not contraindicated if the infant is immunized at birth and given immunoglobins at birth

What are the maternal s/s of chlamydia?

Often asymptomatic, but has highly destructive effects. Salpingitis, PID, ectopic pregnancy, infertility.

What are the maternal s/s of Gonorrhea?

Often asymptomatic, mildly symptomatic. Dysuria, frequency, vaginal discharge, lower abd pain.

What are the fetal/newborn effects of Gonorrhea?

Opthalmia, neonatorum (blindness risk), septicemia, meningitis.

What are the maternal s/s of Rubella?

Pink rash. HA, pink eye, and general discomfort 1 to 5 days before the rash appears. Adults also tend to have more complications, including sore, swollen joints and, less commonly, arthritis, especially in women.

How is toxoplasmosis contracted by the mother?

Poorly cooked infected meat. Exposure to animal waste (no gardening, no cleaning the litterbox)

How do we prevent/treat Rubella?

Prenatal antibody screenings. Live virus vaccine available before at least 4 wks before pregnancy and after birth (no live vaccines during pregnancy though). If immunized after birth, use contraception for a month afterwards.

How do we prevent/treat newborn Toxoplasmosis?

Prevent: antibody screening, but not routine. Treat: Pyrimethamine, sulfadiazine for baby until age 1.

What are the maternal s/s of HIV/AIDS?

Recurrent infections (like pneumonia, esophagitis, toxoplasmosis, CMV, trichomoniasis)

What are the fetal/newborn effects of HPV?

Respiratory papillomas (warts in the throat that can occlude the airway).

How do we prevent/treat Syphilis?

Serologic testing (RPR test). Treat w/ penicillin.

What are the fetal/newborn effects of Rubella?

Spontaneous abortion, congenital rubella syndrome (heart defects, hearing impairment, cataracts, mental retardation). Infant may be infectious for up to 18 months of age.

What are the fetal/newborn effects of Hep B?

Spontaneous abortion, premature birth, hepatitis. Possible liver cancer later in life. Mortality rate of 75% if full blown hepatitis is contracted.

What are the fetal/newborn effects of Syphilis?

Stillbirth, prematurity. Congenital syphilis: clear discharge from nose, copper colors rash on soles/palms, fissues around mouth. May be asymptomatic at birth, but develop symptoms anywhere from 2-20 years later. May have reoccurence later in life (5-15 years). May develop neurosyphilis, deafness, etc.