I treatment of toxop?
asmosLs durmg prnancv when obtaining prenatal care 11 Lh
1., ci.-.em 1al to reduce the risk for congenital mfe.:tton.
'>ulfonamides can be used alone but are less effeLtlve than
1..11rnl1inat1un thl!rapy. Spiramycm is mcce fully ued in
F.u ropc for maternal toxoplasmosi:> and ma.. be used accord
ing t1i specific guidelines within the l'nited States (Duff & gir!-
lncr, 2017).
Group B Streptococcus Infection
( ,roup B S t rept ococcus (GBS) is a leading cause of life-threat
en ing perinatal infections in the Gnited States. The
gram-po itive bacterium colonizes the rectum, Yagina, cer
vix, and ureth ra of pregnant as well as nonpregnant women.
Approximately 20% to 25% of pregnant women are colonized
by GBS in the vaginal or rectal area (Duff & Birsner, 2017), but
i•,o\ating the organism is often possible only intermittently.
Often, these women are asymptomatic, although symptom
atic maternal infections can occur. These infections include
UTls, intrauterine infections, and metritis. !\lost women
respond quickly to antimicrobial therapy (AAP & ACOG,
2012; CDC, 2016e; Duff & Birsner, 2017)
Fetal and Neonatal Effects. Early-onset newborn GBS
disease occurs during the first week after birth, often within
48 hours. Women who have GBS in the rectovaginal area
at the time of birth have a 60% chance of transmitting the
organism to the newborn, and about 1% to 2% of these
infants will develop early-onset GBS disease. Sepsis,
pneumonia , and meningitis are the primary infections in
early-onset GBS disease (AAP & ACOG, 2012). Late-onset
GBS disease occurs after the first week oflife, and
meningitis, pneumonia, and bacteremia are the most common
clinical manifestations (Duff & Birsner, 2017).
Therapeutic Management. Health care providers have
difficulty identifying pregnant women who are asymptomatic
GBS carriers because the duration of carrier status is
unpredictable. Optimal identification of the GBS carrier
status is obtained by vaginal and rectal culture between 35
and 37 weeks of gestation. Women who have had a previous
infant with GBS or a GBS in their urine in any trimester
will be considered GBS-positive at delivery. A woman who
delivers at or before 37 weeks, has ruptured membranes for
18 hours or more, or has a temperature of l00.4°F (38°C) or
h1g 1e.r 1 also considered positive for GBS and should
receive ant1b1ot1c theapy. Cesarean birth before membrane
rupture does nuqu1re GBS antibiotic therapy.
f Penicillin is the first-line agent for antibiotic treatment
o e mfected woman during birth. Cephazolin is the alter-
native for . the pati en t w1'th non-1i.fe-threatening
penicillin
allergy. Clmdamycin is used for the woman at high . k fi
anaphylaxis. ns or
Tuberculosis
Tuberculosis (TB) results from infection with Mycobacterium
be pos1ti\·e. Tuts scr.::enmg mvolve'i an atraderrn I
injtq111n of mycobactenal protein 'purified protean
dc:nv;,t1ve !P P!jl If the reaction is positi..-e or the \'<io:na n
ic; al rc:1<ly k11 1;wn 't'..
haw a positi\·e reaction, her abomcn sould h1.: prr,t1:ctei1
b•:a lead shield ',\ hile z. .::/;·radiograph 15 talu:n,
pr1.:ft:r ;,!J! after the first trimester J1agnosis is confi rmed
by 1'i!;,!in
and identifying the bac•erium i n lhe sputum.. .
,, Sign:.
and symptoms include general ma la1<1<:, fat.1gu(;. Ir. ..
of appetite, weight loss, and fever. Symptos r1ccu: JO t
hr;l;;ie afternoon and eYening and are accompanied by nigh t
r,wr;;;t_ As the disease progresses, a ch ronic cough
dc:vdr1p<. anr!
mucopurulent sputum is produced. . . .
TB increases with p overty, malnutn t1on, and Hf V 1nftc
tion. Worldwide, it is responsible for more deaths than an·
other communicable disease. The incidence is increasing in
inner-city areas and among homeless persons. ft i s also prtV<i·
lent among immigrants from Southeast Asia and Central and
South America.
Fetal and Neonatal Effects. Although peri natal infectirin
is uncommon, it may be acquired as a resul t of the fttl
swallowing or aspirating infected amniotic fluid. Diagno is i
made by finding the bacilli in the gastric aspirate of the neonatt
or in placental tissue.Signs of congenital TB include failure tr1
thrive, lethargy, respiratory distress, fever, and enlargement
of the spleen, liver, and lymph nodes. If the mother remai
untreated, the newborn is at high risk for acquiring TB by
inhalation of infectiou s respiratory droplets from the mother.
Therapeutic Management. Untreated TB poses a greate.
hazard to the fetus than its treatment (CDC, 2016i).Treatmen:
of TB is based on two principles. First, more than one drug
should be used to prevent the growth of resistant organisms.
Second, treatment should continue for a prolonged period
The preferred treatment for pregnant women with active TB
is isoniazid (INH), rifampin (RlF), and ethambutol (DlB
daily for 2 months, followed by INH and RIF daily or twice
weekly for 7 months, for 9 months of total treatment durauon.
Pyridoxine (vitamin B6) should be given with isoniazid to
?revent fetal neurotox:icity and because pregnancy itseli
mcreases he demand for this vitamin. Drug resistance in the
TB orgamsm may require addition of other drugs, although
the followig drugs are not recommended in pregnanC:
strepton:ycm, kanamycin, capreomycin, ethionarnid .
cyclosenne, .pyrainamide, amikacin, and fluoroqui nolone5
(CDC, 20161; Whitty & Dombrowski , 2017).
. Management of the infant born to a mother with TB
mvolves preventin the disease and treating the jn f ect!0
early. If the mother s sputum is free of organisms, the infJfl'
oes not need to be isolated from the mother Breastfeed1n=
J safe, and drugs may be secreted in breast ilk.
Ho\1·e1·er.
t de maternal ntituberculosis drugs in breast milk are no:
:quate for mfant treatment. Drug serum le\'els in rb'
tuberculosis.
liquid
It is transmitted by aerosolized droplets of m1. ant can be to 1.dent1.f)' if levels a re too h 1 h·
mea sure d :1

containing the bacterium , which are inhaled by a non D1sease · focuses on teach ing the mother anv
infected th c . prevention

.e 1am1l)' h. ow the d i' sease .is transmitted so that thef

indi,·idual and taken into the lung. Initially, most individuals ·Jf.
c
are asymptomatic. Women at risk should be screened for TB pr otet the mfant and other family mem bers from airborII'
organisms. TI1e infant should be skin-tested at bir th and 111J'.