Infections / Inflammations

Urinary Tract Infection Most 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 Rocephin Spectinomycin 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

 CYTOMEGALOVIRUS Etiology -- 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

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