Some infections before and during the pregnancy can harm the mother and the

developing fetus. They can cause serious illness, birth defects, and lifelong
disabilities. There are three classes of gynecological infections: toxic shock
syndrome, sexually transmitted infections, and pelvic inflammatory disease. 

 Toxic shock syndrome (TSS): TSS is a rare and potentially fatal

disorder. It is caused by strains of Staphylococcus aureus that
produce toxins that can cause shock, coagulation defects, and tissue
damage if they enter the bloodstream. TSS is associated with the
trapping of bacteria within the reproductive tract for a prolonged
time.
 Sexually transmitted infections (STI): STIs are infections that can
be spread by sexual contact, although several of them also have
other modes of transmission. Human papillomavirus is the most
common viral STI, with more than 100 variations.
 Pelvic inflammatory disease (PID): PID is an infection of the upper
reproductive tract. Asymptomatic STIs are a common cause of PID.
The cervix, uterine cavity, fallopian tubes, and pelvic cavity are often
involved. Infertility may be the result.
Nurses play a key role in educating women concerning vaginal health and the
prevention of sexually transmitted infections. Identifying high-risk behaviors and
providing non-judgemental, sensitive counseling and education should be part of
every prenatal consultation.

Nursing Care Plans

The nursing care plan for clients diagnosed with perinatal infection involves
screening/identifying for prenatal infection, providing information about the
protocol-based care, and promoting a client/fetal well-being.

Here are five (5) nursing care plans (NCP) and nursing diagnoses for

prenatal infection:

1. Risk For Maternal/Fetal Infection

2. Acute Pain 
3. Deficient Knowledge
 4. Risk For Disorganized Infant Behavior
5. Risk For Situational Low Self-esteem
1. Risk For Maternal/Fetal Infection

Risk For Maternal/Fetal Infection

Bacterial infections are the single most common medical complication
encountered by healthcare professionals. Some infections, such as puerperal
endometritis and lower urinary tract infection, are of principal concern to the
mother and pose little or no risk to the fetus or neonate. Others, such as
listeriosis and group B streptococcal (GBS) infection, are of greatest concern to
the fetus. Still others- such as pyelonephritis, chorioamnionitis, and syphilis- may
cause serious morbidity, even life-threatening complications, for both the mother
and the baby (Galan et al., 2020).

Nursing Diagnosis
 Risk for Infection
Risk Factors
 Inadequate primary defenses (e.g., broken skin, stasis of body fluids)
 Inadequate secondary defenses (e.g., decreased hemoglobin,
immunosuppression)
 Inadequate acquired immunity
 Environmental exposure
 Malnutrition
 Rupture of amniotic membranes
Possibly evidenced by
 [Not applicable]
Desired Outcomes

 The client will verbalize understanding of individual causative/risk

factors.
 The client will review techniques and lifestyle changes to reduce the
risk of infection.
  The client will initiate behaviors to limit the spread of infection and
reduce the risk of complications.
 The client will achieve timely healing, free of complications.
Nursing Assessment and Rationales
1. Obtain information regarding the client’s past and present sexual
partners and exposure to sexually transmitted infections (STIs).
Multiple sexual partners or intercourse with bisexual men increases the risk of
exposure to STIs and HIV/AIDS. STIs are diseases that are spread through sexual
contact with an infected partner. The client should also include any sexual contact
with persons who are intravenous drug users.

2. Obtain information about the client’s cultural background for risk factors.
In Africa, the male-to-female ratio of HIV is 1:1 owing to cultural, sexual practices,
poor hygiene, and inadequate health care, while recent arrivals from Asia, South
America, and the Caribbean islands have increased the risk of exposure to the
Hepatitis B virus.

3. Review lifestyle and profession for the presence of associated risk factors.
Drug abusers and healthcare professionals are at risk for exposure to HIV/AIDS
and HBV through contact with contaminated needles, body fluids,
and blood products; tuberculosis through airborne droplets. Adolescents now
account for almost half of the new cases of STIs each year. Pay particular
attention to adolescents who do not have a strong family support system
because it may be difficult for these youth to receive correct information about
preventing STIs.

