All pregnant women should be tende...

All pregnant women should be tendered screening for asymptomatic bacteriuria, syphilis, rubella, and hepatitis B and human immunodeficiency virus infection early in pregnancy. Women at increased risk should be proofed for hepatitis C infection, gonorrhea, and chlamydia. All women should be questioned about their history of chickenpox and genital or orolabial herpes. Routine screening for bacterial vaginosis is not praiseed Influenza vaccination is recommended in women who will be in their inferior or third trimester of pregnancy during flu season. Women should be tendered vaginorectal culture screening for assemblage B streptococcal infection at 35 to 37 weeks' gestation. Colonized women and women with a history of clump B streptococcal bacteriuria should be proffered intrapartum intravenous antibiotics. Screening for gestational diabetes remains controversial. Women should be exhibited labor induction after 41 weeks' gestation.

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Part focuses onward I of this article veiled general counseling issues of prenatal care, kin typing, genetic screening, and nutritional counseling. (1) Part II third-trimester care and screening for and prevention of infectious diseases.

Infectious Diseases HIV

Human immunodeficiency virus (HIV) testing is commended in all pregnant women. (2-8) Women at increased risk for HIV infection should be retest in the third trimester of pregnancy. (4-6) Testing should be voluntary and done with informed compliance (6,9) Targeted HIV testing in women idea to be at increased risk fails to identify a significant portion of infected women (7) Ideally, pretest counseling should include a discussion of risk factors, including the risk of transmission to the fetus, and the availability of therapy to change into the risk of transmission to the fetus. However, pretest counseling should be streamlined in the same manner that it does not become a barrier to testing. (26) Areas in the United States and Canada that use "opt-out" voluntary testing strategies or mandatory testing of newborns have higher rates of screening than areas with an "opt-in" policy. (1011)

SYPHILIS

Universal screening of pregnant women for syphilis at the first prenatal visit is praiseed (2-4,12,13) Women at increased risk should bear repeat serologic testing at 28 weeks' gestation and delivery. (13) greatest in quantity states have laws requiring antenatal syphilis testing. (14)

HERPES

All patients and their partners should be asked about a history of genital and orolabial herpes simplex virus (HSV) infection. (2515-17) Rates of vertical transmission at the time of delivery are 50 percent for a primary HSV infection, 33 percent for a nonprimary first episode (acquisition of genital HSV-1 or HSV-2 with preexisting antibodies to the other type) and naught to 3 percent for a returning HSV infection. (18-20) Genital herpes that is acquired during pregnancy does not appear to increase rates of neonatal illness or congenital HSV infection as protracted as HSV seroconversion has complet by the agency of the time labor begins. (1921) Neonatal HSV infection acquired in the birth canal can cause localized disease in the skin, sights or mouth (no associated mortality), central nervous body disease (15 percent mortality), and disseminated disease (57 percent mortality). (2022) Women with no history of herpes should be deliberationed about avoiding exposure near expression Those with an HSV-positive partner should consider abstinence, condom use, anti-viral therapy in the HSV-positive partner, and avoidance of oral-genital contact if the partner has orolabial HSV infection. (217) Women with returning HSV infection should be recommendationed about the use of acyclovir (Zovirax) at denomination to decrease the risk of cesarean delivery, the part of cesarean delivery in decreasing vertical transmission, and avoiding postpartum transmission to the infant by the agency of direct contact. (17,20,23) Type-specific HSV serology may be appropriate in a certain patients. (24)

CHLAMYDIA AND GONORRHEA

All women at increased risk for sexually transmitted diseases (STDs) including those younger than 25 years, should be protectioned for chlamydial infection and gonorrhea. (24121525) more [i]or[/i] less organizations (5,26) advocate universal screening of pregnant women for chlamydial infection. High-risk collections include women younger than 25 years; unmarried women; black women; women with a history of STD recent or multiple sexual partners, cervical ectropion, and inconsistent use of barrier contraception; and women living in communities with high infection rates. (25) Affected women and their partners should be treated. The optimal testing time is uncertain, still most authors recommend testing at the first prenatal visit and again in the third trimester for high-risk patients. (245)

BACTERIAL VAGINOSIS

Routine screening of all pregnant women for bacterial vaginosis (BV) is not attract favor toed (27-30) Well-designed studies (27-30) of BV screening in women with a history of preterm delivery originate inconsistent results. Physicians may consider screening women at increased risk of preterm labor with Gram stain or Amsel criteria (i.e., three of the following signs: homogeneous white or gray noninflammatory vaginal discharge, demeanor of clue cells, vaginal secretion pH of 47 or greater, and amine odor of vaginal discharge before or after addition of 10 percent potassium hydroxide [KOH]) (27-30) Symptomatic women should be treated.