Complications of pregnancy (infections)/The childbearing family with special needs

A newborn whose mother is known to carry the hepatitis B surface antigen should receive hepatitis B immune globulin soon after birth, followed by hepatitis B vaccine. The infants should receive the second and third doses of vaccine at regularly scheduled times.

How are newborns treated with HBV?

-is a gram-positive bacterial infection that is colonized in the rectum, vagina, cervix, urethra -leading cause of life-threatening perinatal infections in the US -often an expected part of the vaginal flora for nonpregnant clients, and present in some who are -it can cause pneumonia, respiratory distress syndrome, sepsis, and meningitis, if transmitted to the neonate -Late onset (after 1st week of life): meningitis, pneumonia, bacteremia -risk factors: history of positive culture with previous pregnancy · positive GBS culture in current pregnancy · prolong (18 hours plus) rupture of membranes · preterm delivery · LBW · use of intrauterine fetal monitoring · intrapartum maternal fever [100.4F]

What is GBS (Group B streptococcus)?

Malnutrition, vasoconstriction, tachycardia, HTN, spontaneous abortion, preterm labor, abruptio placentae, preeclampsia, retroplacental hemorrhage

What are some of the possible maternal effects from amphetamines and methamphetamines ("speed," "crystal," "glass," "ice," "ecstasy")?

malnutrition, anemia, increased incidence of STD's, HIV exposure, hepatitis, thrombosis, cardiac disease, spontaneous abortion, preterm labor

What are some of the possible maternal effects from opioids (heroin, methadone, morphine)?

Transit respiratory problems, irritability, poor tone, persistent pulmonary HTN

What are some possible fetal or neonatal defects from antidepressants such as selective serotonin reuptake inhibitors (SSRI)?

relief of anxiety and depression, risk for anomalies with paroxetine, small risk for anomalies with other antidepressants

What are some possible maternal effects from antidepressants such as selective serotonin reuptake inhibitors (SSRI)?

-3 types common in the US: A, B, C *Hep A-transmitted through fecal-oral contamination, rarely perinatally; limited by simple hygiene *Hep B-transmitted via blood, saliva, vaginal secretions, semen, breast milk and readily crosses the placenta *Hep C-transmitted through blood products; -including IV drug users -recurrent STDS, including HIV -persons needing recurrent blood products (hemophiliacs)

What are the Hepatitis group transmissions?

-profuse sweating, high blood pressure, tachycardia, irregular respirations, lethargic response to labor, dilated pupils, increased body temperature, sudden onset of severely painful uterine contractions, fetal tachycardia, and excessive fetal activity. -Emotional signs include anger, caustic or abusive reactions to the caregiver, emotional lability, and paranoia

What are the S/S of recent cocaine use?

-S/S: penile discharge, dysuria, testicular edema or pain, urinary frequency, spotting or postcoital bleeding, vulvar itching, gray-white discharge

What are the expected findings of chlamydia?

-physical assessment findings: preterm labor and delivery CHORIOAMNIONITIS , infections of the urinary tract, maternal sepsis, endometriosis after delivery -diagnosis: vaginal and rectal cultures are performed at 35 to 37 weeks -nursing care: administer intrapartum antibiotic prophylaxis to the following clients to decrease transmission to the neonate · client who has a positive screening during current pregnancy · client who has unknown status who is delivering at less than 37 weeks · client who has maternal fever of 100.4F or greater · client who has rupture of membranes for 18 hours plus -patients who had a cesarean birth before ROM does NOT need antibiotic therapy -drug of choice: penicillin

What are the expected findings, lab test and nursing care of GBS?

-Antiretroviral drugs have improved the prognosis for HIV-infected women and their infants -Mothers who receive no or minimal HIV care during the prenatal period may have higher rates of infected infants -Infant infection may occur during pregnancy, during labor and birth, or after birth if the infant is breastfed -An infected newborn is typically asymptomatic at birth, but signs and symptoms may become obvious during the first year of life -S/S: enlargement of liver and spleen, lymphadenopathy, FTT, persistent thrush, chronic/recurrent diarrhea, bacterial infections: meningitis, pneumonia, osteomyelitis, septic arthritis.

