Nursing Care to

Promote Fetal and

Maternal Health
San Sebastian College-Recoletos de Cavite
Bachelor of Science in Nursing - Level II
Presented by: Dr. Archie Guitche
Teratogenic
Maternal
Infections
Teratogenic Maternal Infections

● Teratogenic maternal infections involve viral, bacterial, or protozoan

organisms, which cross the placenta from mother to fetus.

● Most infections that may detract from a healthy pregnancy outcome

cause relatively mild, flu-like symptoms in the woman but can have
much more serious effects on a fetus or newborn.
Teratogenic Maternal Infections

● Preventing and predicting fetal injury from an infection is complicated

because when a disease is subclinical (without any symptoms in the
mother), it is difficult to analyze any effect on the fetus.

● When newborns are tested to see if antibodies against the common

infectious teratogenic diseases are present, the test is described
collectively under the umbrella term TORCH, an acronym for
toxoplasmosis, rubella, cytomegalovirus, and herpes simplex virus
Teratogenic Maternal Infections

Toxoplasmosis
● Toxoplasmosis, a protozoan infection, is spread most commonly
through contact with uncooked meat, although it may also be
contracted through handling cat stool in soil or cat litter.
● Instruct pregnant women to avoid undercooked meat and also not to
change a cat litter box or garden in soil in an area where cats may
defecate to avoid exposure to the disease.
Teratogenic Maternal Infections

Rubella (German Measles)

● The rubella virus usually causes only a mild rash and mild systemic
illness in a woman, but the teratogenic effects on a fetus can be
devastating, such as hearing impairment, cognitive and motor
challenges, cataracts, cardiac defects (most commonly patent
ductus arteriosus and pulmonary stenosis), restricted intrauterine
growth (i.e., small for gestational age), thrombocytopenic purpura,
and dental and facial clefts, such as cleft lip and palate.
Teratogenic Maternal Infections

Herpes Simplex Virus (Genital Herpes Infection)

● Genital herpes simplex virus (HSV) is a sexually transmitted
infection spread by intimate contact.
● The virus spreads into the bloodstream (viremia) and, if a woman is
pregnant, can cross the placenta to a fetus, thus posing substantial
fetal risk
Teratogenic Maternal Infections

Cytomegalovirus
● If a woman acquires a primary CMV infection during pregnancy and
the virus crosses the placenta, the infant may be born with severe
neurologic challenges (e.g., hydrocephalus, microcephaly, or
spasticity) or with eye damage (e.g., optic atrophy or chorioretinitis),
hearing impairment, or chronic liver disease.
● The newborn’s skin may be covered with large petechiae (i.e.,
“blueberry- muffin” lesions).
Teratogenic Maternal Infections

Syphilis
● Syphilis, a sexually transmitted infection, is of great concern for the
maternal–fetal population.
● Early in pregnancy, when the cytotrophoblast layer of the chorionic villi
is still intact, the causative spirochete of syphilis, Treponema pallidum,
apparently cannot cross the placenta and damage the fetus.
● When this layer atrophies at about the 16th to 18th week of
pregnancy, however, the spirochete can cross and cause extensive
fetal damage.
Teratogenic Maternal Infections

Syphilis
● If syphilis is detected in the mother and treated with an antibiotic such
as intramuscular benzathine penicillin in the first trimester, a fetus is
rarely affected. If left untreated beyond the 18th week of gestation,
hearing impairment, cognitive challenge, osteochondritis, and fetal
death are possible.
Teratogenic Maternal Infections

Malaria
● Malaria in humans is caused by intraerythrocytic protozoa of the
genus Plasmodium transmitted to humans by the bite of an infected
female Anopheles mosquito.
● Healthcare providers can contact it from infected blood products.
During pregnancy, women can transmit malaria to a fetus.
Immunization in Pregnancy

• IM (3 doses): 0, 1, 6-12 months

Tetanus-diphtheria-
• Booster: every 10 years, or once per
acellular pertussis (TDaP)
pregnancy
(Inactivated vaccine)
• Preferable between 27 to 36 weeks
Influenza Vaccine • IM (1 dose): Once a year.
(Inactivated vaccine) • Preferable from February to June
Hepatitis B • IM (3 doses): 0, 1, 6 months
(Inactivated vaccine) • Booster not routinely recommended
Tetanus Toxoid Schedule
Immunization in Pregnancy

SAFE CONTRAINDICATED
• Rabies vaccine (killed • Measles
virus) • Mumps
• Hepatitis A (pre-/post- • Rubella
exposure) • Varicella
• Pneumococcus • HPV
• Meningococcus
(outbreak)
• Varicella IgG
Teratogenic Maternal Exposures

Potentially Teratogenic Vaccines

● Live virus vaccines, such as measles, human papillomavirus (HPV),
mumps, rubella, and poliomyelitis (Sabin type), are contraindicated
during pregnancy because they may transmit a viral infection to a
fetus
Teratogenic Maternal Exposures

