7-Medical Conditions In Pregnancy Flashcards
What is the most common medical complication of pregnancy?
Diabetes
2 types:
Overt- diabetic prior to pregnancy
Gestational- diagnosed during pregnancy
How do the pregnancy hormones affect glucose metabolism ?
HPL( human placental lactogen)- anti insulin
Estrogen & progesterone interfere with insulin glucose relation
Insulinase degrades insulin
Diabetic ketoacidosis more common in pregnant women
What are the maternal effects associated with maternal diabetes?
Hyperglycemia and glucosuria DKA Increase incidence of UTI Pregnancy induced hypertension Preeclampsia Retinopathy
What are the fetal/neonatal effects associated with maternal diabetes?
Hypoglycemia Macrosomia Congenital anomalies Hyperbilirubinemia Hypocalcemia Polyhydramnios Spontaneous abortion
When to do the glucose screening test?
With no risk- 1 hour screen @ 24-28 weeks
With risk- screen @ onset of prenatal, may repeat in 3rd trimester or do A1C
If 1 hour abnormal do 3 hour
How to manage maternal diabetes?
Nutritional counseling Record daily sugar readings Keep fasting glucose between 90-100 2 hour glucose <120 Insulin therapy if unsuccessful
How do you conduct the fetal assessment?
Record fetal kick counts ( movement counts) daily between 30-32 weeks
Once or twice weekly non stress test and/or biophysical profile
Serial sonograms to monitor weight(every other week);growth detect anomalies
What is the goal in management of a pregnant diabetic?
Vaginal delivery of a healthy baby
Induction at term can be considered in well controlled diabetic to avoid macrosomia
If on insulin, sugars are monitored and glucose infusion in labor with insulin is administered via IV
What is the postpartum management?
Many patients do not require insulin for first few days after delivery if they were previously on insulin
Glucose is monitored as during pregnancy
Most return to normal status
How do you manage asthma in pregnancy?
Identify situations or substances that trigger asthma and develop plans to avoid them
Educate and reassure patient that therapy is not harmful to the fetus
Peak flow is unchanged by pregnancy
Do ABG if patient hypoxic
What are other evaluations done in management of asthma?
Chest xray to evaluate infiltrate and infection
Gram stain of sputum
Presence of eosinophils—>allergy
Presence of neutrophils—> infections
What is the therapy for acute exacerbation of asthma?
Beta 2 agonist: terbutaline or aminophylline
If therapy not rapid enough, steroids
Steroids have a risk of IUGR
How do you manage asthma during labor and delivery ?
If therapy works continue monitoring and keep patient hydrated
If patient on steroids, may require IV steroids
Avoid morphine and respiratory depressants
Epidural is excellent choice
What are the cardio circulatory changes during normal pregnancy ?
HR Increased
Systolic and diastolic BP decrease the first 3 weeks
Systolic BP starts increasing @ week 32 while diastolic BP @ week 38
Stroke volume, cardiac output increase
What are the risks factors in pregnancy for cardiovascular disease?
Pulmonary HTN and Eisenmenger’s syndrome Aortic stenosis Marfan syndrome Patients with prosthetic valves Uncorrected CHD