What are the fetal and neonatal effects of HIV?

The fetal and neonatal effects of parvovirus B19 infection are failure of red blood cell production, severe fetal anemia, hydrops, and heart failure.

What are the fetal and neonatal effects of parvovirus B19 infection ?

-Fetal demise -FGR -fetal alcohol spectrum disorders -FAS (facial and cranial anomalies, developmental delay, cognitive impairment, short attention span)

What are the fetal or neonatal effects of alcohol (beer, wine, mixed drinks, after dinner drinks)?

-preventable with vaccine, safe during pregnancy -newborn vaccination begins before discharge, 2nd dose given 1-2 months after, 3rd dose given 6-18 months of age. -goals for elimination: *universal newborn vaccinations *routine screening of all pregnant women & provisions of immunoprophylaxis to infants born to infected mothers or women with unknown infection status *routine vaccination to unvaccinated children and adolescents

What are the goals and HBV?

Issues that might arise during the PP period may include the following: · whether to continue or stop antiretroviral therapy · support services needed after discharge · contraceptive counseling, including the information that condoms can reduce the risk for acquiring or transmitting STD's and HIV transmission but have a low rate of effectiveness for contraception · comprehensive follow up for infection indicators and associated medical conditions, counseling for a new diagnosis, and evaluation of the need for continued antiretroviral therapy

What are the nursing considerations for HIV?

fetal hypoxia, tachycardia, meconium staining, stillbirth, prematurity, irritability, sleep followed by agitation, poor response to comforting or interaction, possible attention and language problems

What are the possible effects that cocaine "crack" has on the fetus or neonate?

Hyperarousal state, euphoria, generalized vasoconstriction, HTN, tachycardia, STD's, SAB, abruptio placentae, preeclampsia, PROM, preterm labor, precipitous delivery

What are the possible maternal effects from Cocaine "crack"?

· Can occur during pregnancy can be transmitted to the fetus in two ways: across the placental barrier or by exposure to organisms during birth · may be mild or even sub clinical in the mother, can have serious effects on the fetus

What are viral infections?

-a member of the herpes virus group -is transmitted by droplet infection from person to person -found in: urine, saliva, blood, cervical mucus, semen, breast milk, stool -Transmission: close personal contact is required for these fluids -day care centers common place for transmission -kissing, sexual intercourse -periodic reactivation may occur -mother often unaware of infection since symptoms are vague/asymptomatic

What is CMV (cytomegalovirus)?

-diagnosis of neonatal infection: urine -diagnosis in mother: serum antibodies -Latent virus can be reactivated and cause disease to the fetus in utero or during passage through the birth canal. -fetal/neonatal effects: CNS abnormalities, hearing loss, learning disabilities, hepatosplenomegaly, IUGR, hyperbilirubinemia, hemolytic disorders Therapeutic management: no effective therapy currently available, ultrasound may identify manifestations of infection -prevention: good hygiene and handwashing

What is CMV?

-fetal/neonatal effects: -SAB (spontaneous abortion) -low birth weight -enlarged liver & spleen -jaundice -anemia -coagulation disorders -congenital toxoplasmosis: chorioretinitis, leads to blindness, seizures, hepatosplenomegaly, mental retardation

What is Fetal and neonatal effects of toxoplasmosis?

-infection occurs during pregnancy, fetal death could result, from failure of fetal RBC production, followed by: -severe fetal anemia -hydrops (generalized edema), HF -No specific treatment -Starch baths help reduce pruritus, analgesics for mild joint pain

What is fetal and neonatal effects, and therapeutic management of Parvovirus B19 (5th disease)?

endocervicitis and weakness of fetal membranes increase risk for premature rupture of membranes and preterm labor

What are the perinatal effect of gonorrhea?

-anal lesions present: itching, irritation, rectal bleeding, diarrhea, painful defecation -oral lesions present: ulcerations on lips, tender gums, pharyngitis -dysuria, testicular edema or pain, penile discharge (green, white, yellow, clear) -dysuria, vaginal bleeding between periods, dysmenorrhea

What are the expected findings of gonorrhea?

