Oxford Handbook of Midwifery Read Online Free PDF

some evidence that intrauterine infection can occur, the major risk to the baby is during vaginal birth through an infected cervix.
Up to 70% of babies born to mothers with untreated chlamydia will become infected: 30–40% will develop chlamydial conjunctivitis and 10–20% a characteristic pneumonia.
Chlamydial ophthalmia neonatorum is a notifiable infection.
Chlamydial ophthalmia neonatorum is now much more common than gonococcal ophthalmia, although in practice the two may occur
together; 50% of those with gonococcal ophthalmia also have chlamydia.
CHLAMYDIA
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Chlamydial ophthalmia has an incubation period of 10–14 days, much longer than gonococcal ophthalmia, which is evident in about 48h.
It can permanently affect vision and can even cause blindness.
The orbit of the eye is swollen and there is a mucoid discharge, often known as a ‘sticky eye’.
The midwife must take swabs from both eyes, for chlamydia, gonococcal infection and general culture and sensitivity, and ensure they are immediately transported to the laboratory.
After taking the swab, the eyes are regularly cleansed with normal saline.
Inform the paediatrician, or GP in the community, and ensure the baby is examined and treated as a matter of urgency.
The nasopharynx is also likely to be infected, which may lead to pneumonia unless promptly treated with systemic antibiotics.
It is important to diagnose and treat any baby with chlamydial infection.
It is thought that the baby who is affected by chlamydia pneumonia is
more likely to develop obstructive lung disease and asthma than those with pneumonia from other causes.
It may be up to 7 months before chlamydia infection becomes apparent and cultures from the pharynx, middle ear, vagina, and rectum of the baby are positive.
Knowledge about the prevalence in the community and the effects on both mother and baby should encourage the midwife to take a sexual health history, be proactive in chlamydia testing and offer routine testing to all pregnant women in her care.
Useful websites
British Association for Sexual Health and HIV. Available at: M www.bashh.org.uk.
Chlamydia. Available at: M www.healthcarea2z.org/ditem_print.aspx/315/Chlamydia (accessed 2.5.10).
National Chlamydia Screening Programme. Available at: M www.chlamydiascreening.nhs.uk/ps/ index.html.
Neonatal Conjunctivitis and Pneumonia due to C. trachomatis. Available at: M www.chlamydiae. com/restricted/docs/infections/ophth_neonat.asp (accessed 2.5.10).
Further reading
Brocklehurst P, Rooney G (2009). Interventions for treating genital chlamydia trachomatis infection in pregnancy. Cochrane Database of Systematic Reviews 4 , CD000054.
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. 415–32.
1 British National Formulary (2010). Available at: M www.bnf.org (accessed 2.5.10).
CHAPTER 3 Sexual health
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Genital warts
Genital warts are caused by the human papilloma virus, types 6 and 11.
Sexual transmission is the most usual mode of infection.
The incidence of genital warts diagnosed has steadily been rising over the past 10 years and the highest rates are seen in the female 16–24-year age group.
They are not only uncomfortable, but also psychologically distressing.
They are difficult and time-consuming to treat and may reoccur months or years later.
Refer a woman who has genital warts to a specialist sexual health clinic for treatment and further investigation for other STIs.
A colposcopy may be performed to exclude warts on the cervix.
Although most genital warts are benign, it is important that an annual liquid-based cytology screen is recommended, as human papillomavirus (HPV) types 16, 18, 31, 33, and 35 are strongly associated with
development of cervical cancer.
The midwife has an important role in sexual health promotion,
encouraging safer sex and promoting participation in the