High-risk Pregnancy

CALAMBA, JIM ORLAND Y.

BSN-3A

NCM 101 (8:00-12:00N) MT

MS. EVANGELINE B. MANAQUIL, R.N

HIGH-RISK PREGNANCY is one in which a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the mother, the fetus, or both. DISEASE

CAUSATIVE AGENT

SIGNS AND SYMPTOMS

CAUSE AND EFFECTS

MEDICAL MANAGEMENT

Candida Albicans

Symptoms include vaginal burning, itching, and pain. The genital area is red and inflamed, and there’s a thick vaginal discharge that smells like brewed yeast and looks like cottage cheese. These symptoms can vary in severity and are caused by the waste products of the rapidly multiplying Candida (or other) organisms.

Treating the infection during pregnancy is important because the profuse vaginal discharge and pruritus can be very uncomfortable. If infection is present in the vagina at the time of childbirth, it may cause a candidal infection, or thrush, in the newborn.

Treated by the vaginal application of an OTC antifungal cream such as miconazole (Monistat) for 7 days or a single dose of oral flucanazole (Diflucan).

Single-Cell Protozoan Spread By Coitus

A woman notices a yellowgray, frothy, odorous vaginal discharge.

It is important that trichomoniasis infections be identified and treated because they may be associated with preterm labor, premature rupture of membranes, and postcesarean infection.

The infection is diagnosed by examination of vaginal secretions on a wet slide that has been treated with potassium hydroxide or by a vaginal culture.

A WOMAN WITH CANDIDIASIS

A WOMAN WITH TRICHOMONIASIS

The drug choice is single-dose oral matronidazole.

Gardnerella Vaginalis

The associated discharge is gray and has a fishy odor and pruritus may be intense.

Untreated G. vaginalis infections are associated with amniotic fluid infection, and preterm labor as well as premature rupture of the membranes.

Oral metronidazole (Flagyl) or clindamycin for 7 days

Gram-Negative Parasite.

A heavy, gray-white vaginal discharge.

Associated with premature rupture of membranes, preterm labor, and endometritis because the infant who is born while the infection is present in the vaginal can lead to conjunctivitis or pneumonia after birth. Long term effects in the mother are pelvic inflammatory disease, possibly leading to infertility.

Therapy for nonpregnant women is usually with doxycycline (Vibramycin), a tetracycline. This is contraindicated during pregnancy because of possible fetal long bone deformities so azithromycin (Zithromax) or amoxicillin (Amoxil) is used instead.

A WOMAN WITH BACTERIAL VAGINOSIS

A WOMAN WITH CHLAMYDIA

Intracellular

Diagnostic tests: Vaginal culture is done during a woman’s first prenatal visit. If a woman has multiple sexual partners, screening may be repeated again in the third trimester. Culture of the organism from vaginal secretions using a specific Chlamydia culture kit Gonorrhea is tested as well if Chlamydia infection is documented since there is a association between gonorrhea and Chlamydia.

Caused By A Spirochete Treponema Pallidum.

A WOMAN WITH SYPHILIS

The first stages of syphilis result in a painless ulcer (chancre) on the vulva or vagina. Early in pregnancy (before 18 week), the placenta appears to provide some protection against the disease.

Associated with miscarriages, preterm labor, stillbirth or congenital anomalies in the newborn because the spirochete crosses the placenta freely.

One injection of benzathine penicillin G is a choice for the treatment in syphilis during pregnancy. After therapy, a woman may experience a Jarisch-Herxheimer reaction and is caused by the sudden destruction of spirochetes. This reaction lasts about 24 hours and fades. Diagnostic Tests: Pregnant women are screened for syphilis at a first prenatal visit by a VDRL, ART, or FTA-ABS antibody reaction test. Those who have multiple sexual partners are tested again at about week 36 of pregnancy.

Women are screened again at the beginning of labor and newborns are screened for congenital syphilis by a cord blood sample.

Herpes Virus A WOMAN WITH HERPES SIMPLEX VIRUS TYPE 2 INFECTION

The first time a woman contracts a herpes infection, painful, small, pinpoint vesicles on an erythematous base develop on her vulva or in the vagina, accompanied by a low-grade fever 3-7 days after exposure. Although symptoms fade in a few days, the virus remains in local nerve ganglions, becoming activated again any time she has a break in the skin or also possibility by stress.

Primary infection can cause congenital infection in the newborn because herpes can be transmitted across the placenta. If a woman has primary or secondary active lesions in the vagina or vulva at he time of birth, infection can be transmitted to the newborn which results to congenital herpes, a severe infection that is often fatal.

