Page 689 - Saunders Comprehensive Review For NCLEX-RN

gestation or left in place and a cesarean birth is
performed; if removed, cerclage needs to be repeated
with each successive pregnancy.
5. After placement of the cervical cerclage, monitor for
contractions, rupture of the membranes, and signs of
infection.
6. Instruct the client to report to the PHCP immediately
any postprocedure vaginal bleeding or increased
uterine contractions.

XVI. Infections (TORCH Complex Acronym)

A. Toxoplasmosis (“T”)
1. Caused by infection with the intracellular protozoan
parasite Toxoplasma gondii
2. Produces a rash and symptoms of acute, flu-like
infection in the mother
3. Transmitted to the mother through ingestion of raw
meat or handling of cat litter of infected cats
4. Organism is transmitted to the fetus across the
placenta
5. Can cause miscarriage in the first trimester
6. Client education regarding preventing infection is
critical
B. Other Infections (“O,” includes HIV—discussed earlier, syphilis—
discussed under Sexually Transmitted Infections, parvovirus,
hepatitis B virus [HBV], West Nile, etc.)
C. Rubella (German measles) (“R”)
1. Teratogenic in the first trimester
2. Organism is transmitted to the fetus across the
placenta.
3. Causes congenital defects of the eyes, heart, ears, and
brain
4. Blood titer studies will be done. If not immune (titer
less than 1:8), the client should be vaccinated in the
postpartum period; the client must wait 1 to 3 months
(as specified by the PHCP) before becoming pregnant.
D. Cytomegalovirus (“C”)
1. Organism is transmitted through close personal
contact; it is transmitted across the placenta to the
fetus, or the fetus may be infected through the birth
canal.
2. The mother may be asymptomatic; most infants are
asymptomatic at birth.
3. Cytomegalovirus causes low birth weight, intrauterine
growth restriction, enlarged liver and spleen,
jaundice, blindness, hearing loss, and seizures.
4. Antiviral medications may need to be prescribed for
severe infections in the mother, but these medications

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