Transcript N107 Essentials of Nursing Care: Reproductive Health

N107 Essentials of
Nursing Care:
Reproductive Health
Chapter 3: Needs of the
Childbearing Family:
Antepartal
Chapter Objectives
Understand the S&S of Pregnancy
 ID the physiological changes that take
place during pregnancy
 Know the discomforts of pregnancy and
know appropriate interventions to help with
discomforts
 Describe psychosocial changes in the
expectant family

Chapter Objectives
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Know what a nurse could tell a patient to
promote self-care during pregnancy
Know when a pregnancy is at risk due to chronic
health problems
Be knowledgeable of different medications used
during pregnancy
Be familiar with diagnostic tests and possible
medical interventions used during pregnancy
Be knowledgeable about the process of
conception and implantation
Chapter Objectives
Know about embryonic/fetal development
 Understand the details and importance of
the umbilical cord and placenta
 Describe factors that influence fetal growth
and well-being
 Be knowledgeable of diagnostic test used
during pregnancy

Signs and Symptoms of Pregnancy

Antepartal – beginning of pregnancy to beginning of labor

Pregnancy made possible by the hypothalamic stimulation of the anterior
pituitary hormones: follicle stimulating hormone (FSH), which stimulates
follicle growth within the ovary, and luteinizing hormone (LH) which affects
ovulation

3 categories of S&S of pregnancy
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Presumptive – those felt by the woman
Probable – those changes observed by the examiner
Positive Signs – those signs credited only to the presence of the fetus
Presumptive and probable could have other causes for their
occurrences.
Positive signs are completely objective and cannot be caused by
other pathologic states
Signs and Symptoms of Pregnancy

Presumptive Signs
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Referred to as subjective
Earliest is usually amenorrhea (in those with regular cycles)
Morning sickness (can occur any time during day)

Due to elevated hCG levels and changed CHO metabolism
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hCG is biological marker on which all pregnancy test are based
hCG can be detected in the blood as early as 6 days after conception
(or about 20 days since LMP)
hCG secreted by trophoblast (outer layer of uterus)
Excessive fatigue
Urinary frequency



Enlarging uterus putting pressure on bladder
Symptoms decrease during 2nd trimester as uterus becomes an
abdominal organ
Reappears during 3rd trimester as fetus descends into pelvic region
Signs and Symptoms of Pregnancy

Presumptive Signs (Cont’d)
 Breast
changes (enlargement, tenderness &
tingling)
May occur prior to missing 1st menses
 Growth due to hormones and growth of secretory
ductal system. Tenderness and tingling most
noticeable around nipple area

 Quickening
(fetal movements)
Week 14 – 16 in a multigravida woman
 Week 18 or later in primagravida woman

Signs and Symptoms of Pregnancy

Probable Signs (Objective)
 Observed through inspection or palpation
 Changes in pelvic organs caused by increased
vascular congestion

Only physical signs detectable with the first 3 months of
pregnancy
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Goodell’s sign – softening of cervix
Chadwick’s sign – deep red to purple bluish coloration of the
mucous membranes of cervix, vagina and vulva
Hegar’s Sign – softening and compressibility of the lower
uterine segment
McDonald's Sign – easy flexion of the fundus on the cervix
Braun von Fernwald’s Sign – Softening and slight fullness of
the fundus near the area of implantation
Piskacek’s Sign – a soft lateral bulge with corneal implantation
Signs and Symptoms of Pregnancy

Probable Signs (Cont’d)
 Ultrasound

Uterine soufflé (bruit) – sound of maternal blood
flowing through uterine arteries to placenta
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
Synchronous with maternal pulse
Funic soufflé – caused by fetal blood coursing
though the umbilical cord
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
or fetal stethoscope
Synchronous with fetal heart tone
Fetal heart tone – actual heartbeat of fetus
Signs and Symptoms of Pregnancy

