Methods in Assessing the

Fetal Well-Being
A. FETAL MOVEMENT (Kick counts)
▪ Quickening – begins at 18 – 20 wks. AOG; peaks at
28 – 38 wks. AOG
▪ Average fetal movement = 10 – 12x/ day
▪ Decreased fetal movement = placental insufficiency
▪ SANDOVSKY METHOD
➢ Counting & recording the number of fetal movements in
an hour after meal (mother in left recumbent position)
➢ Normal: 2x/ 10 min. or 10 – 12x/ hr.
➢ Needs Referral: 10 fetal movements in 2 hours

1
 ▪ CARDIFF METHOD (Count-to-Ten)
➢ Recording the time interval it takes for the pregnant woman to
feel the fetal movement.
➢ Normal: 10 fetal movements/ hr.

B. FETAL HEART RATE

▪ As early as the 10th – 11th wk. AOG by Doppler
▪ Normal: 120 – 160 beats/ min.
1) RHYTHM STRIP TESTING
❖ Determine the presence of good baseline rate, long & short
term variability by the use of external fetal heart rate & uterine
contraction monitors for 20 min.
❖ Position: SEMI – FOWLERS
❖ SHORT-TERM VARIABILITY – small changes in FHB from
second to second
❖ LONG-TERM VARIABILITY – differences in FHR that occur
over 20 min. period.
2
3
2) NONSTRESS TESTING
➢ Response of FHR to fetal movement in which the FHR
and Uterine Contraction Monitors are attached.
➢ Position: SEMI-FOWLERS/ LEFT LATERAL
➢ Normal : REACTIVE NONSTRESS TEST
2 – 4 FHR accelerations in 10 min.
➢ Abnormal: NON-REACTIVE NONSTRESS TEST
No accelerations with the fetal movements

3) VIBROACOUSTIC STIMULATION
➢ Test used to stimulate fetal movement by the use of
acoustic stimulator especially if a spontaneous
acceleration has not occurred within 20 min. during
NONSTRESS TEST.

4
4) CONTRACTION STRESS TESTING
▪ Assessing FHR response to uterine contractions
▪ Purpose: to assess the fetal ability to tolerate the stress of
labor.
▪ Position: LEFT LATERAL/ SEMI-FOWLERS
▪ Normal result: NEGATIVE
> No late FHR decelerations present by 3
contractions in 10 min. period
▪ Abnormal: POSITIVE
> presence of late FHR decelerations by
50% or more of uterine contractions.
▪ Contraindication:
➢ Placenta previa
➢ Multifetal pregnancy
➢ Incompetent cervix
➢ Rupture of membranes
5
C. ULTRASONOGRAPHY
▪ Purposes:
1. To diagnose pregnancy as early a s 6 wks.

2. To confirm the size, presence, & location of placenta &

amniotic fluid

3. To establish that a fetus is growing and has no gross

anomalies.

4. To establish sex of the fetus.

5. To establish the presentation and position of the fetus.

6. To predict the maturity of the fetus.

7. To discover complications of pregnancy

6
Preparation for Ultrasound
1. Explain the procedure
2. Encourage to have a full bladder at the time of
procedure (drink a full glass of water every 15 min.
beginning 90 min. before the procedure)
3. Position patient in supine
4. Place a rolled towel or blanket under the right
buttock (prevent supine hypotension syndrome).
5. The gel must be at room temp. or slightly warm
before applying on the abdomen

7
C.1. BIPARIETAL DIAMETER
▪ 8.5 cm. = 40 wks. Of fetal age
C.2. DOPPLER UMBILICAL VELOCIMETRY
▪ Measures the velocity at which RBCs in the uterine
and fetal vessels and traveling.
▪ velocity = poor neonatal outcome
C.3. PLACENTAL GRADING
▪ Grade 0 = 12 – 24 wks. AOG
▪ Grade 1 = 30 – 32 wks.
▪ Grade 2 = 36 wks.
▪ Grade 3 = 38 wks.

