Oxford Handbook of Midwifery by Janet Medforth, Sue Battersby, Maggie Evans, Beverley Marsh, Angela Walker Read Free Book Online

birth, stillbirth, or neonatal death.
If the infant survives and, dependent on the stage of the infection in the mother, there is high risk of infant or childhood morbidity.
Congenital transmission will occur from 4 months onwards and the highest risk is from 6 months onwards, once the Langhan’s layer of the early placenta has completely atrophied, which was the protective mechanism.
A woman diagnosed in pregnancy is likely to have early infectious syphilis and early treatment will prevent congenital infection.
Treatment is usually with a course of intramuscular penicillin. For a woman with penicillin allergy, erythromycin is the drug of choice. Tetracycline is contraindicated in pregnancy.
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Treatment, follow-up, and contact tracing will usually be led by a consultant in genitourinary medicine, to whom the woman should be immediately referred.
If untreated, up to one-third of pregnancies will result in stillbirth and 70–100% of babies will be infected.
Congenital syphilis
Although the incidence of congenital syphilis is estimated at 70 per million births, this is likely to increase, while the overall increase in the incidence in the childbearing age group continues.
Classification will depend on the stage of disease reached, with approximately two-thirds of liveborn infected babies showing no signs or symptoms at birth.
Lesions will develop from 4 months onwards.
Serology at birth is unreliable, because of the presence of passive transfer from the mother; the treponemal-specific IgM light test is unreliable and can give false positive or negative results.
The baby should be further serologically tested at 6 weeks and
3 months of age, allowing time for passive maternal antibodies to disappear.
In subsequent pregnancies, even if the mother has been followed up for 2 years and discharged, the baby should be tested at 3 months of age, in case any trepenomes have persisted in the maternal circulation.
If the mother is still being followed up when she becomes pregnant again she should be immediately referred to the genitourinary medicine (GUM) clinic for investigation and management.
Useful website
British Association for Sexual Health and HIV. Available at: M www.bashh.org.uk.
Further reading
Dapaah S, Dapaah V (2009). Sexually transmissible and reproductive tract infections in pregnancy. In: Fraser D, Cooper M (eds) Myles Textbook for Midwives . 15th edn. London: Churchill Livingstone, pp. 415–432.
1 Health Protection Agency (2009). Syphilis and Lymphogranuloma venereum: Resurgent STI Infections in the UK. Available at: M www.hpa.org.uk/web/HPAwebfile/HPAweb_C1245581513523 (accessed 2.5.10).
CHAPTER 3 Sexual health
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Vaginal infections
During pregnancy an increased vaginal discharge is commonly experienced and is the result of normal physiological changes related to increased blood flow in the reproductive organs, and a decrease in the acidity of the vaginal discharge. Investigation should be considered if the woman reports itching, soreness, offensive smell, or pain on passing urine.
It is important to remember that Chlamydia trachomatis is the most common cause of infection and 70–80% of infected women are asymptomatic. All women should be offered a routine urine-based screening test in early pregnancy and at any other time, as required.
For specific infections see the relevant chapters in this section.
Obtaining a vaginal swab
There are two methods to obtain a vaginal swab; high vaginal and introital.
Usually even though significant vaginal discharge will be apparent, it will possibly be contaminated so obtaining the swab from deeper in the
vagina will yield a more accurate result from laboratory investigation.
A self taken swab is as effective. Tell the woman to count to 60 while rotating the swab in the vagina.
A high vaginal swab is obtained by viewing the upper vagina with a speculum.
Having consented to the procedure and removed the necessary undergarments, the client should lie on an