Other manifestations
 Facial chloasma, melasma (mask of pregnancy)
 Blotchy, brownish hyperpigmentation of the skin over cheeks,
nose & forehead
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Accentuated by sun exposure
nigra – pigmented line down midline of
abdomen
 Striae gravidarum – stretch marks
 Linea
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Abdomen & buttocks
Ballotment – examiner pushes up against cervix with
2 fingers to elicit a passive rebound fetal movement.
ID’d between week 16 - 18
Signs & Symptoms of Pregnancy

Positive signs of pregnancy (definitive)
 Visualization

of fetus via US
Weeks 5 – 6
 Fetal
heart tones heard at 6 weeks
 Fetal heart tones heard by doppler at 10 -17
weeks
 Fetal heart tones heard by stethoscope at
weeks 17 – 19
 Fetal movements palpated at weeks 19 - 22
Physiological Changes During
Pregnancy
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Uterine Growth
 Response
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High levels of estrogen and progesterone
 Fundal

to hormonal stimulus
height
Uterus enlarges at predictable rate. Measurement
used to estimate the duration of pregnancy
Palpable at symphis pubis between week 12 – 14
 Palpable at umbilicus level at week 22 – 24
 At level of xyphoid process at term
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Lightening – fundal height decreases weeks 38 –
40 as fetus descends and engages the pelvis
Physiological Changes During
Pregnancy
Hicks contractions – irregular
painless contractions of the uterus that occur
intermittently throughout pregnancy starting
soon after 4th month
 Braxton
Contractions stimulate the movement of blood
through the placenta and promote oxygen delivery
to the fetus.
 Increase in frequency during late pregnancy.
 Not true labor contractions

Physiological Changes During
Pregnancy

Breast Changes
 Result
of increased levels of estrogen and
progesterone
 Development of mammary glands is complete by mid
pregnancy
 Lactation does not occur until birth of baby and
placenta

Estrogen levels decrease
 Colostrum
 Creamy, white to yellow pre-milk fluid expressed from nipples
as early as week 16
Physiological Changes During
Pregnancy

Skin
 Changes
thought to occur due to increased estrogen,
progesterone and alpha-melanocyte-stimulating
hormone levels
 Sweat and sebaceous glands usually hyperactive
 Angiomas (telangiectasias) - Vascular spider nevi
may appear on the chest, neck, face, arms and legs.
Of no clinical significance and disappear after
pregnancy. Due to increased levels of estrogen
 Palmar erythema – color changes which occur over
the palmer surface of the hands. Due to increased
levels of estrogen and progesterone
Physiological Changes During
Pregnancy
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Hormones
– moderate enlargement; increased
vascularity
 Thyroid
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
T4 levels decrease in response to increased estrogen
Oxygen consumption and basic metabolic rate (BMR)
increase as much as 20-25% secondary to fetal metabolic
activity
 Parathyroid
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Slight secondary hyperparathyroidism
Plasma parathormone are elevated
Coincides with fetal skeletal growth

The increased requirements for calcium and Vitamin D
Physiological Changes During
Pregnancy
 Pituitary

Prolactin
Prolactin responsible for initial lactation
 Posterior
Pituitary
Releases oxytocin which promotes uterine
contractility and the stimulation of milk ejection
from the breasts
 Releases vasopressin which results in increased
BP by vasoconstriction and has an antidiuretic
effect to maintain water balance.

