fun prego complications Flashcards
what is morning sickness?
N +/- V up til 16 wks
what is hyperemesis gravidarum?
severe, excessive form of am sickness associated with weight loss and electrolyte imbalance
when does HEG develop
during 1st and 2cd trimester, persists > 16 wks gestation
what are rf for HEG?
primigravida, previous hyperemesis in past prego, multiple gestations, molar prego
what is the pP of HEG
vomiting center oversensitivity to prego hormones
what are s/sx of HEG
severe N/V, weight loss 5%of preg weight, acidosis from starvation, metabolic hypochloremic alkalosis
how do you tx HEG?
fluids, electrolyte replacement, vitamins
**diet: high protein foods, small frequent meals, avoiding spicy/fatty foods
what is the first line antiemtic for hEG?
pyridoxine (vit B6 +/- doxylamine,
can also use methazine, dimenhydrinate
what is the Rhesus factor?
maternal antibodies that bind to fetal RBC
what is neonatal hemolytic dz?
if the mom is Rh- and the fetus is rh +
pp of rh alloimmunization
occurs if rh neg mom carries rh + fetus w/ exposure to fetal blood mixing (C-section, abruption, palcenta previa, amniocenstesis, vag delivery)
-this mixing causes maternal immunization (mathernal anti-rh antibodies
-during subsequent pregos, if mom crries another rh + fetus, antibodies may cross the placenta and attack the fetal RBC= hemolysis of fetal RBC
what pregos are at risk for this?
rh neg mom with rh+/unknown father
what are s/sx of of rh alloimmunization?
if newborn is Rh+; hemolytic anemia, jaundice, kernicterus, hepatosplenomegaly, chf
fetal hydrops
what is kernicterus?
brain damage that is caused by excessive jaundice (bilirubin goes to brain)
what are fetal hydrops?
fluid accumulation in 2 spaces–> pericardial effusion, ascites, pleural effusion, subq edema
dx of rh alloimm?
prego women: get ABO, rh, indirect erythrocyte antibody screen (1:8-1:32 is associated with fetal hemolysis) indirect coobs
fetal monitoringg in rh allo?
in 2cd trimester: if present, check amniotic fluid (increased bilirubin)
-US of middle cerebral artery (increased flow secondary to decreased viscosity of blood in anemia)
-percutaneous umbilical blood sampling (decreased hematocrit
how to tx rh alloimmunization?
mom: prevention w/ 300 mg Rhogam (pooled anti-d IgG binds to fetal RBC to prevent maternal mixing)
what are the indications for rhogam?
given if Rh -, Ab negative in 3 indications:
- 28 wks gestation
- w/in 72 hrs of delivery of an Rh positive baby
- after any potential mixing of blood (spontaneous abortion, vaginal bleeding,etc)
how to treat erythroblastosis fetalis?
umbilical vein transfusions guided by US
*mod- severe anemia tx w/ antigen-negative RBC
gestational Dm?
glucose intolerance or DM only present during prego: usually subsides postpartum
what are RF for Gest. DM?
fmhx, pmhx of gest. dm, spontaneous abortion, hx of infant >4000g at birth, multiple gestation, obesity, > 25 yso, Aa, hispanic, asian/pacific islander, native american
PP of gestational dm?
cuased by placental release of growth hormone, corticotropin releasing hormone, and human placental lactogen (HPL) –> antagonizes insulin –> works similar to growth hormone as a counterregulatory hormone increasing glucose availability for the growing fetus
dx of gest. dm?
screening: 50 g oral glucose challenge test at 24-28 wks gestation
if greather than 140 after 1 hour, then perform 3 hour oral GTT
how is gest dm confirmed?
3 hr 100 g oral glucose tolerance tests
performed in AM after an o/n fast fasting> 95 1 hr> 180 2hr > 155 3 hr > 140
how is gest dm managed?
daily fingersticks o/n and after each meal
what is the medical tx for gest dm?
insulin bc it doesn’t cross the placenta
can also use glyburide (higher risk of eclampsia)
or metformin
what type of insulin is used for gest dm?
NPH/regular insulin 2/3 in am, 1/3 in PM
0.8IU/kg first trimester, 1.0 IU/kg 2cd trimester, 1.2 IU.kg in 3rd
when is labor induced in gest dm?
@ 38 wks if uncontrolled/macrosomia (c-section may be method of choice)
@40 wks if controlled
what are fetal complications of gest dm?
fetal dmise, congenital malformation, premature labor, neonate hypoglycemia from abrupt removal of maternal glucose, hyperglycemia, shoulder dystocia, macrosomia, birth trauma, neonatal hypocalcemia, hyperbilirubinemia
what er maternal complicatios of gest dm?
preeclampsia, abruptio placentae, >50% chance of developing DM after prego, > 50% change os recurrence,
*mother should be screened at 6 wks postpartum for DM and yearly afterwad
