CARE OF MOTHER WITH

SUDDEN PREGNANCY
COMPLICATION
WEEK 3 I NUR 192 GROUP 3

Galang┃Galingana┃Gonzales┃Gusi┃Janolino
Lazaro┃Leland┃Lipata
PSYCHIATRIC
DISORDER
Depression, Anxiety, Eating Disorder and
Substance abuse or addiction.
01 DEPRESSION
DEPRESSION
Depression is a feeling of sadness that
occurs for more than a year after the
postpartum period and interferes with the
normal functions of the mother is called
postpartum depression (PPD). It is brought
by the hormonal changes in estrogen,
progesterone, and gonadotropin-releasing
hormone rises and falls.
RISK FACTORS:
Experiences that may put some women at a higher risk for depression can include
● Stressful life events.
● Low social support.
● Previous history of depression.
● Family history of depression.
● Difficulty getting pregnant.
● Being a mom to multiples, like twins, or triplets.
● Being a teen mom.
● Preterm (before 37 weeks) labor and delivery.
● Pregnancy and birth complications.
● Having a baby who has been hospitalized.
● Depression can also occur among women with a healthy pregnancy and birth.
 NURSING MANAGEMENT FOR DEPRESSION

The 2007 NICE clinical guideline on antenatal and postnatal mental health also
provides advice about the management of depression in pregnancy. The key stated
priorities are that women requiring psychological interventions ideally should be
seen for treatment within one month, and not more than three months following
initial assessment. Also, particular attention should be paid to explaining risks
before treatment decisions are made; a relevant suggested list of areas to be
covered is provided, as is a list of considerations for individual antidepressant
medications. In addition, the guideline suggests that for those with mild or
moderate depression, self-help strategies, non-directive counselling at home
(listening visits), or brief cognitive behavioural therapy (CBT) or interpersonal
psychotherapy (IPT) should be considered.
POSTPARTUM
CONCEPT MAP
NURSING CRITICAL ACTIONS:
● Assess the woman’s psychological health even before the delivery.
● Assess her history of illnesses to determine if she needs any counseling prior to
her delivery to avoid postpartum depression.
● Assess the well being of the baby.
● Assist the woman in planning for her daily activities, such as her nutrition
program, exercise, and sleep.
● Recommend support groups to the woman so she can have a system where she
can share her feelings.
● Advise the woman to take some time for herself every day so she can have a
break from her regular baby care.
NURSING CRITICAL ACTIONS:
● Encourage the woman to keep in touch with her social circle as they can also
serve as her support system.
● Initiate Routine Screening for Mental Illness in Pregnant and Postpartum Women
● Have the client be screened for depression through brief screening tool.
● Administer medication such as anti-depressants, as indicated.
● Educate the family about the substance abuse and its effects on the family,
emphasize the need for support, care, and concern towards the client.
● Be aware of screening tools and their institution and state’s policy for drug
testing and reporting.
● Refer client to specialist service for mental health. It should involve a variety of
expert professionals to provide effective individualized care.
NURSING ACTIONS
Untreated depression during pregnancy
can cause problems for your baby, like
premature birth. If you think you're
depressed, tell your provider.
01

02
Certain kinds of counseling can help
prevent depression. If you're at risk
for depression, talk to your provider
about finding a counselor.
NURSING ACTIONS
Having no energy and feeling tired all the time, having
headaches, stomach problems or other aches and pains
that don’t go away, If you’re pregnant and you have any of
these signs or symptoms, or if they get worse, call your
health care provider. There are things you and your
03 provider can do to help you feel better.

04
If you're taking an antidepressant when you
get pregnant, don't stop taking it without
talking to your provider first.
NURSING ALERT
● Certain kinds of counseling can help prevent depression. If you're at risk for depression,
talk to your provider about finding a counselor.
● Untreated depression during pregnancy can cause problems for your baby, like
premature birth. If you think you're depressed, tell your provider.
● If you're taking an antidepressant when you get pregnant, don't stop taking it without
talking to your provider first.
● Having no energy and feeling tired all the time, having headaches, stomach problems or
other aches and pains that don’t go away, If you’re pregnant and you have any of these
signs or symptoms, or if they get worse, call your health care provider. There are things
you and your provider can do to help you feel better.
● If you’re worried about hurting yourself, call emergency services.
COMMUNITY RESOURCES
Healthy People 2020

 Attain high-quality, longer lives free of preventable disease,

disability, injury, and premature death;
 Achieve health equity, eliminate disparities, and improve
the health of all groups;
 Create social and physical environments that promote good
health for all; and
 Promote quality of life, healthy development, and healthy
behaviors across all life stages.
COMMUNITY RESOURCES
FREE ONLINE SERVICES

● NCMH Crisis Hotline: Provides free mental health support. Reach them at 0917-899-USAP (8727) or 7-7-
989-USAP (827).
● ·Philippine Mental Health Association online counseling: Get in touch with them via Facebook Messenger
or through pmhacds@gmailcom / 0917-565-2036.
● Mental Health First Responders Emotional/Peer Support Services – access through their google forms:
https://docs.google.com/forms/d/e/1FAIpQLSdPcWQ9oEKcAHMHQ3aDHJlcGoBH28ihIkJ-
_Cs7UGdsrMIwdQ/viewform

ONLINE TELEMENTAL HEALTH SERVICES

● Mind Care Club: NCR-based network of mental health psychiatrists, psychologists, and counselors
delivering treatment and therapy through video conference online
● Recovery Hub: Cebu-based mental health platform that offers Psychiatric Consultations with licensed
Filipino doctors through video conference online. Contact them at their Facebook page or through landline
at (032) 344 2142.
COMMUNITY RESOURCES
HOTLINES

● New DOH – National Center for Mental Health (NCMH) Crisis Hotlines – 0917 899 8727 (USAP) and (02) 7-
989-8727 (USAP)
● Natasha Goulbourn Foundation (NGF) – (02) 8-804-HOPE (4673), 0917 558 HOPE (4673) or 2919 (toll-free
for GLOBE and TM subscribers).