Oral acyclovir (Zovirax) valacyclovir (Valtrex).

or

Women can reduce pain of the lesions by taking sitz baths or applying warm, moist tea bags to the area.

Condoms use by a woman’s partner or by a woman is encouraged to prevent the transmission of the virus.

Diagnostic Tests: Made by the appearance of the lesions, Pap smear, and enzyme-linked immunosorbent assay (ELISA). Caused By A Gram-Negative Coccus Neisseria Gonorrhoeae. A WOMAN WITH GONORRHEA

A yellow-green vaginal discharge may be present, or a woman may be asymptomatic. Male partner usually has severe symptoms of pain on urination and a purulent yellow penile discharge.

Associated with spontaneous miscarriage, preterm birth, and endometritis in the postpartum period because it can result into severe eye infection that can lead to blindness in the newborn if the infection is present at the time of birth. It is also a major cause of pelvic

Oral cefixime (Suprax) or intramuscular ceftiaxone (Rocephin). People who contract gonorrhea also have a chlamydial infection, nonpregnant women should receive doxycycline therapy at the same time. If a woman is pregnant, she should receive amoxicillin or

inflammatory disease and infertility.

(PID)

azithromycin

Diagnostic Tests: Culture of the organism from the vagina, rectum, or urethra. Human Papillomavirus (Hpv)

A WOMAN WITH HUMAN PAPILLLOMAVIRUS INFECTION

At first, lesions appear as discrete papillary structures; they then spread enlarge, and coalesce to form large, cauliflower-like lesions. These tend to increase in size during pregnancy because of the high vascular flow in the pelvic area. They may become secondarily ulcerated and infected which may develop a foul vulvar odor

It associated a cesarean birth because of the vulvar lesions present at the time of birth and obstruct the birth canal. HPV infection is associated with the development of cervical cancer later in life.

Podophyllum (Podofin) applied directly to lesions for nonpregnant women but is contraindicated during pregnancy because of possible toxic effects on the fetus instead, Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) applied to lesions weekly can be used during pregnancy. Large lesions may be removed by laser therapy, cryocautery, or knife excision. With cryocautery, edema at the site is evident immediately; lesions become gangrenous, and sloughing occurs in 7 days. Healing will be complete in 4-6 weeks with only slight depigmentation at the site. Sitz baths and a lidocaine cream may be soothing during healing period.

Streptococcus B

The mother usually experiences no symptoms.

A WOMAN WITH GROUP B STREPTOCOCCAL INFECTION

Leading to preterm birth and postpartum endometritis because of urinary tract infection (UTI) and intraamniotic infection. Neonates at the time of birth will become infected because of placental transfer or from direct contact with the organisms and may develop severe pneumonia, sepsis, respiratory distress syndrome, or meningitis.

A broad-spectrum penicillin such as ampicillin is the treatment of choice. Women who experience rupture of membranes at less than 37 weeks of pregnancy and so have not yet been screened ,ay be treated with intravenous ampicillin to reduce the risk of spreading of infection to the newborn.

Diagnostic Test: Screening for streptococcus B at 35-38 weeks of pregnancy as recommended by the CDC Hepadnavirus A WOMAN WITH HEPATITIS B OR C

Generalized jaundice because of from the transfusion of contaminated blood and plasma or semen, sexual contact, inoculation by a contaminated syringe or needle through IV drug use; may be spread to fetus if mother has infection in third trimester.

High incidence of chronic infection with the virus because it was persisted for longer than six months

Immunity: Natural; one episode induces immunity for the specific type of virus

Active artificial immunity: Vaccine for the HBV virus (recommended for routine immunization series and health care providers) Passive Artificial Immunity: Specific Hepatitis B immune serum globulin

Incubation period: 120 days on average

Diagnostic Test: Hepatitis screening Retrovirus

A WOMAN WITH HIV INFECTION

Rarely begins with reproductive tract irritation, fatigue, anemia, diarrhea, weight loss and may develop opportunistic infections and possibly malignancies.

Associated with low birthweight, preterm birth and also infants born to untreated HIV-positive women will contract the virus and develop AIDS in the first year of life because of the vertical transmission of virus across the placenta at birth.

Zidovudine (ZVD) is administered to the woman beginning with the 14th week of pregnancy and the newborn receives the drug for 6 weeks after birth in which the risk of perinatal transmission can be reduced to only 8%-10%

Nevirapine, a newer antiretroviral drug may reduce the incidence even more.

Diagnostic Test: Done by an ELISA antibody reaction and for confirmation, a Western blot analysis is required. A woman with HIV infection may also have contracted other STI’s such as syphilis,

gonorrhea, Chlamydia, and hepatitis B and should be screened for these as well.