Health Challenges in Pregnancy Flashcards
Risk factors for gestational HTN?
Cause is unknown. Risk factors- obesity, previous pregnancy with HTN/pre-eclampsia, chronic HTN, pre-gestational diabetes, CKD, ART (IVF), nullipara (never been regent before), age (40+), multiple gestation, previous stillbirth/IUGR, ethnicity (INDG, asian, black)
Gestational HTN classification? severe? and what is chronic HTN?
Systolic BP >140 and diastolic >90. Occurs after 20 weeks PP and up to 12 weeks PP.
Severe- >160/>110
Chronic HTN- develops before pregnancy or less than 20 weeks
How to be accurate in BP measurements?
Use appropriate cuff size, BP based on average of at least 2 measurements taken after 5 minutes of rest/15 min apart using same arm
Preeclampsia, severe preeclampsia, and eclampsia?
PE- gestational HTN with proteinuria and 1/more adverse condition
SPE- severe HTN with proteinuria, 1/more adverse condition or severe organ complication
E- experience seizure
Adverse conditions for pre-eclampsia?
Headache/visual disturbances/abdominal+epigastric+RUQ pain (these more likely to be signs of pre-eclampsia). Also N/V, chest pain, SOB, fetal morbidity, abnormal maternal lab values
Consequences of preeclampsia for pregnant client/fetus?
PC- stroke, pulmonary edema, hepatic failure, jaundice, seizures, placental abruption, acute renal failure, HELLP
Fetal- IUGR, oligohydramnios, placental abruption, prematurity, fetal compromise (metabolic acidosis), intrauterine death
Why does pre-eclampsia occur
Abnormal placentation leads to mismatch between fetal demand and supply from the uterus. Leads to decreased plasma volume and vasospasm because mom’s cells are dysfunction. Causes pre-eclampsia
How to prevent eclampsia?
Use low dose aspirin (75-100 mg/day) in pt with increase risk starting pre-pregnancy or before 16 weeks to delivery. Lifestyle changes for exercise and diet. Calcium supplements for clients with low intake of dietary calcium (healthy calcium levels help prevent HTN)
Management of pre-eclampsia and HTN?
Assess pt/fetus, stress reduction, treat BP with antiHTN meds, treat symptoms present, consider seizures prophylaxis
Management at home for non severe HTN?
Monitor own BP, measure weight/test urine protein daily, report S+S of adverse conditions
Management of severe PE or eclampsia in hospitals?
Evaluate fetus (movement, NST, biophysical profile, U/S, measure AFI). Hourly intake/output, frequent VS, montior for adverse conditions, and blood work (liver enzymes, platelets, Hct)
Anti-hypertensives for pre-eclampsia?
Labetalol, nifedipine, hydralazine, and aldomet
Magnesium sulphate? and SE
It’s an anti-convulsant used to prevent seizures and reduce CNS irritability. Usually given 4g IV in 100 mL NS then 1g/h. SE- tachycardia, muscle weakness, lack of energy, respiratory depression, low BP, it can slow labour, and make sure to test reflexes
Signs of magnesium toxicity? and how to treat?
RR <12, oliguria (<30 mLs/hr), diminished/absent DTR, serum magnesium above or below 4.8-9.6 mEq.
Treat with calcium gluconate (antagonist that reverse toxicity)
What is HELLP syndrome?
Hemolysis, elevated liver enzymes, low platelets. This is an issue caused by severe eclampsia where palettes aggregate at sites of vascular damage
What is DIC?
Disseminated intravascular coagulation. Caused by pre-eclampsia, hemorrhage, intrauterine fetal demise, amniotic fluid embolism, sepsis, HELLP. It causes over-activation of normal clotting mechanisms so mini clots develop=depleted platelets=can lead to excessive bleeding
What is gestational diabetes?
Glucose intolerance with onset/first recognition during pregnancy. More common in INDG women
How does pregnancy alter carb metabolism?
- Fetus takes glucose from mother
- Placenta creates hormones which alter effects of/resistance to insulin and glucose tolerance
Effect gestational diabetes has on pregnant client?
Pre-eclampsia/eclampsia risk b/c of vascular changes, PROM, polyjdriamnios, preterm labour, increased shoulder dystocia/C-section risk, increase gestational HTN/T2D later in life, worsening myopathies (vascular, renal, retinal)
Gestational diabetes fetal, baby, and child effects?
F- LGA, IUGR, fetal demise, congenital anomalies (pre-existing diabetes)
B- hypoglycemia, high bilirubinemia, immature respiratory development (RDS)
C- increased risk developing diabetes/obesity
Risk factors for gestational diabetes?
35 yrs+, from high risk population (INDG, african, asian, spanish, south asian), using corticosteroid long term, GDM in previous pregnancy, family with T2D, polycystic ovary syndrome, previous newborn >4 kg
Screening test for gestational diabetes?
Routine for all women. Around 24-28 weeks use non fasting 50g glucose test. Normal results are <7.8, if between 7.8-11 then perform a fasting GTT, and if >11.1 then you get a GDM dx
Care/managament for GD?
