04.13 Infections in Pregnancy

Overview

  1. Specific infections during pregnancy are more concerning due potential transmission to the baby (via placenta or during delivery), which can have detrimental effects on the newborn
  2. TORCH
    1. Toxoplasmosis
    2. Other
      1. ie: Group B strep (GBS), HIV, Syphilis
    3. Rubella
    4. Cytomegalovirus
    5. Herpes simplex

Nursing Points

General

  1. Toxoplasmosis
    1. Parasitic disease transmitted to mother by handling cat litter, undercooked or raw meat; transmitted to baby via placenta
    2. Mother is typically asymptomatic, but may have rash or flu like symptoms for anywhere from a few weeks to months
    3. Fetal death, spontaneous abortion, and neuro complications may result for baby
    4. Educate mom to never change cat litter
  2. Other
    1. Group-B Strep
      1. All women screened for this during prenatal period by a vaginal swab 35-37 weeks
      2. All women have the bacteria but depends on on the amount that is colonized
      3. Prophylactic antibiotics (penicillin or ampicillin) given during labor to women who screen positive
      4. Main cause of bacterial infections in NB’s→ septic
    2. HIV
      1. Delivery by c/s to limit transmission
      2. Infants given antiretrovirals
    3. Syphilis
      1. Woman given penicillin and fetus receives penicillin after delivery
  3. Rubella
    1. Transmitted via placenta
    2. Most dangerous/serious if mother acquires this infection in 1st trimester
    3. Brain damage, hearing loss, miscarriage, stillbirth, and various congenital defects may result
    4. Assess mother’s immunity by drawing titer.  If her titer is non-immune – vaccinated right after delivery
      1. Live vaccine
      2. Protects for future pregnancies
  4. Cytomegalovirus (CMV)
    1. A very common, asymptomatic virus transmitted through body fluids
    2. Transmitted via placenta or during delivery
    3. Potential issues = IUGR, seizures, blindness, hepatomegaly, splenomegaly, jaundice, hearing loss, microcephaly, death
  5. Herpes Simplex
    1. Transmitted during birth, if active lesions present
    2. Acyclovir may be given around 36 weeks to prevent outbreak during labor and delivery
    3. Serious neonatal complications (death, neuro issues)
    4. C-section to prevent transmission if lesions active when patient goes into labor

Assessment

  1. Maternal symptoms
  2. Fetal measurements
  3. Baby assessments

Therapeutic Management

  1. Depend on the infection
    1. Medications  for mother and fetus
    2. Antiretroviral, antibiotics

Nursing Concepts

  1. Infection control
  2. Reproduction
  3. Human Development

Patient Education

  1. Not to change cat litter
  2. STD protection
  3. Hand hygiene

Reference Links

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Video Transcript

In this lesson I will be explaining various infections of pregnancy and your role for patient care.

Infections in pregnancy are thought to be more concerning and this is because there is potential for the infection to transmit to the baby. It can reach the baby either by the placenta or during delivery. These infections can be really harmful to the newborn. So what kinds of infections? There is a mnemonic called TORCH. This stands for toxoplasmosis, other, rubella, cytomegalovirus and herpes simplex. Other is going to stand for any other infectious agent that could harm the mother or reach the baby and cause harm. Some examples are Group Beta strep, HIV, and Syphilis. These are just a few examples.