CLINICS, CENTERS, AND FOUNDATIONS

● PsychConsult Inc. – Located at Cubao, Quezon City. Contact numbers are (02) 8-421-2469 / (02) 8-692-
9844 / 0917 808 0193.
● Philippine Psychiatric Association (PPA) – Located at Ortigas Center, Pasig City. Contact via (02) 635-
9858 or email philpsych.org@gmail.com. Search in their list of PPA Certified Psychiatrists here:
http://philippinepsychiatricassociation.org/psychiatrist/
● Philippine Mental Health Association (PMHA) – HQ located at Quezon City, with chapters at Bacolod-
Negros Occidental, Baguio-Benguet, Cabanatuan-Nueva Ecija, Cagayan de Oro-Misamis Oriental, Cebu,
Dagupan-Pangasinan, Davao, Dumaguete-Negros Oriental, and Lipa-Batangas. Contact through email
pmhacds@gmail.com, or (02) 8-921 4958, (02) 8-921 4959, 0917 565 2036.
COMMUNITY RESOURCES
MENTAL HEALTH SUPPORT GROUPS, PAGES, ADVOCACIES

● Anxiety and Depression Support Philippines

● Baguio Mental Health Support Group
● Be Healed Foundation
● Boxless Society
● Buhay Movement
02 ANXIETY
 DEFINITION

STRESSED & CANNOT GO AWAY CAN BE CLASSIFIED AS:

Anxiety is more than feeling anxious Anxiety disorder

about a specific situation; it occurs when Panic disorder
feelings of being anxious and stressed Obsessive‐compulsive disorder
don’t go away, can’t be controlled easily,
Social anxiety disorder
and come on without any particular
reason. Excessive worry and the stress of Specific phobias, and
anxiety can start to have a serious impact Posttraumatic stress disorder
on your life and your baby’s life. (PTSD).
ANXIETY IN
PREGNANCY
Anxiety, in early pregnancy, results in loss of
fetus and in the second and the third
trimester leads to a decrease in birth weight
and increased activity of the Hypothalamus,
which causes a change in steroidogenes,
destruction of social behavior and fertility
rate in adulthood.
 MANAGEMENT OF ANXIETY
TALK THERAPY
● Talking one-on-one with a
therapist
● Find a support group
● Talking with a social worker or
counselor

PRESCRIPTION MEDICINE
● Always talk to a doctor before
you start taking — or stop taking
— any medicines during your
pregnancy.

OTHER APPROACHES
● Yoga
● Exercise
● Meditation
03 EATING
DISORDERS
EATING DISORDERS
Psychiatric disorders that are characterized by the diminished desire to eat or to gain
weight.

Two Types of Eating Disorder:

1. ANOREXIA NERVOSA - has little to no desire to eat and gain weight

● Characterized by:
○ Refusal to maintain a normal body weight and weight that is 85% or lower
than expected for age and height
○ Intense fear of gaining weight or becoming fat, even when underweight
○ Extreme influence of body weight or shape on self-evaluation
○ Loss of menses for 3 months or never getting menses
● 2 subtypes:
a. Restricting type
b. Binge-eating/purging type
EATING DISORDERS
2. BULIMIA NERVOSA - recurrent episodes of purging after
binge eating
● Defined by:
○ Recurrent episodes of binge eating twice
weekly for 3 months with loss of control
○ Recurrent inappropriate compensatory
behavior in order to prevent weight gain
○ Self-evaluation influenced too much by
body shape and weight
● 2 subtypes:
a. Purging subtype
b. Non-Purging subtype
 IMPACTS OF EATING DISORDERS ON PREGNANCY

Maternal Fetal

• Premature delivery • Low birth weight

• Inadequate or excessive weight • Small-for-gestational-age
gain
• Miscarriage / Stillbirth • Low Apgar scores
• Hyperemesis Gravidarum • Cleft palate
• Delivery by cesarean section
• Fetal abnormalities
• Vaginal bleeding
• Hypertension • Prenatal mortality
• Post episiotomy suture damage
• Breech delivery
 MANAGEMENT OF EATING DISORDERS:

• Educate on the importance of good nutrition and fetal development.

• Provide an explanation of the size, anatomical development, and gestational age of the
fetus that can provide information to the patient that may help her to eat “for the baby,”
with less focus on her own increasing weight.

• Encourage the patient to read materials that connect her nutritional intake with the
growth of the fetus.

• Sensitively inform the patient of the potential harmful effects that eating disorder
behaviors can have on the fetus.
 MANAGEMENT OF EATING DISORDERS:

• Regularly review the health and condition of both mother and the baby.

• Watch for postnatal depression in the postnatal period and for recurrence or
deterioration of the eating disorder.

• Communicate regularly with other specialists and clinicians who may be involved in
treating the patient for the eating disorder or providing care for the pregnancy (e.g.
obstetricians, midwives, psychologists, early childhood nurses)
04
SUBSTANCE
ABUSE /
ADDICTION
 DEFINITION

Addiction is defined by the World Health Organization as “the harmful or hazardous

use of psychoactive substances that leads to dependence syndrome—a cluster of
behavioural, cognitive, and physiological phenomena that develop after repeated
substance use and that typically include a strong desire to take the drug, difficulties in
controlling its use, persisting in its use despite harmful consequences, a higher
priority given to drug use than to other activities and obligations, increased tolerance,
and sometimes a physical withdrawal state.”

Drug addiction during pregnancy and postpartum period is undoubtedly connected to

maternal and fetal morbidity. Maternal drug abuse can affect pregnancy outcomes as
well as childhood health and development.
 SUBSTANCE ABUSE DURING PREGNANCY
Maternal
● Overdose or cardiac arrest.
● Abruptio placenta
● Miscarriage,
● Intra-amniotic infection
● Preeclampsia,
● Septic thrombophlebitis
● Postpartum hemorrhage
Fetal
● Miscarriage and fetal death
● Fetal growth restriction,
● Low-birth weight
● Preterm delivery
● Impaired physical growth and
development,
● Behavioural problems learning
disabilities.
● Neonatal abstinence syndrome
(NAS).
 MANAGEMENT OF SUBSTANCE ABUSE

TRUSTED HEALTHCARE
SUPPORT GROUPS
Women with substance
abuse need to feel safe Use of support groups can
with their providers or provide a compassionate and
they won’t return safe space.

