Antepartum Risk Factors and Complications Flashcards
preeclampsia, criteria for diagnosis 
-effects 5% of pregnancies
-new onset HTN of at least 140/90 on two occasions greater then 4 hours apart
-must include one or more of the following: proteinuria, new onset HA or visual disturbances, thrombocytopenia, impaired liver or kidney function, or pulmonary edema
preeclampsia, treatment/management
most commonly seen after 34 weeks, delivery is the only cure. anti hypertension treatments such as thiazide, hydralazine, propranolol, labetalol, nifedipine, and methyldopa are recommended for HTN treatment as well as anticonvulsants if seizures occur. Magnesium sulfate can be given prophylactically for severe HTN or seizures
eclampsia, what is it? what are its effects on the fetus?
-severe preeclampsia where a seizure occurs.
-long-standing HTN leads to uteroplacental vascular insufficiency which impairs o2 and nutrients to reaching the fetus, resulting in IUGR. Placental abruption risk is increased. IUGR is usually asymmetric, head is normal size but body is small. infant born with IUGR have increased mortality and morbidity rates
HELLP syndrome stands for?
H - hemolysis
EL - elevated liver enzymes
LP - low platelet count
DIC
disseminated intravascular coagulation- abnormal blood clotting throughout the body’s blood vessels
HELLP syndrome, treatment?
platelet transfusion are given in platelets are below 20,000 before delivery or below 50,000 before C-section. Treatment is immediately prior to delivery the mother and fetus are at risk for developing hepatic hemorrhage or permanent liver damage
HELLP syndrome, other complications?
abruptio placenta, DIC, and postpartum hemorrhage
HELLP syndrome, how it presents?
HTN may be less pronounced, RUQ pain related to liver dysfunction, nonspecific flu-like symptoms such as headache, N/V, and visual disturbances
mothers with cardiac disease have what % increase or having a baby with cardiac anomalies?
5-10%
fetal echocardiogram is recommended
marian syndrome and it’s effects on pregnancy?
-inherited disorder, effects connective tissue/fibers that support and anchor organs
-severe risk to mother with mortality rate 25-50% because of the possible rupture of the aorta. also there’s a 50% chance that the infant will inherit the syndrome
what is the most common complication of maternal cardiopulmonary disorders?
premature birth and SGA
maternal mitral valve prolapse risk to fetus?
no risk
explain how DM effects the fetus
elevated maternal blood glucose crosses the placenta to fetus but insulin does not. fetus does not became producing insulin until 20 weeks, prior to that the fetus is exposed to elevated BG levels which restrict growth. at 20 weeks the fetus responds with elevated levels of insulin. elevated insulin and BG levels trigger rapid growth, increased fat and glycogen stores, enlarged liver and spleen, cardiomegaly, and increased head size. sudden withdrawal of material BG at birth puts neonate at increased risk of hypoglycemia at birth
sickle cell anemia
RBCs sickle-shaped and inflexible resulting in accumulating in small vessels and causing painful blockages
what are pregnant woman with sickle cell anemia at risk for? how does it effect the neonate?
urinary infection, pulmonary infection, congestive heart failure, and acute renal failure all which trigger vasooocculusive crises and put the fetus at risk. perinatal mortality rates are 18% caused by sickling of placenta. neonates are increased risk of prematurity and IUGR.
explain why woman are at increased risk of anemia and iron deficiency anemia in pregnancy
the mothers plasma increases about 50%, diluting the the red blood cells. hematocrit drops 38-47%, as low as 30%. the fetus also takes iron from the mother and the mother must compensate for that loss
when hemoglobin drops below 10, what are some of the risk factors for the mother?
infection, preeclampsia, and postpartum hemorrhage
if hemoglobin drops below 6, what are the increased risks for mother and fetus/neonate?
-cardiac failure
-miscarriage, stillborn, low birth weight, neonatal death
what are s/s of iron deficiency anemia?
pallor, glossitis (inflamed tongue), HA, pica, processing to weakness, lethargy, confusion, ataxia (impaired balance), cardiovascular abnormalities
recommended treatment for iron deficiency anemia? and how to promote absorption?
60-120mg daily of elemental iron
-best to avoid caffeine and dairy products within and hour of taking and take some source of vitamin c
s/s of low folate/folic
-asymptomatic (initially)
-GI disturbances such as ingestion, anorexia, and weight loss
-red beefy looking tongue
-pallor
-weakness, fatigue
-forgetfulness, impaired concentration
folate/folic acid deficiency treatment, diet and supplements
-diet: green leafy vegetables, liver, citrus fruits, legumes, nuts and grains
-supplements: L-methylfolate 600-1000mcg daily or folic acid 1-5mg daily
causes for maternal acidosis
uncontrolled diabetes (leading to diabetic ketoacidosis), renal dysfunction, and severe diarrhea
maternal acidosis effects on neonates
decreased APGAR scores, FHR abnormalities, decreased fetal movement