8
C.4. AMNIOTIC FLUID VOLUME ASSESSMENT
▪ The sum of the largest pocket measurements of
amniotic fluid.
▪ Average fluid index = 12 – 15 cm bet. 28 – 40 wks.
▪ Abnormal Finding:
▪ Hydramnios = > 20-24 cm fluid index
▪ Oligohydramnios = < 5 – 6 cm fluid index

9
D. MATERNAL SERUM ALPHA-FETOPROTEIN
 Alpha-fetoprotein (AFP)
➢ A substance produced by the fetal liver that is present in
amniotic fluid and maternal serum.
➢ MSAFP = spina bifida
➢ An AFP multiple of the median (MoM) <2.5 is reported as
screen negative. AFP MoMs > or =2.5 (singleton and twin
pregnancies) are reported as screen positive.
➢ MSAFP = down syndrome
E. TRIPLE SCREENING
▪ An analysis of 3 indicators:
1) MSAFP
2) Unconjugated estriol
3) hCG

10
F. CHORIONIC VILLI SAMPLING

 A biopsy & chromosomal or DNA analysis of chorionic

villi done at 10 – 12 wks. AOG

 An invasive procedure, Ultasonography is used to

direct the procedure.

 COMPLICATIONS:
1) Infection
2) Bleeding
3) Threatened miscarriage

11
Chorionic Villi Sampling

12
G. AMNIOCENTESIS
▪ An invasive procedure that involves withdrawal of
amniotic fluid through the abdominal wall at 14th –
16th wk. of pregnancy.
▪ Women with Rh – blood type need Rh immune
globulin adm. after the procedure to protect fetus
from isoimmunization
 Ultrasonography is used to direct the procedure
 PURPOSE:
➢ To evaluate fetal status (maturity, congenital
anomalies)

13
Amniocentesis

14
▪ INDICATIONS:

1. Maternal age of 35 yrs. or older

2. Previous child with chromosomal abnormalities
3. Parent with chromosomal abnormalities
4. Familial history of neural tube defects
5. Fetal abnormalities per ultrasound
6. Assessment of fetal pulmonary maturity
7. Evaluate alpha-fetal protein (AFP)
8. Diagnosis of fetal hemolytic disease

15
COLOR OF AMNIOTIC FLUID:

➢ NORMAL:
clear, slightly yellow tinge during late pregnancy

➢ ABNORMAL:
strong yellow (blood incompatibility)
green color (meconium staining)

16
 Amniocentesis can provide the
following informations:
1. L/S (Lecithin/sphingomyelin ratio)
▪ These are the protein components of the lung enzyme
surfactant that the alveoli begin to form at about 22nd –
24th wks. Pregnancy
▪ Surfactant
▪ A substance composed of lipoprotein that is secreted by the
alveolar cells of the lung and
serves to maintain the stability of pulmonary tissue by reducing
the surface tension of fluids that coat the lung.
▪ NORMAL: 2:1 (fetal lung maturity)

2. Phosphatidyl Glycerol (PG)

▪ Precursor of surfactant; presence in amniotic fluid of the
NB indicates lung maturity.
▪ Helps confirm fetal maturity
17
3. Bilirubin level
▪ Indicates blood incompatibility or the degree of
destruction of fetal RBCs in an RH sensitized woman.
▪ 1 – 4 mg/100 ml
▪ If elevated:
▪ Reflects release of bilirubin as excessive RBC begin their
breakdown
▪ Bilirubin:
▪ A byproduct of RBC breakdown
4. Creatinine
▪ Level of < 1.8 mg/dl demonstrates maturing kidney
function of fetus
5. Alpha-Fetoprotein
indicates NEURAL TUBE DEFECT

indicates DOWN’S SYNDROME

18
6. Chromosome analysis
▪ Skin cells in the amniotic fluid may be cultured and
stained for karyotyping.

7. Fetal Fibronectin
▪ A glycoprotein that helps placenta attach to the
uterine decidua.
▪ Found abundantly in the amniotic fluid
▪ Can be found in the woman’s cervical mucus early in
pregnancy (fades after 20 wks. AOG)
▪ Detection of this in the amniotic fluid or in the
mother’s vagina indicates that preterm labor may
begin

19
8. Inborn Errors of Metabolism
▪ Examples:
✓ Cystinosis = characterized by cystinuria (characterized by
stone formation in the urinary tract)
✓ Maple syrup urine disease (amino acid disorders) =
characterized by :
❖ Vomiting
❖ Hypertonicity
❖ Severe mental retardation
❖ Seizures
✓ Phenylketonuria
❖ Enzyme deficiency resulting in accumulation of
phenylalanine (an essential amino acid) & its metabolites
in the blood causing severe mental retardation.