Teratogenic Drugs
● Live virus vaccines, such as measles, human papillomavirus (HPV),
two principles always govern drug intake during pregnancy:
• Any drug or herbal supplement, under certain circumstances,
may be detrimental to fetal welfare. Therefore, during pregnancy,
women should not take any drug or supplement not specifically
prescribed or approved by their obstetric provider.
• A woman of childbearing age should not take any drug other than
one prescribed by a obstetric provider to avoid exposure to a
drug should she become pregnant.
Teratogenic Maternal Exposures

Alcohol
● Evidence confirms that when women consume a large quantity of
alcohol during pregnancy, their babies demonstrate a high incidence
of characteristic congenital craniofacial deformities including short
palpebral fissures, a thin upper lip, an upturned nose, as well as
cognitive impairment fetal alcohol spectrum.
Teratogenic Maternal Exposures

Tobacco
● If used by a pregnant woman, it has been shown to cause fetal growth
restriction.
● In addition, a fetus may be at greater risk for being stillborn and, after
birth, may be at a greater risk than others for sudden infant death
syndrome.
Teratogenic Maternal Exposures

Radiation
● Rapidly growing cells are extremely vulnerable to destruction by
radiation. This makes radiation a potent teratogen to unborn children
because they have such a high proportion of rapidly growing cells.
● The most damaging time for exposure and subsequent damage is
from implantation to 6 weeks after conception (a time when many
women are not yet aware they are pregnant).
● The nervous system, brain, and the retinal innervation are growing
rapidly at this time and so are most affected
Preparation for Labor

Preliminary Signs of Labor

● Lightening
○ In primiparas, lightening, or descent of the fetal presenting part
(usually the fetal head) into the pelvis, occurs approximately 10
to 14 days before labor begins.
○ In multiparas, it is not as dramatic and usually occurs on the day
of labor or even after labor has begun.
Preparation for Labor

Preliminary Signs of Labor

● Increase in Energy
○ This increase in activity is related to a boost in epinephrine
release, which is initiated by a decrease in progesterone
production by the placenta.
○ This additional epinephrine prepares a woman’s body for the
work of labor ahead.
Preparation for Labor

Preliminary Signs of Labor

● Slight Loss of Weight

○ As progesterone level falls, body fluid is more easily excreted
from the body.
○ This increase in urine production can lead to a weight loss
between 1 and 3 lb.
Preparation for Labor

Preliminary Signs of Labor

● Backache
○ Because labor contractions begin in the back, an intermittent
backache stronger than usual may be the first symptom a woman
notices.
Preparation for Labor

Preliminary Signs of Labor

● Braxton Hicks Contractions

○ In the last week or days before labor begins, a woman usually
notices extremely strong Braxton Hicks contractions.
Preparation for Labor
Preliminary Signs of Labor

● Ripening of the cervix

○ Throughout pregnancy, the cervix feels softer than usual to
palpation, similar to the consistency of an earlobe (Goodell’s
sign).
○ At term, the cervix becomes still softer (described as “butter
soft”), and it tips forward.
○ Cervical ripening this way is an internal announcement that labor
is very close at hand.
Preparation for Labor

Signs of True Labor

● Uterine Contractions
○ True labor contractions usually begin in the back and sweep
forward across the abdomen similar to the tightening of a rubber
band.
○ They gradually increase in frequency and intensity over a period
of hours.
Preparation for Labor

Signs of True Labor

● Uterine Contractions
○ Contractions are involuntary and come without warning, their
intensity can be frightening in early labor.
○ The typical time of contractions is 5 minutes apart, but this will
vary depending on a woman’s past and present pregnancy
history.
Preparation for Labor

Signs of True Labor

● Show
○ As the cervix softens and ripens, the mucus plug that filled the
cervical canal during pregnancy is expelled.
○ The exposed cervical capillaries seep blood as a result of
pressure exerted by the fetus.
○ This blood, mixed with mucus, takes on a pink tinge and is
referred to as “show” or “bloody show.”
Preparation for Labor

Signs of True Labor

● Rupture of Membranes
○ Labor may begin with rupture of the membranes, experienced
either as a sudden gush or as a scanty, slow seeping of clear
fluid from the vagina.
○ Early rupture of the membranes can actually be advantageous as
it can cause the fetal head to settle snugly into the pelvis, aiding
cervical dilation and shortening labor.
Preparation for Labor

Signs of True Labor

● Rupture of Membranes
○ A woman should telephone her obstetric provider immediately
when her membranes rupture as two risks are associated with
ruptured membranes: intrauterine infection and prolapse of the
umbilical cord (which could cut off the oxygen supply to the fetus)
Preparation for Labor

Signs of True Labor

● Rupture of Membranes
○ If labor does not spontaneously begin by 24 hours after
membrane rupture and the pregnancy is at term, labor will likely
be induced to help reduce the risk of infection.