High Risk AP Pregestational Flashcards
High Risk
women who enter pregnancy with a preexisting disease or chronic medical condition are at increased risk for complication
require extensive surveillance and collaboration of multiple disciples to achieve an optimal pregnancy outcome
Diabetes in Pregnancy
carbohydrate metabolism in pregnancy is affected by pregnancy hormones (they stimulate maternal insulin production) and the fact that maternal insulin does not cross the placenta only glucose
early in pregnancy: increased insulin production and tissue sensitivity which builds up glycogen stores in liver/tissues
2nd half of pregnancy: increased peripheral resistance to insulin, hormones desensitize the body to insulin
(increased hypergycemia and hyperinsulinemia after meal)
Pre-gestational (Preexisting) Diabetes
preexisting type 1 or 2 DM
delivery issues: known delay in surfactant production d/t hyperglycemia and hypeinsulinemia
strict BG control prior to conception and in first trimester b/c it can lead to 5x increase in cardiac and CNS defects in infants
Pre-gestational Diabetes: Risk for Woman and Fetus
Risk for Woman: polyhydramnios
Risk for fetus: 5x increase in cardiac and CNS anomalies, growth disturbances (macrosomia, IUGR from poor perfusion from vascular problems), hypoglycemia, RDS
*anytime there is an issue for fetus that could lead to poor perfusion, the baby is going to create more RBC > polycythemia > hyperbilirubinemia
Gestational Diabetes
- glucose intolerance (diabetes) that develops during pregnancy
- RF: maternal age > 30, obesity, family hx, previous history of GDM, history of LGA newborn > 9lbs,
Screening: abnormal if 1hr glucose tolerance test (GTT) result is >130-140 mg/dl (if outside normal levels then they do 3hr GTT and they must fast before this test)
Management: diet and exercise, potentially meds/insulin
GDM: Risk for Fetus
macrosomia
hypoglycemia after birth
Anemia and Iron-Deficiency Anemia
physiological anemia: caused by increase in plasma volume larger than rise in RBC volume > hemodilution of pregnancy
Iron deficiency anemia occurs when you don’t have the normal increase in RBCs
Risk for woman: fatigue, reduced tolerance to activity
Risk for newborn: preterm birth, IUGR (d/t less oxygen to pass over)
Assessment finding: pallor, fatigue, weakness, and malaise, reduced exercise tolerance, dyspnea, anorexia, PICA, edema, low hgb/hct
Management: iron supplementation (ferrous sulfate 325mg daily)
Nursing action: nutritional counseling, take FeSO4 at hs on empty stomach to increase absorption
Sickle Cell Disease
Risk for Mother: in conditions of low oxygenation they become sickle shaped and clog capillaries (esp in spleen, placenta, bone marrow) causing pain and crisis, nephritis, bacteruria (UTI’s).
Risk for fetus: prematurity, IUGR, death (from poor oxygenation)
Assessment: hgb elecrophoresis
Management: additional folic acid for increased RBC turnover, avoidance of infection, hydration
Nursing: teach about hydration, good hygiene (so they don’t predispose themselves to UTI), avoid infections, take supplements
Alcohol Use in Pregnancy
CNS depressant
risk for fetus: cognitive delays, developmental delays, kidney/vision/oral cleft defects.
Tobacco Use in Pregnancy
risk for mother: reduces uterine blood flow, CO binds to hemoglobin, reducing the O2 carrying capacity
risk to fetus: preterm delivery, low birth weight, stillbirth, transient intrauterine hypoxemia, withdrawal
Cocaine Use in Pregnancy
causes placental vasoconstriction decreases blood flow to the fetus
Marijuana Use in Pregnancy:
maternal effects: causes tachycardia and low blood pressure
fetal effects: ? altered response to visual stimuli, increased tremulousness, high pitched cry, concern of impacting fetal brain development, impaired cognition
