care exam 2 - maternal child: preconception

preconception counseling

includes medical history, infection disease concerns, genetic screening, health promotion, partner violence

STIs assess risk behaviors - 5 P’s

partners, prevention of pregnancy, protection from STIs, practices, past history of STIs

TORCH infections

toxoplasmosis, others, rubella, cytomegalovirus, herpes simplex

TRC infections

aquired antenatal

Others (hepatitis) and Herpes

acquired perinatal

toxoplamosis - causative agent

protozoan toxoplasma gondi

toxoplamosis - maternal symptoms

asymptomatic, fever, rash, eosinophila, immune after first episode

toxoplamosis - risk of fetal infection

incidence increased with gestational age

toxoplamosis - birth prevalence

congenital toxoplasmosis ranges from 10 to 100 cases per 100,00 live births

toxoplamosis - first trimester

more severe; hydrocephalus, nervous system problems, cerebral palsy, epilepsy, enlarged liver/spleen

toxoplamosis - third trimester

newborns are without clinical signs of disease but may develop later in life - vision and hearing loss, learning difficulties

toxoplamosis - maternal screening

toxoplasmosis titers; every 10 weeks throughout pregnancy

toxoplamosis - fetal infection treatment

sulfadine, sulfadiazine & pyrimethamine (avoid in first trimester)

toxoplamosis - prevention

educate

wash hands before eating, handling raw meat, after contact with feces, soil, cook meat adequately

syphilis (other) - patho

bacterium treponema pallidum; enters through subQ tissue during intercourse, biting, oral sex

syphilis (other) - maternal symptoms

non-painful lesions spreads to palms and soles

syphilis (other) - maternal screening

blood test at first prenatal visit and again in third trimester

syphilis (other) - treatment

penicillin

syphilis (other) - fetal infection

transplacental transmission may occur at any time during pregnancy; life threatening, preterm births, disabling morbidities (blindness, deafness, nervous system problems)

varicella (other) - first 20 weeks

birth defect congenital varicella syndrome; underdeveloped arms and legs, incomplete brain development

varicella (other) - delivery/postpartum

life threatening infection; contact may get oral antiviral to reduce severity and complications

Hepatitis A (other)

RNA virus, most common hepatitis infection; fecal-oral contact

Hepatitis A (other) - complications

malaise, jaundice, light color stools, liver failure

Hepatitis A (other) - rate of transmission

low as perinatal transmission virtually never occurs

Hepatitis A (other) - newborn prevention

vaccine (inactive) 2 doses; infants cannot get vaccine until 12 mo

Hepatitis B (other)

DNA virus that can cause chronic infections, liver disease, and can be transmitted from mother to child during birth.

Hepatitis B (other) - complications

hepatitis, cirrhosis, liver cancer

Hepatitis B (other) - rate of transmission mother to fetus

positive HBsAg (acute) = 90% will pass to fetus; chronic carriers about 10-20% will pass to fetus

Hepatitis B (other) - transmission

transplacental to the fetus at birth

Hepatitis B (other) - screening

routine HBsAg

Hepatitis B (other) - prevention

HBIG (hepatitis B immune globulin) & HBV vaccine at birth

Hepatitis B (other) - nonimmune mother exposed in pregnancy

give HBIG and HBV vaccine

Hepatitis C (other)

RNA virus

4% transmitted during birth from infected mother

Hepatitis C (other) - complications

hepatitis, cirrhosis, liver cancer

Hepatitis C (other) - screenings

HCV-A B recommended in high risk pregnant patients

Rubella - route of infection

via respiration as the virus is concentrated in the nasopharyngeal secretions

Rubella - symptoms

mild pyrexia, arthralgia, rash, lymphadenopathy

Rubella - risk of fetal transmission

most risk first 16 weeks gestation; most in first month gestation (50-60%)

Rubella - maternal screening

igG titer in first trimester

Rubella - prevention

vaccine before or after pregnancy (never during or a month before), prevent the spread

Cytomegalovirus - cause

DNA virus in the herpes virus family; 50-60% women have anitbodies present

Cytomegalovirus - maternal symptoms

usually mild or asymptomatic, fever with/without lymphadenopathy, sore throat

Cytomegalovirus - transmission

direct person to person contact

saliva, breastmilk, urine, semen, tears, stool, blood, cervical and vaginal secretions

Cytomegalovirus - fetus complications

delayed speech, learning difficulties dt cerebral calcification, sensorineural hearing loss

Cytomegalovirus - assessment

fetal hearing screens at birth

Cytomegalovirus - newborn treatment

antiviral can be used to decrease symptoms

Cytomegalovirus - prevention

hand washing, contact precautions, sexual protection

Hepres simplex - primary

very painful, fetal loss associated with increased miscarriages when affected in first trimester

Herpes Simplex - recurrent

maternal is a milder case, unilateral

Herpes Simplex - transmission from mother to fetus

occurs at time of delivery in 90-95% of cases with vaginal delivery

Herpes Simplex - fetal loss

associated with increased miscarriages when affected in first trimester dt coagulation, liver, kidney and respiratory issues, encephalitis, seizures, poor feeding, lethargy, hearing, speaking

Herpes Simplex - assessment

any lesion should be suspected active case and cultured

Herpes Simplex - prevention

daily oral acyclovir, c-section if any lesion present at birth, education for S&S and examiniation for outbreak

Herpes Simplex - early detection

promote recommended testing guidelines, follow ups, integrate male paterners into plan of care