infections in pregnancy - week 3 Flashcards
chlamydia ( cause, risk factors, manifestations, screening and. management)
Cause: Bacteria called Chlamydia trachomatis (intracellular parasite)
**Risk factors: **adolescence, multiple sex partners, new sex partner, sex without condom, oral contraceptive use, pregnancy, history of another STI
Manifestations: mucopurulent vaginal discharge, urethritis, bartholinitis, endometritis, salpingitis, dysfunctional uterine bleeding
Screening Urine testing or swab specimen culture, immunofluorescence, EIA, or nucleic acid amplification
Therapeutic Management
Antibiotics (azithromycin-1gm oral single dose)
gonorrhea
- The incidence of reported gonorrhea in Canada has doubled in recent years
- Highly contagious and reportable
Cause:aerobic gram-negative intracellular diplococcus
Site of infection: columnar epithelium of endocervix - Almost exclusively transmitted via sexual activity
Therapeutic management: antibiotic therapy
nursing assessment gonorrhea
* Risk factors: low socioeconomic status, urban living, single status, inconsistent use of barrier contraceptives, age, <20 years, multiple sex partners
* Manifestations: most asymptomatic; abnormal vaginal discharge, dysuria, cervicitis, abnormal vaginal bleeding, Bartholin abscess, PID
Neonatal conjunctivitis if woman gives birth
syphillis
- Curable bacterial infection due to spirochete Treponema pallidum
- Serious systemic disease
Therapeutic management
* Penicillin G (I.M. or I.V.)
* Doxycyline if allergic to penicillin
Re-evaluation with serologic testing
nursing assessment of syphilis
Primary: chancre, painless bilateral adenopathy
Secondary: flu-like symptoms, rash on trunk, palms, and soles, alopecia, adenopathy
Latency: absence of manifestations, positive serology
Tertiary: life-threatening heart disease,
human immunodeficiency virus (HIV) (manifestions and managment)
- The number of Canadians living with HIV is on the rise
- AIDS due to HIV infection
- Fetal and neonatal effects
- HIV and adolescents increasing; most exposed via sexual intercourse
Manifestations: acute phase; asymptomatic with viral replication, immunosuppression with opportunistic infections, AIDS
Therapeutic Management: HAART (Highly active antiretroviral therapy)
Nursing Management
* Education about drug therapy
* Compliance
* Prevention
* Care during pregnancy and childbirth
* Referrals
preganant women who are HIV postive ( assessment and managment)
Impact of pregnancy and HIV: threats to self, fetus, and newbor
Nursing assessment: history and physical examination;
HIV antibody testing; testing for STIs
**Therapeutic management: **
* Pregnancy: oral antiretroviral drugs twice daily from 14 weeks until birth;
* IV administration during labour;
* Oral syrup for newborn in 1st 6 weeks of life;
Nursing management
* Pretest and posttest counselling
* Education
* Support
* Preparation for labour, birth, and afterward
* **Elective cesarean birth **
* Compliance with antiretroviral therapy
* Family planning methods
parvorius B19
- Common childhood infection—no vaccine
- Spreads thru the placenta to fetus, infected blood or the oropharyngeal route (cough, sneeze)
- Specially the first 20 weeks of pregnancy
- Can cause abortion, hydrops, congenital anomalies, myocarditis, learning disabilities
- Test for 2 antibodies P IgG and IgM, ultrasound
- Red rash-maculopapular rash, fever, malaise
- Handwashing, no sharing of food or drinks
toxoplasmosis ( parasite toxoplasma gondii)
- Cat feces, raw meat, sandboxes
- Fetus is premature, SGA, seizures, enlarged liver and spleen
- Painless swollen lymph glands and other generally mild symptoms, like muscle aches, fatigue, headache, fever, and possibly a sore throat or a rash.
- Blood tested to measure levels of 2 antibodies
- Treat with pyrimethamine and sulfadiazine during pregnancy
rubella german measules (virus)
- Droplet infection/direct contact
- Risk to fetus when mom exposed to the infection
- 1st trimester rubella titre is determined and if less than 1:10, woman is non immune
- MMR vaccine is given subcutaneous to mom after the baby’s birth
- If Rhogam is also required, then both the injections are given at the same time (different sites)
- The rubella immunoglobulin may be given during pregnancy to high risk women who are non immune to prevent risk of congenital rubella in the newborn
cytomegalovrius (herpes family
- Most common perinatal viral infection
- Common in crowded conditions, underdeveloped countries, lower socioeconomic group
- Sexual contact, kissing (all body fluids)
- Causes abortion, IUGR, stillbirth, deafness etc
- Fetus gets infected (40%), jaundice, rash at birth
- Fever, sore throat, fatigue
- Antigen, antibodies in blood
- No vaccine, but meds e.g. ganciclovir
genital herpes simplex (HSV) - no cure
- Oral or genital
- Recurrent lifelong viral infection
- Transmission via contact with mucous membranes or breaks in skin with visible or nonvisible lesions
- Kissing, sexual contact and vaginal delivery
- Therapeutic management- No cure
- Diagnosis confirmed via viral culture of fluid from vesicle
- Recurrent infection (more localized and quicker resolution): tingling, itching, pain, unilateral genital lesions (more localized)
- Antiretroviral therapy to reduce or suppress symptoms, shedding, and recurrent episodes
- Booked C section
Nursing managment - Education on mode of transmission
- Coping skills
- Options for treatment and rehabilitation
grouop B streptococcus
- Caused by Group B streptococcus bacteria
- Normal inhabitant in vagina/rectum for 25% women
- Risk of infection to newborn is 1 in 100
- Screening at 35-37 weeks with a vagino-ano-rectal swab, valid only for 5 weeks
- GBS in urine, previous birth of baby with GBS
- iV antibiotics Pen G-5 million units, then 2.5 mu q 4hrly at time of labour/rupture of membranes
- Education
hepatitisu B (HB virus)
Transmission thru sexual contact, blood, unsafe drug use .7 to .9 of population is chronically infected
Risk to fetus is at time of birth
Newborn gets vaccinated at birth with Hep B vaccine 1st dose (within 12 hrs of birth) and subsequent doses at 1 and 6 months
Risk to newborn (preterm, low birth weight, even death)
heptitis B managment
Screening at first prenatal visit (HbsAg)
A positive mom gets immunoglobulin
Pregnant women can be vaccinated if HBsAG negative
Teaching – safe sex, hand washing, careful needle use, method of spread, avoid sharing razors, tooth brushes, utensils.
Vaccinate people in the household