Physiological Changes During
Pregnancy

Adrenals Glands
 Secrete
increased levels of aldosterone by
the early part of 2nd trimester in a protective
response to the increased sodium excretion
associated with progesterone.
 Cortisol production increases which increases
production of insulin but also increases
mother peripheral resistance to insulin

This decreases mother’s ability to use her own
insulin, thus ensuring ample supply of glucose for
fetoplacental unit
Physiological Changes During
Pregnancy

Pancreas
 Responsible
for insulin production to lower
glucose levels
 The fetus requires ample amount of glucose
for growth and development
 The islet of Langerhans (beta cells) are
stressed to meet the mother’s increased
needs for insulin

Deficiency produces S&S of gestational diabetes
Physiological Changes During
Pregnancy

Hormones Required to Maintain Pregnancy

hCG
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Secreted early in pregnancy
Stimulates progesterone and estrogen production by the corpus
luteum to maintain pregnancy until placenta has developed
sufficiently enough to support it
Human Placental Lactogen
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Increases the amount of circulating free fatty acids for maternal
metabolic needs and decreases maternal metabolism of glucose to
favor fetal grown
Physiological Changes During
Pregnancy

Hormones Required to Maintain Pregnancy
 Estrogen
 Stimulates uterine development to provide a suitable
environment for the fetus while helping to develop the ductal
system of the breast in preparation for lactation
 Progesterone
 Maintains the endometrium, inhibiting spontaneous abortion
 Helps development of acini & lobules of the breasts in
preparation for lactation
 Relaxin
 Inhibits uterine activity
 Diminishes the strength of uterine contractions
 Aids in the softening of the cervix
 Has long-term effect of remodeling collagen
Physiological Changes During
Pregnancy
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Other Hormones
 Prostaglandins
 Lipid substances that occur in high concentrations in female
reproductive tract
 Present in the endometrium or lining of uterus during
pregnancy
 Present in the tissue around the ectopically located fertilized
ovum during pregnancy
 Exact functions unknown
 Decreased levels may contribute to HTN and pregnancy
induced HTN (PID)
Physiological Changes During
Pregnancy
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Other Hormones
 Mucus
Plug
Result of secretions from endocervical glands
 Plug seals the endocervical canal & prevents
invasion of bacteria or other substances into uterus
 Secretions favor the growth of yeast organisms 
monilasis, a common vaginal infection during
pregnancy
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Physiological Changes During
Pregnancy
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Metabolic
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The expectant mother must meet her own tissue replacement
needs, those of the fetus, and those preparatory for labor and
lactation
Recommended weight gain
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Woman of normal wt = 25 – 35 pounds
Overweight woman = 15 – 25 pounds
Underweight woman = 28 – 40 pounds
Avg increases
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3.5 – 5 pounds 1st trimester
12 – 16 pounds 2nd trimester
10 – 13 pounds 3rd trimester
Physiological Changes During
Pregnancy

Metabolic (Cont’d)
 Water
retention is a basic chemical alteration
of pregnancy; caused by an increased level of
steroid sex hormones, lowered serum protein
and increased intracapillary pressure
permeability. The extra water is needed for
the fetus, placenta, and amniotic fluid, in
addition to the mother’s increased blood
volume, interstitial fluids, and enlarged
organs.
Physiological Changes During
Pregnancy

BMR (Basic Metabolic Rate) is increased
by 15-20% by term
 Reflects
increased oxygen demand of uterineplacental-fetal unit as well as oxygen
consumption from increased maternal cardiac
work
 High risk for heat intolerance
 During early pregnancy may report feeling hot
& fatigued after slight exertion.
 Greater need for sleep
Physiological Changes During
Pregnancy
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Cardiovascular System
 Growing fetus pushes heart upward and left
 Blood volume increases throughout pregnancy;
45% increase in 3rd trimester
 Cardiac hypertrophy
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
about
Increase in blood volume and cardiac output
Both plasma and erythrocytes increase
 Systemic
Vascular Resistance & Pulmonary Vascular
Resistance decrease enabling circulation to adapt to
higher blood volume while maintaining normal vessel
pressures
Physiological Changes During
Pregnancy