20
THERAPEUTIC NURSING
MANAGEMENT
1. Assist with procedure, monitor for sterility
2. Determine whether the client is to empty her bladder prior
to procedure (empty the bladder to prevent inadvertent
puncture)
3. Position client in left lateral
4. Provide emotional support
5. Refer client for genetic counseling when indicated
6. Women who are Rh negative receive Rho (D) immune
globulin (RhIG; RhoGAM) after the procedure to prevent
fetal isoimmunization (development of antibodies in
response to antigen from another individual of the same
specie)
21
7. Secure an informed consent form, including a clear
explanation of risks of the procedure before the
procedure is done
8. Use universal precautions during the procedure.

COMPLICATIONS:
1. Needle puncture of the fetus
2. Bleeding
3. Loss of amniotic fluid
4. Infection
5. Premature labor
6. Spontaneous abortion
7. Fetal distress

22
H. Percutaneous Umbilical Blood Sampling (PUBS/
Cordocentesis or Funicentesis)
▪ Removal of blood from the fetal umbilical cord (vein)
at about 17 wks.

▪ Blood studies:
1) CBC
2) Direct Coomb’s test (agglutination test used to detect
proteins esp. antibodies on the surface of RBC.
3) Blood gases
4) Karyotyping (chromosomal characteristics)

23
I. Amnioscopy

▪ Visual inspection of the amniotic fluid through the

cervix and membranes with an amnioscope.

▪ PURPOSE:
✓ To detect meconium staining

▪ COMPLICATION:
✓ Rupture of membrane

24
J. FETOSCOPY
▪ Visual inspection of the fetus through a fetoscope
that is inserted by amniocentesis technique in
assessing fetal well-being.
▪ PURPOSES:
1) To confirm intactness of the spinal column
2) Obtain biopsy sample of fetal tissue and fetal blood
samples
3) Perform elemental surgery, such as:
1) inserting polyethylene shunt into the fetal ventricles to
relieve hydrocephalus, or
2) into the bladder to relieve stenosed urethra
▪ COMPLICATION:
1) Premature labor
2) Amnionitis
25
K. BIOPHYSICAL PROFILE
▪ 5 parameters:
1) Fetal heart reactivity
 2 or more accelerations of at least 15 bpm for 15 sec.
over a period of 20 min.
2) Fetal breathing movements
 1 episode of 30 sec. of sustained fetal breathing
movement within 30 min. of observation.
3) Fetal body movements
 3 separate episodes of fetal limb or trunk movements
within 30 min.
4) Fetal tone
 Fetus extends then flexes extremities or spine of at least
once in 30 min.
5) Amniotic volume
 Pocket of amniotic fluid measuring 1 cm in vertical
diameter.
26
K. BIOPHYSICAL PROFILE

Score:
8 – 10 fetus is doing well; healthy fetus
6 - suspicious; requires determination of the need
for immediate delivery of the fetus, considering
maturity of the fetal lungs.
4 - fetus in jeopardy

