TORCH Infections and Pregnancy

• Infections during pregnancy may contribute to fetal morbidity and mortality

TORCH Infections

• Group of infectious diseases passed to a fetus during pregnancy, delivery, or after birth
• Stands for toxoplasmosis, others, rubella, cytomegalovirus, and herpes

Toxoplasmosis

• Organism transmitted through feces of infected animals

Others

• Other infections include HIV, syphilis, parvovirus B19 (fifth disease), varicella (chickenpox), and Zika

Rubella or German Measles

• Exposure in the 1st trimester often results in fetal cardiac defects and death

Cardiac Defects and Death

• In 2nd trimester, can lead to hearing loss and other abnormalities, including growth retardation

Cytomegalovirus

• Herpes virus may be present in adults without symptoms
• Associated with congenital hearing loss and may cause fetal death

Herpes Virus, Type 2, Herpes Simplex

• A sexually transmitted infection caused by bacteria
• Can infect the urethra, rectum, female reproductive tract, mouth, throat, or eyes
• Gonorrhea is commonly spread during vaginal, oral, or anal sexual activity
• Babies can get the infection during childbirth, most commonly affecting the eyes

Group B Streptococcus

• Common bacterium carried in the intestines or lower genital tract, usually harmless in healthy adults
• In newborns, it can cause serious illness known as group B strep disease
• Can also cause dangerous infections in adults with certain chronic medical conditions like diabetes or liver disease

Hepatitis B

• Serious liver infection caused by the hepatitis B virus (HBV)
• Chronic hepatitis B raises the risk of liver failure, liver cancer, and serious scarring of the liver called cirrhosis

HPV

• A viral infection that causes skin or mucous membrane growths (warts)
• Occurs when the virus enters the body, usually through a cut, abrasion, or small tear
• Transferred primarily by skin-to-skin contact

Syphilis

• An infection caused by bacteria, spread through sexual contact
• The cause of syphilis is a bacterium called Treponema pallidum
• Can spread through kissing or touching an active sore on the lips, tongue, mouth, breasts, or genitals
• Can be passed to babies during pregnancy and childbirth, and breastfeeding

Trichomonas

• A sexually transmitted infection caused by a parasite
• In women, trichomoniasis can cause a foul-smelling vaginal discharge, genital itching, and painful urination
• Men with trichomoniasis typically have no symptoms

Candidiasis

• Fungal infection caused by an overgrowth of the yeast Candida
• The yeast gets into the bloodstream and spreads to other areas, such as the eyes, heart, brain, and kidneys
• Candida is a common type of yeast found everywhere

Bacterial Vaginosis

• Happens when the vagina's natural bacteria levels are out of balance

Human Immunodeficiency Virus (HIV)

• Spread by contact with certain bodily fluids of a person with HIV
• Most commonly spread during unprotected sex or through sharing injection drug equipment

Etiology

• Infections may be various viruses
• Infectious organisms may be acquired during sexual intercourse and through use of contaminated articles
• Most organisms cross the placenta barrier and infect the fetus

Pathophysiology

• Infectious organisms are capable of crossing the placental barrier and affecting fetal development

Associated Findings

• Previous history of sexually transmitted infection and PID
• Numerous sexual partners
• Use of intravenous drugs or partners who use intravenous drugs

Common Clinical Manifestations

• PROM, preterm birth, and systemic infections

How to Prevent TORCH

• Avoid contact with sick people, wash hands often, don't share drinks or utensils, avoid traveling to areas where diseases are prevalent, and eat fully cooked meat and eggs

TORCH Transmission

• Intrauterine life (through the placenta)
• During childbirth (through the birth canal)
• After birth (through breastmilk if the mother is breastfeeding)

HIV/AIDS

• Human Immunodeficiency Virus (HIV) attacks the body's immune system, has no cure, and causes AIDS
• Primarily a sexually transmitted infection (STI), transmitted by heterosexual and homosexual practices
• Can also be spread by contact with infected blood, illicit injection drug use, and during pregnancy, childbirth, or breastfeeding
• Without medication, it may take years before HIV weakens the immune system to the point that you have AIDS

Acquired Immunodeficiency Syndrome (AIDS)

• A chronic, potentially life-threatening condition caused by HIV, which damages the immune system and interferes with the body's ability to fight infection and disease
• AIDS is the last stage of HIV infection