4. Assess for any specific signs and symptoms, if present, and notify the
healthcare provider. These may include visible lesions/warts, urinary
frequency, dysuria, cloudy, foul-smelling urine, and changes in color,
consistency, and amount of vaginal discharge.
Identifiable signs of infection assist in determining the mode of treatment. Some
organisms have a predilection for the fetoplacental unit and the neonate,
although the client may be asymptomatic; i.e., Mycoplasma and Ureaplasma
organisms affect many pregnant women and have been cultured in aborted
fetuses, even though the mothers have been free of symptoms. Visible lesions
and warts may indicate herpes simplex virus type II (HSV II)/condyloma, which
can be transmitted to the newborn at the time of delivery if a lesion is present at
term or if viral shedding is occurring. Urinary tract infection symptoms may be
associated with Escherichia coli or GBS, or the client may have asymptomatic
bacteriuria. Abnormal characteristics of vaginal discharges (discoloration, foul-
smelling odor, excessive amount) may indicate an STI.

5. Determine if the infection is either primary or recurrent.

Both herpes viruses (CMV and herpes simplex virus II [HSV-II]) recur in times of
stress. Yet only primary CMV is problematic to the fetus, and only 50% of the
fetuses exposed are affected. Although recurrent HSV-II is associated with
reduced viral shedding time, the newborn, if exposed to the virus at delivery, can
be affected with either visible lesions or a disseminated type of disease. When
this occurs, a severe systemic infection that is often fatal can result.

6. Determine the status of maternal membranes. If they are ruptured,

monitor blood cell count and fetal heart rate; or if the vaginal discharge has
an odor.
Infectious organisms transmitted via the ascending route, including Chlamydia,
mycoplasmas, and Ureaplasma urealyticum, develop bacteremia
and pneumonia or possibly meningitis. Chlamydial infections are associated with
premature rupture of membranes, preterm labor, and endometritis in
the postpartum period. An infant born while a chlamydial infection is present can
develop conjunctivitis or pneumonia after birth.

7. Perform a comprehensive STI and HIV screening.

STI screening is recommended by the CDC because STIs are biological markers of
risk, particularly for HIV acquisition and transmission among certain men who
have sexual activities with other men. STI screening is an essential and underused
component of an STI and HIV risk assessment. Persons seeking treatment
or evaluation for a particular STI should be screened for HIV and other STIs as
indicated by community prevalence and individual risk factors. The client must be
informed about all the tests for STIs they are receiving and notified about tests
for common STIs (Centers for Disease Control and Prevention, 2021).

8. Screen the pregnant woman for HIV during the first prenatal visit and
during the third trimester.
All pregnant women should be tested for HIV during the first prenatal visit. A
second test during the third trimester, preferably at <36 weeks gestation, should
be considered and is recommended for women who are at high risk for acquiring
HIV infection, women who receive health care jurisdictions with high rates of HIV,
and women examined in clinical settings in which HIV incidence is ≥1 per 1,000
women screened per year (Centers for Disease Control and Prevention, 2021).

Nursing Interventions and Rationales

1. Educate the client regarding the proper use of tampons, diaphragms, and
cervical caps.
To prevent toxic shock syndrome, the client should be taught to wash her hands
well when using tampons or a diaphragm. The tampons should be changed every
four hours and not used during sleep, which usually lasts longer than four hours.
The diaphragm should not be used during menstruation or eight weeks after
childbirth.

2. Provide information on how to prevent STIs.

Abstinence or condom use provides the best protection against STIs. Additional
measures include voiding immediately and washing the genitals well with soap
and water after coitus, as well as choosing sexual partners who are at low risk for
infection. Educating adolescents about safer sex practices, including the need for
condom use and the importance of health screening for these disorders, is an
important nursing responsibility.

3. Inform the client about the importance of vaccines against STIs.

Approach the subject of immunization with the client with sensitivity because
some clients, especially teenagers with their parents, are not ready to admit they
might be or soon will become sexually active and need this protection.
Immunizing adolescents against human papillomavirus (HPV) infection should
reduce not only the incidence of HPV infections in the future but also the rate of
cervical and penile cancer as well. The hepatitis B vaccine can prevent the disease,
and immunoglobulin can be administered if known exposure has occurred.

