Facts

Screen all pregnant women at the first prenatal encounter with serologic testing.

But women at high risk of infection need rescreening at 28-32 weeks and at delivery.

Treatment: Penicillin G benzathine

Jarisch-Herxheimer reaction: An acute febrile reaction precipitated by the treatment of syphilis consisting of headache, myalgia, rash and hypotension. It is due to the release of large amounts of treponemal lipopolysaccharide from dying spirochetes. Counsel all patients about JHR. Management is supportive care with antipyretics and IV fluids.

Adverse pregnancy outcomes: Miscarriage, preterm birth, stillbirth, impaired fetal growth, congenital infection, neonatal mortality.

-Treponema pallidum infections the placenta (transplacental transmission to the fetus can occur around 9th to 10th week of gestation)

-Classic radiographic appearance of pneumonia in infants with congenital syphilis: Complete opacification of both lung fields (‘pneumonia alba’)

Facts

Genital Herpes Simplex in pregnancy: presents with painful genital ulcers, fever, dysuria, pruritis.

Diagnosis by finding vesicular or ulcerated lesions, PCR, viral culture

Treatment of primary infection: treat with acyclovir, valacyclovir, famciclovir

Treatment of recurrent infection: treat with antivirals only if there are prolonged and severe symptoms.

Suppressive therapy at 36 weeks: For all women with a genital HSV anytime during pregnancy, initiate suppressive therapy at 36 weeks until the onset of labor, use 400 mg three times daily.

Delivery: mostly vaginal delivery; C-section if there are active genital lesions or pain and burning

Cesarean delivery can decrease but not eliminate the risk of neonatal HSV infection

-Untreated bacteriuria has been associated with an increased risk of preterm birth, low birth weight, and perinatal mortality

-Most common pathogen: E.Coli

-Screen all pregnant women for asymptomatic bacteriuria at 12-16 weeks or the first prenatal visit with the culture of a urine specimen.

-Treat asymptomatic bacteriuria and cystitis: Nitrofurantoin (avoid use during the first trimester and at term), Amoxicillin, amoxicillin-clavulanate, cephalexin, cefpodoxime, Fosfomycin. -Trimethoprim-sulfamethoxazole: Avoid during the first trimester and at term; a folic acid antagonist, caused abnormal embryo development in animal studies.

-Avoid sulfonamides in the last days before delivery because they can displace bilirubin from plasma binding sites in the newborn, increasing the risk for kernicterus.

-Avoid aminoglycosides; they can cause ototoxicity.

-Do not use tetracyclines and fluoroquinolones

Pyelonephritis: presence of flank pain, nausea, vomiting, fever, costovertebral angle tenderness.

Treatment of pyelonephritis: Hospitalization with intravenous antibiotics and later oral antibiotics (ceftriaxone, cephalexin, cefazolin, ampicillin plus gentamicin)

Safe antibiotics throughout pregnancy: Penicillins, Cephalosporins, Aztreonam and Fosfomycin.

Human milk is recommended as the exclusive nutrient source for feeding term infants for the first six months of life and should be continued with the addition of solid foods after six months of age.

Benefits of Breastfeeding:

-Human milk stimulates gastrointestinal growth and motility.

-increases the rate of gastric emptying.

-increases the intestinal lactase activity.

-inhibits microbial activity.

-improves visual function

-lowers the incidence of gastroenteritis and respiratory disease, otitis media, urinary tract infection, sepsis

-prevents overweight and obesity.

-reduces the risk of cancer, heart disease, allergic conditions, diabetes

-improves cognitive development

-promotos stress reduction

Common Problems of Breastfeeding

Inadequate milk production

Poor milk extraction

Improper breastfeeding techniques

Biting

Areolar dermatitis

Nipple and Breast pain (treat with bacitracin or mupirocin, acetaminophen, ibuprofen, antifungals)

Infants with ankyloglossia (treat with lingual frenotomy)

Nipple vasoconstriction (treat with nifedipine, a vasodilator)

Engorgement (apply warm compresses, ibuprofen, acetaminophen, milk removal)

Plugged ducts (learn correct positions and  latch techniques, empty the breast with frequent feeds, acetaminophen, ibuprofen, ultrasound to rule out an abscess

Lactational mastitis: anti-inflammatories, antibiotics (No MRSA risk: dicloxacillin, cephalexin, clindamycin; MRSA risk: use trimethoprim-sulfamethoxazole, clindamycin, linezolid)

Galactoceles: can occur due to unrelieved plugged ducts, need aspiration.