health challenges in pregnancy Flashcards
what are some health challenges in pregnancy?
- hypertension
- diabetes
- infection
- carrying multiples
- age-related
- substance abuse
how common is hypertension in pregnancy?
-10% of pregnancies
what types of hypertensive disorders can be present in pregnancy?
- pre-existing
- gestational hypertension
- preclampsia
- eclampsia
what is the difference between gestational hypertension and preeclampsia?
-gestational hypertension is an elevated BP without protein in unrine
what are some adverse outcomes of hypertension during pregnancy?
- headache
- visual disturbances
- abdominal/epigastric/RUQ pain
- nausea/vomiting
- chest pain/SOB
- abnormal maternal lab values
- fetal morbidity
- edema/weight gain
- hyperreflexia
what blood pressure parameters for preeclampsia?
- systolic greater than 140
- diastolic greater than 90
what are some negative maternal outcomes that can occur because of preeclampsia?
- stroke
- pulmonary edema
- hepatic failure
- jaundice
- seizures
- placental abruption
- acute renal failure
- HELLP syndrome & DIC
What are some negative fetal outcomes that can occur because of preeclampsia?
- IUGR
- oligohydraminos
- absent or reversed end diastolic umbilical artery flow by doppler
- placental abruption
- prematurity
- fetal compromise (metabolic acidosis)
- intrauterine death
what pregnancies is it more likely to have an onset of gestational hypertension or preeclampsia?
- first pregnancy
- first pregnancy with a new partner
- if you have had it in previous pregnancies
what are some risk factors for developing gestational hypertension?
- first pregnancy
- first pregnancy with new partner
- previous pregnancy with hypertension
- personal/family history of hypertension
- poor nutrition
- obesity
- ethnicity
- advanced maternal age
- multiple gestation
- diabetes
what are some initial management strategies for hypertension in pregnancy?
- stress reduction
- reduced activity
- regular maternal and fetal assessment
- treatment of nausea, vomiting, and/or epigastric pain
- drug treatment of blood pressure
- consider seizure prophylaxis
- regular NSTs and ultrasounds
what kind of management may be done in hospital for hypertension during pregnancy?
- fetal movement counting
- NST
- biophysical profile
- ultrasound
- measurement of AFI
- hourly intake and output
- frequent BP measurements
- other vitals
- blood work
- monitoring for adverse conditions
what medications may be used to treat hypertension in pregnancy?
- labetalol (most common, is a beta blocker)
- nifedipine (calcium channel blocker)
- hydralazine (arteriolar dilator)
- aldomet (centrally acting sympatholytic)
what common classification of antihypertensive drug is not appropriate for use in pregnancy?
ACE inhibitors because they can cause renal failure in fetus, cause hypoperfusion to fetus, and IUGR
why would magnesium sulfate be given to a woman with hypertension during pregnancy?
- to reduce CNS irritability to prevent seizure in cases of severe hypertension
- risk is that it can slow labor or cause CNS depression
what is the reversal agent for MgSO4?
calcium gluconate
what are some side effects of MgSO4?
- tachycardia
- kidney toxicity if urine output is decreased
- can slow labour
- muscle weakness
- lack of energy/drowsiness
- respiratory depression
- low blood pressure
what are some signs of MgSO4 toxicity?
- CNS depression
- respiratory depression (rate less than 12)
- oliguria
- absent DTR
- serum magnesium of 4.8 or more
what should be done for a pregnant woman admitted with eclampsia?
- give a bolus of MgSO4
- sedate and use another anticonvulsant like Dilantin
- use diuretic like lasix to treat pulmonary edema if present
- give digitalis for circulatory failure if needed
- deliver baby - if less than 34 weeks, give corticosteriods to mature lungs
what is HELLP syndrome?
Hemolysis
Elevated Liver enzymes
Low Platelets (thrombocytopenia)
- one of the worst outcomes of high BP in pregnancy
- occurs in 4-12% of those with gestational hypertension
what types of diabetes can affect pregnant women?
- pre-existing
- gestational
- pre-existing, not previously diagnosed
how is gestational diabetes differentiated from pre-existing, not previously diagnosed diabetes?
-if present before 20 weeks, considered pre-existing
how prevalent is gestational diabetes in Canada?
3.6% of non-aboriginal women
18% of aboriginal women
what are two ways pregnancy alters carbohydrate metabolism?
- fetus continuously takes glucose from mother
- placenta creates hormones which alter effects and resistance to insulin as well as glucose tolerance
how does carbohydrate metabolism change in the first trimester typically?
- increase in hormones stimulates insulin production and increases tissue response to insulin
- typically insulin needs decrease during this trimester
how does carbohydrate metabolism change in the second and third trimester typically?