•Gonorrhea •Chlamydia •Syphilis •Trichomoniasis

What are STIs (sexually transmitted infections) that could occur during pregnancy?

Unclear; More study needed; May be related to problems in motor development; Increased risk for abnormal ease or mortality unproven

What are some of the fetal or neonatal effects from marijuana ("pot," "weed," "grass")?

A healthy infant is born to a mother with known high-risk behaviors whose HIV status is undetermined. The mother states that she wishes to breastfeed her infant. The nurse's response to the mother's request should be based on which of the following information? A. HIV is rarely transmitted to the newborn through maternal milk. B. Breastfeeding should be withheld until HIV status (maternal) is determined. C. Breastfeeding should be avoided completely in mothers with high-risk behaviors. D. In such infants antiretroviral medication should be started within 12 hours of birth

B. Breastfeeding should be withheld until HIV status (maternal) is determined.

Joanna, a 19-year-old pregnant female, is at the clinic for her 1st prenatal care visit. She is in her 1st trimester. Joanna has been recently diagnosed with HIV and is concerned about the health of her unborn fetus. The nurse counsels Joanna that treatments are available to prevent or minimize perinatal transmission of HIV. The current evidence-based recommendations to prevent perinatal transmission of HIV are to: A. Administer intravenous zidovudine 24 hours before delivery B. Start a combination of antiviral drugs as soon as possible C. Avoid giving antiretroviral drugs until the 28th week of gestation D. Wait until the infant is born because perinatal transmission before delivery is very rare

B. Start a combination of antiviral drugs as soon as possible

Spontaneous abortion, abruptio placentae

How alcohol (beer, wine, mixed drinks, after dinner drinks) effects the mother?

Immunization with varicella-zoster immune globulin (VZIG) is recommended. Because of viral shedding, infected mothers and infants must be isolated from those who are not immune.

How are infants born to mothers with varicella treated?

Hepatitis B virus is transmitted by contact with infected blood, saliva, vaginal secretions, semen, or breast milk.

How is HBV transmitted?

FGR, LBW, NAS, perinatal asphyxia, meconium aspiration syndrome, fetal or neonatal death, SIDS, child abuse and neglect; Long-term developmental effects unclear

What are some of the possible fetal or neonatal effects from opioids (heroin, methadone, morphine)?

-often used with other drugs: tobacco, alcohol, cocaine; exact effects undetermined -relaxation and euphoria -some people experience anxiety, fear, distrust, panic -these effects are more common when too much is taken, the marijuana has an unexpectedly high potency or the person is inexperienced. -psychosis, which includes hallucinations, delusions, and a loss of the sense of personal identity--> when large doses taken

What are some of the maternal effects from marijuana ("pot," "weed," "grass")?

What are fetal or neonatal effects from tobacco use by the mother?

Prematurity, LBW, neurodevelopmental problems, increased incident of SIDS, perinatal mortality

What does caffeine (coffee, tea, cola, chocolate, cold remedies, analgesics) do to the mother?

Stimulate CNS and cardiac function, causes vasoconstriction and mild diuresis, half-life triples during pregnancy

•Cytomegalovirus •Rubella •Varicella-zoster •Herpes simplex •Parvovirus B19 •Hepatitis B •Human immunodeficiency virus (HIV) •Influenza

What are possible infections during pregnancy that are viral?

increase risk for FGR, prematurity, abnormal sleep patterns, agitation, poor feeding, vomiting

What are some of the possible fetal in neonatal effects from amphetamines and methamphetamines ("speed," "crystal," "glass," "ice," "ecstasy")?

· Signs of possible drug use · seeking prenatal care late in pregnancy · failure to keep it prenatal appointments · inconsistent follow through with recommended care · poor grooming, inadequate weight gain · needle punctures, thrombosed veins, Cellulitis · defensive or hostile reactions · anger or apathy regarding pregnancy · severe mood swings

What are signs of possible drug use?

•Toxoplasmosis •Group B streptococcus •Tuberculosis

What are possible infections during pregnancy that are nonviral ?

