Maternal Flashcards
(34 cards)
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
