Complications of Pregnancy: Chapter 8 - Infections

Overview of Maternal Infections

• Maternal infections during pregnancy need prompt identification and treatment by healthcare providers.
• Pregnant clients are at risk for developing infections that can complicate pregnancy, potentially affecting fetal well-being.
• It is critical for all pregnant clients to undergo routine screening during their first prenatal visit and, if necessary, during the third trimester.

Infection Screening Procedures

• Infections can be tested during pelvic exams or via blood, urine, or swab cultures.
• Initial antepartum screening tests include:
  • Syphilis
  • Hepatitis
  • HIV
  • Gonorrhea
  • Chlamydia
• A Pap smear is recommended, which can detect dysplasia and HPV, to be performed during pregnancy.
• In the third trimester, testing should include:
  • Group B Streptococcus (GBS)
  • Retesting for gonorrhea, chlamydia, and HIV if indicated.
• Other relevant infections that may impact pregnancy include:
  • COVID-19
  • TORCH infections
  • Trichomoniasis
  • Pelvic Inflammatory Disease (PID)
  • Herpes Simplex Virus (HSV)
  • Candidiasis

Focus on Specific Infections

HIV/AIDS

• Definition: HIV is a retrovirus that attacks T lymphocytes and leads to immunosuppression.
• Transmission: HIV can be transmitted from the birth parent to the fetus via the placenta during pregnancy and postnatally through breast milk.
• Screening Recommendations: CDC advises all pregnant clients to receive HIV counseling and screening during the initial prenatal visit and again in the third trimester, especially for high-risk individuals.
• Complications of Untreated HIV:
  • Preterm birth
  • Low birth weight infants
  • Perinatal transmission during antepartum and interpartum stages, along with breastfeeding.
• Expected Findings and Assessment Risks:
  • Risk Factors:
  • IV drug use
  • Multiple sexual partners
  • History of STIs
  • Expected Clinical Findings:
  • Fatigue
  • Diarrhea
  • Flu-like symptoms
  • Physical assessment:
  • Diarrhea
  • Weight loss
  • Anemia
• Laboratory Testing Protocols:
  • Informed consent is mandatory before testing.
  • HIV testing is automatically part of routine prenatal panels but can be declined by the client.
  • For those refusing, inform them of the benefits of early detection and risk reduction to the fetus.
  • Rapid testing protocols are followed for clients without prenatal care, with testing beginning with antibody screening tests such as enzyme immunoassay (EIA) and confirmation of positives via Western Blot or immunofluorescence assay.
• Patient-Centered Nursing Care:
  • The primary goal is maintaining CD4 counts greater than 500 cells/mm³.
  • If HIV-positive, clients must adhere to antiretroviral therapy (ART) to minimize fetal transmission risk and be educated on safe sexual practices.
  • Vaccinations such as Hepatitis B and flu shots are encouraged.
  • Encourage using condoms to minimize transmission risk to partners.

Chlamydia

• Definition: Chlamydia is a bacterial infection caused by Chlamydia trachomatis, the most commonly reported STI among American women.
• Screening and Assessment:
  • Recommended that all pregnant clients undergo chlamydia screening at initial prenatal visit and again in the third trimester if under 25 years or at high risk.
  • Complications:
  • Untreated infections may lead to PID, premature rupture of membranes, preterm labor, and postpartum endometritis.
  • Neonates may develop conjunctivitis, often referred to as ophthalmia neonatorum, leading to pneumonia.
• Expected Findings:
  • Clients may be asymptomatic or present with dysuria, urinary frequency, and abnormal discharge.
  • Physical examination may reveal mucopurulent cervical discharge and bleeding.
• Laboratory Testing:
  • Endocervical swab culture is preferred.
• Management and Nursing Actions:
  • Treat all partners and ensure clients complete the entire medication regimen.
  • Clients should be retested within three to four weeks post-treatment.

Gonorrhea

• Definition: Gonorrhea is an STI installed by Neisseria gonorrhoeae, which can result in severe complications if untreated.
• Screening Recommendations:
  • Clients are advised to get screened during initial visits and again in the third trimester.
  • Complications:
  • Untreated gonorrhea can lead to PID, preterm birth, neonatal sepsis, and even blindness.
• Expected Findings:
  • Often asymptomatic; however, clients may report dysuria, pelvic pain, and purulent discharge.
• Laboratory Tests:
  • Nucleic acid amplification tests (NAAT) preferred; cultures for chlamydia and gonorrhea are also done.
• Management and Nursing Actions:
  • Failure to treat can result in significant morbidity. Partners must also be treated to prevent reinfection.

Syphilis

• Definition: An STI caused by Treponema pallidum that can lead to serious long-term complications.
• Transmission: Through sexual contact or from mother to fetus during pregnancy.
• Screening Recommendations:
  • CDC recommends screening at the initial prenatal visit and rescreening in the third trimester for high-risk clients.
• Expected Findings and Complications:
  • Symptoms vary by stage:
  • Primary Stage: Characterized by painless sores (chancres).
  • Secondary Stage: Involves skin rashes and flu-like symptoms.
  • Tertiary Stage: Severe complications affecting organs.
  • Can increase the risk for infections like HIV.
• Management:
  • Treatment typically involves benzathine penicillin G.

Hepatitis B (HBV)

• Definition: A viral infection that can transmit through blood and sexual activity, also to the fetus.
• Screening Recommendations:
  • Routine screening of all pregnant patients for hepatitis B surface antigen.
• Expected Findings:
  • Often asymptomatic, but clients may experience flu-like symptoms.
• Management and Nursing Actions:
  • Avoid hepatotoxic medications and provide education regarding safe practices to prevent transmission.

Group B Streptococcus (GBS)

• Definition: Bacterial infection prevalent in the vagina or rectum, significant during labor.
• Screening Protocols:
  • GBS testing is performed on pregnant clients at 36-37 weeks gestation.
• Complications:
  • Can lead to preterm labor, maternal sepsis, and infections in the neonate.
• Management:
  • Antibiotic prophylaxis is indicated for those with positive cultures, prolonged rupture of membranes, maternal fever, or early delivery.

Human Papillomavirus (HPV)

• Definition: Various strains can cause cervical cancer and genital warts.
• Complications during pregnancy:
  • Growth of genital warts might cause complications during delivery.
• Management:
  • Routine Pap smears recommended; wart treatments are generally deferred until postpartum.

Other Infections

• Trichomoniasis:

  • Caused by Trichomonas vaginalis, can lead to preterm birth.
  • Symptoms include yellow-green discharge and vulvar irritation.

• Candidiasis (VVC):

  • Fungal infection treated to alleviate discomfort and prevent neonatal thrush.
  • Symptoms include thick, white discharge and itching.

• COVID-19:

  • Current research ongoing regarding effects and management during pregnancy. Vaccination is recommended for all pregnant clients.
  • Complications include potential severe maternal and fetal outcomes.

• TORCH Infections:

  • Includes Toxoplasmosis, Other infections (like Hepatitis), Rubella, Cytomegalovirus (CMV), and Herpes Simplex Virus. These infections can cause severe teratogenic effects on the fetus.

Conclusion

In conclusion, appropriate screening and management of infections during pregnancy are crucial to safeguard maternal and fetal health. Continuous education about STIs and adherence to testing protocols are required to mitigate risks associated with these illnesses.