FAMILY FOCUSED AND FINDING SPECIALIZED

NON-STIGMATIZING SUBSTANCE ABUSE
TREATMENT FACILITY
To provide effective and
· Establish trust with
individualized care.
the client, talk to them in
a nonjudgmental
approach.
INFECTIONS
Urinary Tract Infection, Group B strep,
TORCH, STIs and Tuberculosis
01 URINARY TRACT
INFECTION
 Urinary Tract Infection
▪ Most common medical complication in pregnancy.

▪ 95% of UTI occur when bacteria ascend to urethra to the bladder & ascend the ureter to the kidney
(Pyelonephritis)

▪ Etiology:
• (HorSePoTu) - Hormone, Sexual Act, Poop (E.coli), Tummy (uterus presses to the bladder)

▪ Pathogenesis:
• Ureteral dilatation
• Increased bladder volume
• Decreased bladder tone
• Decreased ureteral tone
• Increase in plasma volume
• Glycosuria
• Increase in urinary progestins and estrogens

▪ Risk Factors: Low socioeconomic status, young age, nulliparity, anyone with chronic kidney stones or other
kidney or bladder conditions, people with suppressed immune systems
 Urinary Tract Infection
2 CLASSIFICATION: ASYMPTOMATIC & SYMPTOMATIC
Asymptomatic Bacteriuria Symptomatic: Cystitis Symptomatic: Pyelonephritis

▪ Absence of UTI S/S whose urine culture
satisfies criteria for UTI
▪ UT colonized with significant amounts
of pathogenic bacteria
▪ Pathogen: E.coli (most common),
Klebsiella, Proteus mirabilis & GBS
▪ (+) Screening: Urine culture at 12 to 16
wks. of gestation or at first prenatal visit
▪ Risk of acute pyelonephritis
▪ S/S: frequency, urgency and burning or
painful voiding of small vol. of urine,
nocturia with suprapubic pain and often
low back pain, low grade fever, turbid
urine, pneumaturia
▪ Bladder Infection
▪ Can lead to Pyelonephritis
▪ S/S: may be same as those of cystitis;
include chills, fever, flank pain, colicky
abdominal pain, nausea and vomiting
▪ One or both kidneys become infected
▪ Associated with perinatal complications
such as:
▪ MOTHER
Septicemia
Respiratory distress

▪ FETUS
Low birth weight
Intrauterine fetal death
Premature birth and
Perinatal fetal loss
 MANAGEMENT

• Standard quantitative urine culture should be performed routinely at first antenatal visit.
• Monitor laboratory such as WBC count, urinalysis, bacteria in the urine, urine culture and
sensitivity.
• Monitor increased oral fluid intake (2 to 3 liters a day if no contraindication).
• Changes in urinary pattern such as frequency, urgency, or hesitancy should be monitored.
• Urine characteristics such as the color, concentration, odor, volume, and cloudiness should
monitored.
• Encourage pregnant woman to void often every 2 to 3 hours a day and completely empty the
bladder.
• Take a single urine sample for culture before empiric antibiotic treatment is started.
 MANAGEMENT

• Monitor intake of antibiotics used for the treatment of UTI during pregnancy.
Sulfonamides can only be used early in pregnancy but not near term because they can interfere
with protein binding of bilirubin, which then leads to hyperbilirubinemia in the newborn.
Tetracyclines are contraindicated in pregnancy as they cause retardation of bone growth and
staining of the fetal teeth.
Oral nitrofurantoin and cephalexin are good antibiotic choices for treatment in pregnant women
with asymptomatic bacteriuria and acute cystitis.
Parenteral antibiotic therapy may be required in women with pyelonephritis.
• Complete the whole duration of the antibiotic.
• Given the risks of symptomatic bacteriuria in pregnancy, a urine culture should be performed
seven days after completion of antibiotic treatment as a test of cure.
02 GROUP B
STREPTOCOCCUS
 Group B streptococcus
▪ Most often found in the vagina and rectum - usually causes no harm
▪ Rare and happens to 1 or 2 babies out of 100
▪ GBS is not harmful to mothers; but can affect the baby
▪ How do babies acquire GBS?
• Can be passed from the mother to baby during labor and birth
• Rarely causes infection in the womb before the baby is born (chorioamnionitis) - lead to stillborn
▪ GBS infection may cause: sepsis, pneumonia and/or meningitis. It can also lead to bone infection
(osteomyelitis) and joint infection (septic arthritis).
▪ Risk Factors:
• Had positive GBS swab in the last five weeks
• GBS is detected in urine during pregnancy
• Had a baby before who was infected with GBS
• Labour prematurely or waters break before 37 weeks of pregnancy
• Your waters have been broken for more than 18 hours (prolonged rupture of membranes)
• Have a fever of 38 degrees C or higher during labor.
 Group B streptococcus
Early Onset Late Onset
A baby typically gets sick within 12 to 48 hours A baby gets sick between a week to a few
after birth or up to the first 7 days. Early-onset months after birth; caused by contact with the
disease can cause severe problems, such as: mother after delivery if she is infected and/or
• Inflammation of the covering of the brain or contact with other people who have GBS. Can
spinal cord (meningitis) cause meningitis. Signs and symptoms include
• Infection of the lungs (pneumonia) the following:
• Infection in the blood (sepsis) • Lack of energy
• Irritability
• Poor feeding
• High fever
 MANAGEMENT

▪ Administer antibiotics such as penicillin, cefazolin, clindamycin, or vancomycin if a newborn

displays signs of infections or a blood screening test that is positive against GBS organism.

▪ Educate the parent on why the infant could suddenly become ill, and how to care for an infant
with GBS infection.

▪ Teach women of childbearing age about the importance of immunization against

streptococcal B organisms which could decrease the incidence of newborns infected at birth.

