Infection/sepsis Genital tract sepsis

1. Infection/sepsisGenital tract sepsis • the leading cause of direct maternal deaths • as latedirect deaths occurring more than 6 weeks after the baby's birth • -Genital tract sepsis arises from polymicrobial infections, usually from streptococcal bacteria, which can lead to septicaemia that can affect the pregnant woman ,the fetus. • Signs and symptoms include : • pyrexia, • swinging pyrexia • -hypothermia • -abdominal pain

2. -diarrhoea • - vomiting • - tachycardia • -and tachypnoea. • *effective hygiene and be aware of the risk from others , particularly any who have bacterial throat infections

3. Bacterial Vaginosis (BV) • a common cause of abnormal discharge • Typical symptoms are an offensive, fishy-smelling discharge. • Although BV may regress spontaneously and even if treated with topical or oral metronidazole or clindamycin, it may recur. • Whilst there is evidence that links BV with: • preterm labor • late miscarriage • and premature rupture of membranes

4. Candida albicans • - a yeast that causes itching, soreness and swelling of the genital area producing a creamy-white vaginal discharge. • Candida albicans is not a Sexually Transmifed Infection (STI) as it commonly occurs during: • 1-pregnancy • 2 -following antibiotic therapy • 3- in individuals who have diabetes • 4- a lowered immune system.

5. It is easily diagnosed by a high vaginal swab (HVS) and treatment in pregnancy is via topical cream and/or vaginal pessaries, rather than via the oral route. • Candida does not affect fertility or pregnancy outcome, but the baby may develop oral or genital thrush. • may affect breastfeeding should candida be transferred to the breast while feeding

6. Chlamydia trachomatis • -Chlamydia is the most commonly diagnosed STI, especially in under 25-year-olds, and is caused by the bacterium Chlamydia trachomatis. • - asymptomatic. • -Signs and symptoms include: dysuria, vaginal discharge, lower abdominal pain, post- coital and inter-menstrual bleeding, anal discharge, conjunctivitis, eye infections and • sore throats following anal or oral sexual practices.

7. -If left untreated, Chlamydia infection can cause: • pelvic inflammatory disease (PID), • infertility and • the risk of miscarriage • ectopic pregnancy. • testing • urine testing, • low vaginal swab (self- testing kits) and cervical swab. The NHS National Chlamydia Screening Programme (2012) recommends annual screening for under 25-year-olds if sexually active. Chlamydia can be transmifed to the neonate during vaginal birth and can result in neonatal eye infections and pneumonia. Treatment entails antibiotics such as azithromycin.

8. Cytomegalovirus • (CMV) is a common viral infection • -The virus causes a mild flu-like illness and pregnant women have an increased susceptibility to infection during pregnancy. • - transmission to the fetus causing congenital malformations such as hearing loss, learning difficulties and cerebral palsy. • antiviral drugs have been used to treat CMV,

9. Gonorrhoea • - STI affecting the genital tract (especially the cervix) and rectum. • It is transmifed by sexual activity with an infected individual • caused by the bacterium Neisseria gonorrhoeae. • a, signs and symptoms may occur 2–10 days aher initial contact Such symptoms include painful micturition, yellow/bloodstained vaginal discharge and post-coital bleeding.

10. -If untreated, in women it can cause PID, giving rise to abdominal cramps, fever and inter-menstrual bleeding, with an increased risk of ectopic pregnancy. • Individuals are also at a greater risk of acquiring HIV. • -Testing for gonorrhoea is via urine and cervical swabs. • Treatment is with antibiotics, but drug resistance can be problematic. Gonorrhoea can be transmitted to the neonate during vaginal birth and can result in eye infections.

12. Hepatitis A, B and C • a group of blood-borne viruses that cause hepatocellular • inflammation and necrosis. • -They are found in bodily fluids, e.g. blood, saliva and semen, and are ohen transmitted via sexual activity, by sharing injecting equipment and via the placenta to the fetus during pregnancy. • -vaccination for hepatitis A and B are available. • -Hepatitis B and C can lead to liver failure and death • -Pregnant women routine screening for hepatitis B during early pregnancy and those at risk, e.g. sex workers, can be tested for hepatitis C.

13. During pregnancy women are counselled as to how they can reduce transmission and infants should be given hepatitis B immunization and immunoglobulin with their mother's consent • Breastfeeding is not contraindicated, although the presence of cracked nipples is a significant transmission risk.

14. Human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS) • (HIV) is a retrovirus that weakens an individual's immune system • -There are two types of HIV which belong to the lentivirus subfamily of retroviruses that cause acquired immunodeficiency syndrome (AIDS). • -HIV is transmifed through unprotected sexual activity with an infected person, contact with infected bodily fluids, • e.g. blood, or perinatally via mother-to-fetus-transmission. • - flu-like symptoms, e.g. pyrexia, rash and sore throat. • -Diagnosis is through an HIV test, where blood is examined for the presence of antibodies and/or antigens; this is known as the combined test.

