Oxford Handbook of Midwifery Read Online Free PDF Page A

the incidence.
Broad spectrum antibiotics increase yeast carriage by 10–30%.
Vaginal deodorants, disinfectants, perfumed shower, and bath gels may exacerbate the problem by increasing irritation and vulval excoriation and dermatitis.
Washing and wiping the vulval area should always be from front to back.
The wearing of tight, synthetic clothing should be avoided.
Application of plain yoghurt may soothe the irritation in the short term, but has not been shown to be effective as treatment. Daily oral ingestion of 8oz of active yoghurt has been shown to decrease
incidence of candidal colonization and infection, but this has not been replicated in other studies.
Candidiasis in pregnancy
Vaginal candidiasis is the most common cause of troublesome vaginal discharge and vulval irritation in pregnancy.
It occurs 2–10 times more frequently in pregnant than in non-pregnant women and is more difficult to eradicate.
The problems are worst in the third trimester, with over 50% having a significant colonization due to increasing vaginal glycogen and the changing pH of the vagina in pregnancy.
A Cochrane review of topical treatments for vaginal candidiasis 1 concluded that topical imidazole drugs are more effective than clotrimazole and that treatment over 7 days is more effective than single dose or 3–4-day treatment.
CANDIDIASIS
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Fetal and neonatal infection
The baby may become colonized from an infected birth canal, but is more likely to become infected from poor hand washing hygiene by those caring for or handling the baby, including visitors, or inadequately sterilized or contaminated feeding bottles.
A breastfeeding baby may become infected from a sore nipple that becomes infected.
1 Young GL, Jewell D (2001). Topical treatment for vaginal candidiasis in pregnancy. (Cochrane review). In: Cochrane Library , Issue 3. Oxford: Update Software.
CHAPTER 3 Sexual health
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Chlamydia
Chlamydia trachomatis is the most common cause of bacterial STI in the UK, affecting both men and women, and a leading cause of PID.
Prevalence is highest, but not exclusive, in young sexually active adults, especially those under 25, hence the introduction of the current National Chlamydia Screening Programme in England for the 16–25-year age group.
80% of women and 50% of men have no symptoms and, left untreated, chlamydia can, in women, lead to infertility, ectopic pregnancy, and chronic pelvic pain. In men it may cause urethritis and epididymitis. In both sexes it can cause arthritis—Reiter’s syndrome.
In the symptomatic woman it may cause mucopurulent cervicitis, postcoital and/or intermenstrual bleeding.
Because of the prevalence of chlamydia in the sexually active population and lack of symptoms, it is good midwifery practice to
routinely offer a chlamydia screening test , using a ‘first catch’ urine sample, both at the beginning of pregnancy and again by 36 weeks, to
detect and treat affected women. The newer nucleic acid amplification test (NAAT) is 95% sensitive.
Alternatively, an endocervical swab can be taken.
It is also good practice to screen the male partner(s) and to refer both partners to the local sexual health service for further STI screening, contact tracing, and follow-up.
Antibiotic treatment in pregnancy is usually with a course of erythromycin 500mg twice daily for 14 days, but exact treatment will be decided by the doctor or nurse with prescribing rights. Azithromycin should be used with caution in pregnancy and breastfeeding. 1
Chlamydia in pregnancy
In the pregnant woman the increased vascularity of the cervix may lead to postcoital or irregular spotting or bleeding per vaginam and any woman with such bleeding should be screened for chlamydia.
Chlamydia in pregnancy can cause amnionitis and postnatal endometritis.
The evidence on its role in spontaneous abortion, preterm rupture of the membranes, preterm birth and neonatal death is unclear from studies to date.
Fetal and neonatal infection
Although there is