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Womens Health Exam 1 > Complicated Pregnancies Part 1 > Flashcards

Complicated Pregnancies Part 1 Flashcards

1
Q

What are the main pre gestational problems?

A

Diabetes

Anemias

Heart disease

HIV

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2
Q

What is the definition of pre-gestational problems?

A

Health conditions existing BEFORE pregnancy that affect maternal-fetal health outcomes

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3
Q

Why is pregnancy a diabetogenic state?

A

In all pregnancies, changes occur to ensure that glucose goes to the growing fetus

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4
Q

What are the three phenomenons that mimic diabetes during pregnancy?

A

Mild fasting hypoglycemia

Post prandial hyperglycemia

Hyperinsulinemia

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5
Q

What is hyperinsulinemia

A

First trimester:

Estrogen and progesterone cause higher amount of insulin to be secreted, causing:
- increase in maternal glycogen stores, causing:
- mild hypoglycemia

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6
Q

Why do we develop increased tissue resistance to insulin?

A

In the 2nd and 3rd trimesters, estrogen and progesterone are still present.. but now Human Placental Lactogen (HPL) shows up.. and creates maternal insulin resistance.

And at the same time, glycogen levels decrease = more glucose enters the maternal blood stream, causing elevated post prandial blood sugars

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7
Q

What is maternal insulin resistance

A

Insulin is still there/being produced, but the body isn’t using it correctly, so that glucose can go to the baby

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8
Q

What happens if you have any pre existing diabetes and become pregnant?

A

It will be made worse, and a patient with the potential for diabetes may develop gestational diabetes

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9
Q

What are the maternal risks with diabetes?

A

Hydramnios or polyhydramnios
—increase in amniotic fluid volume
— excessive fetal urination secondary to fetal hyperglycemia

Preeclampsia/ Eclampsia

Labor dystocia
— due to fetopelvic disproportion

Recurrent monilial vaginitis or UTIs

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10
Q

What are fetal risks with diabetes?

A

Macrosomic infant (big baby usually over 4000-5000 grams) if poor glucose control
— high levels of glucose crossing placenta

Respiratory distress syndrome (RDS)
— high levels of fetal insulin inhibit surfactant production

Severe congenital anomalies: often involving heart, CNS, and skeletal system (seen only with pre gestational diabetes)

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11
Q

What are some fetal surveillance for diabetics!?

A

Maternal serum alpha fetoprotein

Ultrasound

Fetal kick counts

Non stress test biweekly

Biophysical profile weekly at 32 weeks

Amniocentesis (if needed) to assess lung maturity

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12
Q

Define anemia

A

In adequate levels of hemoglobin in the blood

Less than 12 gm/dL in non pregnancy

Less than 11 in pregnancy

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13
Q

How do you prevent or treat anemia?

A

To prevent anemia in pregnancy, start 30 mg per day supplements at first prenatal visit - this amount is contained in most prenatal vitamins

If anemia is diagnosed, dosage should increase to 60 mg to 120 mg a day of iron. Add stool softener.

After one month, if anemia persists, further lab studies are indicated

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14
Q

How should we take iron supplementation?

A

Better absorption on empty stomach and if taken with vitamin C
- absorption is reduced by 40-50%
If taken with meals

Client may need to start on lower dose and build up tolerance

Teach that tarry stools and constipation will occur

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15
Q

Why do we need folic acid?

A

Folic acid is necessary for DNA and RNA synthesis, and cell duplication

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16
Q

What happens if there’s a lack of folic acid?

A

Immature RBCs fail to divide, become enlarged (megaloblastic) , and are fewer in number

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17
Q

How to prevent or treat folic acid deficiency

A

Prevention with daily dose of 0.4 mg folate

Treatment if diagnosed: 1 mg folate daily

Iron deficiency almost always coexist with folic acid deficiency, so add iron supplement too

18
Q

What is the #1 cause of US pregnancy death?

A

Cardiovascular disease

19
Q

What is the top four causes of maternal mortality

A

Hypertension

Hemorrhage

Infection

Heart disease

20
Q

Danger signs with cardiac disease?

