There are many potentially serious health problems that pregnant women can transfer to their unborn babies, one of which is a prenatal infection which refers to an infection that is transmitted to the fetus through the placenta.
Nursing Care Plans
The nursing care plan for patients with perinatal infection involves screening/identifying for prenatal infection, providing information about the protocol of care and promoting client/fetal well-being.
Here are three (3) nursing care plans (NCP) for prenatal infection:
Risk For Maternal/Fetal Infection
Risk for Infection: At increased risk for being invaded by pathogenic organisms.
Risk Factors
- Inadequate primary defenses (e.g., broken skin, stasis of body fluids).
- Inadequate secondary defenses (e.g., decreased hemoglobin, immunosuppression).
- Inadequate acquired immunity.
- Environmental exposure.
- Malnutrition.
- Rupture of amniotic membranes.
Possibly evidenced by
- [Not applicable].
Desired Outcomes
- Patient will verbalize understanding of individual causative/risk factors.
- Patient will review techniques and lifestyle changes to reduce risk of infection.
- Patient will initiate behaviors to limit the spread of infection, as appropriate, and reduce the risk of complications.
- Patient will achieve timely healing, free of complications.
| Nursing Interventions | Rationale |
|---|---|
| Obtain information regarding client’s past and present sexual partners and exposure to any STDs. | Multiple sexual partners or intercourse with bisexual men increases risk of exposure to STDs and HIV/AIDS. |
| Obtain information about client’s cultural background for risk factors. | In Africa, male-to-female ratio of HIV is 1:1 owing to cultural sexual practices, poor hygiene, and inadequate health care while recent arrivals from Asia, South America, and the Caribbean islands have increased the risk of exposure to Hepatitis B virus. |
| Review lifestyle and profession for the presence of associated risk factors. | Drug abusers and healthcare professionals are at risk for exposure to HIV/AIDS and HBV through contact with contaminated needles, body fluids, and blood products; tuberculosis through airborne droplets. |
| Assess for any specific signs and symptom, if present, notify healthcare provider: | Identifiable signs of infection assist in determining the mode of treatment. Some organisms have a predilection for the fetoplacental unit and the neonate, although the client may be asymptomatic; i.e., Mycoplasma and Ureaplasma organisms affect a significant number of pregnant women and have been cultured in aborted fetuses, even though the mothers have been free of symptoms. |
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May indicate herpes simplex virus type II (HSVII)/condyloma, which can be transmitted to the newborn at the time of delivery if a lesion is present at term or if viral shedding is occurring. |
| May be associated with Escherichia coli or GBS, or client may have asymptomatic bacteriuria. | |
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| Determine if the viral infection is either primary or recurrent. | Both herpes viruses (CMV and herpes simplex virus II [HSV-II]) recur in times of stress. Yet only primary CMV is problematic to the fetus, and only 50% of fetuses exposed are affected. Although recurrent HSV-II is associated with reduced viral shedding time, the newborn, if exposed to the virus at delivery, can be affected with either visible lesions or a disseminated type of the disease. |
| Determine status of maternal membranes. If they are ruptured, monitor blood cell count and fetal heart rate; or vaginal discharge having an odor) | Infectious organisms transmitted via the ascending route including Chlamydia, mycoplasmas, Ureaplasma urealyticum, develop bacteremia and pneumonia or possibly meningitis. |
| Obtain appropriate specimens and monitor laboratory/ diagnostic studies as indicated: | |
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Approximately 40%–60% of patients with culture positive gonococcus have concomitant chlamydial infection, the most common STD associated with conjunctivitis and pneumonia of the newborn. Other than ophthalmia neonatorum, gonorrheal infection of the newborn is infrequent, but does increase rate of neonatal mortality associated with overwhelming infection. |
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Fever of nonspecific origin and history of abortions, neonatal meningitis, sepsis, congenital listeriosis, or postpartum maternal sepsis may indicate recurrent listerial infections requiring treatment. From 5%–30% of women have positive cultures for GBS, yet may be asymptomatic. Although antepartum treatment for GBS carriers is not recommended, intrapartum treatment with antibiotics is indicated for all women with positive cultures. |