•Caused by: retrovirus HIV •Transmission: -Sexual exposure to genital secretions of an infected person -Parenteral exposure to infected blood or tissue •Common s/s in affected mother: -An early or acute stage occurs several weeks after HIV exposure (stage 1). Flulike symptoms may develop and last a few weeks. -A middle or asymptomatic period of minor or no clinical problems follows (stage 2). This period is characterized by continuous low-level viral replication and CD4 cell loss. -A late period of AIDS follows, which consists of opportunistic infections lasting months or years (stage 3). -During stages 1 and 2, the infected person is said to be HIV-positive. During stage 3 the immune system no longer offers adequate protection, and opportunistic diseases occur. The person is then said to have AIDS, regardless of the CD4 counts

What is HIV (Human immunodeficiency virus)?

-erythema infectiosum, AKA 5th disease -transmission: respiratory secretions, saliva, sputum, nasal mucus -an acute, communicable disease characterized by a highly distinctive rash -starts on the face with a "slapped-cheeks" appearance, followed by generalized maculopapular rash -fever, malaise, joint pain -most contagious before rash is evident -more common among children -often occurs in community epidemics -if the disease occurs in pregnancy, potential fetal and neonatal effects exist

What is Parvovirus B19 (AKA 5th disease)?

-caused by toxoplasma gondii -transmitted through organisms in raw and undercooked meat -contact with infected cat feces or soil -crosses the placental barrier to the fetus if the expectant mother acquires infection during pregnancy -mother experiences a few days of: fever, muscle pains, swollen glands, unaware of disease -no specific treatment exists

What is S/S and treatment of toxoplasmosis?

-Toxoplasmosis -Other (varicella, parvovirus, Hep B) -Rubella _Cytomegalovirus -Herpes simplex

What is TORCH?

-a group of infections that can cross the placenta and have a teratogenic effects on the fetus -does not include all the major infects that can present risks to the mother and fetus -immunologic survey used to identify existence of these infections in the mother (to identify fetal risks) or newborn (detection of antibodies against infections) -prenatal testing

What is TORCH?

the physical and psychological dependence on a substance (alcohol, nicotine, drugs-either prescription, illicit). When present during pregnancy, poses serious risk to both mother and infant.

What is chemical dependence?

-causative organism: bacterium chlamydia trachomatis -most common STD in the US -often accompanies gonorrhea -difficult to diagnose because client is asymptomatic -if left untreated in females, can lead to PID (pelvic inflammatory disease), can cause infertility and ectopic pregnancy -CDC recommends yearly screening of all sexually active females younger than 25 or those at high risk. -all pregnant females screened at 1st prenatal visit and rescreened in 3rd trimester if high-risk -if left untreated during pregnancy, can cause premature rupture of membranes, preterm labor, postpartum endometritis -if transmitted to neonate, can cause conjunctivitis and pneumonia after delivery

What is chlamydia?

-an inflammatory process that involves the uveal tract and choroid. -a lining of the retina deep in the eye -inflammation can affect vision -Symptoms: -Pain or redness in the eye -Blurred vision, or seeing "floaters" -Sensitivity to light -Excessive tearing -Causes: infection or autoimmune diseases, including HIV/AIDS, syphilis, sarcoidosis, tuberculosis, and congenital toxoplasmosis. -Risk factors: Having or having a history of an autoimmune or infectious disease, such asrheumatoid arthritis, sarcoidosis, syphilis, tuberculosis, or congenital toxoplasmosis

What is chorioretinitis?

-Diagnosis: urine or cervical culture -cephalosporins (ceftriaxone) recommended for gonorrhea during pregnancy --> tetracycline should not be used in pregnant women -20%-25% of women with gonorrhea also have chlamydial infection, azithromycin or amoxicillin is recommended for treatment -infants are to be treated with ophthalmic antibiotic such as ceftriaxone at birth for prevention of ophthalmia neonatorum

What is diagnosis and treatment of women and infants with gonorrhea?

