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Clinical Approach to Infections in Pregnancy
Vineet Mishra, Madhuri Chandra
CHAPTER 1:
Overview: Impact of Viral Infections on Mother and Fetus
CASE SCENARIO
OBJECTIVES
INTRODUCTION
PREDOMINANTLY FETAL/NEONATAL AFFECTION
Diagnosing TORCH Infections in the Pregnant Women
Common Infections
Genital Herpes
Varicella-zoster
Cytomegalovirus
Rubella
TORCH Infections in the Current Perspective (Table 1.3)
BOTH MATERNAL AND NEONATAL AFFECTION
HIV
Hepatitis B
Hepatitis C Virus Infection
PREDOMINANTLY MATERNAL AFFECTION
Hepatitis E Virus
Influenza
CHAPTER 2:
Screening for Infections in Pregnancy: Current Guidelines
INTRODUCTION
CLASSIFICATION OF INFECTIONS IN PREGNANCY
ANTENATAL SCREENING FOR INFECTIONS
Routine Screening
Not Usually Included as Routine Screening
Screening for Infections
Recommendations for Screening for Hepatitis B Infection
Interpretation of Hepatitis B Serologic Test Results1
SCREENING AND REFERRAL ALGORITHM FOR HEPATITIS B VIRAL INFECTION IN PREGNANT WOMEN4 (FLOW CHART 2.1)
Recommendations for Screening for Syphilis Infection5
Algorithm for Antenatal Screening for Syphilis6 (Flow chart 2.2)
RECOMMENDATIONS FOR SCREENING FOR HUMAN IMMUNODEFICIENCY VIRUS INFECTION
WHO Recommendations8
RECOMMENDATIONS FOR SCREENING FOR URINARY TRACT INFECTIONS
CHAPTER 3:
Rubella
CASE SCENARIO
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
VERTICAL TRANSMISSION RATES AND RISK OF CONGENITAL RUBELLA SYNDROME
Fetal Infection Rates
Risk of CRS
CONGENITAL RUBELLA SYNDROME
DIAGNOSIS OF RUBELLA INFECTION
Diagnosis of Maternal Infection
Diagnosis of Fetal Infection
Diagnosis in Infant
MANAGEMENT OF RUBELLA INFECTION IN PREGNANCY
Antenatal Screening
Immune Pregnant Women
Nonimmune or Status of Immunity Unknown
TREATMENT
Rubella Vaccine
VACCINATION SCHEDULE
CHAPTER 4:
Parvovirus B19
CASE SCENARIO
Queries
OBJECTIVE
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
Symptoms and Signs
Fetal Manifestations
MANAGEMENT
Diagnosis of Fetal Infection
Management of Fetal Hydrops and Anemia
CHAPTER 5:
Cytomegalovirus
INTRODUCTION
CASE SCENARIO
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
Laboratory Investigations and Interpretation
How do we Confirm that there is an Intrauterine Infection?
Any Therapy can be Offered if Intrauterine Infection is Proved?
Can any Preventive Strategies be Offered?
Is Screening for CMV Recommended in Pregnancy?
