Anemia

Physiologic anemia is normal anemia in pregnancy because of hemodilu-tion due to volume expansion.

Anemia for a pregnant woman is a drop in Hgb by 10 g/dL or Hct by 30%.

Incidence: 20 to 60% of pregnant women, 80% is iron-deficiency type Risks: Preterm delivery, IUGR, low birth weight Therapy is 325 mg tid of FeSO4 (prophylaxis is q d)

INFECTION AND PREGNANCY

See Tables 8-2 through 8-4

Persistent nausea and vomiting in late pregnancy should prompt a search for underlying pathology (e.g., gastroenteritis, cholecystitis, pancreatitis, hepatitis, peptic ulcer, pyelonephritis, fatty liver of pregnancy, and psychological or social issues).

The two most common causes of anemia during pregnancy and the puerperium are iron deficiency and acute blood loss.

TABLE 8-2. Perinatal Infections

Intrauterine0

Viral

Bacterial

Protozoan

Transplacental

Varicella-zoster Coxsackie virus Parvovirus Rubella

Cytomegalovirus Human immunodeficiency virus

(HIV)

Listeria Syphilis

Toxoplasmosis Malaria

Ascending infection

Herpes simplex

(GBS) Coliforms

Intrapartum^

Maternal exposure

Papillomavirus

HIV HBV

Gonorrhea Chlamydia GBS TB

External contamination

HSV

Staphylococcus Coliforms

TABLE 8-2. Perinatal Infections (continued)

Neonatal

TABLE 8-2. Perinatal Infections (continued)

Human HSV

Staphylococcus

trans

mission

Respirators

Staphylococcus

and

Coliforms

catheters

a Bacteria, viruses, or parasites may gain access transplacentally or cross the intact membranes. b Organisms may colonize and infect the fetus during L&D.

TABLE 8-3. Viral Infections and Their Potential Fetal Effects

TABLE 8-3. Viral Infections and Their Potential Fetal Effects

Virus

Fetal Effects

Maternal Effects

Prophylaxis

Treatment

Varicella-zoster0

Transmitted transplacentally

■ Chorioretinitis

■ Cerebral cortical atrophy

■ Hydronephrosis

■ Cutaneous and bony leg defects (scars)

■ Microcephaly

Pneumonitis

Vaccine not recommended for pregnant women

Varicella-zoster immunoglobulin within 96 hrs of exposure C-section should be performed if there are active lesions.

■ Neural tube defects

■ Death

Vaccination is recommended for pregnant women who have chronic underlying disease or who are routinely exposed.

Amantadine within 48 hrs of onset of symptoms in non-immunized, high-risk patients

■ Congenital anomalies

■ Hydrops

Viremia ^ slapped cheek appearance

If + serology ^ US; if + hydrops ^ consider fetal transfusion.

Rubella

Congenital rubella syndrome

Cataracts/glaucoma

■ Patent ductus arteriosus

■ Mental retardation

(attenuated live virus) of the non-pregnant female

Consider therapeutic abortion, depending on time of exposure during pregnancy.

Hepatitis B

Range from mild liver

Maternal screening

disfunction to death

early in pregnancy.

Maternal HbsAg

positive is high risk

of transmitting to

fetus. If mother is

positive, give

neonate HepB IgG at

birth, 3 months, and

6 months.

TABLE 8-3. Viral Infections and Their Potential Fetal Effects (continued)

Virus

Fetal Effects

Maternal Effects

Prophylaxis

Treatment

Cytomegalovirus

Causes in utero infection in 1% of all newborns but only 10% of infected show disease.

■ Cytomegalic inclusion disease

Mononucleosis-like syndrome

None

■ Hepatospleno-megaly

Thrombocytopenia

■ Microcephaly

■ Intracranial calcifications

■ Chorioretinitis

■ Mental retardation

■ Jaundice

a Infection may be especially severe in pregnant women.

TABLE 8-4. Bacterial Infections and Their Potential Fetal Effects

Bacteria

Fetal Effects

Maternal Effects

Prophylaxis

Streptococcus

(Streptococcus agalactiae)

■ Preterm labor

■ Premature rupture of membranes

■ Ophthalmia neonatorum

■ Meningitis ^ neurologic sequelae in survivors

■ Chorioamnionitis

■ Puerperal sepsis

■ Osteomyelitis

Intrapartum maternal penicillin G in women with + cultures at 35-37 wks' GA

Neonatal penicillin G IM in the delivery room (there is no universal treatment)

Salmonella

■ Bacteremia

IV fluid rehydration0

Borrelia burgdorferi (Lyme)

■ Congenital infection

■ Preterm labor

■ Disseminated infection

■ Meningitis

■ Arthritis

Oral amoxicillin or penicillin

Primary and secondary syphilis

■ Hepatosplenomegaly

■ Lymphadenopathy

■ Hemolysis

Chlamydia trachomatis

■ Conjunctivitis

■ Pneumonia

■ Screen in early pregnancy

Erythromycin or azithromycin

Neisseria gonorrhoeae

■ Conjunctivitis

Otitis externa

■ Pharyngitis

Screen in early pregnancy

Penicillin or ceftriaxone

TABLE 8-4. Bacterial Infections and Their Potential Fetal Effects (continued)

Bacteria

Fetal Effects

Maternal Effects

Prophylaxis

Treatment

TABLE 8-4. Bacterial Infections and Their Potential Fetal Effects (continued)

Toxoplasma gondii Transplacental

Spiramycin

infection occurs.

(macrolide

■ Congenital disease

antibiotic)

■ Hydrocephaly/

microcephaly

■ Hepatospleno-

megaly

■ Seizures

■ Intracranial

calcifications

■ Chorioretinitis

■ Mental retardation

1 Antimicrobials prolong the carrier state and are not given in uncomplicated infections.

1 Antimicrobials prolong the carrier state and are not given in uncomplicated infections.

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