▪ Teach the mother about common signs and symptoms of late-onset GBS (fever, irritability,
poor feeding). Advice mother to call healthcare provider if she detects any of these signs and
symptoms.
 Sexually Transmitted Infections (STIs)
Sexually transmitted infections (STIs) are also called sexually transmitted diseases, or STDs. STIs
include chlamydia, gonorrhea, trichomoniasis, genital herpes, genital warts, HIV, and syphilis.

• Generally acquired by sexual contact. The organisms (bacteria, viruses or parasites) that cause
sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and
other bodily fluids
• Some STIs can pass from mother to baby during pregnancy and through breastfeeding.

Having an STI during pregnancy can cause:

▪ Premature labor (labor before 37 weeks of pregnancy). Early (preterm) birth is the number one
cause of infant death and can lead to long-term developmental and health problems in children.
▪ Infection in the uterus (womb) after birth.
 The Effects of STDs During Pregnancy

Chlamydia • Untreated chlamydial infection has been linked to problems during pregnancy, including
preterm labor, premature rupture of membranes, and low birth weight.

• The newborn may also become infected during delivery as the baby passes through the birth
canal.

• Exposed newborns can develop eye and lung infections.

• Untreated gonococcal infection in pregnancy has been linked to miscarriages, premature birth
Gonorrhea and low birth weight, premature rupture of membranes, and chorioamnionitis.

• Gonorrhea can also infect an infant during delivery as the infant passes through the birth
canal.
• If untreated, infants can develop eye infections

Trichomoniasis • Infection in pregnancy has been linked to premature rupture of membranes, preterm birth, and
low birth weight infants.
 The Effects of STDs During Pregnancy

Herpes Simplex Virus ∙ Transmission may occur during pregnancy and after delivery.

∙ The risk of transmission to the neonate from an infected mother is high.

Human ∙ Passes from mother to child are during pregnancy, labor, and delivery, or through
Immunodeficiency breastfeeding.
Virus

Syphilis ∙ May be transmitted to a baby by an infected mother during pregnancy.

∙ Can lead to a serious multisystem infection, known as congenital syphilis.
∙ Been linked to premature births, stillbirths, and, in some cases, death shortly after
birth.
∙ Develop problems in multiple organs, including the brain, eyes, ears, heart, skin,
teeth, and bones.
 MANAGEMENT

GONORRHEA
● One intramuscular injection of ceftriaxone (Rocephin) plus 7 days of oral doxycycline (Vibramycin) or
azithromycin (Zithromax) is the current recommended therapy because this treatment regimen is
effective for gonorrhea, chlamydia, and syphilis.
● Sexual partners should receive the same treatment.

SYPHILIS
● Benzathine penicillin G, given intramuscularly in two sites, is effective therapy.
● For the adolescent who is sensitive to penicillin, either oral erythromycin or tetracycline can be given
for 10 to 15 days.
● Sexual partners are treated in the same way as the person with an active infection.
● Therapy effectively arrests the disease at whatever stage it has reached.
● Be certain adolescent are screened for all STIs with both a history and a physical examination, and
that sexuality is discussed at healthcare visits.
 MANAGEMENT

HPV
● The vaccines, Gardasil or Cervarix, are recommended as part of routine administration to
both early teenage girls and boys to prevent such infections.
● Approach the subject of immunization with parents and teenagers with sensitivity
because some parents and children are not ready to admit they might be or will soon
become sexually active and need this protection.
● Podophyllum is contraindicated during pregnancy because of possible toxic effects on
the fetus.
● Trichloroacetic acid (TCA) or bichloroacetic acid (BCA) applied to the lesions weekly
may be effective and can be used during pregnancy.
● The presence of vulvar lesions appears to have no effect on the fetus during pregnancy,
but if they are so large, they obstruct the birth canal for birth, a cesarean birth may be
scheduled.
 MANAGEMENT
HIV/AIDS

● Women who are identified as HIV positive need education about reproductive life planning so they can
effectively prevent pregnancy if they so desire.
● Progression of the disease is assessed by frequent CD4 cell counts and viral load levels during the
pregnancy.
● Maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral zidovudine, which
helps to dramatically halt maternal–fetal transmission along with one or more PIs, such as ritonavir
(Norvir) or indinavir (Crixivan), in conjunction with an NRTI.
● If Pneumocystis pneumonia develops, a woman is treated with TMP-SMZ
● Kaposi sarcoma is normally treated with chemotherapy.
● Thrombocytopenia (low platelet counts) may be present as a part of HIV disease pathology or as a
response to zidovudine therapy. Women may need a platelet transfusion close to birth.
● To reduce the risk of mother-to-newborn transmission, affected women should be offered the option of
a cesarean birth.
● Follow-up testing of newborns being treated with zidovudine for the first 6 weeks of life is important.
04 TUBERCULOSIS
 Tuberculosis
▪ Infectious disease in the lungs. ▪ Risk factors:
▪ Pathogen: Mycobacterium tuberculosis (MTB) • Positive family history or past history.
▪ Transmission: aerosol from infected individuals when • Low socioeconomic status.
s/he cough, sneeze, sing, or speak; respiratory • Area of high prevalence of tuberculosis.
droplets persist in the air for hours • HIV infection.
• Alcohol addiction.
• Intravenous drug abuse

EFFECT OF TB ON PREGNANCY

MOTHER FETUS
▪ Pregnant women with untreated TB are more likely ▪ Underweight infant
to have: ▪ Low APGAR score
▪ Pre- eclampsia ▪ Perinatal death
▪ Spontaneous abortion ▪ IUGR
▪ Preterm labour ▪ Preterm labour.
▪ Difficult labour and PPH. ▪ New born babies are at risk of postnatally acquired
▪ Intrauterine fetal death. TB if mother has still TB at the time of birth.
▪ Anemia
 MANAGEMENT