CARE PATHWAY16
CHAPTER 6:
Enterovirus: Coxsackie Virus
INTRODUCTION
EPIDEMIOLOGY1,2
Virology
Coxsackie Virus A
Coxsackie Virus B
Transmission
CLINICAL PRESENTATION
Coxsackie Virus A
Coxsackie Virus B
Diagnosis1
Newer Techniques
EFFECTS OF COXSACKIE VIRUS INFECTION DURING PREGNANCY3
Perinatal Effects
Effects in Pregnancy9
MANAGEMENT1
Prognosis1,11
CHAPTER 7:
Varicella (Chickenpox)
CASE HISTORIES
Objectives
Pathophysiology
Clinical Features
Diagnosis
FETAL VARICELLA SYNDROME
Prevention
Treatment
Immunization
CHAPTER 8:
Viral Hepatitis A and E
CASE SCENARIO
VIRAL HEPATITIS IN PREGNANCY
HEPATITIS A IN PREGNANCY
Introduction
Pathophysiology and Transmission
Clinical Manifestations
Management
Prevention
HEPATITIS E IN PREGNANCY
Introduction
Pathophysiology and Transmission
Clinical Manifestations
Management
Complications
Prevention
WHO Current Views
CHAPTER 9:
Viral Hepatitis B and C
CASE SCENARIO
INTRODUCTION
HEPATITIS B AND C IN PREGNANCY
HEPATITIS B IN PREGNANCY
Clinical Manifestations
Maternal Infection
Fetal Infection
Diagnosis
Management
Prevention
HEPATITIS C
Clinical Manifestations
Maternal
Fetal
Diagnosis
Management
CHAPTER 10:
Mumps and Measles
MUMPS
Case History
Objectives
INTRODUCTION
PATHOPHYSIOLOGY
COMPLICATIONS TO MOTHER AND FETUS
Clinical Approach
MEASLES
Case History
Objectives
INTRODUCTION
PATHOPHYSIOLOGY
COMPLICATIONS IN PREGNANCY
Clinical Approach
CHAPTER 11:
Influenza
CASE SCENARIO
Objectives
INTRODUCTION
ETIOPATHOGENESIS
PREGNANCY AND INFLUENZA
CLINICAL MANIFESTATIONS
MANAGEMENT
Diagnosis
Treatment
WHO RECOMMENDATIONS FOR TREATMENT
Vaccination
Guidelines
DECISION FOR DELIVERY
POSTNATAL MANAGEMENT
CHAPTER 12:
Genital Herpes
CASE SCENARIO
Objectives
INTRODUCTION
ETIOPATHOGENESIS
Perinatal Transmission of HSV
Risks of Transmission of HSV-2
CLINICAL MANIFESTATIONS
Maternal Infection
Neonatal HSV Infections
MANAGEMENT
Diagnosis
TREATMENT
Antiviral Therapy
Current Strategies in Prevention of Vertical HSV Transmission Include
CHAPTER 13:
Human Immunodeficiency Virus: Preventing Vertical Transmission
CASE SCENARIO
OBJECTIVES
INTRODUCTION
Magnitude of Problem
Etiopathogenesis
Mode of Transmission
Clinical Manifestations
Maternal Infection
Goals of PPTCT Programme
Management
Choice of ART Regimen for HIV-infected Pregnant Women
Postpartum
CHAPTER 14:
Preventing HIV Transmission: Pre-exposure Prophylaxis and Postexposure Prophylaxis
CASE SCENARIO
INTRODUCTION
PATHOPHYSIOLOGY
OCCUPATIONAL EXPOSURE AND POSTEXPOSURE PROPHYLAXIS
Clinical Approach
Universal Precautions
Management of Accidental Exposure (Based on NACO Guidelines for Postexposure Prophylaxis of HIV5)
Source Categories
Counseling for PEP
PEP Regime (Table 14.3)7
Follow-up
Management of Spills
Processing Items for Reuse (Soiled Linen/Gloves/Glass Syringes/Instruments)