Valued Information

• No cure for HIV/AIDS, but medications can control the infection and prevent progression
• Antiviral treatments for HIV have reduced AIDS deaths

5 Prime Modes of Transmission

• Unprotected penetrative sex
• Injection drug use
• Unsafe blood and blood products
• Mother-to-child spread during pregnancy, delivery, and breastfeeding

Note

• Tears, saliva, and sweat of a person infected with HIV may be the least of bodily fluids to be transmitted

Stage 1: Acute HIV Infection

• Occurs 1-2 weeks after infection and presents with nonspecific symptoms (low-grade fever, headache, body malaise, skin rash, lymphadenopathy)

Stage 2: Asymptomatic Infection

• The infection remains controlled until the immune system becomes too compromised
• Can require 10 years to acquire HIV through unsafe multiple sexual practices

Stage 3: Symptomatic Infection

• Viral activity causes damage, and symptoms include fatigue, fever, body malaise, weight loss, chronic diarrhea, swollen lymph glands, sore throat, skin rashes, headache, and soaking night sweats

Stage 4: AIDS

• Severe damage to the immune system occurs, major opportunistic infections and cancers may develop
• Opportunistic infections can be caused by bacteria, viruses, fungi, or parasites, and can occur due to weakened immune systems
• 500-1500 CELLS / MM is a normal level of CD4 / T-Helper cells
• 200 CELLS CD4 And T-Helper cells is positive for HIV / AIDS

Prevention

• Use condoms, always use sterile needles, avoid sharing razors, and watch out for blood-stained needles or metal objects
• Nonoxynol 9 is a substance in condoms to prevent or kill bacteria or viruses

Nursing Tips

• A = Abstinence, B = Be loyal, C = Condom use, D = Do not do drugs, E = Education = awareness

Complications of HIV

• Infections such as tuberculosis (TB), pneumonia, cytomegalovirus, candidiasis, cryptococcal meningitis, and toxoplasmosis can occur
• Cryptosporidiosis is an infection that causes diarrhea when swallowing food or water tainted with feces

Common Cancer Types

• Kaposi's sarcoma is a type of cancer in the lining of the blood and lymph vessels, that has symptoms of painless purplish spots on the legs, face, and feet
• Lymphomas are a general term for cancers that start in the lymph system

Signs and Symptoms

• Wasting syndrome
• Sudden weight loss
• Neurological complications
• Kidney disease

Pathophysiology

• Transmitted via unprotected sexual activity, blood transfusions, hypodermic needles, and from mother to child
• The virus replicates inside and kills T-helper cells
• There is an initial period of influenza-like illness, and then a latent, asymptomatic phase
• When the CD4 lymphocyte count falls below 200 cells/mL of blood, the HIV host has progressed to AIDS

Common Tests and Procedures

• Low CD4 Below 200 / T-Helper cells means an indication of HIV infection
• A blood test to measure the amount of HIV occurs with Viral Load
• Drug resistance test to check if the infected virus is resistant to certain drugs
• A Laboratory examination checks for diseases/damage
• A Nucleic acid amplification test detects the genetic material of the causative virus also is used
• An ELISA test detects HIV for antibodies and antigens in the blood also known as an enzyme immunoassay (EIA) used
• Antigens triggers the body to generate immune response against it and includes allergens, bacteria, fungi and viruses, and toxins
• ELISA is the case you get a positive you follow up by a Western Blot,
• Currently only ELISA is needed now, Western Blot is no longer used, and today the ELISA test is followed by a HIV Differentiation Assay.
• A HIV Differentiation Assay to confirm HIV infection now.
• This is followed by a HIV Genetic Material Detection Test to check on the infection status

Medications

• Retrovir is an antiviral medicine that is not a cure used to prevent an HIV-infected woman from passing the virus to her newborn and it is Given orally after the 14th week of gestation
• Zidovudine (ZDV) also known as azidothymidine (AZT), is an antiretroviral medication to prevent and treat HIV/AIDS that is generally recommended for use in combination with other antiretrovirals
• is usually used to prevent mother to child spread during birth or after a needlestick injury or other potential exposure through mouth or slow injection to the vein.