• Review the woman's history for risk factors such as immuno-compromised status, recent
immigration status, homeless, overcrowded living conditions, and injectable drug use.
• At antepartum visits, be alert for clinical manifestation of TB including fatigue, fever or night sweats,
nonproductive cough, slow weight loss, anemia, hemoptysis, and anorexia.
• If the TB is suspected or the woman is at risk for developing TB, anticipate screening with purified
protein derivative (PPD) administered by intradermal injection.
• If the client has been exposed to TB, a reddened induration will appear within 72 hours.
• If the test is positive anticipate a follow up chest x-ray with lead shielding over the abdomen and
sputum culture to confirm the diagnosis.
• Complaining with the multidrug therapy is critical to protect the woman and her fetus from
progression of TB.
 MANAGEMENT

• Provide education about the disease process, the mode of transmission, prevention,
potential complications, and the importance of adhering to the treatment regimen.
• Stressing the importance of health promotion activities throughout the pregnancy is
important. Some suggestion might include:
▪ Avoiding crowded living conditions.
▪ Avoiding sick people.
▪ Maintaining adequate hydration.
▪ Eating a nutritious well-balanced diet.
▪ Keeping all prenatal appointments to evaluate fetal growth and wellbeing.
▪ Getting plenty of air by going outside frequently.
 MANAGEMENT

• Determining the woman's understanding of her condition and treatment plan is important
for compliance.
• Breastfeeding is not contraindicated during the medication regimen and should be
encouraged
• Management of the newborn of a mother with TB involves preventing transmission by
teaching the parent not to sneeze, cough or talk directly into the newborns face.
05 TORCH SYNDROME
 TORCH SYNDROME
• A group of viral, bacterial, and protozoan infections that gain access to the fetal blood
stream transplacentally via the chorionic villi.

• (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles),

(C)ytomegalovirus, and (H)erpes Simplex.
 TOXOPLASMOSIS
• Caused by protozoan intracellular parasite- • Most women are asymptomatic.
toxoplasma gondii • Effects to MOTHER
• Modes of Transmission • Only about 10% of women have s/s during acute
• Feco-oral route infection-
• By eating infected raw or cooked meat • Lymphadenopathy- indicates recent infection,
• Contact with infected cat faeces. these are generally non tender, and
• Or through placenta. nonsuppurative.
• Oocytes >> Sporophytes >> Trophocytes • Other symptoms are flu like illness such as:
• Fetal death higher with infection in 1st trimester
• Infection rate is higher with infection in the 3rd • Fever
trimester. • Fatigue,
• Headache
• Risk of fetal infection • Muscle pain,
• 1st trimester- 15% ( decreases the incidence • Sore throat
of infection but serious diseases are
common, including abortion).
• 2nd trimester- 25%
• 3rd trimester- 65% ( 90% newborns are
without clinical signs of infection.)
 TOXOPLASMOSIS

Severe and rare symptoms are:

• Polymyositis
• Dermatomyositis
• Chorioretinitis
• Effects to INFANT
• At the risk of developing congenital toxoplasmosis
• Chorioretinitis
• Hydrocephalus
• Intracranial calcification

Other symptoms
• Fever
• Rash
• Microcephaly
• Seizures
• Jaundice
• Thrombocytopenia
• Lymphadenopathy
 OTHER AGENTS
 Congenital syphilis
• Sexually Transmitted Disease
• Occurs when an infected mother transmit it to
the infant.
 MOTHER
• May cause stillbirth or miscarriage
• Primary Stage
• Ulcer or sore around their genitals or
mouth (3–12 weeks after infection) -
usually painless and doesn’t bleed
• Sores can heal and disaappear but a
mother is still infected.
• Secondary Stage
• Two to six months after getting infected, people
can develop a rash (on the face, palms and soles
of the feet), swollen glands, warts or lumps
(around genitals, anus, mouth), and hair loss.
• Latent and tertiary stages
• Latent: no physical signs, but can still pass to
pass to the baby.
• Tertiary: no treatment for two years; affects the
brain, heart, large blood vessels, the spinal cord,
skin and bones. And can lead to permanent
physical and intellectual disability, and death.
 OTHER AGENTS

 INFANT  Varicella zoster virus

• The child born with congenital syphilis may
have:
• Skin rashes
• Enlarged lymph nodes
• Tiny red spots under the skin due to
bleeding from tiny blood vessels
• Perforation in the upper palate
• Hearing loss
• Bleeding gums
• Widely spaced small teeth
• Can damage the baby’s vital organs including the
liver, brain, spinal cord and skin (rashes, warts or
lumps).
• It can also affect bone and muscle development.
• VZV is a member of herpes virus family
• Can cause chickenpox (varicella) and/or
shingles (herpes zoster)
• Highly contagious and spreads easily from
one person to another
• Mode of Transmission
• Touching a surface contaminated with the
droplets
• Inhaling the droplets when an infected person
coughs or sneezes
• Varicella
• Causes an itchy, blister-like rash on the skin
• Fever, fatigue, and headache
 OTHER AGENTS

• Herpes zoster
 Effects to Mother
• Painful rash with blisters
• Less severe than varicella • Approximately 10 to 20 percent of those infected
• Doesn’t spread from one person to another with varicella develop pneumonia, a severe lung
• When gets infected from shingles blisters - infection.
person who did not infected with chickenpox • Encephalitis, or an inflammation of the brain
before will develop chickenpox instead tissue, may also occur in a very small number of
pregnant women with varicella.
• Other symptoms of herpes zoster may include:
 Transmission of Varicella from Mother to Infant
• A fever
• General discomfort
• A pregnant mother can transmit varicella to her
• Muscle aches
baby via the placenta.
• A headache
• The baby may also contract congenital varicella
• Swollen lymph nodes
if delivery occurs while the mother is still
• Upset stomach
infected and hasn’t yet developed antibodies to
the virus.
 OTHER AGENTS
• Effects to FETUS
• First 12 weeks - 0.5 to 1 percent risk of
developing a rare birth defect known as
congenital varicella syndrome
• Congenital varicella syndrome: underdeveloped
arms and legs, eye inflammation, and incomplete
brain development
• Between weeks 13 and 20 - the baby has a 2
percent risk of having birth defects.
• If varicella develops within five days or within
one to two weeks after delivery, the baby might
be born with a potentially life-threatening
infection called congenital varicella.
 HIV (Human Immunodeficiency Virus)
• HIV (Human Immunodeficiency Virus) is a virus
that causes AIDS (Acquired Immunodeficiency
Syndrome).
• A person may be “HIV positive” but not have
AIDS.
• An HIV infected person may not develop AIDS for
10 years or longer.
• Mode of Transmission
• Infected blood, semen or vaginal fluids come in
contact with broken skin or mucous membranes
 OTHER AGENTS