27
1
Specific Objectives:
1. Identify the factors that influence the woman’s attitude
towards pregnancy.
2. Identify the emotional responses of the woman to pregnancy.
3. Describe the psychological tasks the pregnant woman has to
accomplish in each trimester.
4. Know the discomforts commonly felt during the each trimester
of pregnancy.
5. Identify teratogenic factors and their effects to the fetus.
6. Recognize the danger signs of pregnancy.
7. Plan nursing care related to health promotion, discomforts and
danger signs related to pregnancy and limitation of exposure
to teratogens
2
 Factors that Influence the Woman’s
Attitude towards Pregnancy
1. Social
Ø Personal experiences
Ø Experiences of friends & relatives
2. Cultural
Ø Beliefs
Ø Taboos
3. Family
Ø The family in which the woman was raised.
4. Individual
Ø Woman’s ability to cope with or adapt to stress
Ø Ability to adapt to being a mother
3
 Emotional Responses
1. Ambivalence
2. Grief
3. Narcissism
4. Introversion vs. Extroversion
5. Body Image & Boundary
6. Stress
7. Couvade Syndrome
8. Emotional Lability
9. Changes in Sexual Desire
10. Changes in the Expectant Family
4
 Psychological Tasks the Pregnant Woman
has to Accomplish in each Trimester
§ FIRST TRIMESTER  Common reaction is
Task: Accepting the ambivalence
Pregnancy
 Begins to imagine herself
§ 2nd TRIMESTER as a mother (anticipatory
Task: Accepting the Baby role-playing)
 Woman feels fetal
movement
§ 3rd TRIMESTER  “nest-building” activities
Task: Preparing for the  Role-playing
Baby & Parenthood
 fantasizing
5
 Health Promotion
1. Self-care needs
1) Bathing
§ daily tub baths or showers are recommended.
§ heat exposure for a lengthy time could lead to
hyperthermia in the fetus and birth defects (specifically
esophageal atresia, omphalocele, and gastroschisis)
2) Breast care
 wear a firm, supportive bra with wide straps
 Teach her to wash her breasts with clear tap water (no
soap, because that could be drying and cause her nipples
to crack) daily to remove the colostrum and reduce the
risk of infection.
 Health Promotion
1. Self-care needs
3) Dental care
 There is a strong correlation between poor oral health
and preterm birth, so maintaining good oral health
during pregnancy is important
 When bacteria in the mouth interact with sugar, this
lowers the pH of the mouth, creating an acid medium
that can lead to etching or destruction of the enamel of
teeth
 Health Promotion
1. Self-care needs
4) Perineal hygiene
 Maintain good perineal hygiene.
 Caution them to always wipe front to back after voiding to
prevent bringing contamination forward from the rectum.
5) Clothing
 Women should be cautioned to avoid garters, extremely firm
girdles with panty legs, and knee-high stockings during pregnancy
because these may impede lower extremity circulation.
 Suggest wearing shoes with a moderate-to-low heel to minimize
pelvic tilt and possible backache as well as to reduce the risk of
falling.
 Health Promotion
2. Sexual activity
 Women who have a history of previous preterm birth should
consult their obstetric provider for specific advice.
 Women whose membranes have ruptured or who have vaginal
spotting should be advised against coitus until examined by
their primary care provider to prevent possible infection or
complications.
 Changes in sexual position may be needed to increase comfort.
 Health Promotion
3. Exercise
 220 – 20 (age of woman) = 200 x 70% = 140 bpm
 Walking is the best exercise during pregnancy
 women should be encouraged to take a walk daily unless
inclement weather, many levels of stairs, or an unsafe
neighborhood are contraindications.
 Yoga is also a good exercise as long as positions are limited to those
in which pregnant women are able to maintain balance
 Swimming is a good activity for pregnant women and, like bathing, is
not contraindicated as long as membranes are intact.
 Please refer to the GUIDELINES FOR EXERCISE IN PREGNANCY p. 261
 Health Promotion
4. Sleep
 growth hormone secretion is at its highest level—that is, during
sleep.
 A good resting or sleeping position is a left-sided Sims position,
with the top leg forward
5. Employment
 May continue to work unless a woman’s job involves exposure to
toxic substances, lifting heavy objects, other kinds of excessive
physical strain, long periods of standing or sitting, or having to
maintain body balance.
 please refer to GUIDELINES FOR PREGNANT WOMEN
WORKING OUTSIDE THEIR HOME p. 263
