Maternal infections can be teratogenic, can cause adverse effects to the fertilized ovum, embryo or fetus. The occurrence of these infections can involve either sexually transmitted or through systemic infection. TORCH infections are diseases identified as causing serious harm to the embryo or fetus. Organisms with these infections can cross the placenta and may be a virus, bacteria or a protozoon. The infected woman will just manifest mild flu-like symptoms. However, a more serious or worst fatal effect on a fetus or newborn is at risk. It is difficult to prevent and predict fetal injury from these infections because the mother may manifest no symptoms and yet internally the infection is injuring the fetus.
The umbrella term TORCH is an abbreviation for diseases that are collectively known and tested to cross the placenta and cause fetal harm which includes: Toxoplasmosis, Rubella, Cytomegalovirus and Herpes Simplex Virus. Some sources identify “O” as “other infections” which could include syphilis, hepatitis B virus and human immunodeficiency virus (HIV). Generally, TORCH infections are diseases identified to cause serious harm to the embryo or fetus.
Toxoplasmosis is caused by the protozoan Toxoplama Gondii. It is spread most commonly through contact or eating poorly cooked or uncooked meat. Handling infected cat stool in soil or cat litter may also contribute to the spread of this disease. The pregnant woman experiences no symptoms (asymptomatic) of the disease. However, few days after body malaise and cervical lymphadenopathy may be observed and experienced.
Clinical Manifestations of Toxoplasmosis
The clinical manifestations experienced by a pregnant woman with toxoplasmosis are the following:
- Body malaise
- Cervical lymphadenopathy
If the infection crosses the placenta, the infant may be born with the following problems:
- Central nervous system damage
- Intracerebral calcification
- Retinal deformities
Nursing Diagnosis for Toxoplasmosis
- Serum analysis during pregnancy such as the Sabin-Feldman dye test
Nursing Management for Toxoplasmosis
- Therapy with Sulfonamides – Sulfadiazine, if the diagnosis is established by serum analysis during pregnancy. However, the prevention of fetal deformities is uncertain. Taking this medication also leads to increased bilirubin in newborns.
- Pyrimethamine, an antiprotozoal agent can also be used. Pregnant women taking this drug must be monitored early in pregnancy as this drug is an antifolic drug that reduces folic acid levels.
- If toxoplasmosis is diagnosed before 20 weeks age of gestation damage to the fetus is more severe than if the disease is acquired later.
- The incidence of abortion, stillbirths, neonatal deaths and severe congenital anomalies is high.