• Transmission of HIV from Mother to Infant • Effects to Pregnancy

• During pregnancy, HIV can pass through the • More likely to experience complications like
placenta and infect the fetus. preterm birth, intrauterine growth restriction
and stillbirth (more common in developing
• During labor and delivery, the baby may be countries)
exposed to the virus in the mother’s blood and
other fluids. When a woman goes into labor, the
amniotic sac breaks (her water breaks). Once
this occurs, the risk of transmitting HIV to the
baby increases. Most babies who get HIV from
their mothers become infected around the time
of delivery.

• Breastfeeding also can transmit the virus to the

baby.
 RUBELLA
• German measles/ three-day measles; contagious
viral infection
• Causative Agent: Rubella virus; virus multiply in
the cytoplasm of infected cell
 Mode of Transmission:
• Person to person - via respiratory route
droplet from nose and throat
droplet nuclei (aerosols)
maintain in human transmission
through chain
infection
• Acquired during pregnancy - vertical
transmission
virus can enter via placenta and infect
the fetus in utero
Rubella Pathogenesis:
 Respiratory transmission of virus
 replication in nasopharynx and regional lymph
nodes
 viremia (virus enter bloodstream) 5-7 days after
exposure with spread to tissues
 placenta and fetus infected via hematogenous
spread during viremia.
Rubella in Trimesters:
 1st trimester - abnormalities in 85% of cases;
greater damage in organs
 2nd trimester - leads to defects in 16%
 greater than 20 weeks - fetal defects uncommon
 3rd trimester - infants not generally affected
 RUBELLA
Complications:
• Rubella in first few months of pregnancy/first  Congenital Rubella Syndrome:
trimester = higher chance of causing severe • Greatest in first 16 weeks of pregnancy
damage to developing baby. • Mother passes rubella to baby during pregnancy
• May cause one or more birth defects including:
Signs and Symptoms: • Heart problems
• Flu-like symptoms followed by rash • Microcephaly
(lasts about three days) • Vision problems
• Hearing problems
• Flu-like symptoms: • Intellectual disability
• Low-grade fever • Bone problems
• Headache • Growth problems
• Runny nose • Liver and spleen damage
• Red eyes
• Swollen glands  Miscarriage
• Muscle/joint pain Baby dies in uterus 20 weeks of pregnancy
 Stillbirth
Baby dies in uterus after 20 weeks of pregnancy
 Premature birth
Early birth, before 37 weeks of pregnancy
 CYTOMEGALOVIRUS
• Cytomegalovirus, or CMV, is a common and
usually harmless virus that can infect people of all
ages.
• The CMV virus is only harmful to pregnancy when
it is active. This is usually:
• When you catch it for the first time
• If it is reactivated (because you have a weakened
immune system)
• If you have been infected again by a different strain
of CMV
• Mode of Transmission
• CMV is usually passed on through bodily fluids,
such as urine, saliva, blood, mucus and tears.
 Effects to Mother
Mild symptoms:
• Fever, sore throat, fatigue and swollen glands.
Effects to Infant/Fetus
 Once the baby is born, most will not show any signs
of CMV at birth and will go on to have no problems
at all.
 Around 1 in 7 babies who have caught congenital
CMV will go on to develop a hearing loss over time.
 They could also have developmental or learning
difficulties, but this is very rare.
• Microcephaly (a small head), little red spots
(petechiae), jaundice, enlarged liver and spleen,
hearing loss and calcium deposits in the brain.
 Some also develop problems such as physical
impairments, seizures, Attention Deficit Hyperactivity
Disorder (ADHD), autism, developmental delay or visual
impairment.
 HERPES SIMPLEX
• Sexually Transmitted Disease
• The herpes simplex virus causes a variety of
infections, characterized by dormant periods with
no symptoms and sporadic outbreaks of red,
itchy, painful blisters.
Effect on to the Mother
• 2 Types of Herpes Simplex: genital herpes and
oral herpes (also called cold sores or fever
blisters)
• Type 1 (HSV-1) infections are most often found
on the mouth, while type 2 (HSV-2) infections
tend to occur in the genital area.
• Fever, sore throat, fatigue and swollen glands.
• Mode of Transmission
• A person can contract herpes when broken skin
or their mouth, penis, vagina, or anus come into
contact with the virus.
• The virus can be contagious even when visible
symptoms are absent and can be transmitted via
saliva and viral shedding from tissue that
appears healthy.
• Transmission of Herpes Simplex from the Mother to the
Infant
• The overall risk is low that a mother with herpes
will transmit the virus to their child via childbirth,
as long as they are not experiencing an active
outbreak at the time of delivery.
 HERPES SIMPLEX
• The specific risk of transmitting the herpes
simplex virus to a baby depends on several
factors:
• Exposure of the infant to herpes lesions during
delivery.
• Whether the mother has antibodies to the
herpes simplex virus.
• Whether the infant has time to acquire these
antibodies before delivery.
• Fever, sore throat, fatigue and swollen glands.
• Effect on the Infant
• A primary or recurrent HSV-1 infection during labor is
more easily transmitted to the infant but the disease
is generally limited to the mouth, eyes, and mucous
membranes.
• Primary infection with HSV-2 is more likely to affect
the central nervous system, causing seizures,
meningitis, developmental delay, and death.
• Signs of HSV infection in babies include low-grade
fever, rash or blisters, poor feeding, seizures, and
lethargy. Symptoms can begin two to 12 days after
exposure, and the illness can worsen quickly.
 MANAGEMENT:
MANAGEMENT: TOXOPLASMOSIS

• Treatment of toxoplasmosis in the infected pregnant women is variable, depending on

maternal immune status, gestational age, and presence of fetal infection.

