INFECTIONS DURING PREGNANCY

DEEPTHY P.THOMAS
II YEAR MSC NURSING
GOVT.COLLEGE OF NURSING
ALAPPUZHA
 TYPES

 BACTERIAL INFECTION
 VIRAL INFECTIONS
 FUNGAL INFECTIONS
 PARASITIC AND PROTOZOAL INFECTIONS
 BACTERIAL INFECTIONS

GROUP B STREPTOCOCCAL INFECTION (GBS)

Organism
 Streptococcus agalactiae
 Risk factors

Risk factors for early onset neonatal GBS include:

 Positive prenatal culture for GBS this pregnancy
 Preterm birth of less than 37 weeks of gestation
 PROM for longer than 18 hours.
 Intrapartum maternal fever greater than 38°C
screening
 Management

The CDC recommends intrapartum antimicrobial

prophylaxis for

 Preterm labour before 37 weeks of gestation

 Duration of ruptured membranes longer than 18
hours.
 Intrapartum temperature greater than 100.4°F
 pencillin G
 Ampicillin.
 Cefazolin .
TUBERCULOSIS IN PREGNANCY
 Risk factors for TB

 Positive family history or past history

 Low socioeconomic status
 Area with high prevalence of tuberculosis
 HIV infection
 Alcohol addiction
 Intravenous drug abuse.
 Clinical features:

 Cough
 Weight loss
 Sleep sweats
 Evening pyrexia
 Malaise and
 Fatigue
 enlarged lymph nodes or pleural rub
 Diagnosis:

 Tuberculin skin test

 X- ray chest
 Early morning sputum (3 samples) for acid- fast
bacilli
 Gastric washings
 Diagnostic bronchoscopy
 Extra pulmonary sites- lymph nodes, bones ( rare in
pregnancy).
Effect of pregnancy on pulmonary
TB

 Pregnancy does not worsen the clinical

course of TB.
 Effect of TB on pregnancy

 The fertility rate is low

 a higher incidence of toxaemia, Preterm labour PPH
and difficult labour in pregnant patients suffering
from TB.
 the maternal and fetal prognosis is good and
therapeutic abortion is not necessary except in a
patient with multidrug resistance.
 Effect on the mother

 Pregnancy may worsen the maternal outcome in

drug resistant patients. Medical termination of
pregnancy may be considered in selected cases.
 Effects on the fetus

 Effective chemotherapy has reduced the

incidence of low birth weight.
 Streptomycin use was associated with
congenital deafness.
 Treatment

 Rifampicin
 isoniazid
 Ethambutol
 Pyrazinamide
 Newer anti-tubercular drugs include clofazimine,
ciprofloxacin, ofloxacin, amikacin, clarithromycin
and azithromycin.
 Obstetric management:

 In pregnancy
 In labour
 Breast feeding
 Contraception
BACTERIAL VAGINOSIS
 BACTERIAL VAGINOSIS

Organism-
 Gardnerella vaginalis, Mobiluncus, Mycoplasmas
hominis, Prevotella, and Atopobium vaginae.
 Transmission

 sexual intercourse, hormonal changes, pregnancy,

antibiotic administration, or use of nonoxynol-9
spermicidal products, douching.
 Signs and symptoms

 Thin, gray or white

homogeneous vaginal
discharge.
 Increased vaginal discharge
odor (fishy) after intercourse.
 Alkaline pH (> 4.5); bacterial
vaginosis does not cause vaginal
itching or dysuria.
 Treatment

symptomatic
metronidazole (Flagyl), 500 mg orally twice daily for
7 days .
Asymptomatic
 asymptomatic pregnant patients with antibiotics for
bacterial vaginosis to prevent pre term labour.
 Effect on pregnancy outcome

 spontaneous abortion, premature rupture of

membranes and pre term labour.
 chorioamnionitis and postpartum endometritis.
 May cause neonatal septicemia.
CANDIDIASIS
 CANDIDIASIS

Organism:
 Candida albicans, Candida tropicalis
 Transmission

 cause vaginal pH to be more alkaline and high

estrogen levels causing increased production of
vaginal glycogen.
 Signs and symptoms

 Vaginal and vulvar irritation (erythematous and

edematous)
 Pruritic, white, curd like vaginal discharge
 Yeasty odor
 Dysuria
 Dyspareunia
 Screening