Controlled diet, insulin as needed, exercise, glucose monitoring 4-7x/day, want to maintain euglycemic state (hemoglobin A1C <7%), increased folic acid, oral anti glycemics if they are safe
Iron deficiency anemia and S+S? how to treat
Occurs in 30% of pregnancies. S+S are fatigue, weak, dizzy, irritable, hair loss, dyspnea. Oral iron is first lien treatment (parenteral iron is safe in 2nd trimester and on)
Adverse outcomes from iron deficient anemia?
LBW, SGA, preterm birth, PPH (need for blood transfusion), long term neurocognitive effects in child
Multiple birth risks?
Preterm labour, anemia/HTN, abnormal presentation, twin to twin transfusion syndrome, uterine dysfunction, placenta previa/abruption, prolapsed cord, PPH
Risk to mom because of multiple birth?
C/S, GHTN, PPH. complaints of SOB/edema/Nausea/vomit/heartburn/insomnia/fatigue/weight gain
What is twin to twin transfusion syndrome?
one twin gets more perfusion than the other, causes them to grow more/have more nutrients (donor twin does better because they learn to survive with stress/having less), happens in identical twin pregnancies when they share a placenta (very rare)
Obesity in pregnancy?
Excessive limitless weight gain in pregnancy (common cause of obesity later in life). Usually gain >25 kg in pregnancy and have a hard time loosing PP weight.
Complications of obesity in pregnancy, intrapartum, for baby, and PP?
P- HTN, diabetes, preterm/posterm, spontaneous abortion
IP- stillbirth, LGA, shoulder dystocia, increased C/S, anesthesia challenged
B- macrosomia (large baby), hypoglycemia, BF issues, congenital anomalies
PP- depression, PPH, infection, thrombosis
Obesity recommendations in pregnancy?
Begin pregnancy with BMI <30 (total weight gain is then 7 kg). Increase folic acid and exercise. Assess for risk of VTE
Adolescent pregnancy physical and psycho-social risks? and what can we do to help?
Physical- preterm birth, LBW, anemia, GHTN, cephalic pelvic disproportion
Promote physical health wot regular prenatal visits/education, support, info about complications, and family adaption.
PS- substance abuse, poverty, less prenatal visits, interruption of education/developmental tasks
Support them in school, develop trusting relationship with HCP, promote self esteem/problem solving skills
Older gravida risks?
> 35 have decline in fertility, increase in chronic disease (HTN, cardiac, thyroid, cancers), difficulty in pregnancy (GDM, GHTN, PTL, multiples, IUGR, placenta previa, miscarriage, ectopic, stillbirth, baby death). Increased C/S and induction rates, and increased genetic conditions/anomalies
Methadone in pregnancy?
Used for women abdicated to opioids. It blocks withdrawal symptoms/cravings for the drug. Does cross placenta but impact is less than if they’re not on it (leads to reduced head circumference, LBW, withdrawal symptoms in baby).
Cannabis in pregnancy?
Negatively impacts fertility and it crosses the placenta (can lead to preterm delivery, LBW, birth defects). Can lead to long term effects in childhood (poor memory/verbal skills, behavioural issues). It also passes through BF (lethargy, poor feeding)
Substance use care for PP client and baby?
PP client- assess for withdrawal symptoms, assess for signs of drug use (leaving unit, leave baby unattended)
Infant- signs of withdrawal
Pregnancy and caffeine?
Should have no more than 300 mg/day (about 2 cups of coffee). Large amounts of caffeine increases risk for miscarriage and premature delivery
What are teratogens?
Substances that harm an unborn baby like alcohol, drugs, prescribed meds, and pathogens
What does CHEAP TORCHES stand for?
Infections that cause problems in pregnancy
C- chickenpox/shingels
H- hepatitis B, C, D, E
E- enteroviruses
A- AIDS
P- parvovirus B19
T- toxoplasmosis
O- other (GBS, candida, listeria)
R- rubella
C- cytomegalovirus
H- HSV
E- every STI
S- syphilis
S
Syphilis?
High rates in sask. Most high between people are 20-39 yrs. Causes problems with eyes/ears/teeth/bones. Testing should be done before or during pregnancy
STIs, UTIs, and STIBBIs?
Most are asymptomatic so screening it’s important. These infections may causes preterm delivery, spontaneous abortions, and maternal/fetal morbidity
COVID 19 and pregnancy?
Infection increased risk of preterm delivery. Vaccination recommended during pregnancy/while BF.
How to HIV transmitted and what can be done to reduced transmission
3 modes- in utero/pregnancy, during labour/birth, and through BF. Reduce transmission by developing behaviours that support healthy immune system (good sleep/nutrition), complimentary treatments (traditional healing practices), use of combination anti-retroviral therapy, and mode of delivery of baby depended on viral load. With treatment the transition rate is 2%
HIV care?
In pregnancy use 3 part anti-viral treatment to reduce transmission to infant. In labour add IV ZDV. Give newborn ZDV oral suspension for 6 weeks (test at birth, 1 month, 3 month, and 18 months). Formula feeding recommended to reduce transmission