• Spiramycin can be obtained from the Food and Drug Administration to treat laboratory
confirmed acute maternal infection.

• If fetal infection is documented, a combination of pyrimethamine, folic acid, and a

sulfonamide (usually sulfadiazine) is recommended.

• Prepare for termination of pregnancy or labor induction.

 MANAGEMENT:
MANAGEMENT: OTHER AGENTS

CONGENITAL SYPHILIS

• Benzathine penicillin G is given intramuscularly in two sites, this is an effective

therapy against congenital syphilis.

• For the adolescent who is sensitive to penicillin, either oral erythromycin or

tetracycline can be given for 10 to 15 days.

• One injection of benzathine penicillin G is the drug of choice for the treatment of
syphilis during pregnancy the same as for those who are not pregnant.

• If the woman has syphilis, her infant needs penicillin therapy at birth as well.
 MANAGEMENT:
MANAGEMENT: OTHER AGENTS

VARICELLA ZOSTER
• The first nursing action is to decrease scratching to reduce infection by applying
oatmeal-based creams along with an antihistamine such as diphenhydramine
(Benadryl) which can reduce pruritus, and an antipyretic such as acetaminophen
(Tylenol) which can reduce fever.

• In high-risk patients (such as those on steroids or chemotherapy and those who are
immunodeficient or older than 13 years of age), acyclovir (Zovirax), an antiviral, may be
prescribed to reduce the number of lesions and shorten the course of the illness.

• During hospitalization due to a complication of varicella infection, standard infection

precautions along with airborne and contact precautions are adhered to until all lesions
are crusted.
 MANAGEMENT:
MANAGEMENT: OTHER AGENTS

HIV
• Women who are identified as HIV positive need education about reproductive life
planning so they can effectively prevent pregnancy if they so desire.

• Progression of the disease is assessed by frequent CD4 cell counts and viral load levels
during the pregnancy.

• Maintain the CD4 cell count at greater than 500 cells/mm3 by administering oral
zidovudine, which helps to dramatically halt maternal–fetal transmission along with
one or more PIs, such as ritonavir (Norvir) or indinavir (Crixivan), in conjunction with an
NRTI.

• If Pneumocystis pneumonia develops, a woman is treated with TMP-SMZ .

• Kaposi sarcoma is normally treated with chemotherapy.

 MANAGEMENT:
MANAGEMENT: OTHER AGENTS

HIV

• Thrombocytopenia (low platelet counts) may be present as a part of HIV disease

pathology or as a response to zidovudine therapy. Women may need a platelet
transfusion close to birth.

• To reduce the risk of mother-to-newborn transmission, affected women should be

offered the option of a cesarean birth.

• Follow-up testing of newborns being treated with zidovudine for the first 6 weeks of life
is important.
 MANAGEMENT:
MANAGEMENT: RUBELLA

• Pregnant woman with a positive rubella screen should be immediately referred to a fetal medicine
specialist for counselling and further management.

• There is no treatment for rubella; supportive care should be offered.

Isolation and quarantine.
Increase fluid intake.
Rest and good ventilation.

• Antipyretics can be given for fever.

• Passive immunization using immunoglobulin is not recommended. May be treated with antibodies
called hyperimmune globulin that can fight off the virus or to help reduce symptoms.

• Droplet precautions are recommended for 7 days after the onset of the rash.

• Counsel pregnant woman regarding maternal fetal transmission and Offred pregnancy termination. .
 MANAGEMENT:
MANAGEMENT: CYTOMEGALOVIRUS

• Antiviral treatment has not been offered to pregnant women with CMV infection.

• Prenatal treatment of the pregnant mother with CMV hyperimmune globulin (CMV
enriched antibody) may reduce the transmission of CMV to the fetus and reduce or
reverse some of the effects of CMV on the fetus.

• Simple hygiene‐based measures that have been shown to reduce the risk of CMV
acquisition.
• Thorough handwashing before eating and avoiding crowds.

• Educating women with young children or who work with young children that they
are at increased risk and that attention to hygiene will help prevent
cytomegalovirus (CMV) transmission.
 MANAGEMENT:
MANAGEMENT: CYTOMEGALOVIRUS

• Counseling regarding the stage of infection and gestational age, understanding that
most fetuses develop normally.

• Counselling regarding pregnancy termination may be an option in rare cases, especially

in the face of abnormal ultrasound findings.

• Pregnant women should be urged to adopt safe sexual practices.

 MANAGEMENT:
MANAGEMENT:HERPES

• Suspected genital herpes should be referred to a genitourinary medicine physician who

will confirm or refute the diagnosis.

• Symptomatic first episode HSV infection during pregnancy can be treated with systemic
acyclovir, valacyclovir, or famciclovir for 7 days.

• Severe recurrent disease may also benefit from antiviral therapy, but mild recurrent
disease will not.

• Acyclovir or valacyclovir therapy in the latter part of pregnancy (36 weeks’ gestation until
delivery) has been shown to decrease HSV outbreaks at term, decreasing the need for
cesarean delivery.

• Paracetamol and topical lidocaine 2% gel can be offered as symptomatic relief.

 MANAGEMENT:
MANAGEMENT:HERPES

• Woman with a known history of HSV infection should be questioned regarding prodromal
symptoms (vulvar itching, burning) and recent HSV lesions.

• A careful examination of the vulva, vagina, and cervix should be performed for herpetic
lesions.

• Counsel woman regarding possible cesarean delivery as women with any evidence of
prodromal or active HSV infection should be offered a cesarean delivery.