 Saline or KOH wet mount microscopically examined:

shows hyphae, pseudohyphae and budding yeast
 Usually pH lower than 4.7
 Whiff test absent amine (fishy) odor
 Treatment in pregnancy

 Use an antifungal, intravaginal agent such as

butoconazole, clotrimazole, miconazole or
terconazole
 Sitz baths
LEPROSY (HENSEN DISEASE) IN
PREGNANCY
 mycobacterium leprae
 With established leprosy, there is chance of
exacerbation of the lesions during pregnancy.
 However, the baby should be separated from the
infected mother, immediately after delivery.
 When the disease becomes quiescent and non-
infectious, the baby may be given to the mother.
 Dapsone and Clofazimine appear safe in pregnancy..
GONORRHOEA
 GONORRHOEA

Organism:
 Neisseria gonorrhoeae
Transmission:
 Gonorrhea is transmitted by close sexual
contact. The incubation period is 3 to 5 days.
 Signs and symptoms

 Vaginal discharge: may be profuse purulent and

yellow green
 Itching or swelling of vulva
 Dysuria
 Dyspareunia
 Joint and tendon pain
 Anal discharge, discomfort and pain with rectal
infection.
 Screening

 Molecular diagnostics .
 Endocervical culture
 Treatment in Pregnancy

 cefixime, 400 mg orally, or one dose of Ceftriaxone,

125 mg intramuscularly.
 Sexual partners within the preceding 60 days should
be identified, examined, cultured and treated.
 Effect on pregnancy outcome

 It can affect pregnancy outcome in any trimester,

causing chorioamnionitis, pre term delivery, PROM,
IUGR or postpartum sepsis.
 If the organism is present at the time of delivery, the
greatest neonatal risk is gonococcal ophthalmia,
which can cause blindness.
SYPHILIS
 SYPHILIS

 Syphilis is a sexually transmitted disease caused by

Treponema pallidum.
 Signs and symptoms

 Incubation- 10 to 90 days
 Primary syphilis
Stage one is evident by a chancre, which is highly
infectious, painless, round ulcerated sore that does
not get better fast. It may last 3 to 6 weeks.
Secondary syphilis:
 evident by a maculopapular rash
 This rash usually exhibited between 1 week and 3
months after primary chancre. It typically clears in
2-6 weeks but can last upto one year.
 Other manifestations include wart like genital
growth, lymphadenopathy, fever, sore throat, patchy
hair loss, head ache weight loss, muscle aches and
tiredness.
Latent syphilis:
 Stage three is usually asymptomatic. The spirochete
goes to hiding for 5 to 20 years. The patient is
seroactive during this stage.
 During the first year of this stage, the patient is
infectious.
 Tertiary syphilis:
 The fourth stage is remanifestation of the disease. It
slowly destroys the heart eyes, brain, CNS, and
occasionally the liver, bones and skin.
 Investigations:

 Serological test- VDRL

 fluorescent treponemal antibody absorption test
(FTA- ABS)
 Treponema pallidum micro –haemagglutination
(MHA- TP) test which are specific.
 Treatment

For Mother:
 For primary and secondary syphilis(<I year
duration): Benzathine penicillin 2.4 million units
intramuscularly single dose.
 When the duration is more than 1 year- Benzathine
penicillin 2.4 million units intramuscularly weekly
for 3 doses is given.
 For Baby:
 Positive serological reaction with a single
intramuscular dose of penicillin G 50,000 units per
kg body weight.
 Infected baby with positive serological reaction- (1)
isolation with mother (2) IM administration of
aqueous procaine penicillin G 50,000 units per kg
body weight each day for 10 days.
URINARY TRACT INFECTIONS
 URINARY TRACT INFECTIONS

 Asymptomatic bacteriuria
 Cystitis
 Pyelonephritis
 Organism:
 E.coli, klebsiella pneumonia, proteus species in
recurrent UTI. Less frequent gram positive causative
organism includes group B streptococci, enterococci
and staphylococci.
 Transmission:

 sexual intercourse and improper wiping after

defecation.
 Signs and symptoms

 Urinary frequency
 Urinary urgency
 Dysuria
 Hesitancy and dribbling
 Suprapubic tenderness
 Gross hematuria
 Accompanying symptoms with pyelonephritis
usually are chills, fever, and backpain with
costovertebral angle tenderness.
 Screening