15. Pregnant women are offered an HIV test in early pregnancy • Although there is no cure for HIV, antiretroviral (ART) therapy has significantly reduced the morbidity and mortality • The average time for progression from HIV to AIDS is between 5 and 20 years. • -transmission occurs during birth or in the postnatal period through breastfeeding ( • - with elective caesarean section and the avoidance of breastfeeding.

17. Human papillomavirus • (HPV) is STI • known to cause genital warts, which are more common in teenagers and young adults. • as small, fleshy, painless growths, single or in clusters, appearing on the vaginal and anal regions following close genital contact or sexual activity with an affected person. • The warts usually appear within 2–3 months of infection, but can take up to a year to become evident.

18. Treatment is either with topical lotions/creams or physical ablation, or a combination. • -rare cases of transmissions to the baby during birth. • HPV 16 and 18 are associated with cervical cancer and vaccinations are available to all young women up to the age of 18 years

19. Streptococcus A and B • -group A: • acute pharyngitis • -toxic shock syndrome • - cellulitis and puerperal sepsis. • Group B streptococcus (GBS) bacteria are commonly found in the vagina and lower bowel • GBS is not contagious, but it can cause neonatal GBS infection if the fetus comes into contact with the bacteria, usually during birth.

20. However, GBS infection has been known to pass across the membranes and colonize the fetus in utero. • -Women at higher risk of GBS include those in : • -preterm labour • - premature pre-labour rupture of membranes • -, prolonged rupture of membranes (>18 hr) • - those with maternal pyrexia • - a previous history of GBS. • lower vaginal swabs and rectal swabs in those at risk and IV antibiotics administered between 4 and 6 hours before birth

21. - There are two types of neonatal GBS. The most common type is early onset GBS, which is seen in 75% of cases and occurs within the first week of life, usually presenting within 24 hours of birth. The • other type is late onset GBS, which presents in 25% of cases within the first 3 months of life. • Signs and symptoms in an affected neonate may be vague and include problems maintaining their temperature, grunting, limpness, poor feeding behaviours and seizures.

22. Syphilis • -Syphilis is a STI caused by the spirochete bacterium Treponema pallidum . • -Transmission occurs through contact with a syphilitic sore or chancre. • - four stages: • Primary: occurring on average 21 days after exposure, where a single painless, firm, non-itchy ulcer or chancre appears. • Secondary: occurs between 4 and 10 weeks after exposure, with the appearance of a non- itchy, diffuse rash with fever and sore throat evident. In the latent stage, the individual is generally asymptomatic, but still contagious to others. • Tertiary: can occur between 3 to 15 years after the initial exposure. If the individual does not seek treatment, they will exhibit neurological symptoms such as general paresis and seizures, as well as cardiac symptoms including aneurysms.

23. -The presence of syphilitic sores increases the transmission risk of HIV. Diagnosis is via a blood test and the treatment is penicillin. • -It is highly likely that transmission of syphilis will occur in pregnancy, causing preterm birth, stillbirth or perinatal death, thus screening for syphilis should be routinely offered to all pregnant women during the early antenatal period • -The baby may be born with congenital syphilis, which is asymptomatic during infancy, but later in childhood they may develop multi-organ conditions such as deafness, seizures and cataracts.

25. Urinary tract infection • - (UTI) is a common problem in pregnancy • - The bacteria originate from the bowel and the most commonly encountered is Escherichia coli (E. coli). • - asymptomatic or present with symptoms of dysuria (a burning pain on micturition), frequency (small regular amounts of urine), suprapubic discomfort and haematuria (blood in the urine).

26. -If the infection is confined to the bladder it is termed cystitis, and in addition to these symptoms there may be urgency of micturition. • -The infection can ascend to the kidneys and pyelonephritis develops. • -Acute pyelonephritis may present with nausea and vomiting, pyrexia, rigors and abdominal pain • -If inadequately treated, septicaemia may result, leading to acute renal failure, multiple organ failure and death

27. Asymptomatic bacteriuria (ABU), as the name implies, is an infection without symptoms • and occurs in 2–10% of pregnancies • women will proceed to develop pyelonephritis and there is also risk of preterm labour • All pregnant women should have their urine tested for nitrates (which are produced by most urinary pathogens) at each antenatal visit. • -A mid-stream specimen of urine (MSSU) should be taken early in pregnancy • -Treatment is with antibiotics according to the culture and sensitivity from the MSSU results, and the MSSU should be repeated following treatment.

28. - The midwife should encourage the woman to drink at least 2 litres of fluid per day, comply with antibiotic therapy, give advice on personal hygiene, especially following micturition, and recommend cranberry juice which may reduce infection and its symptoms • -If the infection is still active when the woman commences labour she should be reviewed by the obstetrician and IV antibiotics may be commenced for the duration of labour and the immediate postnatal period. • -Urinary catheterization should be avoided. If the UTI persists into the postnatal period, then further investigations are indicated).