ch 19: conditions existing before conception Flashcards
asthma teaching
continue to take asthma medications, stop smoking, evaluate exacerbations
the goal of asthma treatment during pregnancy is to
optimize control & limit exacerbations
med for hypothyroidism
levothyroxine
T/F: levothyroxine can be continued as originally prescribed during pregnancy
F: needs to be adjusted early on
may cause pregnancy loss of low birth weight; drugs cross placenta, suppress fetal thyroid synthesis = fetal anomalies
hyperthyroidism tx
pregestational DM
goal is glycemic control
- labor induced
- glucose/insulin infusion during labor
risks of uncontrolled pregestational DM
- macrosomia
- preeclampsia
- perinatal death
- fetal loss
- preterm birth
congenital anomalies
type O mothers with a baby type A/B blood
ABO incompatibility
Rh neg mom to Rh pos baby
Rh incompatability
what to watch for with blood incompatibility in the newborn
hyperbilirubinemia
when to give RhoGAM
28wks, anytime bleeding/invasive procedures
asymptomatic, no limitation physical activity
class I CVD
symptomatic (dyspnea, angina) with increased activity
class II CVD
symptomatic (fatigue, palpitation) with normal activity
class III CVD
symptomatic at rest or with any physical activity
class IV CVD
care during L&D w/ CVD
- side-lying
- FHR
- maternal ECG
- analgesics, epidural
- O2
- no pushing, no stirrups
BP higher than 140/90 predating pregnancy or appears before 20wks pregnancy
chronic HTN
obesity complications
- GDM
- preeclampsia
- labor induction/induction failure
- slow 1st stage labor
- macrosomia
- PP thromboembolism
T/F: even if don’t menstruate, still ovulate
T
eating disorders teaching
pregnancy should be planned for tie of remission
T/F: physiologic anemia is an unexpected finding in pregnancy
F
normal Hgb level in pregnancy
11-14
anemic level in pregnancy
<10.5
complications of substance abuse in pregnancy
- neonatal abstinence syndrome (withdrawal)
- fetal alchohol syndrome
- preterm birth
- intrauterine growth restriction
- stillbirth
maintenance tx and standard of care for substance abuse
methadone
breastfeeding is contraindicated in pt who are:
- taking acetaminophen
- alcohol consumption
- cocaine/heroin use
tx depression during pregnancy
SSRIs (no known teratogenic affects but can lead to lower APGAR scores)
anxiety treatment options
antidepressants, counseling, benzos (can cause withdrawal, higher risk fetal loss/preterm birth)
advanced maternal age
35+
