Maternal Flashcards
How long is a term pregnancy
280 days long, 40 weeks
Maternal Diabetes Mellitus
Type 1 + 2
can cause spontaneous abortions and congenital malformations
goal is to establish glycemic control to decrese rate of hyperglycemia and ketosis
type 1
autoimmune disease. Can cause decrease BF to the kidneys + pelvic vesesels reducing uterine bloof flow causing IUGR
- moms high change of experiencing hypoglycemia and SKA
Type 2
hyperglycemia caused by increased insulin resistance, hepatic glucose production, abnormal insulin secretion
gestational diabetes
moms have been having higher insulin resistance before conception
increased risk for obese women, previous GDM hx
dx with 1 hour glucose challenge @24-28 weeks if fails will do 3 hour challenge
effect on infant with diabetes mom
- increase fetal hyperglycemia + insulin production
s/sx macrosomia, SGA,
neural tube defects, CV malformation
respiratory distress due to inhibition of phospholipid production and decerased synthesis of surfacrtant
infant can present with hypocalcemia due to dimished parathyropid response and polycythemia due to chronic hypoxic state in the fetus
maternal hypertension
- causes uteroplacental ischemia, decreased blood flow
s/sx htn, proteinuria (poor renal perf), edema, bp >140/90, headahce, hyperreflex with clonus, visual changes, epigastric pain
»_space; eclampsia: seizures, coma, HELLP sundrome
mange BP, corticosteroids, monitor baby, IV mag + labetalol or hydralazine
give infant betamethasone to increase lung maturity, x2 Q24
reduced uteroplacental ischemia
ischemic lesion on the vascular bed of the placenta causing fetal growth restriction and prematurity
neonate + mom HTN
- placenta insuff, IGUR, hypoglycemia, maladaption, hypoxia, low blood count,
labetalol + mag sulfacte SE for infant
Mag - resp dep, poor feed, lethagy, hypotonia
labetalol- hypoglycemia, hypotension, bradycardia, resp depression, transient tachypnea
hyperthyroidism maternal
thyroid hormones
- T3 + T4 hormones cross placenta, TSH does not
- maternal T4 important for fetal brain devlopment in first trimester
- drugs tx thyoid effect the fetal thyroid
hypothyroidism
infant effects
- hashimoto’s thyroidutus
if left untreated can cause neur delays
tx is replacemtn hormones during preg. L-thyroxine
infant - neurodevelopment delays, cong goiter, low iodine levels
tx thyroxine therapy
hyperthyroidism
- graves disease
untreated can place mom at risk for thyroid storm (excess t4) putting them at risk for htn, HF, and minimal cardiac reserve, hydrops
sx of thyrotoxicosis start presenting by the 2nd week of life.
infant risk for IUGR, cardiac, goiter, CHF, hyperthroidism, neuro delay
congenital goiters neonate
both hypo + hyperthyroidism
autoimmune antibodies can cause congenital goiters if large enough can cause tracheal obstruction or CF
tx propranolol
ABO incompatibility
screen O type moms
most common
less severe
IgG pass the placenta to the fetus causes hemolysis increase bili levels
RH incompatibility/ isoimmune hemolytic anemia
Fetus with RH + and Mom with no antigen
- mom produces immune response to produce antibodies against baby’s antigen. Moms antibodies enter fetal circulation and destroys fetals RBCs
- infants RBCs destroyes causing hemolysis
ssx: anemia from hemolysis, hypoxia, acidosis, CHF, hydrops, hypoglycemia, + Direct commbs test
prevent by gicing anti d immune globulin which will destroy fetak RBC in maternal circulation which blocks maternal antibody production(guve at 28 weeks, after delivery, and after amniocentesis
Direct vs Indirect Coombs testq
Direct Coombs positive: indicates maternal IgG antibodies are attached to the surface of infants blood
positive indirect indicates maternal antibodies against the infant are present in maternal serum
Maternal Systemic Lupus
+ neonates effects
Autoimmune disease
mom’sx ssx:htn, thrombotic events, spont abortion, preterm delivery. Time pregnancy during disease remission
antibodies transfer to the placenta
neonate: lupus like rash thrombocytopenia, hemolysis
maternal antibodies to anti-Ro/SSa and anti La/SS-B antigens = risk for congenital heart block Need pacemaker,
Cocaine
CNS stimulant crosses the placenta + blood brain barrier
vasoconstrictive effects decrease blood to placenta, NAS will occur on 2-3 day
amphetamines + methamphetamine
CNS stimulant
fetus: growth restriction, brain lesion (cause brain hemorrhage), cleft lip/palate
neonate: neuro, hypoglycemia, poor feeds, seizures, SIDS
alcohol
Fetal alcohol spectrum disorder.
opioids
ex. morphine, heorin, codein, fentanyl, methadone
neonate: LBW, neuro, withdrawal
NAS - withdrawal 2-4 days
NAS
neuro: high pitched crym tremors, increased wakefulness
GI: vomiting, fever, sweating
metabolic, vaso, respiratory: fever, sneezing, tachypnea, sweating
SSRI
antidepressant
Neonate s/sx: crying, irritable, tremors, fever, hypertonia, poor feeds, resp distress
NOT WITHDRAWAL - drug toxicity
non stress test
- evaluates fetal anutonomic nervous system
- fetal movement + fetal heart accels which is predictive of absence of fetal metabolic acidemia
Reactive NST ; increase FHR 15BPM for 15 secs above basline HR x2 in 20minutes
Nonreactive NST: lack of FHR accel during 40 minute
contraction stress test
- evaluates uterine contractions (causes interruption of uteroplacental perfusion) and transiet fetal hypoxemia
- min 3 contractions of 40 secs in 10 min period
Negative CST- no FHR decel
Positive CST: late decel associated with hypoxia and acidosis admited for induction
BPP
biophysical profile = NST + US
ASsess: fetal breathing, body movements, fetal tone, amniotic fluid vol, NSTover 30 minutes. Total of 10
8-10 = normal
if lower will be induced
Head Compression in labor
- causes a vagal response and reflow slowing FHR
early + late decels (occur after the contraction has started. Indicates interruption in fetal O2)
Cord Compressiong
umb is lopped around body with oligohydraminos + ROM
Variable decels - abrupt descent. Usually HR recovers quick but if it doesnt it is an indication of diminshed O2 and hypoxia
can cause prlonged decels which resolves with intrauterine resucitation or delivery
cord prolapse
- when the cord slips below the presenting part and UC is compressed by the present part
- tracing will show abrupt occurence of persistent severe variable decels or bradycardia
placental previa
placenta implants low in the uterus near cev os
- episodic, painless, mat bleediing
- as gestation progresses, placenta can move from the cerv os
need c/s
placental abruption
placenta suddenly separates from uterus
s/sx dark or bright red bleeding, abd or lower back pain, board like and tender abd, uterine irritability
Stillborn, anemia hypovolemia, premie, hypoxemia
antenatal steroids
- given to reduce respiratory distress and IVH
Magnesium sulfate + neonate
reduce occurenc of CP