CHAPTER 15:
Vector-borne Viral Infections: Dengue, Chikungunya and Zika
VECTOR-BORNE VIRAL INFECTIONS
Case Scenario
DENGUE VIRUS
Introduction
Pathophysiology
Clinical Presentation
Maternal Infection
Fetal Infection
Diagnosis
Management6
Postdelivery
CHIKUNGUNYA VIRUS
Introduction
Pathogenesis
Clinical Features
Diagnosis
Management10
Prevention
ZIKA VIRUS
Introduction
Clinical Features
Diagnosis
Vertical Transmission of Zika
Management
Prevention of Zika Virus Infection
CHAPTER 16:
Tuberculosis
CASE SCENARIO
Objectives
INTRODUCTION
Burden of Tuberculosis during Pregnancy
CLINICAL MANIFESTATIONS
Maternal Infections
Fetal Infections
Diagnosis
TREATMENT OF TUBERCULOSIS IN PREGNANCY
First-line Therapy
Multidrug-resistant Tuberculosis
FIRST-LINE DRUGS8
Isoniazid
Rifampicin
Ethambutol
Pyrazinamide
SECOND-LINE MANAGEMENT
Fluoroquinolones
Streptomycin and Amikacin
Capreomycin, Ethionamide and Prothionamide
Cycloserine
Para-aminosalicylic Acid
Amoxycillin/Clavulanic Acid
CHAPTER 17:
Syphilis and Other Bacterial Sexually Transmitted Infections
CASE SCENARIO
Objectives
INTRODUCTION
DEFENSE MECHANISM OF GENITAL TRACT IN PREGNANCY
SYPHILIS (FLOW CHART 17.1)
Introduction
Pathophysiology
CLINICAL MANIFESTATIONS
Maternal Infections
Risk of Vertical Transmission
Diagnosis
Treatment
CHLAMYDIA TRACHOMATIS
Introduction
Pathophysiology
Clinical Manifestations
Diagnosis
Treatment
GONORRHEA
Introduction
Pathophysiology
Clinical Considerations
Diagnosis
Treatment
TRICHOMONIASIS
Introduction
Pathophysiology
Clinical Consideration
Diagnosis
Treatment
CHAPTER 18:
Bacterial Vaginosis
CASE SCENARIO
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL FEATURES
Complications in Pregnancy
Clinical Approach
Treatment
CHAPTER 19:
Malaria
CASE SCENARIO
INTRODUCTION
MALARIA TRANSMISSION IN INDIA
PATHOPHYSIOLOGY
Effect of Pregnancy on Malaria
Effect of Malaria on Pregnancy
Risk Factors7
CLINICAL PRESENTATION
INVESTIGATIONS
TREATMENT GUIDELINES1,8
Uncomplicated P. f alciparum Infection
P. vivax Infection1,8
Severe Malaria1,8
WHO Definition of Severe Malaria (Table 19.4)
PREVENTION
Preventing Malaria in Pregnant Women
CHAPTER 20:
Toxoplasmosis
ILLUSTRATIVE CASE HISTORY
QUESTIONS AND CONTROVERSIES
OBJECTIVES
INTRODUCTION
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
Maternal Infection
Fetal Infection
DIAGNOSIS
Investigations: Serology
Investigations: Invasive Tests
MANAGEMENT RATIONALE FOR TERMINATION OF PREGNANCY
Antibiotics for Treating Toxoplasmosis in Pregnancy
Toxoplasmosis in the Immunocompromised Pregnant Woman
CHAPTER 21:
Listeriosis
CASE SCENARIO
Objectives
INCIDENCE
Sources of Contamination
PATHOPHYSIOLOGY
CLINICAL PRESENTATION
MANAGEMENT
TREATMENT
Treatment Algorithm (Flow chart 21.1)
Why should we be Worried?
