IMMUNIZATIONS DURING PREGNANCY
Vaccination against COVID-19 is recommended for women who are pregnant, trying to get pregnant or may become pregnant, and who are breastfeeding. The CDC has determined that the benefits of vaccination outweigh any risks. There is no evidence that vaccination causes problems with fertility in men or women. Pregnant women who have been vaccinated may receive the COVID-19 booster shot. There have been rare reports of thrombosis with thrombocytopenia syndrome in women younger than 50 years old who received the Johnson and Johnson’s Janssen vaccine. This risk has not been found with the Pfizer-BioNTech and Moderna vaccines; women younger than 50 years old with access to multiple vaccines may want to factor this into their decision-making process.
The recommended regimen for antimicrobial prophylaxis against group B streptococcus is penicillin G, 5 million units intravenously as a loading dose and then 2.5–3 million units intravenously every 4 hours until delivery. In penicillin-allergic patients not at high risk for anaphylaxis, 2 g of cefazolin can be given intravenously as an initial dose and then 1 g intravenously every 8 hours until delivery. In patients at high risk for anaphylaxis, vancomycin, 20 mg/kg intravenously every 8 hours until delivery, can be used. Clindamycin, 900 mg intravenously every 8 hours until delivery, can also be used after a group B streptococcal isolate has been confirmed to be susceptible to clindamycin.
American College of Obstetricians and Gynecologists. Obstet Gynecol. [PMID: 34794160]
MATERNAL HEPATITIS B & C CARRIER STATE
Universal screening for hepatitis C virus in pregnancy is recommended. Direct-acting antiviral regimens should only be initiated during pregnancy if in the setting of a clinical trial. Cesarean section is not recommended solely for a maternal history of hepatitis C. During labor, early rupture of membranes and placement of a fetal scalp electrode should be avoided if safe to do so.
Dotters-Katz SK et al. Am J Obstet Gynecol. [PMID: 34116035]
CHOLELITHIASIS & CHOLECYSTITIS
The most common cause of acute pancreatitis in pregnancy is gallstone disease. The diagnosis can be confirmed with an appropriate history and an elevated serum amylase or lipase. Management is conservative, including bowel rest, intravenous fluids, supplemental nutrition if necessary, and analgesics. CT imaging should be avoided unless severe complications are suspected.
Abushamma S et al. Obstet Gynecol. [PMID: 34011887]