CALAMBA, JIM ORLAND Y. BSN-3A NCM 101 (8:00-12:00N) MT MS. EVANGELINE B. MANAQUIL, R.

HIGH-RISK PREGNANCY is one in which a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the mother, the fetus, or both.

DISEASE CAUSATIVE AGENT SIGNS AND SYMPTOMS CAUSE AND EFFECTS MEDICAL MANAGEMENT

Candida Albicans Symptoms include vaginal Treating the infection during Treated by the vaginal
burning, itching, and pain. pregnancy is important application of an OTC
The genital area is red and because the profuse vaginal antifungal cream such as
inflamed, and there’s a thick discharge and pruritus can be miconazole (Monistat) for 7
vaginal discharge that smells very uncomfortable. If days or a single dose of oral
like brewed yeast and looks infection is present in the flucanazole (Diflucan).
A WOMAN WITH like cottage cheese. These vagina at the time of
symptoms can vary in childbirth, it may cause a
CANDIDIASIS severity and are caused by candidal infection, or thrush,
the waste products of the in the newborn.
rapidly multiplying Candida
(or other) organisms.
Single-Cell Protozoan Spread A woman notices a yellow- It is important that The infection is diagnosed by
By Coitus gray, frothy, odorous vaginal trichomoniasis infections be examination of vaginal
A WOMAN WITH discharge. identified and treated secretions on a wet slide that
TRICHOMONIASIS because they may be has been treated with
associated with preterm potassium hydroxide or by a
labor, premature rupture of vaginal culture.
membranes, and post-
The drug choice is single-dose
cesarean infection.
oral matronidazole.
 Gardnerella Vaginalis The associated discharge is Untreated G. vaginalis Oral metronidazole (Flagyl) or
gray and has a fishy odor and infections are associated with clindamycin for 7 days
A WOMAN WITH BACTERIAL pruritus may be intense. amniotic fluid infection, and
VAGINOSIS preterm labor as well as
premature rupture of the
membranes.

Gram-Negative Intracellular A heavy, gray-white vaginal Associated with premature Therapy for nonpregnant
Parasite. discharge. rupture of membranes, women is usually with
preterm labor, and doxycycline (Vibramycin), a
endometritis because the tetracycline. This is
infant who is born while the contraindicated during
A WOMAN WITH CHLAMYDIA
infection is present in the pregnancy because of
vaginal can lead to possible fetal long bone
conjunctivitis or pneumonia deformities so azithromycin
after birth. Long term effects (Zithromax) or amoxicillin
in the mother are pelvic (Amoxil) is used instead.
inflammatory disease,
Diagnostic tests:
possibly leading to infertility.
Vaginal culture is done during
a woman’s first prenatal visit.
If a woman has multiple
sexual partners, screening
may be repeated again in the
third trimester.

Culture of the organism from

vaginal secretions using a
specific Chlamydia culture kit

Gonorrhea is tested as well if

Chlamydia infection is
documented since there is a
association between
gonorrhea and Chlamydia.
 Caused By A Spirochete The first stages of syphilis
Treponema Pallidum. result in a painless ulcer
(chancre) on the vulva or
vagina. Early in pregnancy
(before 18 week), the
A WOMAN WITH SYPHILIS
placenta appears to provide
some protection against the
disease.
Associated with miscarriages, One injection of benzathine
preterm labor, stillbirth or penicillin G is a choice for the
congenital anomalies in the treatment in syphilis during
newborn because the pregnancy. After therapy, a
spirochete crosses the woman may experience a
placenta freely. Jarisch-Herxheimer reaction
and is caused by the sudden
destruction of spirochetes.
This reaction lasts about 24
hours and fades.
Diagnostic Tests:
Pregnant women are
screened for syphilis at a first
prenatal visit by a VDRL, ART,
or FTA-ABS antibody reaction
test. Those who have multiple
sexual partners are tested
again at about week 36 of
pregnancy.
Women are screened again at
the beginning of labor and
newborns are screened for
congenital syphilis by a cord
blood sample.
 Herpes Virus The first time a woman
contracts a herpes infection,
painful, small, pinpoint
A WOMAN WITH HERPES vesicles on an erythematous
SIMPLEX VIRUS TYPE 2 base develop on her vulva or
INFECTION in the vagina, accompanied
by a low-grade fever 3-7 days
after exposure. Although
symptoms fade in a few days,
the virus remains in local
nerve ganglions, becoming
activated again any time she
has a break in the skin or
also possibility by stress.
Primary infection can cause
congenital infection in the
newborn because herpes can
be transmitted across the
placenta. If a woman has
primary or secondary active
lesions in the vagina or vulva
at he time of birth, infection
can be transmitted to the
newborn which results to
congenital herpes, a severe
infection that is often fatal.
Oral acyclovir (Zovirax) or
valacyclovir (Valtrex).
Women can reduce pain of
the lesions by taking sitz
baths or applying warm, moist
tea bags to the area.
Condoms use by a woman’s
partner or by a woman is
encouraged to prevent the
transmission of the virus.