CV System (cont’d)
 CO
increases due to increased tissue demand for
oxygen
 CO higher when lying in lateral recumbent position;
lower when in supine position
 CO increased with labor and birth
 Organ systems receive additional blood flow
according to their increased workload
 Heart rate increases about 10-15 BPM
 Palpitations and dysrhythmias may occur.
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If no underlying pathology, no treatment required
Physiological Changes During
Pregnancy
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CV (cont’d)
 BP

considerations
Same position, same arm, correct cuff size
 Dependent
edema, varicose veins,
hemorrhoids due to uterus compressing iliac
veins and inferior vena cava  increased
venous pressure and reduced blood flow to
lower extremities

More prone to postural hypotension
Physiological Changes During
Pregnancy
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CV (cont’d)
 Venal
Caval Syndrome (Supine hypotensive
syndrome/autocaval compression)

Enlarging uterus putting pressure on the vena cava
when in supine position
Interferes with blood return
 Significant decrease in BP with symptoms
 Dizziness, pallor, clamminess
 Corrected by placing in left side-lying position
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Physiological Changes During
Pregnancy
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CV (cont’d)
 Blood

volume increases 40-50%
Peripheral vasodilation maintains normal BP
 Total
erythrocyte volume increases about 30% in
women who receive iron supplementation; only 18%
in those without iron supplementation
 Plasma increase > RBC production  decrease in
Hematocrit (psuedoanemia)

Elevated erythrocyte production increases need for iron,
because iron is necessary for the formation of hemoglobin
(oxygen carrying component of erythrocytes)
Physiological Changes During
Pregnancy

CV (cont’d)
risk for hypercoagulation (clot
formation)
 Higher
Various clotting factors increase during pregnancy
 Fibrinolytic activity (dissolving actions of clots)
decreased
 Venous stasis DVT formation
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Physiological Changes During
Pregnancy
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Respiratory System
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Maternal oxygen requirements increase
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Increase in BMR
Need to add tissue mass in uterus and breast
Fetus requires oxygen and needs to dispose of carbon monoxide
Elevated estrogen levels
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cause ligaments of rib cage to relax which allows increased chest
expansion
Cause an increase in vascularization in upper respiratory tract
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 capillary congestion  nasal & sinus congestion, nosebleeds,
changes in voice, changes in respiratory center (a lower threshold for
CO2)
During advanced pregnancy, increased awareness of the need
to breathe evident; some complain of SOB; some complain of
dyspnea at rest
Physiological Changes During
Pregnancy

Gastrointestinal (GI)
 During
pregnancy
Appetite increases, intestinal secretions reduced,
liver function is altered, absorption of nutrients is
enhanced, colon is displaced, GI motility
decreases
 Bowel sounds decrease, nausea and vomiting are
common
 An increase in blood flow and pressure on pelvic
areas (later in pregnancy) places pregnant woman
at increased risk for hemorrhoids

Physiological Changes During
Pregnancy
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GI (cont’d)
 Early

in pregnancy
Morning sickness (with or with vomiting)
Can occur at any time of day/night
 Usually appears 4-6 weeks & subsides after 1st trimester
 Triggered by sight or odors
 Appetite may be decreased
 hCG has depressant effect on appetite

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Hyperemesis (severe vomiting)
Should not continue beyond 1st trimester
 Should not be accompanied by fever, pain or weight loss
 If either occurs, medical intervention necessary

Physiological Changes During
Pregnancy

GI (cont’d)
 Morning
sickness rarely has harmful effects on
mother or fetus
 Rising levels of estrogen cause selective increase in
vascularity and connective tissue proliferation
(gingivitis) and causes gums to bleed
 Hiatal hernia


Can occur after 7th month of pregnancy
Usually due to displacement of stomach
Physiological Changes During
Pregnancy

GI (cont’d)
 increased
progesterone production causes:
Esophageal regurgitation, slower emptying of
stomach and reverse peristalsis from decreased
tone and motility of smooth muscles
 Increase in water absorption from colon 
constipation

 Increased
risk for gallstones
Physiological Changes During
Pregnancy

Genitourinary System(GU)
 Affected
by pressure from bladder, increased blood
flow & increased filtration in the tubules