A

Cough- with or without hemoptysis

Dyspnea- progressive, upon exertion

Edema- progressive, including extremities, face, eyelids

Heart murmurs

Palpitations

21
Q

What are the major causes for bleeding in pregnancy?

A

Spontaneous abortion (miscarriage)

Ectopic pregnancy

Gestational trophoblastic disease (molar pregnancy)

Abruptio placentae (premature detachment of the placenta off the wall of the uterus)

Placenta previa (abnormal implantation of the placenta either partially or completely in front of the cervix)

22
Q

What is the greatest risk factor for spontaneous abortions?

A

Advanced maternal age (over 35)

23
Q

Over 50% of miscarriages are due to what?

A

Over 50% are related to chromosomal abnormalities

24
Q

What are some causes for miscarriages?

A

Teratogens, faulty implantation, placenta abnormalities, weakened cervix, previous history, maternal illness

25
Q

What is the pathophysiology of a miscarriage?

A

Usually embryonic death occurs and hCG production ceases

Then estrogen and progesterone decreases.. the interline decidua is sloughed off

Uterus becomes irritable, contracts, and the fetus is expelled

26
Q

What are the 5 types of miscarriages?

A

Threatened

Imminent/ inevitable

Incomplete

Complete

Missed

27
Q

What is threatened miscarriages?

A

Unexplained bleeding, cramping, backache

Cervix closed

28
Q

What is imminent/inevitable miscarriages?

A

Increase bleeding and cramping

Cervix dilates

29
Q

What is incomplete miscarriages?

A

Part of the products of conception are retained

Cervix dilated

30
Q

What is a complete miscarriage?

A

All products of conception expelled

31
Q

What is a missed spontaneous abortion?

A

Fetus dies but not expelled

Cervix closed

32
Q

What is an ectopic pregnancy?

A

Implantation of a fertilized ovum in a site other than the endometrial lining of the uterus

33
Q

Where is the most common location for an ectopic pregnancy?

A

The ampulla of the fallopian tube

34
Q

How does an ectopic pregnancy present itself?

A

First it will be normal signs and symptoms of pregnancy

But eventually.. the embryo outgrow the tubal space, and the tube ruptures:

Bleeding
One sided and lower abdominal pain
Fainting, dizziness
Referred right shoulder pain

35
Q

How to evaluate an ectopic pregnancy?

A

Menstrual history

Pelvic exam to assess for masses or tenderness

Labs: quantitative beta HCG (increase more slowly than in a viable IUP)

36
Q

How do you manage an ectopic pregnancy?

A

Methotrexate IM if stable, unruptured, 4cm or less, no cardiac motion

Other cases would need laparoscopic surgery

RhoGAM if RH negative

37
Q

What is a molar pregnancy

A

Pathologic proliferation of trophoblastic cells (outer most layer of embryonic cells)—- instead of a baby it’s a hydropic (fluid filled) grape like clusters

Woman with GTD not only suffers the loss of pregnancy, but the remote, yet real possibility of developing choriocarcinoma

38
Q

How does a molar pregnancy present itself?

A

Vaginal bleeding (generally dark brown… prune juice colour)

Anemia

Hydropic vessels passed

Uterine enlargement greater than expected

No fetal tones, yet presence of other symptoms of pregnancy

Elevated serum hCG

Very low levels of maternal serum alpha fetoprotein (MSAFP)

39
Q

What is gestational diabetes (GDM)

A

The pancreas is unable to produce the amount of insulin required to overcome insulin resistance caused by the hormones… which means glucose levels rise abnormally and the patient becomes gestational diabetic

40
Q

How do you screen for GDM?

A

Test between 24-28 weeks when human placental lactogen (Hpl) is really high

Non-fasting one hour glucose tolerance test and if it’s 140 or above, a fasting 3 hour glucose test is ordered

41
Q

What does a GDM diagnosis mean for the mom?

A

It’s a higher maternal risk for C section, polyhydramnios, and ketoacidosis

42
Q

What does a GDM diagnosis mean for the fetus?

A

Higher fetal neonatal risk for macrosomia, respiratory distress syndrome, hypoglycemia after birth, and hyperbilirubinemia

Womens Health Exam 1 (6 decks)

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