Review Practice Exercise 3

Maternal Risk Factors > Maternal Newborn

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Practice Exercise 3

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Total Questions : 5

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Question 1:

Which infection, if contracted during the first trimester, can lead to congenital rubella syndrome?

A. Cytomegalovirus B. Toxoplasmosis C. Rubella D. Group B Streptococcus

Answer and Explanation

Choice A:

Cytomegalovirus is the most common congenital viral infection and may cause microcephaly, periventricular calcifications, and sensorineural hearing loss, but it does not cause congenital rubella syndrome.

Choice B:

Toxoplasmosis, caused by Toxoplasma gondii, can result in chorioretinitis, hydrocephalus, and intracranial calcifications. It is transmitted through undercooked meat or cat feces exposure, not associated with congenital rubella syndrome.

Choice C:

Rubella infection in the first trimester directly causes congenital rubella syndrome. Viral replication in fetal tissues disrupts organogenesis, leading to the classic triad of deafness, cataracts, and cardiac anomalies. The risk of fetal malformation is highest when infection occurs before 12 weeks.

Choice D:

Group B Streptococcus is a bacterial infection causing neonatal sepsis, pneumonia, and meningitis if transmitted during delivery. It does not produce teratogenic effects in utero and is unrelated to rubella.

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Question 2:

Which of the following sexually transmitted infections (STIs) is part of the TORCH infections that can lead to significant congenital anomalies?

A. Chlamydia B. Gonorrhea C. Syphilis D. Trichomoniasis

Answer and Explanation

Choice A:

Chlamydia is associated with neonatal conjunctivitis and pneumonia but is not classified under TORCH infections. It does not typically cause congenital structural anomalies.

Choice B:

Gonorrhea can cause ophthalmia neonatorum and neonatal sepsis but is not part of TORCH and does not produce congenital anomalies in utero.

Choice C:

Syphilis is part of the “O” in TORCH and can cross the placenta at any stage of pregnancy. It causes congenital syphilis with manifestations such as hydrops fetalis, hepatomegaly, skin lesions, and later findings including Hutchinson teeth and saddle nose deformity.

Choice D:

Trichomoniasis causes preterm rupture of membranes, preterm birth, and low birth weight but does not cause congenital anomalies and is not part of TORCH.

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Question 3:

What is the primary reason for administering prophylactic antibiotics during labor to a pregnant woman who tested positive for Group B Streptococcus (GBS)?

A. To prevent maternal postpartum infection B. To prevent neonatal GBS sepsis C. To reduce the risk of maternal hemorrhage D. To enhance uterine contractions

Answer and Explanation

Choice A:

Prophylactic antibiotics are not given to prevent maternal postpartum infection. GBS rarely causes maternal endometritis or wound infection; the intervention specifically targets neonatal transmission.

Choice B:

The primary reason for giving intrapartum antibiotics in GBS-positive mothers is to prevent neonatal GBS sepsis, which can occur within the first 7 days of life and has a high mortality rate.

Choice C:

Antibiotics do not influence coagulation pathways and therefore have no effect on maternal hemorrhage risk. Hemorrhage prevention relies on uterotonics and active management of the third stage of labor.

Choice D:

Antibiotics do not stimulate uterine contractions. Uterine contractility is managed with oxytocin, prostaglandins, or other uterotonics, not antimicrobial therapy.

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Question 4:

Which of the following are potential neonatal complications of TORCH infections? Select all that apply.

A. Microcephaly B. Neonatal hypoglycemia C. Sensorineural hearing loss D. Congenital cataracts E. Shoulder dystocia

Answer and Explanation

Choice A:

Microcephaly occurs due to impaired brain development from intrauterine infection. Viral invasion such as cytomegalovirus and rubella directly damages neural progenitor cells, resulting in reduced cranial growth.

Choice B:

Neonatal hypoglycemia is not a direct complication of TORCH infections. It is typically associated with maternal diabetes, intrauterine growth restriction, or perinatal stress. TORCH pathogens primarily cause structural anomalies and neurologic deficits rather than acute metabolic derangements.

Choice C:

Sensorineural hearing loss is linked to cytomegalovirus and rubella infections. Viral damage to the inner ear structures and auditory nerve occurs in utero, leading to irreversible deficits after birth.

Choice D:

Congenital cataracts develop primarily from rubella infection. Viral replication in the developing lens leads to opacity formation and impaired visual development that can cause lifelong blindness if untreated.

Choice E:

Shoulder dystocia is a mechanical complication of labor, not an outcome of TORCH infections. It is caused by fetal macrosomia, maternal diabetes, or abnormal pelvic anatomy, not intrauterine infection. TORCH-related complications are congenital abnormalities, not intrapartum mechanical problems.

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Question 5:

Which of the following are key nursing interventions for preventing vertical transmission of infections during pregnancy? Select all that apply.

A. Administering penicillin for GBS-positive mothers during labor B. Educating patients on avoiding undercooked meat to prevent toxoplasmosis C. Screening for HIV at the initial prenatal visit D. Monitoring blood glucose levels for infection control E. Recommending cesarean delivery for active HSV lesions

Answer and Explanation

Choice A:

Administering penicillin for GBS-positive mothers during labor prevents neonatal sepsis, pneumonia, and meningitis by reducing bacterial colonization in the birth canal.

Choice B:

Educating patients on avoiding undercooked meat reduces toxoplasmosis risk, since Toxoplasma gondii cysts survive in raw or poorly cooked animal tissue and can cross the placenta.

Choice C:

Screening for HIV at the initial prenatal visit ensures early detection and initiation of antiretroviral therapy, which reduces mother-to-child transmission rates from about 25% to less than 2%.

Choice D:

Monitoring blood glucose levels is important for detecting gestational diabetes, but it does not prevent vertical transmission of infections. Hyperglycemia increases risk of macrosomia and neonatal hypoglycemia, but it is unrelated to infectious disease transmission from mother to fetus.

Choice E:

Recommending cesarean delivery for active HSV lesions prevents neonatal exposure to herpes simplex virus during passage through the birth canal, thereby reducing risk of neonatal herpes infection.

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Practice Exercise 3

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