A 24-year-old woman comes to the office for a routine prenatal visit at 32 weeks gestation. Last week, she was evaluated for postcoital spotting. The cervix was closed, and there was no evidence of preterm labor. Nucleic acid amplification testing (NAAT) performed at that visit was positive for Chlamydia trachomatis. Routine NAAT was negative for C trachomatis at the initial prenatal visit. Today, the patient has no vaginal bleeding, leakage of fluid, or contractions. Fetal movement is normal. She has no chronic medical conditions or previous surgeries. The patient does not use tobacco, alcohol, or illicit drugs. She had 3 sexual partners prior to marriage. She has been in a monogamous relationship with her husband for the last 2 years and is sexually active with him. The patient swims at the local pool regularly but stopped after the episode of vaginal bleeding. Blood pressure is 110/70 mm Hg and pulse is 72/min. Fundal height is 32 cm. Fetal heart rate is 140/min by Doppler ultrasound. Urine dipstick is negative for glucose and protein. The patient is concerned about the results and wonders how she acquired the infection during her pregnancy.
If left untreated, this patient is at increased risk for which of the following pregnancy complications?

Question

A 24-year-old woman comes to the office for a routine prenatal visit at 32 weeks gestation.  Last week, she was evaluated for postcoital spotting.  The cervix was closed, and there was no evidence of preterm labor.  Nucleic acid amplification testing (NAAT) performed at that visit was positive for Chlamydia trachomatis.  Routine NAAT was negative for C trachomatis at the initial prenatal visit.  Today, the patient has no vaginal bleeding, leakage of fluid, or contractions.  Fetal movement is normal.  She has no chronic medical conditions or previous surgeries.  The patient does not use tobacco, alcohol, or illicit drugs.  She had 3 sexual partners prior to marriage.  She has been in a monogamous relationship with her husband for the last 2 years and is sexually active with him.  The patient swims at the local pool regularly but stopped after the episode of vaginal bleeding.  Blood pressure is 110/70 mm Hg and pulse is 72/min.  Fundal height is 32 cm.  Fetal heart rate is 140/min by Doppler ultrasound.  Urine dipstick is negative for glucose and protein.  The patient is concerned about the results and wonders how she acquired the infection during her pregnancy.
If left untreated, this patient is at increased risk for which of the following pregnancy complications?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfb5_dce7_8f63_1bc934daabff_MD0005_00 Nonpregnant patients with Chlamydia trachomatis confirmed on nucleic acid amplification testing (NAAT) are typically treated with doxycycline monotherapy. However, because doxycycline is a potential teratogen, pregnant patients are treated with azithromycin. All sexual partners are also treated to prevent reinfection, and patients are advised to abstain from intercourse for 7 days following the completion of treatment. Untreated, undertreated, or recurrent chlamydial infection can lead to ascending infection into the uterine cavity. If the infection or associated inflammation compromises the amniotic sac or uterus, patients become at increased risk for obstetric complications (eg, preterm prelabor rupture of membranes, preterm labor, postpartum endometritis). In addition, vertical transmission via contact between the fetus and infected maternal discharge during delivery can result in complications, including neonatal pneumonia and neonatal conjunctivitis. Therefore, patients treated for a sexually transmitted infection during pregnancy require retesting a month after completion of treatment to ensure response to therapy (ie, test of cure). Patients with a sexually transmitted infection diagnosed earlier during pregnancy are also retested in the third trimester, prior to delivery. (Choice A) Abruptio placentae, premature placental separation from the uterus prior to delivery, occurs when maternal vessels rupture, causing bleeding at the uteroplacental interface. Risk factors include maternal hypertension, abdominal trauma, or cocaine or tobacco use, none of which are seen in this patient. Chlamydia is not a risk factor. Abruptio placentae (Choice B) Risk factors for acute pyelonephritis in pregnancy include untreated asymptomatic bacteriuria and pregestational diabetes mellitus. C trachomatis can cause urethritis but is not a cause of upper urinary tract infections. (Choice C) Pathogens that cause in utero infection (eg, toxoplasmosis, Listeria, parvovirus B19) are associated with an increased risk of intrauterine fetal demise. C trachomatis may be vertically transmitted to the neonate during delivery, but it does not cause intrauterine fetal demise. (Choice D) Risks for postpartum hemorrhage include grand multiparity, multiple gestation, polyhydramnios, prolonged labor, and maternal bleeding disorders (eg, von Willebrand disease). Educational objective: Untreated Chlamydia trachomatis infection during pregnancy is associated with obstetric complications (eg, preterm prelabor rupture of membranes, preterm labor, postpartum endometritis) and neonatal complications (eg, neonatal conjunctivitis, pneumonia). First-line treatment for chlamydia in pregnant women is azithromycin. References: Update to CDC's treatment guidelines for gonococcal infection, 2020. (http://www.ncbi.nlm.nih.gov/pubmed/33332296) Chlamydia trachomatis infection during pregnancy: known unknowns. (http://www.ncbi.nlm.nih.gov/pubmed/21794209)

A 24-Year-Old Woman Comes to the Office for a Routine