Common disorders in Antepartum- EXAM 1 Flashcards
Anemia during pregnancy
Inadequate levels of hemoglobin in the blood
12g/dL in non pregnant woman
<11 g/dL in pregnant woman
Can be effected by ethnicity, smoking, nutrition or medications
Iron deficiency anemia
Most common in pregnancy
May be asymptomatic but more susceptible to infection, high blood pressure and postpartum hemorrhage
Prevent: by iron supplements and vitamin c for better absorption
Treatment: Oral doses of elemental iron. Continue treatment for about 3 months after anemia has been corrected
Do not take iron with milk or antacids
Folic acid deficiency anemia
Large immature RBC
Essential for normal growth and development
Prevent: daily supplement of 400 mcg per day
Treatment: 1 mg/day of folic acid supplement
Anticonvulsants, oral contraceptives, sulfa drugs and alcohol can decrease absorption
Sickle Cell disease
Fetal death due to sickling attacks in placenta
Additional folic acid supplements requiresd
Maternal infection should be treated promptly
Make sure hydrated and increase fluids, water!
Dehydration, fever can trigger sickling crisis
Diabetes
GDM
Can be caused from unidentified preexisting disease
Important to diagnose due to increased risk for perinatal morbidity, mortality
Consquences of changing hormone levels
Effects of pregnancy on Cardiovascular system
Blood volume increased by 45%, provides for the exchange of nutrients, oxygen, and waste products in the placenta, reserves for blood loss at birth
Pulse rate increased by 10-15 beats/min ( 75-115 is new normal )
Signs of CHF
persistent cough
moist lung sounds
difficulty breathing on exertion
fatigue or fainting
severe pitting edema of the lower extremities
palpations
changes in fetal heart rate
CHF treatment
limit physical activity
drug therapy:
beta-adrenergic blockers, anticoagulants and diuretics
Vaginal birth is preferred bc it carries less risks for infection and respiratory complications
Supine hypotension syndrome
vena cava syndrome
Occurs when women lies flat on her back and heavy uterus compresses vena cava
can lead to fetal hypoxia
Symptoms: faintness, lightheadedness, dizziness, agitation
Turning to side relieves pressure on the inferior vena cava, preferably the left side
Pregnancy induced hypertension
Condition that affects woman’s kidneys, heart or blood circulation
Develops gradually during the second half of pregnancy
symptoms: abnormal rise in blood pressure, rapid weight gain, swollen face and fingers, headaches and blurred vision
Hypertension DURING pregnancy
GH: preeclampsia and Eclampsia
Present after 20 week of gestation
30mm or more systolic increase over baseline
15 mm diastolic increasse
Danger signs in pregnancy
sudden gush of fluid from vagina
vaginal bleeding
abdominal pain
epigastric pain
Edema of face and hands
chills with fever over 100.4
painful urination or reduced urine output
persistent vomiting
Severe persistent headache
Blurred vision or dizziness
Ectopic pregnancy manifestations & Tx
Lower abdominal pain and light vaginal bleeding
Vaginal bleeding and signs of hypovolemic shock if tube ruptures
Treatment: pregnancy test, transvaginal ultrasound, priority is to control bleeding
Treat w/ Methotrexate or surgery to remove from tube
Signs and symptoms of hypovolemic shock
fetal heart rate changes
rising weak pulse
rising respiratory rate
shallow, irregular respirations
falling blood pressure
decreased or absent urinary output
pale skin or mucous membrane
cold, clammy skin
faintness
thrist
Hydatidiform mole manifestations & Tx
Bleeding, Higher then expected levels of hCG
“snowstorm: pattern on ultrasound with no sign of fetal development
Rapid uterine growth but failure to detect fetal heart activity
Treated through uterine evacuation or dilation and evacuation
Rh incompatibility
mom is rh negative and fetus is rh positive
Her body will respond by making antibodies to destroy rh positive erythrocytes
RhoGAM is given at 28 weeks and within 72 hours of delivery to the mother
TORCH
Infections that can be devastating to the fetus or newborn
Toxoplasmosis
Other
Rubella
CMV
Herpes
CMV & Tx
Cytomegalovirus
infected infant may have seizure, blindness, deafness, dental abnormalities and petechiae
Treatment: none but therapeutic abortion may be offered if detected early in pregnancy
Rubella
mild viral disease
low grade fever and rash
destructive to developing fetus
women shouldn’t get pregnant for a month if she receives vaccine before pregnancy!
Not given during pregnancy because vaccine is from a live virus!!
Rubella effect on embryo/fetus
small head size
intellectual disability
congenital cataracts
deafness
cardiac effects
IUGR
Herpesvirus
2 types; Type 1 and 2
1: likely to cause fever, blisters or cold sores
2:likley to cause genital herpes
Lies dormant in nerves, can reactivate at any time
Hepatitis B & Tx
transmitted by blood, saliva, vaginal secretions, semen and breast milk; can also cross the placenta
Can be infected during delivery; will receive a single dose of hep b immune globulin, followed by hep b vaccine
STI’s
syphallis, gonorrheam chlymydia, trichomoniasis, condylomata
HIV
acquired through sexual contact, membrane/ perinatal exposure
Causes AIDS
Cripples the immune system
Taxoplasmosis
acquired by contact of cat feces or raw meat
transmitted through placenta
causes: low birth rate, enlarged liver or spleen, jaundice, anemia, inflammation of eye structures, neurologic damage
Strep
leading cause of perinatal infection with high mortality rate
Organism found in woman rectume, vagina, cervix, throat or skin
exposure is greater if the labor is long or the women experiences premature rupture of membranes
TB
mother can be tested for PPD skin test or serum quantiferon gold
if mother is active, infant must be kept away from mother until she had been cleared by PHD
UTI
Pressure on urinary structures alters self cleaning
Prevents bladder from emptying completely
Retained urine becomes more alkaline
May develop cystitis: burning urination, increased frequency, slightly elevated temperature
Placenta Previa
abdomen & interventions
Attachment of the placenta is partially or fully covered in the cervical opening
Three types: marginal, partial, total
Baby is in abnormal position
Painless, bright red bleeding, episodes of bleeding, spontaneous bleeding after sex
Nontender abdomen, relaxed and soft uterus
No sex, no vaginal exam, no manipulation of vagina or optimum, bedrest you know strenuous activity. Continuously monitor mom and baby and pad count, left side lying, if bleeding persist C-section
Abrupto placentae
abdomen & interventions & causes
Premature detachment of the placenta before childbirth. Baby is so stressed and there is decreased fetal movement. Mother is faint & nauseous
Concealed blood loss, blood is pulling, dark vaginal bleeding in extender fundal height
Abdominal pain, hard Abdomen, uterine contractions don’t relax
Monitor for concealed bleeding, no abdominal or vaginal exams, left side lying, prepare for delivery!!!
Caused due to trauma, previous history of it, chronic hypertension, preeclampsia, premature rupture of membranes, smoking/cocaine, having multiple babies at once