Substance Abuse

• Substances abuse is a Pattern of harmful use of any substance for mood-altering purposes and can be repeated harmful
• Is risky for: Miscarriage, stillbirth, Mental retardation, Fetal deformities, Low birth weight, Small for gestational age, Sudden infant death syndrome- SIDS/CRIB DEATH.
• Alcohol consumption or of any kind of substance abuse is the leading cause of preventable birth defects in the fetus

Types of Substance Abuse

• Prescription drug abuse, Illegal drug abuse, Alcohol abuse, Solvent abuse/inhalants, or Legal High Abuse can happen

Signs and Symptoms

• Behavioral changes and physical changes that can show that there is some type of substance abuse/ addiction
• Is the main culprit in: SUDDEN MOOD SWINGS, POOR WORK PERFORMANCE, LACK OF FOCUS/CONCENTRATION, ISOLATION, HAVING SORE JAW, STEALING AND LYING, LACK OF SELF-CARE, LACK OF CONFIDENCE AND SELF-ESTEEM
• Also: Red eyes, talkativeness and hyperactivity, tremors, sweating and cold, pale skin, poor hygiene, etc

5P's of Labor and Delivery Problems and Issues

Passenger

• Fetus
• Position/Presentation

Problems Associated

• Fetal size is very important as it has been known to cause:
  • Fetal head may not be in proportion to the pelvis- causing prolonged painful labor (Dystocia)
    • CEPHALOPELVIC Disproportion to lead to failure to descent or arrest descent causing in arrest of the descent later on

Malpresentation

• Can lead to abnormal and difficult labor

Passageway

• Maternal Bony Pelvis is just as important because the type of pelvic shape you have would be a factor

• Woman may experience poor uterine contraction, slow dilatation, slow descent/ failure to descent and prolonged labor

    - Normally Shaped Pelvis or Gynecoid is ideal round shallow and open and has normal measurement of 12.5 to 13.5cm
    -Cephalopelvic Disproportion (CPD) -complication that occurs when the baby is too large to fit through the mother's pelvis
       Also:
         Shoulder Dystocia- Prolonged painful active labor, PROLONGED ACTIVE PHASE
  

Psyche

• Is the Mental state as the Mindset of the mother about labor and delivery process
• Fear and Anxiety is mainly focused in the labor A stressful event is for most women

Power

• The Primary uterine contractions/ force of contraction
  • Involuntary which can be known as Rhythmical and the Regular Activity of Uterine Musculature is the Labor and Delivery which is initiated by the release of hormones; OXYTOCIN, PROTAGLANDIN, ESTROGEN, PROGESTERONE

Placenta

• Which has to be Temporary fetal organ Producing Also, production of conception
• *Problems:
• Abruptio Placenta
• Placenta Previa
• Prolapse of the cord due to PROM
• Placenta Acreta- deep implantation of the placenta

Cesarean Section (CS) is Delivery via an ABDOMINAL INCISION- Removal of the fetus from the uterus through an incision made into the maternal abdominal wall and uterine myometrium and can be:

• Refers to the patient’s initial experience to Primary Cesarean Section:
• Refers to any subsequent abdominal CS deliveries to Repeat Cesarean Section:.
• An Elective Cesarean Section: is One that is planned and performed before the onset of labor

Indications/ Predisposing Factors:

• CPD: CEPHALOPELVIC DISPROPORTION- Leading cause of primary cesarean section

• Previous CS- Leading cause of secondary cesarean section

• Contracted Pelvis

• Fetal distress

• Prolonged Painful Labor/Dystocia

• Gestational Diabetes Mellitus Placenta Previa/abruptio Placenta/ PIH/ HELLP(Complications and acronyms that are tied to pregnancy conditions that may require emergency surgical interventions) Postmaturity Abnormal Fetal Presentation and Position: Breech/Transverse

• Cord is also likely to be: Prolapsed to PROM

• Mother must also have: Mother with Pelvic Tumor/Pelvic Fracture

• Baby may have any: Fetal Abnormalities such as Hydrocephalus

• Baby may develop Large Body Fetus

• Mother had too many children to hold up as Multi parity

• May develop Vaginal Infection TYPES OF CESAREAN BIRTH:

• classic Or Vertical or Transverse Low Segment

• *- Mother would Also may may Complications such as Complications such as Placenta attachment disorders

• Anesthesia Complication– CNS depressant/Damage during surgery.

• Longer complications of: Longer healing would lead to infection during cs

• *-Newborn can also have -Respiratory risks for newborn