6. Travel
Health Promotion
 Advise a woman who is taking a long trip by automobile to plan
for frequent rest or stretch periods.
 Preferably every hour, but at least every 2 hours, she should get out of the
car and walk a short distance.
 This break relieves stiffness and muscle aches and improves lower
extremity circulation, helping prevent varicosities, hemorrhoids, and
thrombophlebitis.
 Caution her not to eat unwashed fruits or vegetables or raw meats and not to
drink unpurified water.
 she should make arrangements to visit a healthcare provider in that area so
she can keep the schedule of her regular prenatal visits. Also, make certain
she has enough of her prescribed vitamin supplement plus adequate
prescriptions for refills as necessary.
 Minor Body Changes of Pregnancy
(1st Trimester)
1. Breast tenderness - wide strap bra
2. Palmar erythema (palmar pruritus)
 due to increased estrogen
 may apply calamine lotion
3. Constipation
4. Nausea, vomiting and pyrosis (heartburn)
5. Fatigue
 due to increased metabolic requirement
 increase amount of rest & sleep
 Minor Body Changes of Pregnancy
(1st Trimester)
6. Muscle cramps
 dorsiflex foot; elevate LE freq.,
 Due to decreased serum calcium levels, increased serum
phophorus levels, and possibly, interference with circulation.
 Take a calcium supplement
 Take magnesium lactate or citrate once in the morning and
again in the evening as these bind phosphorus in the intestinal
tract and thereby lower its circulating level
7. hypotension
 Minor Body Changes of Pregnancy
(1st Trimester)
8. Varicosities - elevate leg 15-20 min 2x/day
9. Hemorrhoids
10. Heart palpitations
 due to increased blood volume
 Gradual, slow movements will help prevent this from happening.
11. Frequent urination
 void as often as necessary, as urine stasis can lead to infection.
 perform Kegel exercises are exercises designed to strengthen the
pubococcygeal muscles. Each is a separate exercise and should be done
about three times per day.
12. Abdominal discomfort
13. leukorrhea
 Minor Body Changes of Pregnancy
Late Pregnancy
1. Backache – pelvic rock/tilt; squat instead of bend
2. Headache – due to expanding blood volume
3. Dyspnea
4. Ankle edema – due to general fluid retention
5. Braxton Hicks contractions
 Complications of Pregnancy
(danger signs)
1. Vaginal bleeding
§ all women with spotting need further evaluation.
2. Persistent vomiting
§ Persistent or extended vomiting depletes the nutritional supply
available to a fetus and thus is a danger to the pregnancy.
3. Chills and fever or pain on urination
§ May indicate an intrauterine infection, a potentially serious complication
for both a woman and a fetus.
§ Pain on urination is a symptom of a urinary infection, and are associated
with preterm birth.
 Complications of Pregnancy
(danger signs)
4. Sudden escape of clear fluid from the vagina
§ means the membranes have ruptured
§ umbilical cord may prolapse.
§ If the fetal head then presses on the misplaced cord,
oxygenation can be compromised and the fetus will
be in immediate and grave danger.
§ Urine can be identified by Nitrazine paper as urine
is acidotic (the test strip turns yellow), whereas
amniotic fluid is alkaline (the strip turns blue).
 Complications of Pregnancy
(danger signs)
5. Abdominal or chest pain
§ Abdominal pain could be a sign of
1) tubal (ectopic) pregnancy,
2) separation of the placenta (abruptio placenta)
3) preterm labor (regular contractions, cervical changes)
4) appendicitis
5) ulcer, or pancreatitis.
§ Chest pain and shortness of breath may indicate a pulmonary
embolus, a complication that can follow thrombophlebitis.
6. Increase or decrease in fetal movement
*Sandovsky method= Normal: 10-12x/hr.
 Complications of Pregnancy
(danger signs)
7. Gestational hypertension.
§ usually after 20 weeks of pregnancy.
§ S/Sx:
1) Rapid weight gain
v Over 2 lbs/week in 2nd tri, 1 lb/week 3rd tri (Normal: 3-12-12)
2) Swelling of the face or fingers
3) Flashes of light or dots before the eyes
 Complications of Pregnancy
(danger signs)
7. Gestational hypertension.
4) Dimness or blurring of vision
5) Severe, continuous headache
§ may signal cerebral edema or acute hypertension.
6) Decreased urine output (Normal: 30 ml/hr)
7) Right upper quadrant pain unrelated to fetal position
§ ischemia of the liver
8) Blood pressure increased above 140/90 mmHg
 Preventing Fetal Exposure to
TERATOGENS
What is a teratogen?

