What is ToRCH?
Infections acquired in utero or during delivery that lead to significant fetal or neonatal mortality
- Toxoplasmosis
- Other: syphilis
- Rubella
- Cytomegalovirus
- Herpes simplex virus
Pt comes into contact w/ cat feces & poorly cooked meat. What bacteria is she at risk of being infected with? Leading to fetal OR neonatal mortality…
Toxoplasma gondii
Dx of Toxoplamosis
- What will show on US?
- At birth, what sxs do pt have?
- What is the classic triad at birth?
- What are the other 5 sxs?
- US: intracranial calcifications
- Most are asymptomatic
- Triad: Chorioretinitis, hydrocephalus, intracranial calcifications
- Fever, jaundice, thrombocytopenia, seizures, maculopapular rash
How is Toxoplasmosis dx and tx?
Dx: Anti-Toxoplasma immunoglobulin IgM & IgG
Tx: 3 meds for 1 year (Pyrimethamine, Sulfadiazine, Folinic Acid)
What bacteria causes syphilis?
What is the transmission rate?
How is it transferred?
- Treponema pallidum
- 100%
- Sexual & Vertical
Infant w/ syphillis will show what 3 sxs of early disease?
- Blood tinged nasal secretions (snuffles)
- Diffuse osteochondritis
- Saddle nose (secondary to syphilitic rhinitis)
Infant w/ syphilis in late disease will show what 2 signs?
- Hutchinson teeth (notching of permanent incisors)
- Anterior bowing of tibia (Saber shins)
How is syphilis in infant diagnosed?
If infant has clinical findings suggestive of syphilis, mother is tested for RPR/VDRL + Fluorescence Treponemal Antigen (FTA) serology
How is syphilis treated?
Procaine Penicillin G x 10-14 days
Hematogenous spread infecting the placenta spreading through vascular system of fetus
- Prevented w/ universal immunization
- 1st trimester maternal infection is 80% transmission
- 2nd trimester maternal infection is 50% transmission
Rubella
- Hearing loss***
- Blueberry muffin rash*** (purpuric skin lesions)
- Cataracts
- Patent ductus arteriosus
- Jaundice
- Thrombocytopenia
- Hepatosplenomegaly
Rubella
How is Rubella diagnosed and treated?
IgM rubella antibody (serum or culture)
Tx: No effective therapy for active infection
- Member of herpes family
- Transmitted via bodily fluids / secretions
Cytomegalovirus
What is the #1 congenital infection?
Cytomegalovirus
What is the #1 cause for sensorineural hearing loss?
Cytomegalovirus
- Microcephaly
- Intracranial calcifications
- IUGR
- Chorioretinitis
- Severe mental retardation
Dx? How is it diagnosed?
Cytomegalovirus
- CMV detection via urine or saliva
Herpes Simplex Virus
- How is it transmitted?
- Rate of transmission?
- How is transmission to baby prevented?
- Vertical
- 50%
- C-section
- Seizures
- Resp distress
- Mucocutaneous vesicles
- Meningitis
- Encephalitis
- Conjunctivitis
Dx? Diagnosed how? Tx?
Herpes Simplex Virus
- Oropharyngeal culture
- LP
- HSV serology
- Tx: Acyclovir
What is the purpose of Intrapartum Fetal Heart Monitoring? (4)
◦Assesses adequacy of fetal oxygenation
◦Presence of fetal metabolic acidemia
◦Allows for timely intervention
◦Reduces likelihood of neurologic injury and death
What is a normal FHR pattern?
- Baseline FHR is 110-160 bpm
- Moderate FHR variability (6-25 bpm)
- Absence of LATE or variable FHR decelerations
- Change in above requires prompt intervention
What are “accelerations?”
- Elevations in HR above baseline (110-160) so if above 160 bpm
- Reassuring
- >32 w: 15 bpm lasting 15 seconds
- <32 w: 10 bpm lasting 15 seconds
- Non-stress test: 2 or more accelerations in a 20 min period
3 types of Decelerations in fetal distress?
Early, Late, or Variable
Early, Late, or Variable deceleration of fetal distress?
- Mirror contractions
- Seen with head compression
Early
Early, Late, or Variable deceleration of fetal distress?
- Falls in heart rate after contraction has started
- Seen with fetal hypoxia
Late (do a C-section)