1st trimester
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2nd trimester
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Bladder irritability, nocturia, frequency due to growing uterus
placing pressure on bladder
Bladder is pulled up and out of pelvis into abdomen
3rd trimester

Due to pressure from presenting part, impaired drainage of
blood and lymph, bladder more susceptible to infection and
trauma
Physiological Changes During
Pregnancy

GU (cont’d)

Susceptibility to infection
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Greater glucose content
More alkaline (pH increased)
Stagnated urine (takes longer to reach bladder)
Renal function
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Glomerular Filtration Rate (GFR) increases
Renal Plasma Flow (RPF) increases
Least efficient when in the supine position
Most efficient in lateral recumbent position


Side lying increases renal perfusion, increases UOP, and decreases
edema
Due to vena cava syndrome and compression of aorta, CO drops as
does renal perfusion
Physiological Changes During
Pregnancy

GU (cont’d)
 Renal
system can overstressed by excessive sodium
intake or restriction or by using diuretics
 Extra sodium is needed for both mother and fetus
during pregnancy
 Selective renal tubular reabsorption maintains sodium
and water balance regardless of changes in dietary
intake and losses
 Severe hypovolemia and reduced placental perfusion
are consequences of using diuretics during
pregnancy
Physiological Changes During
Pregnancy

GU (cont’d)
 Glucose

reabsorption is impaired
Glucosuria varies in time and degree
 Proteinuria
does not usually occur in normal
pregnancy except during labor or after birth
The amount of protein excreted does not indicate
the severity of renal disease
 Values of 1+ protein (per dipstick) is acceptable

Physiological Changes During
Pregnancy

Musculoskeletal



Alterations in posture and gait due to weight gain
Spinal curvatures are re-aligned
Lordosis develops



Pelvic joints become more mobile and relaxed due to increased
estrogen & other circulating hormones (relaxin)


An increase in curvature of spine
The head is held Lordly, like a King to maintain balance
This also allows an increase in pelvic dimensions preparing for labor
and birth
Abdominal walls stretch and loose tone
Discomforts of Pregnancy

First Trimester
 Breast
Changes
 Urgency/Frequency
 Languor & Malaise/Fatigue
 Nausea/Vomiting (Morning Sickness
 Ptyalism (Excessive Salivation)
 Psychological Effects; Mood Swings; Mixed
Feelings
Discomforts of Pregnancy

Second Trimester
 Skin
changes
 Spider Nevi (Telangiectasias
 Palmar Erythema
 Pruritus
 Palpitations
 Supine Hypotension (Vena Cava Syndrome)
 Orthostatic Hypotension
Discomforts of Pregnancy

2nd Trimester (Cont’d)
 Food
Cravings
 Heartburn/Indigestion
 Constipation
 Flatulence/Bloating/Belching
 Varicose Veins
 Leukorrhea
 Headaches
Discomforts of Pregnancy

2nd Trimester (Cont’d)
 Carpal
Tunnel Syndrome
 Acrodysesthesia (Numbness/Tingling of
Fingers
 Round Ligament Pain/Tenderness
 Joint Pain/Backache/Pelvic Pressure
Hypermobility of Joints
Discomforts of Pregnancy

Third Trimester
 Respiratory
Discomforts
 Insomnia
 Psychological
Responses/Mood Swings
Mixed Feelings/Anxiety
 Hyperemia, Hypertrophy, Bleeding
Tendencies
 Return of GU Symptoms
Discomforts of Pregnancy

3rd Trimester (Cont’d)
 Perineal
Discomfort and Pressure
 Braxton Hicks Contractions
 Leg Cramps
 Marked Edema
 Nasal Stuffiness
The Expectant Family

Psychosocial Changes
 Pregnancy
represents a turning point in the affected
individuals’ lives
 Support system
 Altered routines and family dynamics
 Financial issues




