Module 9 (Exam 3) Independent Study 1 Flashcards
Teratogen
Any agent that adversely affects normal growth and development of the embryo or fetus
- Infectious agents
- Drugs or other substances
- Environmental chemicals
- Radiation
- Maternal hyperthermia
- Effects of maternal morbidity
Greatest vulnerability to teratogens
2-8 weeks’ gestation (organogenesis)
Principles of teratongenicity
- Most vulnerable at 2-8 weeks gestation
- Greater potency and exposure = greater risk for embryonic/fetal injury
- Genetic pre-disposition = greater risk
- Fetal harm may result even in absence of maternal illness
Viral Agents
- Rubella
- Hepatitis B
- Cytomegalovirus
- Varicella Zoster Virus
- Herpes Simplex
- Human Immunodeficiency Virus (HIV)
Sexually transmitted infections
- Syphillis
- Gonorrhea
- Clamydia
- Trichomoniasis
- Condyloma Acuminatum
Medications
- Category A: no evidence of risk
- Category B: no studies in pregnant women
- Category C: Adverse implact in animals
- Category D:Evidence of human risk
- Category X: Absolute contraindications
- Eliminate drug or reduce dosage
- Substitute safer preparation
Alcohol or Illicit Drugs
- No level of ETOH intake is considered safe during pregnancy
- Illicit drugs place the developing fetus and are at high risk for impairments to normal development
Fetal Alcohol Spectrum Disorder
- Hypothesized to be the leading cause of preventable birth defects
- Prenatal and postnatal growth restriction
- CNS/developmental abnormalities
- Facial anomalies
Hyperthermia
Can be induced by hot tubs and saunas
Mechanical disruptions
- Oligohydramnios
- Uterine Malformations
Cytomegalovirus (CMV)
Member of the herpes group that is widespread and eventually infects most humans. Daycare centers are a common place for transmission of CMV. After primary infection the virus becomes latent and periodic reactivation and shedding of the virus may occur.
Transmission/Maternal Impact:
- Close contact with bodily fluids
- Organism crosses placental barrier
- Mother is often asymptomatic
Potential Fetal/Neonatal Impact:
- Risk is greatest when primary maternal infection occurs during prregnancy
- Most (90%) fetuses are not impacted
- 10% will present with CMV at birth
- Another 10% will develop learning disabilities or hearing impairment
Management:
- No effective chemical management for congenital infection
Nursing Implications:
- Prevention-based initatives
Rubella
Caused by a virus.
Transmission/Maternal Impact:
- Droplet Infection
- Direct Contact
- Organism crosses placental barrier
- Maternal signs and symptoms generally are mild
Potential Fetal/Neonatal Impact:
- SAB common with 1st trimester exposure
- Survival often accompanied by:
- Vision/Hearing Impairment
- Developmental/Cognitive Delays
Management:
- No effective chemical management for congenital infection
- Maternal MMR vaccine prior to pregnancy
Nursing Implications:
- Prevention-based initiatives
- Counsel avoidance of pregnancy X28 days after vaccination
- Live, attenuated virus
Hepatitis B (Hep B)
Transmission/Maternal Impact:
- Bodily Fluids
- Direct Contact during Birth
- Organism crosses placental barrier
- Risk of transmission rises as pregnancy progresses
- Maternal illness may be acute or chronic
Potential Fetal/Neonatal Impact:
- Preterm labor and birth
- Low birth weight
- Acute or chronic Hep. B infection
- Neonatal death
Management:
- Maternal Hep. B vaccine X3 (safe during pregnancy)
- Neonatal Hep. B immune globulin (HBIG) and initial Hep B vaccine within 12 hours of birth
Nursing Implications:
- Prevention-based initatives
Herpes Simplex Virus
Transmission/Maternal Impact:
- Transplacental infection is rare
- Most commonly transmits to fetus after ROM as virus ascends OR
- Vertical transmission during birth
- Mother may present with intial or recurrent infection
Potential Fetal/Neonatal Impact:
- SAB
- Preterm labor
- Intrauterine growth restriction: greatest risk when primary infection occurs during pregnancy
- High neonatal mortality rate with systemic infection
Management:
- Acyclovir (Zovirax) is safe during pregnancy but not CDC recommended
- C-section delivery in presence of active lesion(s)
Nursing Implications:
- Prevention and suppresion-based initivates
- Anticipatory guidance re potential for change in delivery method
Human Papilloma Virus (HPV)
Transmission/Maternal Impact:
- Vertical transmission during birth
- Organism rarely crosses placental barrier
Potential Fetal/Neonatal Impact:
- Evidence does not correlate HPV with birth defects
Management:
- Chemical management is not recommended during pregnancy
- Cryotherapy is considered safe
- Vaccination prior to pregnancy
Nursing Implications:
- Prevention-based initiatives