4. Instruct against the use of douching.

Douching results in changes in the vaginal flora and predisposes the client to
develop pelvic inflammatory disease (PID), bacterial vaginosis, and ectopic
pregnancies. However, many women practice regular douching, believing that it
is cleansing. The nurse can play an important role in educating the client to
prevent PID.

5. Educate the client on how to prevent acquiring toxoplasmosis.

Removing a cat from the home during pregnancy as a means of prevention is
unnecessary as long as the cat is healthy. However, taking in a new cat, which
could be infected, is unwise. Instruct the pregnant client to avoid undercooked
meat and also not to change a cat litter box or garden in the soil in an area where
cats may defecate to avoid exposure to the disease. Reinforce proper hand
washing after handling uncooked meat.

6. Offer the client prevention counseling on STI or HIV.

Prevention counseling is most effective if provided in a nonjudgmental and
empathetic manner appropriate to the client’s culture, language, sex and gender
identity, sexual orientation, age, and developmental level. Prevention counseling
for STIs and HIV should be offered to all sexually active adolescents and to all
adults who have received an STI diagnosis, have had an STI during the previous
year, or have had multiple sexual partners. One such approach, known as client-
centered STI and HIV prevention counseling, involves tailoring a discussion of risk
reduction to the person’s situation (Centers for Disease Control and Prevention,
2021).

7. Obtain appropriate specimens and monitor laboratory/ diagnostic studies

as indicated.
Candidal infections are diagnosed by removing a sample of the discharge from
the vaginal wall and placing it on a glass slide with drops of hydroxide solution
added. Under a microscope, typical fungal hyphae indicate the presence of
Candida organisms. Most STIs are diagnosed by microscopic examination of a
sample of the vaginal discharge. Culture of lesion secretions or isolation of HSV
antibodies diagnoses Herpes infection. Urine culture should be obtained from
clients with vulvovaginitis to rule out gonorrhea.

8. Assist as necessary with sputum collection and chest x-rays for clients

with respiratory symptoms.
This helps in identifying causative organisms in bacterial pneumonia and active
tuberculosis. Screening of tuberculosis early in pregnancy is important because it
is a chronic and debilitating disease that increases the risk of miscarriage.
Additionally, the change in the shape of the maternal lung tissue as the growing
uterus presses on the lungs may reactivate already healed lesions, thus worsening
the disease.

9. Administer antibiotics and other medications as indicated to the client

and her sexual partner.
Treatment or alleviation of symptoms for STIs may include antibiotics such as
azithromycin, doxycycline, erythromycin, ceftriaxone, and benzathine penicillin G;
antivirals such as acyclovir; and antifungals such as miconazole, clotrimazole, or
fluconazole. Metronidazole or tinidazole is indicated for treating trichomonas and
Gardnerella infections and bacterial vaginosis.

10. Prepare for/assist in transfer to the tertiary care center as indicated.

Availability of staff and equipment ensures optimal care of high-risk clients and
fetuses/newborns. Treatment for toxic shock syndrome includes hospitalization
for the administration of vasopressor drugs and fluid replacement.

11. Prepare to assist with procedures to remove lesions or warts.

Treatment for human papillomavirus includes cryotherapy, laser vaporization,
electrodiathermy, and electrofulguration with a loop electrode excision
procedure. Therapy for such lesions is aimed at dissolving the lesions and also
ending any secondary infection present. With cryocautery, edema at the site is
evident immediately; lesions become gangrenous, and sloughing occurs in seven
days, with healing complete in four to six weeks with only slight depigmentation
present.

12. Prepare for termination of pregnancy or labor induction, as indicated.

Pregnancy may be terminated for such conditions as toxoplasmosis occurring
before 20 weeks of gestation or rubella in the first trimester. An infant born after
contracting either cytomegalovirus or toxoplasmosis may be born with
congenital anomalies from the virus invasion. Elective termination is mainly
a surgical procedure. Therefore, nurses employed in healthcare agencies where
induced abortions are rendered and be asked to as