Will expectant mother work during pregnancy?
Will expectant mother work after baby is born?
Who will provide childcare if mother does work?
Will housework & care for the child at home be divided?
The Expectant Family

Emotional Responses
 Ambivalence,
introversion, mood swings & changes in
body image
 Ambivalence may be related to many things (See
page 73)
 Indirect evidence of ambivalence





c/o prolonged or frequent depression
Physical discomforts
Body image
Excessive mood swings
Difficulty accepting life changes resulting from pregnancy
The Expectant Family

Emotional Responses (cont’d)
 Women
with unplanned or unwanted
pregnancies experience:
Increased depression
 Increased stress
 Decreased support from the father
 Decreased overall satisfaction with life

The Expectant Family

Emotional Responses

Women with planned pregnancies







tend to be happier
Experience less physical discomforts
Tolerate discomforts associated with 3rd trimester
Introversion is common during pregnancy
Mood swings
Need increased love and affection from partner
Concerns about body image

Personality traits, values, social network responses and attitude
toward pregnancy are thought to influence her body image
The Expectant Family

Role Transition
 Four
psychological tasks the expectant mother
undertakes to maintain her intactness and that of her
family while also incorporating her new child into the
family system:




Prenatal care
Seeking partner’s acceptance and support
Preparing herself to protect fetus and child once born
Learning to delay immediate gratification to meet the needs
of another
The Expectant Family

The Expectant Father

May experience ambivalence and stress also






Reality of new role
Financial issues
Unexpected events
Health of baby
His role during labor and birth
The successful father:





Likes children
Excited about fatherhood
Want to nurture
Have parenting confidence
Share experience of pregnancy and childbirth with their parents
The Expectant Family

The Expectant Father

1st trimester



2nd trimester




Confused by woman’s mood swings
Resentful of attention given to mother-to-be
Feel more involved by feeling fetal movements
See fetus on US
Plans parenting style
3rd trimester


Afraid of hurting unborn child during intercourse
Have increased anxiety over outcome of partner and baby during
labor and birth
Promotion of Self-Care During
Pregnancy

Estimated Date of Birth
 AKA Estimated


Due Date
Most common method = Nagele’s Rule




Date of Confinement (EDC)
LMP – 3 months + 7 days
LMP (5/8/2011) – 3 months = 2/8/11
2/8/11 + 7 days = EDC of 2/15/2012
Rule can be adjusted for those who have irregular menstrual
cycles
 Fundal
Height (See page 77)
Promotion of Self-Care During
Pregnancy

Nutrition/Supplements
Pregnant woman need additional 300 kilocalories per day during 2nd &
3rd trimesters
 Lactating mother needs additional 500 kilocalories per day
 Factors that increase nutrient needs:
 Uterine-placental unit
 Maternal blood volume and constituents,
 Maternal mammary changes
 Metabolic needs (BMR increases)
 Daily food plan should include all food groups + Vitamins + Minerals
 See page 77-80
 PICA (non food sources) or non-nutritional food should be avoided
as much as possible
 Nurse should be non-judgmental when assessing for PICA

Promotion of Self-Care During
Pregnancy

Teratogenic Substances



Substances that cause abnormal development of the embryo
 Alcohol  fetal alcohol syndrome
 Maternal alcohol use  spontaneous abortion
 Smoking  IUGR
 Increase risks for preterm labor, premature rupture of
membrane (PROM), abruption placentae, placenta previa
and fetal death R/T decreased placental perfusion
Illegal or Controlled Substance Abuse
 IUGR and developmental delay
Focus for mother with any detrimental habit should be Good
Nutrition
Promotion of Self-Care During
Pregnancy

Teratogenic Substances
 Congenital
anomaly
 Condition present at birth
 Known
human teratogens
Drugs, chemicals, infections, radiation, DM, PKU
 Greatest impact during periods of rapid
differentiation

Embryonic period (days 15 – 60)
 Fetus unable to use maternal reserves, subsequently all
nutrients come directly from mother’s diet