Diagnostic Tests:

Made by the appearance of

the lesions, Pap smear, and
enzyme-linked
immunosorbent assay
(ELISA).
Caused By A Gram-Negative A yellow-green vaginal Associated with spontaneous Oral cefixime (Suprax) or
Coccus Neisseria discharge may be present, or miscarriage, preterm birth, intramuscular ceftiaxone
Gonorrhoeae. a woman may be and endometritis in the (Rocephin). People who
asymptomatic. Male partner postpartum period because it contract gonorrhea also have
usually has severe symptoms can result into severe eye a chlamydial infection,
A WOMAN WITH
of pain on urination and a infection that can lead to nonpregnant women should
GONORRHEA
purulent yellow penile blindness in the newborn if receive doxycycline therapy
discharge. the infection is present at the at the same time. If a woman
time of birth. It is also a is pregnant, she should
major cause of pelvic receive amoxicillin or
 inflammatory disease (PID) azithromycin
and infertility.

Diagnostic Tests:

Culture of the organism from

the vagina, rectum, or
urethra.
Human Papillomavirus (Hpv) At first, lesions appear as It associated a cesarean birth Podophyllum (Podofin) applied
discrete papillary structures; because of the vulvar lesions directly to lesions for
they then spread enlarge, present at the time of birth nonpregnant women but is
A WOMAN WITH HUMAN and coalesce to form large, and obstruct the birth canal. contraindicated during
PAPILLLOMAVIRUS cauliflower-like lesions. These HPV infection is associated pregnancy because of
INFECTION tend to increase in size with the development of possible toxic effects on the
during pregnancy because of cervical cancer later in life. fetus instead, Trichloroacetic
the high vascular flow in the acid (TCA) or bichloroacetic
pelvic area. They may acid (BCA) applied to lesions
become secondarily weekly can be used during
ulcerated and infected which pregnancy.
may develop a foul vulvar
Large lesions may be
odor
removed by laser therapy,
cryocautery, or knife excision.
With cryocautery, edema at
the site is evident
immediately; lesions become
gangrenous, and sloughing
occurs in 7 days. Healing will
be complete in 4-6 weeks
with only slight
depigmentation at the site.

Sitz baths and a lidocaine

cream may be soothing
during healing period.
 Streptococcus B The mother usually Leading to preterm birth and A broad-spectrum penicillin
experiences no symptoms. postpartum endometritis such as ampicillin is the
because of urinary tract treatment of choice.
infection (UTI) and intra-
Women who experience
amniotic infection. Neonates
A WOMAN WITH GROUP B rupture of membranes at less
at the time of birth will
STREPTOCOCCAL INFECTION than 37 weeks of pregnancy
become infected because of
and so have not yet been
placental transfer or from
screened ,ay be treated with
direct contact with the
intravenous ampicillin to
organisms and may develop
reduce the risk of spreading
severe pneumonia, sepsis,
of infection to the newborn.
respiratory distress
syndrome, or meningitis.

Diagnostic Test:

Screening for streptococcus B

at 35-38 weeks of pregnancy
as recommended by the CDC
Hepadnavirus Generalized jaundice High incidence of chronic Immunity: Natural; one
because of from the infection with the virus episode induces immunity for
A WOMAN WITH transfusion of contaminated because it was persisted for the specific type of virus
blood and plasma or semen, longer than six months
HEPATITIS B OR C sexual contact, inoculation by
a contaminated syringe or Active artificial immunity:
needle through IV drug use; Vaccine for the HBV virus
may be spread to fetus if (recommended for routine
mother has infection in third immunization series and
trimester. health care providers)

Passive Artificial Immunity:

Specific Hepatitis B immune
serum globulin
 Incubation period: 120 days
on average

Diagnostic Test:

Hepatitis screening
Retrovirus Rarely begins with Associated with low Zidovudine (ZVD) is
reproductive tract irritation, birthweight, preterm birth administered to the woman
fatigue, anemia, diarrhea, and also infants born to beginning with the 14th week
weight loss and may develop untreated HIV-positive of pregnancy and the
opportunistic infections and women will contract the virus newborn receives the drug for
A WOMAN WITH HIV
possibly malignancies. and develop AIDS in the first 6 weeks after birth in which
INFECTION
year of life because of the the risk of perinatal
vertical transmission of virus transmission can be reduced
across the placenta at birth. to only 8%-10%

Nevirapine, a newer
antiretroviral drug may
reduce the incidence even
more.

Diagnostic Test:

Done by an ELISA antibody

reaction and for confirmation,
a Western blot analysis is
required.

A woman with HIV infection

may also have contracted
other STI’s such as syphilis,
gonorrhea, Chlamydia, and
hepatitis B and should be
screened for these as well.