Maternal infections: diagnosis and management

Topical antiviral and antifungal medications in pregnancy: a review of safety profiles

Medications should be employed with caution in women of childbearing age who are pregnant or considering pregnancy. Compared to oral or parenteral agents, topical medications have limited systemic absorption and are deemed safer. However, their safety profile must be assessed cautiously due to the limited available data. In this article, we aggregate human and animal studies to provide recommendations on utilizing topical antiviral and antifungal medications in pregnancy. For antiviral medications, acyclovir and trichloroacetic acid are safe to use in pregnancy. Docosanol, imiquimod and penciclovir are likely safe, but should be utilized as second-line agents. Podofilox and podophyllin resin should be avoided. For antifungal medications, clotrimazole, miconazole and nystatin are considered first-line agents. Butenafine, ciclopirox, naftifine, oxiconazole and terbinafine may be utilized after the above agents. Econazole should be avoided during the first trimester and used sparingly during 2nd and 3rd trimester. Ketoconazole and selenium sulphide are likely safe, but should be employed in limited areas for brief periods.

Profile and microbiological isolates of asymptomatic bacteriuria among pregnant women in Abakaliki, Nigeria

Background

Detecting and treating asymptomatic bacteriuria (ASB) prevents urinary tract infection and its consequences. The cost-effectiveness of routine screening for ASB in pregnancy is controversial. In populations with high prevalence, however, it is worthwhile and justifiable.

Aim

To determine the profile, prevalence, microbiological isolates, and risk factors of ASB among booking antenatal clinic attendees in Abakaliki, Nigeria.

Materials and methods

This was a cross-sectional study involving booking antenatal clinic attendees at the Federal Teaching Hospital, Abakaliki, who met the inclusion criteria. This study occurred between January and December, 2012. The midstream urine samples of these women were subjected to microscopy, culture, and sensitivity.

Results

A total of 300 randomly selected booking antenatal clinic attendees participated in the study; 74 of them had ASB, giving a prevalence of 24.7%. With the exception of rural residence, sociodemographic and obstetric characteristics did not influence the risk of ASB among the participants in this study. Staphylococcus aureus was the commonest organism isolated. The majority of the organisms were sensitive to ofloxacin and ceftriaxone.

Conclusion

There is a high prevalence of ASB among pregnant women in Abakaliki. With the exception of rural dwelling, sociodemographic and obstetric characteristics did not significantly influence the risk of ASB among these pregnant women. Therefore, routine ASB screening of pregnant women is recommended in our environment.

Living with genital herpes: how effective is antiviral therapy?

Twenty-five percent of American women and 20% of American men have genital herpes. Most of these individuals have never been diagnosed because of the prevalence of atypical clinical presentation and subclinical infection. This chronic, recurrent infection poses a significant public health challenge, particularly in women of childbearing age, who are at risk of transmitting the virus to their infants during pregnancy and birth, as well as to their discordant sexual partners. Antiviral therapy decreases the rate of recurrent episodes, decreases asymptomatic shedding of the virus, reduces the risk of transmission to sexual partners, and reduces the rate of operative delivery in women with a history of genital herpes. This article reviews the literature to explore evidence-based strategies for addressing the physical and psychological sequelae of herpes simplex virus infection and for accurately diagnosing and managing neonates who acquire this infection perinatally.

Diagnosis and treatment of herpes simplex infection during pregnancy

When pregnant women acquire primary herpes simplex genital infections or experience recurrent infections around the time of delivery, the risk of transmitting the disease to their newborns is significant. This perinatal transmission can result in a serious neonatal illness. Issues surrounding screening, treatment, and mode of delivery to prevent perinatal transmission often are confusing and controversial. Nurses delivering care to childbearing women and their newborns must be aware of the current information to give accurate and helpful information and support. Nurses also need to understand the effect this disease has both physiologically and psychosocially on women with primary infections, recurrent infections, and women at risk of acquiring the infection during pregnancy.