Is any factor, chemical or physical, that

adversely affects the fertilized ovum,
embryo or fetus.

Is any agent that can induce or increase the

incidence of a congenital malformation.
 Effects of teratogens on the Fetus
 Factors that influence the amount of damage a
teratogen can cause:
1) Strength of teratogens (ex: radiation)
2) Timing of the teratogenic insult
▪ If a teratogen is introduced before implantation,
for example, either the zygote is destroyed or it
appears unaffected.
▪ If the insult occurs when the main body systems are
being formed (in the second to eighth weeks of
embryonic life), a fetus is very vulnerable to injury.
▪ During the last trimester, the potential for harm
again decreases because all the organs of a fetus
are formed and are merely maturing.
 Effects of teratogens on the Fetus
 Factors that influence the amount of damage a
teratogen can cause:
3) Teratogen’s affinity for specific body tissues.
▪ Lead and mercury, for example, attack and
disable nervous tissue.
▪ Thalidomide (Immunoprin), originally used to
treat nausea in pregnancy, is now prescribed for
cancer therapy, and it may cause limb defects.
▪ Tetracycline (Apo-Tetra), a common antibiotic,
causes tooth enamel deficiencies, and possibly,
long bone deformities.
▪ The rubella virus affects many organs, with the
eyes, ears, heart, and brain the four most
commonly attacked
 Teratogenic Maternal Infections
 Teratogenic maternal infections involve viral,
bacterial, or protozoan organisms, which
cross the placenta from mother to fetus.
 Malaria
 caused by intraerythrocytic protozoa of the
genus Plasmodium transmitted to humans by
the bite of an infected
female Anopheles mosquito.
 Healthcare providers can contract it from
infected blood products.
 During pregnancy, women can transmit
malaria to a fetus.
 Teratogenic Maternal Infections

 Malaria
A number of drugs, such as
chloroquine (Aralen) in the first
trimester and mefloquine (Lariam) in
the second or third trimesters, are
helpful.
 Women who will be visiting an area
known to be epidemic for malaria can
begin treatment as prophylaxis up to 2
weeks before travel.
 Teratogenic Maternal Infections
 When newborns are tested to see if
antibodies against the common infectious
teratogenic diseases are present, the test
is described collectively under the
umbrella term TORCH:
 Toxoplasmosis
 Rubella
 Cytomegalovirus
 Herpes simplex virus
 Note: some sources identify the O with
“other infections”, which include syphilis, HBV
(Hep B virus), and HIV.
 Toxoplasmosis
 A protozoan infection, is spread most commonly
through contact with uncooked meat, although it
may also be contracted through handling cat stool in
soil or cat litter.
 If the infection crosses the placenta, the infant may
be born with CNS damage, hydrocephalus,
microcephaly, intracerebral calcification, & retinal
deformities.
 Pyrimethamine, an antifolic acid drug and an
antiprotozoal agent is used cautiously early in
pregnancy to prevent reducing folic acid levels.
 Rubella
Fetal damage from maternal infection with
rubella (german measles) includes:
1) deafness
2) mental and motor changes
3) Cataracts
4) cardiac defects(most commonly patent ductus
arteriosus & pulmonary stenosis)
5) retarded intrauterine growth(small for
gestational age)
6) thrombocytopenic purpura (patches of
purplish discoloration)
7) dental & facial clefts, such as cleft lip &
palate (Lee& Bowden, 2000)
 A woman who is not immunized before pregnancy
cannot be immunized during pregnancy.
▪ because the vaccine contains a live virus that
would have effects similar to those occurring with
a subclinical case of rubella.
 After a rubella immunization, a woman is advised
not to become pregnant for 3months until the
rubella virus is no longer active.
▪ all pregnant women should avoid contact with
children with rashes.
▪ all pregnant women should avoid contact with
children with rashes.
▪ Nurses who care for pregnant women or newborns
should receive immunization against rubella
 All women w/ low rubella titers should be
immunized to provide protection against
rubella in future pregnancies

▪ A titer greater than 1:8 suggests immunity to the

disease.
▪ A titer of less than 1:8 suggests a woman is
susceptible to viral invasion.
▪ A titer that is greatly increased over a previous
reading or is initially extremely high suggests a
recent infection has occurred.
 Cytomegalovirus (CMV)