-is transmitted by sexual contact with an infected person, by contact with infected body fluids, and through the placenta from mother to fetus -during the initial phase, the person may be unaware of the infection, yet highly infectious -there is a latent period, averaging 10 years, from infection to development of acquired immunodeficiency syndrome (AIDS), corresponding to the type of treatment received -a person infected can pass the virus to another person, even if he or she does not have symptoms -there is no cure for infection or AIDS; antiretroviral medications are available to slow the replication of the virus and delay onset of opportunistic diseases -antiretroviral treatment should be part of the medication regimen for a pregnant woman to reduce the risk for transmission to her fetus. the newborn also should receive antiretroviral treatment after birth

What is facts about HIV?

-pregnancy complications from recurrent infection are rare -if primary infection occurs during pregnancy, rates of SAB, IUGR, and preterm labor increase -neonatal infection uncommon but potentially devastating -neonate infection limited to skin lesions or systemic (disseminated) infection -symptoms usually appear within 1st week and progresses rapidly -likelihood of death or serious sequelae in infants who have systemic herpes infection is approximately 50% -greatest risk for neonatal infection is if the mother has a primary (rather than recurrent) infection during perinatal period. -d/t amount of virus shed is higher during a primary infection than during subsequent ones

What is fetal and neonatal effects of HSV?

-Perinatal infection is uncommon -May be acquired as a result of the fetus swallowing or aspirating infected amniotic fluid -Signs of congenital TB include failure to thrive, lethargy, respiratory distress, fever, and enlargement of the spleen, liver, and lymph nodes -If the mother remains untreated, the newborn is at high risk for acquiring TB by inhalation of infectious respiratory droplets from the mother

What is fetal and neonatal effects of TB?

-depends on the of maternal infection -1st trimester, fetus has small risk for congenital varicella syndrome -greatest risk for development is during 13-20 weeks -limb hypoplasia, cutaneous scars, chorioretinitis, cataracts, microcephaly, IUGR -if infant is infected during the prenatal period (5 days before and 2 days after birth) no benefit of maternal antibodies -VZIG (varicella-zoster immune globulin) is given -infants born before 28 weeks/1,000g or less are given VZIG no maternal antibodies

What is fetal and neonatal effects of varicella-zoster (chickenpox)?

-risk for prematurity, LBW, neonatal death increase when mother has infection during pregnancy --Infection of newborn whose mother is positive Hepatitis B Surface Antigen (HepBSag+) can be prevented by hepatitis B immune globulin (HBIG) followed by hepatitis B vaccine within 12 hours of birth -Vaccine should be repeated at 1-2 months, and 6-18 months -Breastfeeding Safety: Considered safe as long as newborn receives HBIG and Hep B vaccine

What is fetal and neonatal effects, therapeutic management of HBV?

-can cross the placental barrier and infect the fetus at any time during pregnancy -greatest risk to the fetus is during the 1st trimester -can cause fetal consequences (miscarriage 1/3, congenital anomalies, death) -congenital anomalies: deafness, developmental delay, cataracts, cardiac defects, IUGR, microcephaly are most common complications -infants born to mothers with German measles are contagious to other infants and nonimmunized adults. -as the pregnancy progresses, the risk for congenital decreases.

What is fetal and neonatal effects?

-Causative organism: bacterium Neisseria gonorrhoeae -not transmitted via placenta -Transmission: from mother to newborn during birth may cause ophthalmia neonatorum -bacterial infection primarily spread by anal-to-genital or oral-to-genital contact -Females are frequently asymptomatic -if left untreated, can cause tubal scarring, can lead to PID (causing infertility) -yearly screening for all sexually active females younger than 25 yoa, or those with multiple sex partners -all pregnant mothers should be screened at 1st prenatal visit, rescreened in the 3rd trimester if at high-risk -if left untreated, neonate may have ophthalmia neonatorum, which can lead to blindness

What is gonorrhea?

-Most common STD in HSV group -Caused by HSV type or type 2 -most infections of genital herpes is type 2 -occurs as a direct contact of the skin or mucous membrane with an active lesion -lesions form at site of contact -group of painful papules that progress rapidly to become vesicles, shallow ulcers, pustules and crusts -can be reactivated later as recurrent infection

What is herpes simplex?

