Concurrent disorders of pregnancy (unit 2) Flashcards
anemia during pregnancy
- Hgb < 11 g/dl in 1st & 3rd trimester
- Hgb < 10.5 in 2nd trimester
- Hct < 33%
main consequence of anemia
•less O2 carrying capacity
•CO inc.
•inc. pressure in vessels
*can cause preeclampsia, CHF
causes of anemia
- malnutrition
- hemolysis
- blood loss
s/sx Fe deficiency anemia
•pallor •fatigue •lethargy •HA •pica *most common anemia
fetal effects r/t Fe deficiency anemia
- unclear b/c fetus receives adequate stores at cost to mom
* anemia has to be profound for fetal O2 supply to be impacted
FeSO4
- Fe replacement
- b/t meals on empty stomach
- take w/ vit. C
- avoid bran, tea, coffee, milk, egg yolks
folic acid deficiency anemia
- causes slowing of DNA synthesis, resulting in many immature or decreased formation of RBCs
- needs double in PG
fetal effects r/t folic acid anemia
- r/o SAb, placental abruption, cleft palate/lip
* r/o neural tube defects (biggest)
folic acid sources
•liver •kidney/lima beans •dark greens •supplements (recommend 600 mcg/day in childbearing women) *extra need in multifetal PG
causes of sickle cell anemia exacerbation in pregnancy
- low O2 sats- greater needs
- dehydration- morning sickness
- infection- suppressed so doesn’t attack baby
maternal effects of sickle cell trait
- usually do fine in PG
- higher r/o UTI and Fe deficiency
- r/o UPI
- more prone to develop pyleonephritis, bone infection, heart dz
sickle cell crisis in PG mom
- temporary cessation of bone marrow fxn
- hemolytic crisis
- massive erythrocyte dysfunction (-> jaundice)
fetal effects of sickle cell anemia
- prematurity
- death r/t crisis
- possible SC anemia (autosomal recessive)
- intra uterine groth restriction (IUGR)
sickle cell management
- freq. Hgb, Fe, IBC, folate labs
- close fetal surveillance
- assess/prevent crisis
- exchange transfusion
- prophylactic transfusion controversial
exchange transfusion
•RBCs removed and replaced
goals of sickle cell management
*adequate hydration/nutrition •good hygiene •adequate rest •prompt tx of infection *prevent crisis
thalassemia
- genetic disorder affecting synth of hemoglobin
* causes short life span of RBC
s/sx thalassemia in children
- none at birth
* become anemic b/t 3 and 18 months b/c can’t make enough Hgb
anemia progression s/sx in thalassemia children
- failure to thrive/grow
- poor feeding/emesis
- irritability/crying
- pallor
women w/ thalassemia trait
•typically have uncomplicated PG when seek genetic counseling
women w/ thalassemia dz
•infertility common •50% of PG complicated -stillbirth -IUGR -preeclampsia -PTD
maternal effects of thalassemia during PG
•mild anemia
*DONT give Fe supp. b/c they store Fe in excess and it’s hard to excrete
fetal effects of thalassemia
- may/may not cause morbidity
* r/o inheriting dz or having problems associated
asthma and pregnancy
- affects 1-4% of women
- ½ improve
- ¼ worsen
- ¼ stay same
- labor can exacerbate attack
cystic fibrosis and pregnancy
- if not advanced, tolerate PG well
* if have advanced, often have PG hypoxia and pulmonary infections
pregnancy and SLE
- r/o exacerbation
- s/sx of joint pain, photosensitivity, butterfly rash
- if pass 1st trimester, 90% chance for live birth
fetal effects SLE
- congenital heart block
* SAb in 1st trimester
rheumatoid arthritis and pregnancy
•symptoms usually greatly improved during PG
epilepsy and pregnancy
•increased r/o IUFD & PTL •anti-convulsant tx controversial -dec. clotting; inc. bleeding -compete for Fe -teratogenic
what dz could epilepsy during pregnancy be confused with?