 Cytomegalovirus (CMV), a member of the HSV

family.
 can cause extensive damage to a fetus while
causing few symptoms in a woman (Martin &
Satin, 2015).
 not sexually transmitted but spreads from person
to person by droplet infection such as occurs with
sneezing.
 Cytomegalovirus (CMV)
 If a woman acquires a primary CMV infection
during pregnancy and the virus crosses the
placenta
 the infant may be born with severe neurologic
challenges (e.g., hydrocephalus, microcephaly, or
spasticity) or with eye damage (e.g., optic atrophy
or chorioretinitis), hearing impairment, or chronic
liver disease.
 The newborn’s skin may be covered with large
petechiae (i.e., “blueberry-muffin” lesions).
 Cytomegalovirus (CMV)
 Because a woman has almost no symptoms, she
may not even be aware she contracted an
infection.
 Diagnosis in the mother or infant can be
established by the isolation of CMV antibodies in
blood serum (BLOOD CULTURE).
 Unfortunately, there is NO TREATMENT for the
infection even if it presents in the mother with
enough symptoms to allow detection.
 Cytomegalovirus (CMV)
 Because there is no treatment or vaccine for the
disease, routine screening for CMV during
pregnancy is not recommended.
▪ Advise women to wash hands thoroughly before
eating
▪ avoid crowds of young children at daycare or
nursery school settings to help prevent exposure
(Drew, Stapleton, Abu, et al., 2015).
 Herpes Simplex Virus (Genital Herpes
Infection)
 The virus spreads into the bloodstream
(viremia) and crosses the placenta to the
fetus.

 1st trimester
 congenitalanomalies or spontaneous
miscarriage may occur.

 2nd or 3rd
high incidence of premature birth,
intrauterine growth retardation, & continuing
infection of the newborn birth.
 Herpes Simplex Virus (Genital Herpes
Infection)
 Ifgenital lesions are present at the time of
birth, however, a fetus may contract the
virus from direct exposure during birth.
 Cesarean birth is usually advised to reduce the
risk of this route of infection.
 This awareness of the placental spread of
HSV has increased the importance of
obtaining information about exposure to
HSV or any painful perineal or vaginal
lesions that might indicate this infection at
prenatal visits through conscientious history
taking.
 Herpes Simplex Virus (Genital Herpes
Infection)
 Acyclovir (Zovirax) or valacyclovir (Valtrex)
can both be safely administered to women
who develop lesions during pregnancy as
well as to their newborns at birth (Groves,
2016).
 Either drug is recommended daily as
prophylaxis at 36 weeks of pregnancy to prevent
a lesion at the time of birth.
 The primary mechanism for protecting a fetus,
however, is disease prevention.
 Urging women to practice safer sex is important
to lessen their exposure to this and other
sexually transmitted infections.
 Other Viral Diseases
 Syphilis
 sexually transmitted infection
 Treponema Pallidum cannot cross the placenta
when cytotrophoblast layer of chorionic villi is still
intact.
 this layer atrophies at 16th – 18th week and
treponema pallidum can then cross the placenta
and cause extensive damage.
 For these reasons, serologic screening (either by a
venereal disease research laboratory [VDRL] or a
rapid plasma reagin [RPR] test) is done at a first
prenatal visit;
 The test may then be repeated again close to term
(the eighth month) if recent exposure is a concern.
 Other Viral Diseases
 Syphilis
 If treated with benzathine penicillin in the 1st
trimester, fetus is rarely affected.
 If left untreated beyond 18th week:
Hearing impairment
Cognitive challenge
Osteochondritis
Fetal death
 Other Viral Diseases
 Syphilis
 Evenwhen a woman has been treated with
antibiotics, the serum titer remains high up
to 200 days;
 anincreasing titer suggests reinfection has
occurred.
 Inan infant born to a woman with syphilis,
the serologic test for syphilis may remain
positive for up to 3 months even though the
disease was treated during pregnancy.
 Other Viral Diseases
 Syphilis
 Thenewborn with congenital syphilis may
have:
congenital anomalies
extreme rhinitis (sniffles)
characteristic syphilitic rash, all of which
identify the baby as high risk at birth
(Akahira-Azuma, Kubota, Hosokawa, et al.,
2015).
When the baby’s primary teeth come in,
they are often oddly shaped (i.e.,
Hutchinson teeth).
 Other Viral Diseases
 Syphilis
▪ As with all sexually transmitted infections,
prevention through safer sex practices is key.
 Rubeola (measles), coxsackievirus (human
enterovirus A,B,C), infectious parotitis
(mumps), varicella (chickenpox),
poliomyelitis, influenza, and viral
hepatitis all may be teratogenic.
▪ Women are advised to be vaccinated against
influenza before pregnancy.
 Other Viral Diseases
 Ifparvovirus B19, the causative agent of
erythema infectiosum (also called fifth
disease) and a common viral disease in school-
age children, contracted during pregnancy:
▪ it can cross the placenta and attack the red
blood cells of the fetus.
 Infection
with the virus during early
pregnancy
▪ associated with fetal death.
 If the infection occurs late in pregnancy
▪ the infant may be born with severe anemia and
congenital heart disease (American College of
Obstetricians and Gynecologists, 2015).
 Other Viral Diseases
 Lyme Disease
a multisystem disease caused by the spirochete Borrelia
Burgdorferi, is spread by the bite of a deer tick.
 Signs/symptoms:
1) Erythema chronicum migrans (large, macular lesions
with a clear center)
2) Pain in large joints
3) Spontaneous miscarriage
4) Severe congenital anomalies
▪ Treatment:
1) Tetracycline & doxycycline (for non-pregnant)
2) Penicillin (for pregnant)
 Potential Teratogenicity of Vaccines

