Infections / Inflammations

Urinary Tract InfectionMost common infection complicating

Pregnancy Etiology

Pressure on ureters and bladder causing Stasis with compression of ureters

Reflux Hormonal effects cause decrease tone

of bladder Assessment

Dysuria, frequency, urgency lower abdominal pain; costal

vertebral pain fever

Interventions Monthly cultures Oral Sulfonamides; Amoxicillin,

Ampicillin, Cephalosporins, NO tetracyclines

Increase fluid intake to 3 – 4 liters / day

Knee chest position Complication

Uterine Irritability, Premature labor

T O R C H A Infections T = Toxoplasmosis O = Other Syphilis, Gonorrhea, Chlamydial,Hepatitis A or B R = Rubella C = Cytomegalovirus H = Herpes A = Aids

Toxoplasmosis Etiology

Protozoan infection. Raw meat and cat litter

Maternal and Fetal Effects Mom - flu-like symptoms, lymphadenopathy Fetus – stillborn, premature birth,

microcephaly; mental retardation

Interventions / Nursing Care

* Instruct to cook meat thoroughly* Avoid changing cat litter* Advise to wear gloves when working in the garden Treatment: Sulfa drugs

Syphilis

Etiology• Spirochete – Treponema Pallium

Maternal and Fetal Effects May pass across the placenta to fetus

causing spontaneous abortion. Major cause of late,second trimester abortions

Infant born with congenital anomalies

Syphilis

Intervention:• 1. Penicillin

• 2. Advise to return for prenatal visits monthly to assess for reinfection.

• 3. Advise that if treated early, fetus may not be infected

Gonorrhea Etiology – Neisseria Gonorrhoeae Maternal and Fetal Effects:

May get infected during vaginal delivery causing Ophthalmia neonatorium (blindness) in the infant

Mom will experience dysuria, frequency, urgency

Major cause Pelvic Inflammatory Disease which leads to infertility.

Treated with RocephinSpectinomycin

Treat partner!!

Chlamydia Three times more common than

gonorrhea. Etiology – Chlamydia trachomatis Maternal and Fetal Effects

Mom – pelvic inflammatory disease, dysuria, abortions, pre-term labor

Fetus -- Stillbirth, Chylamydial pneumonia

Interventions Erythromycin, doxycycline, zithromax Advise treatment of both partners is

very important

Hepatitis A or B Highly contagious when transmitted by

direct contact with blood or body fluids Maternal and Fetal Effects:

• All moms should be tested for Hep B during pregnancy

• Fetus may be born with low birth weight and liver changes\

• May be infected through placenta, at time of birth, or breast milk

Intervention:• Recommend Hepatitis B vaccination to both

mother and baby after delivery.

Rubella

Etiology Spread by droplet infection or through

direct contact with articles contaminated with nasopharyngeal secretions.

Crosses placenta Maternal and Fetal Effects

Mom– fever, general malaise, rash Most serious problem is to the fetus--

causes many congenital anomalies (cataracts, heart defects)

Intervention Determine immune status of mother. If

titer is low, vaccine given in early postpartum period

CYTOMEGALOVIRUSEtiology -- Member of the Herpes virus

• Crosses the placenta to the fetus or contracted during delivery. Cannot breast feed because transmitted through breast milk

Effects on Mom and Fetus• Mom – no symptoms, not know until after

birth of the baby• Fetus -- Severe brain damage; Eye

damage

Intervention No drug available at this time Teach mom should not breast feed baby Isolate baby after birth

Herpes Simplex Type 2 Maternal and Fetal Effects

Painful lesions, blisters that may rupture and leave shallow lesions that crust over and disappear in 2-6 weeks

Culture lesions to detect if Herpes, No cure

If mom has an outbreak close to delivery, then cannot deliver vaginally. Must deliver by Cesarean birth

*Virus is lethal to fetus if inoculated at birth Intervention:

Zivorax

AIDS• Etiology: Human Immunodeficiency

Virus, HIV

Transmission of HIV to the fetus from seropositive mom by: Perinatal transmission – through the placenta

at birth when the infant is exposed to maternal blood and vaginal secretions.

Through breast milk

**The virus must enter the baby’s bloodstream to produce infection.

Maternal and Fetal Effects:Mom - brief febrile illness after

exposure to with symptoms of fatigue and lymphadenopathy

Fetus has less than 2% chance of being infected because of meds, cesarean delivery, and bottlefeeding.

No symptoms until about 1 year of

age

HIV

Diagnosis: The mother can be diagnosed by the

ELISA test and confirmed using the Western Blot.

Assess immunodeficiency as determined by CD4+ lymphocyte count

Evaluate risk of disease progression by assessing plasma HIV-1 which provides information about the viral load (amount of virus present in the body).

Interventions Provide Emotional Support

Teach measures to promote wellness Give Antiretroviral drugs – zidovudine (ZDV) or

Retrovir (AZT) Oral drug daily IV drugs during labor and delivery Oral liquid form of drugs to newborn starting 8

hours after delivery for 6 weeks

Provide information about resources

The End

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