-may be responsible for premature rupture of membranes, premature labor, chorioamnionitis -fetus may be infected during birth and suffer neonatal conjunctivitis or pneumonitis -conjunctivitis is preventable by erythromycin ophthalmic ointment

What is perinatal, fetal and neonatal effects of chlamaydia?

-prevention and protection for NEXT pregnancy -pregnant women NOT immunized, but members of household -receive vaccine before discharge, 2nd dose 4-8 weeks pp -avoid pregnancy for 1 month after each injection

What is postpartum management of varicella-zoster (chickenpox)?

Sexual transmission can be avoided by several methods: · abstinence · if infected persons do not have vaginal intercourse with susceptible persons · barrier methods such as latex condoms reduce contact with infectious secretions · condom also offers protection from transmission through oral sex · For IV drug users, watch the equipment with water, soap, and bleach before each use to reduce transmission of the virus through soiled needles

What is prevention of HIV?

-AKA German measles -transmitted from person to person through droplets or through direct contact w/articles contaminated by nasopharyngeal secretions -a vaccine is available for prevention, however it cannot be given during pregnancy -immunization should be given to the woman before discharge after the birth -avoid pregnancy for 4 weeks after the immunization -vaccine available in 1969 -congenital German measles can have severe consequences: fever, general malaise, maculopapular rash begins on face and migrates over body, joint pain, mild lymphedema

What is rubella?

change in blood test from negative to positive indicating development of antibodies in response to infection or immunization

What is seroconversion?

•Causative organism: Spirochete Treponema pallidum •Transmission: -If untreated, infection may cross placenta to fetus •Fetal and Neonatal Effects: -Spontaneous abortion, stillborn infant, premature labor and birth, or congenital syphilis -Major signs of congenital syphilis are enlarged liver and spleen, skin lesions, rashes, osteitis, pneumonia, and hepatitis. •Therapeutic Management -Benzathine penicillin G is primary treatment to cure disease in both woman and fetus. Women who are allergic are desensitized and then treated.

What is syphilis?

-integrates its viral genetic makeup into the genetic makeup of the cell when infecting it. -The disease worsens as more cells cease to function, and a greater number of viruses are produced -the principle mechanism which leads to infection to immunodeficiency is through is destructive effect on cells that provide and regulate immunity -The clinical course of infection follows fairly predictable stages: · an early stage or acute stage occurs several weeks after exposure. Flu like symptoms may develop & last a few weeks. · A middle or asymptomatic period of minor or no clinical problems follows. This period Is characterized by continuous low level viral replication and CD4 cell loss. · A late period of AIDS follows, which consist of opportunistic infections lasting months or years. -during stages 1 & 2, the infected person is said to be positive. -During stage 3, the immune system no longer offers adequate protection, an opportunistic disease occurs. The person is then said to have AIDS, regardless of the CD4 counts.

What is the pathophysiology of HIV?

-Cook meat, particularly pork, beef, and lamb, thoroughly until the juices run clear. -Avoid touching the mucous membranes of your mouth and eyes while handling raw meat. -Wash all surfaces that come in contact with uncooked meat. -Wash your hands thoroughly after handling raw meat. -Avoid uncooked eggs and unpasteurized milk. -Wash fruits and vegetables before consumption. -Avoid contact with materials that are possibly contaminated with cat feces (such as cat litter boxes, sandboxes, garden soil).

What is the prevention of toxoplasmosis?

-causative organism: mycobacterium tuberculosis -Transmission: aerosolized droplets containing bacterium, inhaled by a noninfected individual and taken into lungs -Screening: intradermal injection of mycobacterial protein (purified protein derivative [PPD]) -if screening is positive or woman is already known to have a positive screening, her abdomen should be protected by a lead shield while a chest radiograph is taken, preferably after the 1st trimester -Diagnosis: confirmed by isolation and identify the bacterium in the sputum

What is the screening and diagnosis of TB?