 Microscopic examination shows WBC, bacteria may

or may not be present.
 Dip urine may be positive for nitrates and leukocyte
esterase
 Clean catch midstream specimen for culture and
sensitivity.
 Treatment in pregnancy for
asymptomatic bacteriuria and acute
cystitis:
 antibiotic therapy for asymptomatic bacteruria is
effective in lowering the risk of pyelonephritis and
preterm labour. Usually 7-10 day course is preferred
 Treatment in pregnancy for
pyelonephritis:

 The usual treatment is amoxicillin clavulanate(

augmentin) 875 mg bd for 7-10 days
 Cephalosporin
 Effect on pregnancy outcome

 The endotoxins released from gram negative bacteria

may stimulate the production of prostaglandins and
thus cause preterm labour.
VIRAL INFECTIONS IN
PREGNANCY
AIDS
 Organism:
 the HIV organism is a retrovirus of the lentivirus
family that has an affinity for the T- lymphocytes,
macrophages and monocytes.
 Transmission

 infected blood or body secretions of semen or vaginal

fluid.
 unprotected sexual activity
 sharing of contaminated needles.
 Pediatric HIV primarily results from perinatal or
breast feeding transmission
 Immunopathogenesis

 leads to slow but progressive destruction of T cells

 The incubation period is about 1 to 3 weeks.
 After a peak viral load there is gradual fall
 more destruction of host cells  progressive
immunosupression  opportunistic infections and
cancers
 Clinical presentation:

 fever, malaise, headache, sore throat,

lymphadenopathy and maculopapular rash.
 constitutional symptoms like weight loss,
lymphadenopathy or protracted diarrhea.
 multiple opportunistic infections with candida,
tuberculosis, pnemocystitis, and others
 Diagnosis:

 enzyme immunoassay
 Western blot test or immunofluroscence assay
 Management:

 Prenatal care
 Voluntary serological testing for HIV
 Counseling
 assessed by – CD4+ T lymphocyte counts and HIV
RNA at every 3 to 4 months interval
 Highly active antiretroviral therapy(HAART)
(1) Nucleoside reverse transcriptase inhibitors
(Zidovudine, Zalcitabine, Lamivudine, Stavudine)
(2) Nonnucleoside reverse transcriptase inhibitors
(Nevirapine, Delavirdine) (3) Protease inhibitors
(Indinavir, Saquinavir, Ritonavir) (4) Entry
inhibitors (Efavirenz).
 Intrapartum care
 Zidovudine is given IV infusion starting at the onset
of labour or 4 hours before caesaren section. Loading
dose 2 mg/kg/hr until cord clamping is done.
 Amniotomy and oxytocin augmentation for vaginal
delivery should be avoided whenever possible.
 Elective caesarean delivery is recommended at 38
weeks of women receiving HAART
 Postpartum care
 Breast feeding
 Zidovudine syrup- 2mg/kg, is given to the neonate 4
times daily for first 6 weeks of life.
 TORCH INFECTIONS

 Toxoplasmosis
 This is a systemic infection caused by the protozoan
Toxoplasma gondii
 Consequences of fetal infection

 The classic triad of hydrocephalus, intracranial

calcification and chorioretinitis.
 The common manifestations are mental retardation,
seizure disorder, hepatosplenomegaly and central
nervous system (CNS) involvement.
 Management

 Prenatal counselling
 Prevention
 Medications: Pyrimethamine and sulphadiazine
plus folinic acid.
 Rubella

 RNA toga virus

 spread by nasopharyngeal droplets, with an
incubation period of 14- 21 days.
 A disease prodrome of malaise, fever, headache,
conjunctivitis and pharyngitis, lasting 1-5 days,
precedes the classic manifestations of widespread
pink/red maculopapular rash and generalized
lymphadenopathy.
Effect of maternal infection on the fetus
and newborn

 Spontaneous abortion
 Congenital rubella syndrome causing symmetric
IUGR, congenital heart disease, hepato-
splenomegaly and thrombocytopenic purpura.
 CNS manifestations include deafness, eye lesions
such as congenital cataract, retinopathy,
microphthalmia, microcephaly, pan-encephalitis,
brain calcification and psychomotor disorders.
 Management

 Immunization of all adult women.

