High Risk Pregnancy

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High Risk Pregnancy
-pregnant with a concurrent medical disease
-with pregnancy related complication
-presence of external factor that jeopardizes the health of the mother, the fetus, or both

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Candidiasis (Moniliasis)
INCIDENCE:
• 75% of women will have at least 1 episode of VVC with 40-45% having 2 or more episodes ETIOLOGIC AGENT:
• Candida albicans, Candida glabrata

MODE OF TRANSMISSION
normal flora of the skin & vagina
not considered as sexually transmitted
RISK FACTOR for Candida overgrowth
-pregnancy
-use of OCPs
-prolonged antibiotic use
-Diabetes
-Iron deficiency anemia
-use of immunosuppresants/ immunologically deficient (e.g. HIV infection)

SIGNS & SYMPTOMS:
• -severe itching, soreness &/or burning discomfort in the vagina & vulva • -dysuria & dyspareunia
PHYSICAL EXAMINATION
• -thick cream cheese-like vaginal discharge
• -vagina appears red & irritated

LABORATORY DIAGNOSIS
• -Direct microscopy (10% KOH) ➡ mycelia (long thread-like fibers) & psudeohyphae, budding of yeast • -(+) growth on vaginal yeast culture

TREATMENT
• -local - Clotrimazole 1% cream 5g intravaginally x 7 days or • -Clotrimazole 100 mg vaginal tablet x 7days
• -Miconazole 2% cream 5 g intravaginally x 7 days • -Miconazole 100 mg vaginal suppository, 1 supp. x 7 days or • -Nystatin 100,000 units vaginal tablet x 14 days

Trichomoniasis
• -one of the more common sexually transmitted diseases • accounts for 1/4 of vaginitis cases
• -ETIOLOGIC AGENT: Trichomonas vaginalis
• -a pear shaped single-cell protozoan
• -can withstand fairly extreme changes in the vaginal environment • -may infect the vagina, urethra & paraurethral glands • -grows best under anaerobic condition at pH >/= 5 TRANSMISSION

• -sexual contact
• -vertical transmission (during birth)
SIGNS & SYMPTOMS
• -none - asymptomatic women
• -women w/ symptoms may reveal
• -yellow frothy, odorous, vaginal discharge • -dyspareunia
• -dysuria
• -vulvar itching
PHYSICAL EXAMINATION
• -purulent, homogeneous frothy vaginal discharge • -vulvar or vaginal erythema
• -strawberry cervix
DIAGNOSTIC TESTS
• -Wet smear - microscopic ID of the mobile trichomonads w/ increase leukocytes (PMN’s) • -(+) Whiff Test upon application of 10% KOH on vaginal secretion ➠ strong fishy odor • vaginal pH > 4.5

Bacterial Vaginosis
-previously known as non-specific vaginitis or Gardnerella vaginitis -caused by an alteration in the vaginal ecosystem
-overgrowth of several anerobic bacteria & a reduction or absence of the lactobacilli -limited number of leukocytes ( vaginosis )

ETIOLOGIC AGENT:
-Gardnerella vaginalis, Mycoplasma hominis, Bacteroides species MODE OF TRANSMISSION:
-currently not considered a STD but acquisition appears to be related to sexual activity SIGNS & SYMPTOMS:
-majority are asymptomatic
-may present with thin, off-white, “fishy odor” discharge adherent to vaginal walls

LABORATORY TESTS:
-Wet mount preparation “clue cells” - bacterial laden epithelial cells -(+)Whiff test ➠ strong fishy odor

TREATMENT:
-All pregnant women w/ symptomatic disease require treatment -asymptomatic pregnant women at high risk for preterm delivery ➠ should also be treated -Clindamycin 300 mg BID x 7 days or
-Metronidazole 500 mg BID PO x 7 days or
-Metronidazole 250 mg TID PO x 7 days

Differential Diagnosis of Vaginal Infections

|Diagnostic Criteria|Normal |Bacterial Vaginosis |Trichomonas Vaginitis|Candida | | | |...
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