Nursing Care of Women with High-Risk Pregnancy PDF

Nursing Care of Women with High Risk Pregnancy Maternity Nursing ( eo ) Dr. Dalal Yehia  Sexual Transmitted Diseases Infections in Pregnancy Toxoplasmosis It caused by the protozoan toxoplasma gondi which transmitted to humans in raw meat, unpasteurized goat milk or...

Nursing Care of Women with High Risk Pregnancy Maternity Nursing ( eo ) Dr. Dalal Yehia  Sexual Transmitted Diseases Infections in Pregnancy Toxoplasmosis It caused by the protozoan toxoplasma gondi which transmitted to humans in raw meat, unpasteurized goat milk or cat feces.  E ects of Toxoplasmosis on Pregnant woman Fetus/newborn Spontaneous Microcephaly abo ion Hydrocephaly Chorioretinitis Hepatosplenomegaly Jaundice Mental retardation  Investigations: 1) TORCH screening T: toxoplasmosis O: others (hepatitis B, HIV, Chlamydia, Varicella). R: Rubella C: Cytomegalovirus H: Herpes simplex 2) Blood serum study, high antibody and toxoplasmosis gonodi in the serum. 3) Indirect immuno urescent to diagnose toxoplasmosis.  Rubella It caused by rubella virus. E ects of rubella on the fetus/newborn 1- fetal death. 2- Low bi h weight. 3- Congenital rubella syndrome ( babies develop deafness, cataract, jaundice, purpura, hepatosplenomegaly, congenital hea diseases, or mental retardation).  Assessment 1- Personal histo 2- Virological test. Management 1- early diagnosis may help to o er a choice of termination of pregnancy. 2- Explain to the pregnant woman the e ect of the disease on pregnancy. 3- In the rst week post delive , the woman can be vaccinated in order to prevent such complications during subsequent pregnancies. 4- Advice the woman to use a bi h spacing methods for (3) months after vaccination. 5- e woman shouldn’t be vaccinated against rubella during pregnancy.  Chlamydia Trichomoniasis Signs and symptoms; mucopurulent vaginal discharge from the endoce ix, abdominal pain, frequency of micturation, and dysuria. E ects of Chlamydia Trichomoniasis: On the mother On the newborn Salpingitis Conjunctivitis Ce icitis Ophthalmia neonatrum Vulvitis Blindness du to corneal scaring Seconda Upper respirato tract infe ility infection  Management: 1- Good hygienic practice 2- Usually e thromycin 500 mg BD is given during pregnancy. 3- Treat the husband.  Herpes Genitalis It caused by herpes simplex virus. Signs and symptoms 1- Close-packed vesicles. 2- Sever dysuria. 3- retention of urine. 4- Inguinal lymph nodes may enlarged & tender. 5- Mild fever 6- Sever pain due to ne e involvement.  Diagnosis 1- ESR ( ereythro sedimentation rate) 2- Clinical examination ( see the vesicles and enlarge lymph nodes). Management 1- bed rest. 2- Keep the lesion clean. 3- Analgesics to relieve pain. 4- application of antiviral agent ( acyclovir) 5- Prevent seconda infection and recurrence of the disease.  Viral Hepatitis Hepatitis A, B, C, are a serious complication of pregnancy. Signs and Symptoms 1- Low fever. 2- General malaise 3- Anorexia 4- Abdominal pain. 5- Nausea and vomiting 6- Jaundice. E ects of viral hepatitis on : Mother Fetus Postpa um Abo ion hemorrhage Hepatic coma Preterm bi h Intrauterine death  Diagnosis 1- Blood screening for antibodies HbsAg 2- Serum bilirubin. 3- Clinical examination Management 1- Isolate the woman, espically if she is in labor. 2- best rest until the bilirubin level is normal. 3- easily digestable high caloric diet. 4- give injection of Vit. K before the onset of labor. 5- Prophylactic Oxytocin to be given. 6- Infants born to HbsAg positive mother should receiv e.05 ml of immunoglobulin at bi h and to be repeated at 3 and 6 months. 7- prophylactic immunoglobulin is given to woman who had histo of contact.  Moniliasis It is caused by Candida Albicans. Signs and Symptoms; white cruddy discharge, dysuria, severe itching, dyspareunia. Diagnosis: presence of hyphae and spores in vaginal smear. E ects on pregnancy; the fetus may contract thrush during vaginal delive. Management; Intravaginal inse ion of clotrimazole suppositories at bed time for one week.  Trichomoniasis It is caused by trichmonas vaginalis. Sign and symptoms; frothy greenish gray discharge, prutitus, urina symptoms (dysuria, frequent micturation). Diagnosis; Motile agellated trichomonads on vaginal smear. Management; Antibiotics that prescribed by the doctor for both the woman and the husband.  Syphilis It is caused by Treponema Palladium. e transmission of syphilis to the fetus may result in the development of congenital syphilis with sever complications. E ect of Syphilis on the pregnancy, abo ion, pre-term delive , and prenatal death (20%).  Prevention: Fetal congenital syphilis can be prevented by identi cation and treatment of the infected mother during pregnancy, Most infected woman are asymptomatic ,and can be identi ed by serological screening. Treatment: *- Antibiotics *- Infants and husband should be treated if found to be infected. Follow up of infected mothers is necessa.  Gonorrhea It is caused by Neisseria Gonorrhea. E ects of gonorrhea on mother and fetus/newborn Mother Fetus/newborn Risk of septic infection Intrauterine growth retardation Chorioamnionitis Premature delive Ophthalmia neonatorum Premature rupture of membrane  Signs and Symptoms; majority of cases are asymptomatic , leucorrhoea, vaginal discharge ( greenish, profuse, o ensive, and irritating), frequency and dysuria. Management; good hygiene practice, medication as Dr. orders.  Acquired Immune-De ciency Syndrome ( AIDS) It is caused by Human Immuno Virus (HIV) which causes gradual decline in the immune system function. Pregnancy may cause clinical symptoms of HIV to accelerate. Transmission of the virus from the mother to the fetus through; transplacentally during delive , and breast milk. E ects of AIDS on the mother and fetus/newborn Mother Fetus/newborn Premature rupture of Fetal death the membrane Postpa um Preterm bi h endometritis High incidence of Low bi h weight infectious diseases HIV infection Diagnosis Blood test ( present of HIV). Management and treatment 1- treat infections. 2- diet counsel to has high protein and caloric diet. 3- antiretroviral therapy. 4- spiritual care and social suppo.