Prevention of Contracting Chlamydia during Pregnancy

Chlamydia is the most prevalent sexually transmitted infection in the United Sates, especially among young women. While this infection is curable, it can yield complications for women who are pregnant. Chlamydia is known to be linked to adverse outcomes such as preterm premature rupture of membranes, preterm births, endometriosis, low birth weights/small for gestational age, spontaneous abortion, and intrauterine fetal demise (Olsen-Chen C, 2018). Since the infection is often asymptomatic (80-90% of cases), treatment is not sought out (Olsen-Chen C, 2018). Nurses can play a pivotal role in helping treat the infection, manage fetal and maternal well-being, and educating expecting mothers on the risks of Chlamydia during pregnancy and how to prevent contracting the infection in the future.

Evidence-Based Practice

Evidenced-based practice has shown that a key factor in managing and treating pregnant clients with and STI such as Chlamydia is building a rapport with the patient. Having a strong relationship with the patient allows the client to feel comfortable enough to answer questions honestly which allows the nurse to accurately assess and develop a plan for managing the patient. Routine STI screening has also been implemented into prenatal care. This routine screening has allowed heath care providers to detect infections early and treat them quick and effectively which can minimize the risks associated with the infection during pregnancy. For women who have infections, education and treatment are vital. Treatment with erythromycin and azithromycin have successfully treated Chlamydia in pregnant women. Detailed education on Chlamydia is essential in the plan of care. Assessing the client’s specific educational needs will allow the nurse to ensure the client has the best understanding of what is being told to them. Nurses can provide education on the risks of risky sexual behaviors, importance of barrier methods during sex, and the need for STI testing periodically. By educating our clients, we provide them with knowledge which allows them to make educated decisions and facilitate personal health promotion. These new strengths the client possesses leads to better health outcomes for clients overall (Scott L, 2019).

Nursing Considerations

`As a nurse, knowing and understanding the risks associated with sexually transmitted infections, such as Chlamydia, during pregnancy is extremely important. This infection has major complications that need to be monitored for closely and the importance of treatment for the mother is imperative. The nurse should monitor the client for possible adverse outcomes such as premature birth, preterm premature rupture of membranes, or spontaneous abortion (Ahmadi A, 2016). Symptoms for these events can include but are not limited to gush of vaginal fluid/leakage, foul smelling discharge, fever, abdominal pain, vaginal bleeding, lower back pain, contractions and pelvic pain. The nurse should instruct the client to report any of these symptoms right away as they can implicate serious complications have occurred with the pregnancy (Ahmadi A, 2016). There are two treatments for Chlamydia. One option is erythromycin 500 mg four times per day for one week and a test of cure will be done at 5 weeks after the treatment is completed. The alternative treatment option is 1 gram of Azithromycin by mouth as soon as possible. The nurse should educate the mother on the importance of a follow up with the doctor 6 weeks after discharge to determine if the treatment was successful. The doctor will do a “test of cure” to make this determination. The nurse should also educate the client about safe sex and how to avoid future contraction of Chlamydia and other STIs.

Healthy People 2020

Healthy people 2020 identifies a goal that seeks to improve the health of all women, infants and children by reducing the incidence of STIs during pregnancy. This goal is deemed important because the health and well-bring will impact future generations while also simultaneously providing health care professionals opportunities to gain a better understanding of these infections. This will aid in the ability to predict health related challenges that families may encounter. Carter county’s incidence STIs for the year of 2016 is 511,400 cases reported. The amount of cases reported in Carter county are significantly more than Oklahoma’s lowest reporting county, Alfalfa, which reported 119,300 cases for the year of 2016. Carter county is in the 59th percentile of the 77 counties, so it is reasonable to say that this county does not meet the HP 2020 goal.

Client Implications

Chlamydia has many adverse events that can occur with pregnant clients. The client should be well informed about how Chlamydia is contracted, how to perform safe sex practices and routine STI testing. It is the hope that with thorough education given to the client that they can remain STI free throughout the rest of their pregnancy and in the future. The nurse should provide education about safe sex with an emphasis on the use of condoms (both male and female) (Scott L, 2019). The nurse should inform the client about how having multiple partners can increase the client’s likelihood of contracting a STI, so the use of barrier methods is important (Scott L, 2019). The patient’s ability to adhere to the medication regimen should be evaluated in order to provide the best treatment plan. If the patient has a hectic schedule or if the patient has trouble remembering to take medication, the provider should take this into consideration and opt for the immediate dose of Azithromycin rather than the Erythromycin which is taken daily for up 7-14 days. Cultural barriers for pregnant women are issues that the nurse should take into consideration. While education on barrier methods is recommended, some cultures do not accept this practice (Weisz J, 2011). Other cultural barriers revolve around the issue that STI have limited recognition as an important health complication, so they go unreported or untreated and spread (Ortayli N, 2014).