Chlamydia - Infectious Diseases in Pregnancy

 CHLAMYDIA

 

Antepartum screening for Chlamydia trachomatis should be performed early in pregnancy and repeated in the third trimester based on risk factors (see Table 16.1). It has been detected in 2% to 13% of pregnant women, depending on the population, and is generally found in 5% of all popula-tions. In pregnant women, infection is often asymptomatic but may cause urethritis or mucopurulent cervicitis. Like gonorrhea, infection of the upper genital tract is uncom-mon during pregnancy, although chlamydia infection has been associated with postpartum endometritis and infertil-ity. Diagnosis is made by culture, direct fluorescent anti-body staining, enzyme immunoassay, DNA probe, or PCR.

 

Maternal chlamydia infection at the time of delivery results in colonization of the neonate in 50% of cases. Neonates colonized at birth may go on to develop puru-lent conjunctivitis soon after birth or pneumonia at 1 to 3 months of age. Routine prophylaxis against neonatal gonococcal ophthalmia is not generally effective against chlamydial conjunctivitis; systemic treatment of the infant is necessary. Fortunately, neonatal chlamydial ophthalmia and pneumonia are becoming less common with the insti-tution of universal prenatal screening and treatment. Recommended treatment of genital infection with C. tra-chomatis in pregnancy includes azithromycin or amoxicillin.

Doxycycline and ofloxacin are contraindicated during preg-nancy.

Repeat testing to confirm successful treatment, preferably by culture performed 3 to 4 weeks after completion of ther-apy, is recommended in pregnancy.

Comments

Post a Comment

Popular posts from this blog

The Postpartum Visit

  THE POSTPARTUM VISIT   At the time of the first postpartum visit, inquiries should be made into the following: status of breastfeeding, re-turn of menstruation, resumption of coital activity, use of contraception, interaction of the newborn with the fam-ily, and resumption of other physical activities such as return to work. Observation about and appropriate ques-tions concerning sadness and depression, anxiety, the par-ents’ concerns about infant care, and the relationship of mother and her partner are also part of the first postpar-tum visit. Involutional changes will have occurred in most instances. Inflammatory changes because of the healing of the cervix may result in minor atypia on a Pap smear performed at this time. Unless there is a history of signifi-cant cervical dysplasia, repeating the Pap smear in 3 months is appropriate.
Read more

Clinical Findings of Tubal Ectopic Pregnancy

  CLINICAL FINDINGS   Abdominal and pelvic findings are notoriously scant in many women before tubal rupture. Prior to rupture, the di-agnosis of an ectopic pregnancy is primarily based on labo-ratory and ultrasound findings. With rupture, however, nearly three-fourths of women will have marked tender-ness on both abdominal and pelvic examination, and pain is aggravated with cervical manipulation. A pelvic mass, in-cluding fullness posterolateral to the uterus, can be palpated in about 20% of women. Initially, the ectopic pregnancy may feel soft and elastic, whereas extensive hemorrhage produces a firmer consistency. Many times, discomfort pre-cludes palpation of the mass. Avoidance of pelvic examina-tions may actually help avert iatrogenic rupture.   Fever is not expected, although a mild elevation in temperature in response to intraperitoneal blood may occur. A temperature of 38 ° C may suggest an infectious cause to a patient’s symptoms. Abdominal distension and tender...
Read more

Anxiety, Depression, and the Postpartum Period

Image
  ANXIETY, DEPRESSION, AND THE POSTPARTUM PERIOD   Although pregnancy and childbirth are usually joyous times, depression to some degree is actually common in the postpartum period. There is a wide spectrum of response to pregnancy and delivery, ranging from mild postpartum blues to postpartum depression (Table 11.2). Approximately 70% to 80% of women report feeling sad, anxious, or angry beginning 2–4 days after birth. These  postpartumblues  may come and go throughout the day, are usuallymild, and abate within 1 to 2 weeks. Supportive care and reassurance are helpful in ensuring that symptoms are self-limited. Approximately 10% to 15% of new mothers ex-perience  postpartum depression (PPD),  which is a more serious disorder and usually requires medication and counseling.  PPD differs from postpartum blues in the sever-ity and duration of symptoms.  Women with PPD have pro-nounced feelings of sadness, anxiety, and despair that interfere with acti...
Read more