• Women known to be HSV seropositive at her first prenatal visit should be counseled
regarding safe sexual practices and counseled to avoid intercourse with a partner known
or suspected of having HSV, particularly in the third trimester.
TORCH SYNDROME
CONCEPT MAP
 CRITICAL NURSING ACTION
TOXOPLASMOSIS
 Determine whether the baby also is infected.
Amniocentesis and ultrasound scan may
recommend.
 In cases of fetal infection is confirmed,
Pyrimethamine and sulfadiazine are administered.
 Monitor the use of Pyrimethamine which can
cause dose-related suppression of the bone
marrow.
 Monitor side effects of Spiramycin such as nausea
or rashes.
 Monitor the effects of toxoplasmosis in pregnancy
such as flu or glandular fever, sometimes
including swollen lymph nodes.
RUBELLA
 Assess hygienic practices to prevent the spread
of the disease.
 Detailed ultrasound examination and assessment
of AF viral RNA are recommended, particularly for
infections occurring between 12 and 18WG.
 Specific pediatric examination of the newborn
and testing for RV-IgM are recommended for
infection after 18WG.
 Monitor isolation precautions to decrease
transmission.
 Monitor the effects of rubella in pregnancy such
as low-grade fever and mild cold-like symptoms
followed by a rash.
 CRITICAL NURSING ACTION

CYTOMEGALOVIRUS HERPES

 Monitor antiviral therapy to women with a clinical

 Determine whether the baby also is infected.
history of genital herpes and for primary
Amniocentesis and ultrasound scan may
outbreaks that occur in the third trimester.
recommend.
 If severe genital HSV infection, intravenous
 Assess hygienic practices to prevent the administration of acyclovir may be beneficial.
spread of the disease.
 Monitor use topical steroids (anti-inflammatory
 Monitor the effects of cytomegalovirus in effect), antihistamines (anti-itching effect).
pregnancy such as fever and fatigue.
 Monitor pruritus or irritations from the lesions,
amount of scratching, redness, and drainage from
the lesions.

 Assess patient for flu-like symptoms, and low-

grade fever, lymph nodes in the groin and blister.
 To prevent risk of toxoplasmosis, teach patient the following:

 Cook food to safe temperatures.

 Freeze meat for several days at sub-zero (0° F) temperatures
before cooking to greatly reduce chance of infection.
 Peel or wash fruits and vegetables thoroughly before eating.
 Wash cutting boards, dishes, counters, utensils, and hands with

TOXOPLASMOSIS soapy water after contact with raw meat, poultry, seafood, or
unwashed fruits or vegetables.
 Do not eat raw or undercooked oysters, mussels, or clams.
NURSING ALERT  Wear gloves when gardening and during any contact with soil or
sand because it might be contaminated with cat feces that
contain Toxoplasma.
 Feed cats only canned or dried commercial food or well-cooked
table food, not raw or undercooked meats.
 Ensure that the cat litter box is changed daily.
 Keep cats indoors to prevent them from hunting and reduce the
chances they will become infected with Toxoplasma.
 To prevent the risk of developing rubella, teach patient the
following:

 Women who are planning to become pregnant should check

with their doctor to make sure they are vaccinated before they
get pregnant.
 Because MMR vaccine is an attenuated (weakened) live virus
RUBELLA vaccine, pregnant women who are not vaccinated should wait
to get MMR vaccine until after they have given birth.
NURSING ALERT  Adult women of childbearing age should avoid getting
pregnant for at least four weeks after receiving MMR vaccine.
 Pregnant women should NOT get MMR vaccine.
 If a patient get rubella or are exposed to rubella while they are
pregnant, contact doctor immediately.
 Pregnant women are recommended to take steps to reduce their
risk of exposure to CMV and so reduce the risk of their
developing baby becoming infected by:

 Wash hands often with soap and running water for at least 15
seconds and dry them thoroughly.
CYTOMEGALOVIRUS  Do not share food, drinks, eating utensils or toothbrushes with
young children.
NURSING ALERT  Avoid contact with saliva when kissing a child.
 Use simple detergent and water to clean toys, countertops and
other surfaces that come into contact with children's urine,
mucous, or saliva.
 To reduce the risk of complication during pregnancy, patients
who are at risk of having herpes simplex should:

 Inform their healthcare provider.

HERPES SIMPLEX  Take anti-herpes medication towards the end of their
pregnancy.
NURSING ALERT
 If a woman has herpes sore at delivery, a ‘C-section’ is usually
performed.

COMMUNITY RESOURCES
Community Resources are assets
in a community that help meet
certain needs for those around
them. These assets can be
people, places or structures, and
community services.
 General
National Safe Motherhood Program
• For Filipino women to have full access to health
services towards making their pregnancy and
delivery safer
• https://doh.gov.ph/national-safe-motherhood-
program
 Tuberculosis
National Tuberculosis Tb Control Program
• To reduce TB burden (TB incidence and TB
mortality)
• To achieve catastrophic cost of TB-affected
households
• To responsively deliver TB service
• https://doh.gov.ph/national-tuberculosis-control-
program
 STI
Department of Health (HIV/STI Prevention
Program)
• Philippine National AIDS Council (PNAC)
• STI/AIDS Cooperative Central Laboratory
(SCCL)
• AIDS Society of the Philippines (ASP)
• Affiliation Against AIDS in Mindanao
(ALAGAD-Mindanao)

• https://doh.gov.ph/national-hiv/sti-
prevention-program
THANK YOU!
References

Pillitteri, Adele. (2010). Maternal & Child Health Nursing : Care of the Childbearing &
Childrearing Family (Edition 6). Philadelphia: Wolter Kluwer.

Bouthry, E., Picone, O., Hamdi, G., Grangeot‐Keros, L., Ayoubi, J., & Vauloup‐Fellous, C.
(2014, September 16). Rubella and Pregnancy.
from https://obgyn.onlinelibrary.wiley.com/doi/pdf/10.1002/pd.4467Cytomegalovirus in
pregnancy. (n.d.).

https://glowm.com/resources/glowm/cd/pages/v3/v3c045.htmlManagement of genital
herpes in Pregnancy: ACOG practice.: Obstetrics & Gynecology. (n.d)

https://journals.lww.com/greenjournal/Fulltext/2020/05000/Management_of_Genital_Herp
es_in_PregnancyPreventing congenital toxoplasmosis. (n.d.).,
from https://www.cdc.gov/mmwr/preview/mmwrhtml/rr4902a5.htm