 Education of parents about the dangers of rubella
infection.
 All pregnant women should be screened for rubella
antibodies at the first prenatal visit.
 Cyto megalo virus

 It is a double stranded DNA virus that belongs to the

herpes virus family. Humans are the only known
hosts of this virus.
 Transmission

 CMV is transmitted through blood via transfusion or

transplacental route commonly and droplet
infection. Body fluids: semen, vaginal secretions,
saliva, urine, breast milk (rare), organ transplant and
rarely through direct contact.
Effect of maternal infection on the fetus
and the newborn

 About 15% of the infants are symptomatic

non-immune hydrops, symmetric IUGR,
hepatosplenomegaly, CNS sequeale like
chorioretinitis, microcephaly, hydrocephaly and
calcifications.
 Almost 85% of infants are asymptomatic
 Management

 Prenatal counselling is highly recommended.

 Drugs such as ganciclovir, forcarnet and cidoforvir.
 Herpes simplex virus

 simplex virus is a member of the herpes virus family.

It is a DNA virus
 Transmission

 Transmission is through intimate mucocutaneous

contact. It is one of the most contagious sexually
transmitted diseases (STDs).
 Significance:

 Spontaneous abortion
 Intra uterine growth retardation
 Fetal death
 Preterm labour
 Neonatal infection
 Neonatal herpes
 Management

 Acyclovir administered 200mg, four times daily for

14 days.
 Topical application of acyclovir cream
 Severe infections : IV administration of Acyclovir 5
mg/kg body weight/ 8 hourly for 5 days.
 HEPATITIS B

 The virus is transmitted by parenteral route,

sexual contact, and vertical transmission and also
through breast milk.
 Maternal infection

 The acute infection is manifested by flu like illness as

malaise, anorexia, nausea and vomiting. There may
be arthralgia and skin rash.
 Diagnosis

 Diagnosis is confirmed by serological detection of

HBsAg (denote high infectivity) and antibody to
hepatitis B core antigen (HBcAg).
 Management

 Rest
 Isolation
 Nutrition
 Drugs
 Prevention of complications
 HUMAN PAPILLOMA VIRUS ( HPV)

 Condylomata acuminate
 Effect in pregnancy

 can grow more rapidly during pregnancy and are

located over the genital tract and the perineal
regions.
 They can grow so large as to cause dystocia and
severe hemorrhage when disruption occurs during
vaginal delivery.
 Management

 Excisions of the lesions by cautery or use of

cryosurgery
 PARASITIC AND PROTOZOAL
INFESTATIONS

 MALARIA
 Effects of malaria on the mother

 Anaemia
 Hypoglycemia
 Metabolic acidosis
 Jaundice due to hepatic dysfunction
 Renal failure- due to block of renal micro circulation
 Pulmonary edema and respiratory distress
 Convulsions and coma- cerebral malaria
 Effects on the fetus

 Abortion
 Preterm labor
 Pre maturity
 IUGR
 IUFD
 Management

 Prevention from mosquito bites using mosquito nets

and repellents.
 Prophylaxis with chloroquine ( 300mg base) orally
once a week
INTESTINAL WORMS
 CHLAMYDIA

 Organism:
 Chlamydia trachomatis
NURSING MANAGEMENT
 Primary prevention of STI
 Secondary prevention
 Tertiary prevention
 Nursing diagnosis

 Acute pain related to excoriation from scratching

pruritic areas, ulcerations etc.
 Impaired skin integrity related to presence of skin
infections.
 Risk for complications, IUGR; spontaneous abortion;
PROM; preterm labour and fetal death related to
presence of STDs or other infections.
 Risk for fetal or neonatal infections, fetal
malformations and anomalies related to
complications of maternal TORCH or STDs.
 Sexual dysfunction or ineffective sexuality patterns
related to perineal discomfort and prescribed abstinence
during treatment.
 Self esteem disturbance related to the diagnosis of
sexually transmitted disease.
 Ineffective coping related to diagnosis of STDs.
 Knowledge deficit related to disease condition, mode of
transmission, fetal outcome, possible treatment
opportunities etc.
 Fear and anxiety related to the possible fetal outcome
secondary to the infections.
THANK YOU……