early and late toxicity Flashcards
what is early toxicosis
pathological conditions during the first trimester (16 wks) d/2 presence of the gestational sac
typs of early toxicosis
pytalism
n/v
what is pytalism
hypersalivation w/ loss of 1-1.5l
consequneces
reduced blood volume
dysprotenemia
skin maceration
rx of pytalism
tincture of belladona & atropine
epidemiology of N/V in pregnancy
66% get nausea
50% get vomiting
typical in morning but can be all day
decreases in 2nd TMster
why does n/v occur in preg
hormomal changes and elevated hCG
degrees of vomiting
light
moderate
severe
light vomitting
2-4x/ day after meals
slight tachyK
normal general state
moderate
5-10x/day non postprandial
assoc w/ weight loss, ketosis and increased temp
severe= hyperemesis gravidarum
rare condition(4/1000) caused by impulses from uterus to maternal diencephalon
20-25x/ day
stim by loud sounds and moving
Dehydration weight loss >10kg increased body temp low bp 90/60 oliguria azotemia encephalopathy
rx of severe n/v
dont admit 2 sufferes on the same ward as they provoke each other
IV rehydration w/ albumin
antiemetics(metoclopramide)
hepatoprotection
reasons to terminate preg
hepatic failure
encephalopathy
renal failure: oliguria, azotemia
refactory to rx
late toxicosis
preeclampsia eclampsia chronic htn chronic htm w/ superimposed preeclampsia gestational htn
preeclampsia
eclampsia
chronic htn
chronic htm w/ superimposed
preeeclampsia notes
what is chronic htm w/ superimposed preeclampsia
HTN b4 preg plus
- new w proteinuria
- sudden increase in already htnsive bp
- thrombocytopenia
- increase asat/alat
gestational htn (20wks)
mild htn w/o signs of preeclampsia
develops at 20 wks gest
resolves by 12th pp week
can potentially progress to preeclampsia
management of late toxicosis
depend on gestational age and htn severity
observation: 2x/week
- restrict movement
- bp mon
- fetal growth mon
- look for s/s of preeclampsia
nedical management of late toxicosis
Acute- IV HYDRALAZINE
Expectant rx- Methydopa and nifedipine
Preventing eclampsia : MgS04
Contraindicated drugs in late toxicosis
ARB & ACE inhib
what is the only cure for late toxicosis
DELIVERY
