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
s/s of acute fatty liver pregnancy (AFLP) in mother
N/V, upper GI hemorrhage, coagulopathy, pancreatitis, hypoglycemia, jaundice, general malaise, and renal and hepatic failure
what is AFLP?
-acute fatty liver pregnancy
-most common cause of liver failure in pregnancy
-characterized by micro-vesicular fat deposits in liver that interfere with liver function
how does AFLP effect neonates?
some die in utero and 15% die after birth. may exhibit signs of cardiomyopathy, liver failure, myopathy (skeletal disorder), neuropathy, and hypoglycemia.
treatment for AFLP?
immediate delivery of neonate via induction or c-section. treatment for the mother may included IV fluids, blood products, coagulation factors, plasma exchange or plasmapheresis (similar to dialysis, specifically removes antibodies) with continuous renal replacement. some women may require liver transplant
how does SLE (lupus) effect the mother?
higher rates or HTN and preeclampsia. woman must be monitored closely for flare ups during pregnancy
what is SLE?
-systemic lupus erythematosus
-systemic reaction to collagen or connective tissue and may result in wide spread damage or vessels and organs
how does SLE effect neonates?
impaired circulation due to placental infarction, preterm delivery, fetal growth restrictions, spontaneous abortion and stillborns. also the neonate may inherit lupus (symptoms appearing up to 4 weeks post birth) indications include congenital heart block, autoimmune hemolysis, thrombocytopenia, and lupus dermatitis
cholelithiasis/cholecystitis in pregnancy S/S
RUQ pain, N/V, low grade fever, elevated WBC, clay colored stools and jaundice
why do pregnant woman have increased risk of cholelithiasis and cholecystitis
increased estrogen and increased biliary sludge
cholelithiasis vs cholecystitis?
cholelithiasis is the formation of gallstones. cholecystitis is inflammation of the gallbladder
what is the is the treatment for cholelithiasis/cholecystitis in pregnancy?
medical management most common in first and third trimesters, surgery in 2nd trimester (safest due to the size of the fetus)
how does material hypothyroidism effect the fetus?
threatens the development of fetal brain and spinal cord. T4 is needed proper development and the fetus is not capable of T4 production during critical period of growth. fetal death can occur
how does hyperthyroidism effect pregnancy?
difficult because it mimics pregnancy symptoms. can be temporary in early pregnancy but thyroid levels should return to normal in 2nd trimester. continued high levels can cause thyroid crisis resulting in fetal death or premature birth
CHEAP TORCHES stands for?
- C - chickenpox
- H - Hepatitis
- E - Enterovirus
- A - AIDs (HIV)
- P - Parvovirus
- T - Toxoplasmosis
- O - Other (GBS, Yeast, TB)
- R - Rubella (measles)
- C - Cyomegalovirus
- H - Herpes
- E - Every Other STI
- S - Syphilis
to avoid toxoplasmosis, a pregnant woman should…
-avoid poorly cooked or raw meats including pork, beef or lamb
-wash fruits and vegetables thoroughly
-avoid cat litter box
- wear gloves when gardening and avoid areas with cats
Dx and and treatment of toxoplasmosis
- blood test
- treatment is antibiotics and anti malarial agents
fetuses exposed to toxoplasmosis may have… (3)
-chororentintis - inflammation behind the retina which can progress to blindness in adolescence
-hydrocephalus - build up of CSF
-intracranial calcifications - linked to mental retardation, seizures and motor and developmental delays
untreated early syphilis can cause…
miscarriage, premature birth, stillborn, deformities, developmental delays and seizures. more then half of fetuses infected with syphilis do not make it to term or die soon afterwards
newborns with congenital syphilis may develop…
-snuffles - highly infection mucus
-palmar of solar hand and foot rash
-most children do not show s/s for weeks to months after birth
children with congenital syphilis…
(after 2 years old)
- hutchinson’s teeth - notched incisors or widely spaced pegged teeth
-saddle nose (collapse of the boney part of nose
-frontal bossing - usually pronounced forehead
how can syphilis be treated for fetus or neonates?
- neonates can be treated with antibiotics
-if mother takes antibiotics early in pregnancy the infant is at minimal risk for infection
congenital varicella syndrome birth defects: (7)
-limb atrophy
-damage to brain
-abnormally small head
-vision problems, cataracts
-psychomotor skill problems
-learning disabilities
-mental retardation
congenital varicella syndrome treatment for newborn?
giving the neoborn varicella zoster immune golovin immediately after birth to lessen the severity of the disease
how to treat mother and fetus if mother has varicella during pregnancy?
IV antiviral
what if mother has varicella or been immunized prior to pregnancy
antibodies were formed and will be transferred to fetus, mother nor fetus will become infected during pregnancy
how to prevent HIV from being transmitted from mother to child
ART (antiretroviral therapy) can reduce the mother to child infection rate to less then 1%, without treatment it is 15-45%
should HIV positive woman breastfeed?
should not breast feed, HIV can be spread via breast milk even with ART
how should newborns be treated and tested, born to a HIV positive mother
-6 weeks course of ART
- tested for HIV 2-3 weeks of life, again at 4-8weeks and then again at 4-6 months of age
s/s or HIV in newborn
-poor weight gain
-repeated fungal mouth infections
-enlarged lymph nodes
-multiple bacterial infections (PNA)
-neurological problems
rubella can cause ______ in pregnancy (4)
miscarriage, stillborn, premature birth or congenital rubella syndrome
congenital, rubella syndrome, causes birth defects such as…
-patient ductile arteriosis
-cataracts
-deafness
-intellectual disabilities
-Bone and growth problems
-liver and spleen damage
-“blueberry muffins rash”
treatment for rubella is…
prevention. most damage is done in first trimester where if the mother gets rubella later there is less harm. MMR vaccine can not be given during pregnancy since it is a live virus. must be given before or after delivery
what is cytomegalovirus?
form of herpes, normally health adults don’t have symptoms and a mother with antibodies to it can pass those to the fetus. it become a concern if the mother contracts the virus during pregnancy
symptoms or CMV can cause…
may or may not be seen at birth…
-premature birth
-low birth weight
-blueberry muffins skin rash
-liver or spleen enlargement
-microcephaly (small head)
-hearing loss
-mental retardation
-seizures
HSV transmission from mother to baby
- when women contract their first herpes infection near the time of birth, this has the highest risk of infection for newborns
-HSV transmission almost always occurs after ROM or during vaginal birth, placental transfer is rafe
HSV transmission to newborn is evident by…(3)
-skin, eye and mouth herpes (external lesions but not internal)
-disseminated herpes (affects internal organs especially the liver)
-central nervous system herpes (infection in the nervous system and brain) infant presents w seizure, tremors, poor feeding, lethargy, irritability, unstable temps and bulging fontabelles
treatment for HSV in newborns..
antiviral treatment reduces and the morbidity and mortality of infant