-Multiple antiretroviral drugs from different classes are beneficial in extending life after infection and reducing the transmission rate to the infant. Guidelines for the latest treatments from the National Institutes of Health for pregnant as well as nonpregnant patients may be found at www.aidsinfo.nih.gov/guidelines -Maternal zidovudine (ZDV) therapy to reduce infant HIV infection should consider many situations, such as the following: •Whether the mother has had any antiretroviral therapy during pregnancy, including ZDV, and when it began •Whether the mother had any prenatal care and when she started •Fetal gestational age •If the membranes have ruptured, how long they have been ruptured

What is the therapeutic management of HIV?

-no known cure -acyclovir prescribed to reduce symptoms and shorten duration of lesions -acyclovir may be given during late pregnancy to a woman with a recurrent outbreak to reduce possibility of having active lesions at time of birth -vaginal birth allowed if no genital herpes at time of labor -cesarean birth recommended for women with active lesions in the genital area -careful handwashing technique -mothers may breastfeed if no lesions on breast -infant observed for signs of infection: -temperature, instability, lethargy -poor sucking reflex, jaundice, seizures and herpetic lesions -acyclovir therapy prescribed for neonatal infection

What is the therapeutic management of HSV?

-Untreated TB poses a greater hazard to the fetus than its treatment -Preferred treatment for pregnant women with active TB is isoniazid (INH), rifampin (RIF), and ethambutol (EMB) daily for 2 months, followed by INH and RIF daily or twice weekly for 7 months, for 9 months of total treatment duration -Pyridoxine (vitamin B6) should be given with isoniazid to prevent fetal neurotoxicity and because pregnancy itself increases the demand for this vitamin

What is the therapeutic management of TB?

•Transmission: Direct contact of the skin or mucous membrane with an active lesion -Vertical transmission (from mother to infant) generally occurs in 1 of 2 ways: (1)after rupture of membranes, when the virus ascends from active lesions (2)during birth, when the fetus comes in contact with infectious genital secretions or when the fetal skin is punctured, such as with a fetal scalp electrode

What is the transmission of herpes simplex?

-immune testing recommended for pregnant women presumed susceptible -VZIG administered to women exposed, have fetuses at high-risk for congenital varicella syndrome -women infected should report pulmonary symptoms immediately -hospitalization, fetal surveillance -full respiratory support, hemodynamic monitoring for varicella-zoster pneumonia -Acyclovir primary drug -infants with infected mothers will receive VZIG ASAP but within 96 hours of birth provides passive immunity -infected women and infants highly contagious -placed in airborne and contact isolation -staff members vaccinated should come in contact with these clients

What is therapeutic management for varicella-zoster (chickenpox)?

-both partners should be treated to prevent recurrent infection -use of condoms decreases risk of infection -Azithromycin or amoxicillin is recommended treatment during pregnancy. -Tetracycline should not be used during pregnancy

What is therapeutic management of chlamyida?

-Prevention is key -immune women do not become infected -postpartum-get vaccine -not to get pregnant in the 28 day window, possible risks to fetus during this time

What is therapeutic management of rubella?

•Causative organism: Protozoan Trichomonas vaginalis •Common cause of vaginitis in 10%-50% of pregnant women. •Perinatal and Postpartal Effects: -Associated with premature rupture of membranes and postpartum endometritis. •Treatment -Metronidazole (Flagyl), pregnancy category B, may be given to pregnant woman as 2-g single oral dose

What is trichomoniasis?

-AKA chickenpox caused by: varicella-zoster virus (belongs to the HV family) -found through the respiratory tract -transmission: direct contact -s/s: fever, general malaise, pruritic, vesicular lesions -immunization is available -reactivated, herpes zoster (shingles) results

What is varicella-zoster (chickenpox)?

Decreased placental perfusion, abruptio placentae, anemia, PROM, preterm labor, spontaneous abortion

What tobacco does to the mother?

The 1st trimester is the time of organogenesis, when damage can be done to all developing organ systems.

Why is rubella infection most dangerous in the 1st trimester?

What are fetal or neonatal effects from caffeine?

crosses placental barrier and stimulate fetus; Teratogen effects are undocumented

Erythromycin ophthalmic ointment

to prevent ophthalmia neonatorum