- placenta begins to secrete human placental lactogen
- increases resistance to insulin and decreases glucose tolerance
- insulin needs increase (may double or triple by end of pregnancy)
- increased insulin required to maintain normal concentration
- results in renal threshold for glucose decreasing
what are some negative outcome that can occur because of gestational diabetes?
- increased risk of hypertension
- polyhydramnios
- PROM or PPROM
- preterm labour
- worsening myopathies (vascular, renal, retinal)
- increases ketosis
- increased risk of T2DM later in life
why can gestational diabetes lead to polyhydramnios
because amniotic fluid is largely made of fetal urine and diabetes increases urine output
what are some risk factors for GDM?
- previous history
- family history of diabetes
- previous or suspected macrosomia (LGA baby)
- obesity
- previous unexplained stillbirth or miscarriage
- previous infant with hypoglycemia or hyperbilirubinemia
- polycyctic ovarian syndrome
- repeated glycosuria or proteinuria in pregnancy
- ethnicity
what are some possible negative fetal effects from GDM?
- macrosomia (LGA baby)
- intrauterine growth restriction
- fetal demise
- congenital anomalies
what are some possible negative neonatal effects of GDM?
- hypoglycemia
- hyperbilirubinemia
- immature respirator development because insulin interferes with production of surfactant
when is screening usually done for GDM?
24-28 weeks using a 50g glucose challenge test with a threashold of 7.8 mmol/L (140mg/dL)
-definitive diagnosis with a 75 or 100g GTT
what are some strategies to treat GDM?
- diet
- insulin as needed
- oral antiglycemics (gilburide or metformin)
- increase in folic acid up to 5 mg/day
- BGM 4-7x per day
what percentage of women develop T2DM within 5 years of having GDM
45-50%
why are the numbers of multiple gestations increasing in Canada?
- use of assistive reproduction technologies
- increasing maternal age (which increases likelihood of more than one egg being released at once)
what are risks associated with multiple gestation?
- preterm labour
- anemia
- hypertension
- abnormal fetal presentation
- twin-to-twin transfusion syndrome
- uterine dysfunction
- abruptio placentae and placenta previa
- prolapsed cord
- PPH
what are risks during pregnancy associated with obesity?
- spontaneous abortion/stillbirth
- hypertension
- diabetes
what are intrapartum risks associated with obesity?
- macrosomia
- shoulder dystocia
- difficulty assessing fetus/contractions
- increased need for C/S
- anesthesia challenges
- increased risk of thromboembolism
what are neonatal risks associated with obesity?
- hypoglycemia
- breastfeeding issues
- birth defects
what are some postpartum risks associated with obesity?
- infection
- decreased mobility
- thrombosis
- increased recovery and healing time
what are the SOGC recommendation related to obesity?
- begin pregnancy with a BMI of less than 30 ideally
- if starting with greater than 30, total weight gain should be 7kg
- take more folic acid preconception and during first trimester
- exercise
what are some physical risks associated with adolescent pregnancy?
- preterm birth
- low birth weight infants
- gestational hypertension
- anemia
- cephalopelvic disproportion
what are some psychosocial risks associated with adolescent pregnancy?
- interruption of maternal developmental tasks
- substance abuse
- poverty
- interruption/cessation of education
- less prenatal visits
what are some risks to baby associated with methadone use by mother?
- reduced head circumference
- low birth weight
- withdrawal symptoms
what is the upper limit for caffeine per day a pregnant or breastfeeding mother should have?
- no more than 300 mg of caffeine
- approximately 2 250ml cups
what are some risks associated with large amounts of caffeine intake in a pregnant woman
- miscarriage
- premature delivery
- low birth weight
- withdrawal symptoms in newborn
what does the acronym TORCH stand for?
infections during pregnancy that can cause problems: Toxoplasmosis Other (STIs, HIV, Hepatitis, GBS) Rubella Cytomegalovirus Herpes Simplex
when are women typically screened for GBS during pregnancy?
35-37 weeks
what are some risk factors for GBS infection in an infant?
- preterm labour before 37 weeks
- term rupture of membranes greater than 18 hours
- unexplained mild fever during labour
- previous baby with GBS infection
- previous or present GBS bacteriuria
Without treatment, what is the chance of HIV being transmitted from mother to baby?
25%
with proper treatment, what is the chance of HIV being transmitted from mother to child?
2%
what are factors that decrease transmission risk of HIV from mother to child?
- mom having behaviors that support healthy immune system
- combined anti-retroviral therapy
- appropriate delivery mode based on maternal viral load
- complimentary treatments
what is the three part antiretroviral treatment regimen given to reduce risk of transmission of HIV to an infant:
- pregnancy combination antiretroviral therapy for mom
- added IV ZDV during labour and/or 3 hours prior to C/S
- infant given ZDV oral suspension for 6 weeks
