Maternal Infections and Fetal Complications: A Nursing Guide

Standard protocol involves screening the pregnant person at 36–37 weeks gestation.

• If GBS positive or status is unknown: The client requires antibiotic prophylaxis with IV Penicillin G at least 4 hours before birth.
• Preterm Labor Note: If a client is in preterm labor, antibiotic prophylaxis for GBS is a key component of management.

Sexually Transmitted Infections: Gonorrhea, Chlamydia, and Syphilis

STIs pose significant risks for both maternal and neonatal health, often presenting with minimal symptoms in the parent.

Gonorrhea and Chlamydia

These infections can lead to premature rupture of membranes (PROM), prematurity, chorioamnionitis, and neonatal sepsis or blindness.

• Treatment: The pregnant person is typically treated with oral Azithromycin.
• Neonatal Care: All neonates should receive prophylactic ophthalmic Erythromycin ointment to prevent infection.

Syphilis

Syphilis can be congenital or acquired and is characterized by a primary lesion known as a chancre—a painless, popular lesion in the genital tract. If untreated, it can lead to spontaneous abortion, stillbirth, prematurity, and severe neonatal complications such as bone damage, anemia, deafness, and meningitis.

• Treatment: Penicillin G (IM) is the primary treatment, often requiring multiple doses depending on the length of the infection.

Hepatitis B and Vertical Transmission

Hepatitis B is a bloodborne pathogen with a high rate of vertical transmission from mother to child. Most newborns infected with Hepatitis B will go on to develop chronic Hepatitis B.

Nurses must ensure all patients are screened prenatally. The management of the newborn depends on the mother's status:

1. If Mother is Positive: The newborn must receive both the Hepatitis B Immune Globulin (HBIG) AND the Hepatitis B vaccine within 12 hours of birth.
2. If Mother is Negative: The newborn should still receive the Hepatitis B vaccine within 12 hours of birth.

Note that vaginal birth is acceptable for Hepatitis B-positive clients, and breastfeeding is safe as long as the mother's nipples are not bleeding.

The TORCH Complex

The TORCH complex is a group of infections that can cause significant developmental and physical harm to the fetus.

Nursing Education: Emphasize the importance of preconception vaccination for Rubella (MMR) and Varicella to prevent these infections from occurring during pregnancy.

Herpes Simplex Virus (HSV)

Herpes Simplex Virus is transmitted through contact with the skin or mucous membranes. The primary concern during delivery is the risk of the neonate coming into direct contact with an active lesion.

Delivery Recommendations: If the pregnant person has active lesions within 6 weeks of term, or if they exhibit prodromal signs (warning signs) of an outbreak, a C-section is recommended to prevent neonatal contact with the virus. Regardless of the delivery method, nurses should avoid invasive procedures that could break the fetus's skin.

Summary of Nursing Considerations

When managing clients at risk for infection, the nurse's role is multifaceted:

• Assessment: Monitor for signs of infection (fever, discharge, lesions) and assess fetal well-being (fetal movement, nonstress testing).
• Intervention: Administer prescribed antibiotics (like Penicillin G) or antivirals (ART) promptly.
• Education: Provide clear guidance on vaccination, dietary safety (avoiding raw meat for Toxoplasmosis), and the importance of medication adherence.