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Asymptomatic bacteriuria (colony count greater than 100,000/mL) occurs in as many as 12% of prenatal clients and has been associated with acute and chronic pyelonephritis, preterm delivery, chorioamnionitis, postpartum maternal sepsis, and congenital defects. From 1%–5% UTIs are linked to GBS, which is the leading cause of neonatal meningitis |
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From 5%–15% of women of childbearing age are still susceptible to rubella, which has identifiable teratogenic effects on the fetus. If rubella is contracted in the first trimester, the fetus has no chance of escaping teratogenic effects. If rubella is contracted in the second trimester, the fetus has a 50% chance of being affected. |
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Hepatitis in the first and second trimesters rarely affects the fetus. Women who contract hepatitis in the third trimester have a 60% chance of transmitting it to offspring coming in contact with blood products at the time of delivery. Carrier status can be passed on to infants if they are not treated at birth. This can possibly result in cirrhosis and hepatocellular carcinoma. |
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Determines number of T4 helper cells to monitor progression of HIV. |
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AIDS destroys the immune system, causing a variety of problems, including Herpes simplex virus-II, cytomegalovirus, toxoplasmosis, candidiasis, Kaposi’s sarcoma, and pneumonia. |
| Assist as necessary with sputum collection and chest x-rays for client with respiratory symptoms. | Helps in identifying causative organism in bacterial pneumonia and active tuberculosis. Note: Tuberculosis is not exacerbated by pregnancy. |
| Administer antibiotics/medications as indicated: | |
| Generally not recommended in treatment of HSV-II, unless primary infection disseminates. | |
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Although controversial, these drugs are approved by the FDA and have been shown to reduce transmission to the fetus by 68% and to prolong life in HIV-positive clients. Research suggests ZVD administration in the second trimester can reduce maternal transmission of HIV to the neonate by over 60%. |
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UTI, listeriosis, gonorrhea, syphilis, bacterial pneumonia, all respond to antimicrobial treatment. Note: Prenatal treatment of client who is carrier of GBS is not effective, because recolonization can occur before birth, with infant still at risk for neonatal sepsis or meningitis. |
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Controls active disease progression in toxoplasmosis, but have known teratogenic effects on fetus during the first and probably second trimesters. |
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Counteracts side effects of pyrimethamine. |
| Indicated for treatment of trichomonal infections after 20 weeks’ gestation. Treatment in the first 20 weeks’ is symptomatic; the trichomonal infection may be receptive to Mycelex vaginal suppositories. Note: Both partners must be treated to prevent reinfection. | |
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Indicated for treatment of Candida albicans. Note:Diabetic client is prone to monilial infection, which may be extremely resistant to prenatal treatment. |
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Recommended for exposure to hepatitis A or B. |
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Treatment of choice for tuberculosis (or seroconversion to positive PPD in last 2 yr), with no known teratogenic effects. Streptomycin is avoided, owing to its association with vestibular and auditory defects, and pyrazinamide is also contraindicated. If time of seroconversion is unknown and chest x-ray is negative, treatment is begun after pregnancy; or if client is over age 35 with unknown or prolonged positive PPD, INH prophylaxis is not recommended in the absence of active disease because of risk of hepatotoxicity. Note: Pyridoxine (vitamin B6) is recommended for any pregnant woman receiving INH. |
| Prepare for/assist in transfer to tertiary care center as indicated. | Availability of staff and equipment ensures optimal care of high-risk client and fetus/newborn. |
| Prepare for termination of pregnancy or labor induction, as indicated. | Pregnancy may be terminated for such conditions as toxoplasmosis occurring prior to 20 wk gestation or rubella in the first trimester. Note: AZT in combination with cesarean birth decreases neonatal HIV infection rate, allowing pregnancy to be carried to term as appropriate, in presence of maternal HIV infection. |