•eclampsia
multiple sclerosis and pregnancy
•medications contraindicated in PG and BF, so may have bowel, bladder, ambulation, and fatigue issues
4 cardinal signs of diabetes
- polyuria
- polydipsia
- polyphagia
- weight loss
diabetes in 1st trimester
•usually not an issue b/c insulin needs are lower
diabetes in 2nd/3rd trimester
- insulin needs increase
* pancreas can’t respond sufficiently, so have hyperglycemia
pre-existing diabetes and PG
- difficult to control insulin
- N/V
- inc. energy needs
- vascular disorders can worsen
pre-existing diabetes increases risk of…
- ABs
- congenital anomalies
- macrosomia (lots of sugar)
- shoulder dystocia (macrosomic)
- PIH
- C/S
- over dissension of uterus
- IUGR
- UPI (uterus is peripheral vascular site)
why does pre-existing diabetes increase r/o IUGR
•vasoconstriction @ uterus
influence of diabetes on newborn
- cardiac anomalies
- hypoglycemia (rebound)
- resp. distress syndrome (late surfactant development)
- birth trauma (macrosomia)
- hypocalcemia
- hyperbilirubinemia (r/t birth trauma)
screening for diabetes
- urine dip (prot, ket, WBC, sugar)
- Hgb A1c (2.5-5.9%)
- GCT (24-28 wk)
- OGTT (if GCT abnormal)
GDM diagnosis criteria
- must have 2/4 abnormal to be GDM
1. fasting- 95
2. 1 hr- 180
3. 2 hr- 155
4. 3 hr- 140
diabetes management
- 2200-2400 cal diet
- exercise
- SBGM 4-6x/day
- insulin admin/control
- monitor fetal status
why risk of macrosomia
•hyperinsulinemia
fetal lung maturity in DM mom
- surfactant development later
- inc. risk of respiratory distress
- ideal to have vag birth (squeeze lungs)
hyperemesis gravidarum
•excessive N/V past 12 wks •leads to: -5% wt loss -electrolyte imbalance -dehydration -ketosis
hyperemesis gravidarum risk factors
- < 20 y/o
- obesity
- first PG
- multifetal
- gestation trophoblastic dz
- psych d/o
- hyperthyroidism
- vit. B deficiency
- high stress
hyperemesis gravidarum effect on fetus
- IUGR
* preterm birth
mitral valve prolapse PG implications
•give abx before delivery
rheumatic heart dz
- occurs when strep throat proceeds into heart dz, causing scarring on heart and stenosis
- mitral valve stenosis inc. pressure in R atrium -> pulmonary HTN/edema -> HF
cardiomyopathy
•heart dz that begins last weeks of PG-20 wk PP
•s/sx same as HF
•tx: anticoag; antiarrhythmias, anti-infect; diuretics
*reoccurrence in subsequent PG, so contraindicated
class I heart dz
- uncompromised
- no limitation of physical activity
- 1% mortality
- Ex: MVP
class II heart dz
- slight limitation of physical activity d/t fatigue, dyspnea, palpitation, angina
- mortality 5-15%
class III heart dz
- moderated/marked limitation of physical activity
- symptoms w/ less than ordinary activity
- mortality 25-50%
class IV heart dz
- inability to carry on any physical activity w/o discomfort
- cardiac insufficiency even at rest
- CANNOT sustain PG
s/sx heart dz
- frequent cough
- dyspnea
- edema
- murmor
- palpitation
- rales
management of heart dz
- high iron/protein intake
- avoid excessive wt gain
- freq. rest
- prophylactic abx
Bell’s Palsy
•sudden unilateral neuropathy of 7th CN (facial) •paralysis/weakness on one side of face •inc. risk during PG •tx: steroids *spontaneously resolves w/ time
TORCH
•Toxoplasmosis •Other: gonorrhea, syphilis, varicella zoster, hep B, HIV •Ruebella •Cytomegalovirus (CMV) •Herpes Simplex Virus *infections during PG
toxoplasmosis
- protozoan transmitted through undercooked meat & contact with infected cat feces
- crosses placental barrier
- often subclinical (no s/sx)
- IgG/IgM confirm
toxoplasmosis in infant
- may be asymptomatic
- VLBW
- enlarged spleen/liver
- jaundice
- anemia
varicella-zoster virus
•chicken pox
•herpes thru resp. contact
•may cause PTL, encephalitis, pneumonia
*fetal effects uncommon after 20 wk b/c placental immunity protects
congenital varicella syndrome
- fetal effects if varicella in 1st 20 wks
- limb hypoplasia
- cutaneous scars
- microcephaly
hepatitis B transmission
- blood, saliva, vag secretions, seme, breast milk
* crosses placental barrier
hep B s/sx
- emesis
- abd pain
- jaundice
- fever
- rash
- painful joints
HIV and PG
- infant has 20-30% r/o contracting form mom w/o tx
* prevention is only tx
zidovudine
- PO medication given to HIV+ mom @ 14 wks to prevent vertical transmission
- IV during labor
- elixir for newborn up to 6 wk
preventing HIV transmission to newborn
- zidovudine
- DONT BF
- elective C/S @ 38 wk
- DONT want ROM
rubella
- crosses placental barrier
- greatest risk in 1st trimester (SAb)
- can cause fetal deafness, retardation, IUGR, cardiac comp, microcephaly
cytomegalovirus (CMV)
- herpes family
- can cause fetal deafness, retardation, seizure, blindness, dental d/o
- tx infant w/ Gancyclovir
herpes virus
- vertical transmission as fetus descends or during birth
- C/S if active lesions
- if contracted in 1st 20 wks, SAB, IUGR, PTL
- tx: mom w/ acyclovir
parvovirus B19 (fifths dz)
- transplacental and respiratory secretions (daycare)
- maternal effects of “slapped face”, arthralgia, malaise, SAb
- fetal effect: hydrops (U/S)
fetal hydrops
- immature erythrocytes replace hemolyzed erythrocytes
- placenta and fetal face become edematous
- can lead to uterine rupture
group beta strep neo/infant effects
•spesis
•pneumonia
•meningitis***
*crucial to screen mom @ 36 wks (vag swab)
GBS abx tx if…
- hx of infant w/ GBS
- GBS during current PG
- preterm birth
- maternal fever during labor
- ROM > 18 hrs
tuberculosis
•rare perinatal (infant has to aspirate amniotic fld)
•s/sx of FFT, lethargy, resp. distress, fever, large spleen/nodes/liver
•tx w/ Rafampin, INH and B6
*antiviral drugs contraindicated
why fetus at risk later in PG when exposed to external trauma
- less amniotic:fetal ratio
* less cushion
most important for trauma during PG
•left lateral position
