••• Chapter 14^ Management of Medical and Surgical Conditions in Pregnancy^137
❍ For whom is the pneumococcal vaccine recommended?
Immunocompromised women, those with HIV, smoking history, diabetes, asplenia, or cardiac, pulmonary, or
renal disease.
❍ What is the treatment of influenza in pregnancy?
Supportive treatment as well as oseltamivir 75 mg bid for 5 days.
❍ For whom is influenza vaccination recommended?
All pregnant women should receive influenza vaccination.
❍ Which women should receive testing for tuberculosis?
Healthcare workers, history of contact with infected persons, foreign-born, HIV-infected, working or living in
homeless shelters, alcoholics, illicit drug use, detainees, and prisoners.
❍ What is the next step for women with a positive purified protein derivative (PPD)?
Chest X-ray to determine if there is evidence of active disease.
❍ When should pregnant women be treated for a positive PPD?
In general treatment should be delayed for 3 to 6 months postpartum. In cases of a known recent conversion or
HIV-positive women should be treated right away because they are at higher risk of developing active TB. They
should be given isoniazid 300 mg daily for 1 year.
❍ What is the treatment of active tuberculosis in pregnancy?
Three-drug regimen with isoniazid, rifampin, and ethambutol for 9 months
GASTROINTESTINAL
❍ What is the definition of hyperemesis gravidarum?
Vomiting sufficiently severe to cause weight loss, dehydration, metabolic alkalosis, and hypokalemia.
❍ What is the recurrence rate of hyperemesis requiring hospitalization?
Up to 20% of women have a recurrence of hyperemesis in a subsequent pregnancy.
❍ What is the treatment of hyperemesis?
Inpatient management with intravenous (IV) hydration if vomiting persists, antiemetics such as promethazine,
prochlorperazine, ondansetron, or metoclopramide. Short courses of steroids may decrease readmission rates.
❍ What is the management of women with peptic ulcers in pregnancy?
Antacids, H2-receptor blockers, or proton pump inhibitors. If Helicobacter pylori infection is identified, it should
be treated with an antibiotic regimen that does not include tetracycline.
❍ What is the management of ulcerative colitis in pregnancy?
5-Aminosalicyclic acid or mesalamine both may be used for active colitis.