Promotion of Self-Care During
Pregnancy
 Activity
and Exercise
 Consult
physician before starting an exercise regimen
 Exercise should be moderate and consistent
 Fluid intake should be increased before during and
after exercise to prevent dehydration

Dehydration  preterm labor
 Aerobic
exercise recommended with maternal
HR<or= 140

Do NOT proceed to fatigue or exhaustion  decrease uterine
profusion &/or fetoplacental deoxygenation
Promotion of Self-Care During
Pregnancy

Screenings and Lab Test
 Numerous
Labs, blood type & Rh, rubella, TB, urine, renal
function, pap smear, STD/HIV.
 Alpha-fetoprotein is done at 16 weeks
 Triple Marker Test (Triple Screen)
 Group B Streptococci

Promotion of Self-Care During
Pregnancy

Screenings and Lab Test

HIV (Human Immunodeficiency Virus)
 causes Acquired Immune Deficiency Disease [AIDS]
 Should be tested during prenatal period
 Pregnancy is discouraged
 Common presenting problems
 Chronic vaginitis & candidiasis (thrush)
 Treatment started prior to 14th week of pregnancy has shown
a 66% decrease in lateral transmission to fetus with
caesarian section
 Treatment is Zidovudine (AZT)


Fetus will test positive for HIV antibody for up to 18 months
even if not infected
HIV can be transmitted through breast milk
Promotion of Self-Care During
Pregnancy

Screenings and Lab Test
 TORCH
Infections
Toxoplasmosis
 Other infections
 Rubella Virus
 Cytomegalovirus
 Herpes simplex Virus

Promotion of Self-Care During
Pregnancy

Screenings and Lab Test
 TORCH
Infections
 Toxoplasmosis

Cause




Consumption of infected raw or undercooked meat or handling
infection cat litter
Can cause spontaneous abortions &/or congenital infections
Diagnosis: Serologic testing
Treatment: Pyrimethamin and sulfadiazine

Can reduce risk to fetus by 60%
Promotion of Self-Care During
Pregnancy

Screenings and Lab Test
 TORCH

Infections
Other Infections
Hepatitis A, B, C, D
 Causes:
 Hep A – feces
 Hep B – blood products & body fluids
 Hep C – direct blood contact (IV drug users,
receivers of blood products)
 Hep D – same as Hep B;

Promotion of Self-Care During
Pregnancy

Screenings and Lab Test
 TORCH Infections
 Rubella (German Measles)





Cause: contact with droplets
Clinical Signs
 Heart Dz, IUGR, cataracts
Complications: spontaneous abortions, heart damage,
cataracts, mental retardation
Infants are infectious and require isolation
Prevention: Rubella vaccine (prenatal assessment)
 Serious fetal consequences; vaccination not warranted
during pregnancy
Promotion of Self-Care During
Pregnancy

Screenings and Lab Test

TORCH Infections
 Cytomegalovirus





Cause: Herpes Virus
 Transmitted by respiratory droplets or body fluids (less likely)
 Women who have + titer usually have chronic or recurrent
infections
 Not normally harmful to mothers with intact immune systems
Treatment: No known treatment
Complications: Primary cause of congenital infection in fetus and
neonate
Most common infectious cause of mental retardation
Most at Risk: women who work or have children in daycare, mental
health facilities or certain health care settings
Promotion of Self-Care During
Pregnancy

Screenings and Lab Test

TORCH Infections

Herpes Simplex Virus (HSV)




Type I – contact with oral secretions
Type II –contact with genital secretions
Treatment: Acyclovir
Prevention of lateral transfer: Cesarean birth within 4 hours of
ruptured membranes


Neonate and fetal effects are profound
Good hand washing especially if lesions are present
Healthcare providers with oral lesions present should practice good
hand hygiene and wear masks when in contact with newborns
Anyone with skin lesions should not give direct care until lesions are
dried and crusted.