 Live virus vaccines such as:

 Measles
 Mumps
 rubella and
 poliomyelitis (sabin type), are contraindicated
during pregnancy because they may transmit
the viral infection to the fetus.
 Teratogenicity of Drugs
 2 principles related to drug intake during
pregnancy:

 Any drug or herbal supplement, under certain

circumstances, may be detrimental to fetal welfare.

❖ during pregnancy, women should not take any drug or

supplement not specifically prescribed by their
physician or nurse midwife.

 A woman of childbearing age and ability should take

no drugs other than those prescribed by the physician
or nurse midwife to avoid exposure to a drug should
she become pregnant.
 Teratogenicity of Alcohol
 Alcohol is a common drug abused by women of childbearing
age. Infants born to alcoholic mothers demonstrate prenatal
and postnatal growth deficiency, mental retardation, and
other malformations.
 Fetuses cannot remove breakdown products of alcohol from
their body leading to vit. B deficiency and neurologic damage.
 There are subtle but classical facial features associated with
fetal alcohol syndrome including short palpebral fissures,
maxillary hypoplasia, a smooth philtrum, and congenital heart
disease.
 Even moderate alcohol consumption consisting of 2 to 3oz. of
hard liquor per day may produce the fetal alcohol effects.
 Teratogenicity of Cigarettes
 Growth retardation
 Sudden infant death syndrome (Pollack, 2001)
 Low birth weight in infants of smoking mothers
results from vasoconstriction of the uterine
vessels, an effect of nicotine that limits the
blood supply to the fetus.
 Inhaled carbon monoxide is another contributing
factor.
 Reducing the number of cigarettes smoked per day
should help diminish adverse effects on the fetus.
 Environmental Teratogens
 Metal and chemical hazards
 ex: pesticides& carbon monoxide
 Radiation
 has been proven to be a potent teratogen to
unborn children because of high proportion of
rapidly growing cells present.
 Hyperthermia & Hypothermia
 (hyper) maybe detrimental to growth because
it interferes with cell metabolism
 (hypo) the effects is not well known.
 Teratogenicity of Maternal Stress
 Emotionally disturbed pregnancy, once filled with
anxiety and worry beyond the usual amount could
produce physiologic changes through its effect on
the sympathetic division of the autonomic nervous
system.
 Primary changes includes increase in heart rate,
constriction of the peripheral blood vessels, a
decrease in gastrointestinal motility, & dilation
of coronary blood vessels (the fight-or-flight
syndrome)
 The constriction of uterine vessels could interfere
with the blood and nutrient supply to the fetus.