CONCLUSION
CHAPTER 22:
Gastrointestinal Infections and Infestations
CASE DISCUSSION
Objectives
INTRODUCTION
COMMON PARASITIC INFESTATIONS
Amebiasis
Giardiasis
HELMINTHIC (WORM) INFECTIONS
Ankylostomiasis (Hookworm)
Ascariasis (Roundworm)
Enterobiasis (Pinworm/Threadworm)
Strongyloidiasis (Threadworm)
Trichuriasis (Whipworm)
Tapeworm Infestation
Schistosomiasis (Liverfluke)
CHAPTER 23:
Urinary Tract Infections
CASE SCENARIOS
OBJECTIVES
INTRODUCTION
DEFINITIONS
CLASSIFICATION
ETIOPATHOGENESIS
CLINICAL PRESENTATION
Asymptomatic Bacteriuria
Diagnosis
Management
Symptomatic UTI
Cystitis/Urethritis
Acute Pyelonephritis
Diagnosis: Lab Investigations
Treatment of Pyelonephritis
CHAPTER 24:
Ultrasound Imaging: Fetal Manifestations of Viral Exposure and Infections
INTRODUCTION
Viral Agents
DIAGNOSIS
ROLE OF ULTRASOUND IN THE MANAGEMENT OF CONGENITAL INFECTIONS
ULTRASOUND FINDINGS IN CONGENITAL VIRAL INFECTIONS
Cranial Lesions
Hydrocephalus/Ventriculomegaly
Hydranencephaly (Fig. 24.2)
Intracranial Calcification (Figs 24.3A and B)
Microcephaly (Figs 24.4A and B)
Abdomen
Hyperechoic Bowel (Fig. 24.5)
Hepatosplenomegaly (Fig. 24.6)
Intra-abdominal Calcification (Fig. 24.7)
Nonimmune Hydrops Fetalis (Figs 24.8A to D)
Cardiac Abnormalities (Figs 24.9A and B)
Limb Defects (Figs 24.10A and B)
Placentomegaly (Fig. 24.8B)
Amniotic Fluid Volume (Figs 24.8B and 24.11A)
Intrauterine Growth Restriction (Fig. 24.11A)
Other Defects
Early Pregnancy Loss
SPECIFIC ULTRASOUND FINDINGS
Cytomegalovirus (See Figs 24.1, 24.2, 24.5, 24.6)
Rubella (Figs 24.11A to C)
Herpes Simplex Virus
Human Immunodeficiency Virus
Varicella-zoster Virus (See Figs 24.10A and B)
Parvovirus B19 (See Figs 24.8 and 24.12)
Zika Virus (See Figs 24.3A and B)
INTERVENTIONAL ULTRASOUND IN CONGENITAL VIRAL INFECTIONS
Diagnosis
Therapy
DOPPLER ULTRASOUND IN CONGENITAL INFECTIONS
3D ULTRASOUND IN CONGENITAL INFECTIONS (SEE FIGS 24.8D, 24.10B, 24.11C)
ANOMALIES DETECTED IN RELATION TO CONGENITAL INFECTION44
DISADVANTAGES OF 3D ULTRASOUND
CHAPTER 25:
Vaccination for Women Contemplating Pregnancy
INTRODUCTION
MEASLES, MUMPS AND RUBELLA (GERMAN MEASLES)
VARICELLA (CHICKEN POX)
INFLUENZA VACCINE
Contraindications
Side Effects
DIPHTHERIA, TETANUS, PERTUSSIS VACCINE
PNEUMOCOCCAL VACCINE
HEPATITIS A
HEPATITIS B
MENINGOCOCCAL VACCINE
CHAPTER 26:
Antibiotic Use in Pregnancy
INTRODUCTION
PREGNANCY AND ANTIBIOTICS
INFECTIONS AND PREGNANCY
Asymptomatic Bacteriuria and Urinary Tract Infections
Infections and Preterm Labor
Need for Antibiotic Administration in Pregnancy
Efficacy and Safety of Antibiotics in Pregnancy
Antibiotics and Fetus: The Dilemma
FDA Approval
List of Various Antibiotics Safe in Pregnancy
Antitubercular Therapy during Pregnancy and Lactation10
Effects on Breastfeeding
Antimalarials in Pregnancy
Antibiotic Use during Pregnancy and Asthma in Preschool Children11
Antibiotics Associated with Increased Risk of Cerebral Palsy12
Association of Prenatal Antibiotics with Fetal Size and Cord Blood Leptin and Adiponectin13
CONCLUSION: THE ART OF BALANCING
CHAPTER 27:
Managing the Pregnant Woman with Systemic Inflammatory Response Syndrome, Sepsis and Septic Shock
CASE HISTORY
OBJECTIVES
PATHOPHYSIOLOGY
Diagnosis
SPECIFIC CONDITIONS
Septic Abortion
Chorioamnionitis
Pneumonia
Acute Pyelonephritis
COMPLICATIONS
Maternal Complications
Perinatal Complications
MANAGEMENT
Prevention
Tuberculosis
HIV
Malaria
INDEX
TOC
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