Let’s now look at the infections in more detail. Toxoplasmosis is a parasitic disease that is transmitted to the mother from cat litter and then can be transmitted to the fetus through the placenta. This can cause fetal demise, abortion or neuro complications. Other is any infectious agent that can harm the mom or baby during pregnancy or through delivery. So just a few big ones to know are group beta Strep or GBS, HIV, and syphilis. I want to explain GBS and HIV because this is very important to understand for testing purposes. It is a bacteria that all women have in the vagina. A vaginal swab is done between 34-37 weeks and this is just going to detect the amount. If above a certain threshold they are said to be GBS positive. If not at that amount then they are GBS negative. Patients will receive prophylactic antibiotics when they are in labor if they are GBS positive. Penicillin is the drug of choice and this will protect the baby from the bacteria when he or she passes through the vagina. A baby that is exposed to it can become septic. With HIV the big thing to know is delivery is by c-section to limit transmission, infants are given antiretrovirals after delivery, and they can not breastfeed because it can pass through breastmilk. Rubella is usually something we are vaccinated for but if titers are non-immune and the patient contracts rubella it can be transmitted by the placenta. It is really dangerous if the mother contracts in the first trimester because all the fetal development is happening. There can be brain damage, hearing loss, miscarriage, stillbirth, and various congenital defects as a result. We need to assess mother’s immunity by drawing titer. If her titer is non-immune then we can be aware to assess the fetus for possible effects of rubella and vaccination needs to occur after the delivery because the vaccine is live and live vaccines are never given in pregnancy because they can cross the placenta. Cytomegalovirus also known as CMV is common and transmitted through body fluids. Patients often just feel as they have a cold. CMV can then be transmitted by the placenta. Issues with CMV are IUGR, seizures, blindness, hepatomegaly, splenomegaly, jaundice, hearing loss, microcephaly, and death. So big problems with this one and unfortunately it is often passed in daycares so if a parent has another child in daycare they are really at risk to get this. Herpes simplex virus is transmitted during birth, if there is an active lesions present. Patients will be prophylactically treated with Acyclovir starting around 36 weeks to prevent outbreak during labor and delivery even if a lesion has not been detected. There are serious neonatal complications with this one. Death and neuro issues are highly likely if a lesion is present and undetected so for this reason a c-section will be done to prevent transmission if lesions are active when patient goes into labor.
For assessments we need to look at the maternal labs. Whats her rubella status? HIV? Syphilis? Hepatiti? Does she have anything that should alert us to be concerned? Baby assessment is done at delivery to assess for any skin lesions, vitals and visual findings that would alert us that the baby has been infected. Fetal measurements are done by ultrasound during pregnancy and this will alert us if the baby is not growing properly and is IUGR or brain measurements to ensure that neurologically there is no compromise showing.

Therapeutic management is going to depend on the infection. Medications will be given if they can. This could be antiretrovirals, antibiotics, and antivirals. Monitoring will be done of the mother and fetus to ensure we have a proper assessment on what the infection is doing.

Education should revolve around ensuring that the mother never changes cat litter. She needs education on iSTD protection to ensure STDs are not transmitted to her such as herpes, syphilis, hepatitis, and HIV. And proper hand hygiene to help limit exposure to things such as CMV.
Our nursing concepts for infections in pregnancy are Infection control, reproduction, and human development. We need the patient to avoid certain and many infections for proper human development to occur.
Our key points to remember is the mnemonic TORCH which stands for toxoplasmosis, other, rubella, cytomegalovirus, and herpes. Remember other is going to be really anything else but the main ones are GBS, HIV, Syphilis, but also include hepatitis and other infections that can cross from mom to baby during pregnancy or at delivery. These can all cause severe problems to the fetus because it can cross the placenta. Treatment is going to vary based on what the infection is.

Make sure you check out the resources attached to this lesson and review the TORCH mnemonic. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 8

A nurse is caring for a pregnant client who is crying because she found out she is Group Beta Strep positive. What is the best response by the nurse?

  • Question 2 of 8

A nurse is caring for a pregnant client that has a prior diagnosis of herpes. What should the nurse expect to be included in her plan of care?

  • Question 3 of 8

A nurse is educating a 12 week pregnant client who is HIV positive. Which of the following should be included in the education?

  • Question 4 of 8

You are working in a OB clinic and seeing a patient who is 27 weeks pregnant. Which of the following statements is the MOST concerning to you?

  • Question 5 of 8

A nurse is caring for a mother who is 35 weeks’ pregnant. The client’s medical record states that she tested positive for group B Streptococcus infection. Which of the following precautions should be given in this situation?

  • Question 6 of 8

A nurse is caring for a client during her first prenatal appointment. What is the priority question during the prenatal interview?

  • Question 7 of 8

A nurse is caring for a pregnant client who is rubella non-immune. What should be included in her plan of care?

  • Question 8 of 8

A pregnant client had a positive test for TB. She is not experiencing any symptoms, and the nurse is providing information about the illness. Which statement by the nurse is correct in this situation?

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