Module 5

Question 1

Heroin: Treatment

Answer 1

• Methadone (most common treatment for pregnant women)
• Buprenorphine (Linked to better treatment adherence w/ fewer side effects and overdoses
• Naltrexone (Opioid antagonist, non-addictive may improve compliance is an issue)
• Behavioral therapy mixed w/ pharmacology. (MAT)

Question 2

Pathophysiology of Diabetes

Answer 2

• Endocrine disorder of carbohydrate metabolism
  -Results from inadequate production or utilization of insulin
• Breakdown of fats and proteins for energy
• Cellular and extracellular dehydration

Question 3

Four Cardinal Signs and Symptoms of Diabetes

Answer 3

Polyuria
Polydipsia
Weight Loss
Polyphagia

Question 4

Polyuria

Answer 4

From increased vascular volume due to hyperosmolarity of blood from hyperglycemia kidneys function to excrete large volume of urine

Question 5

Polydipsia

Answer 5

Caused by the underlying dehydration created by polyuria and cellular dehydration

Question 6

Weight Loss

Answer 6

Occurs as a result of the breakdown of fats and muscle; of which ketones and fatty acids are the end product

Question 7

Polyphagia

Answer 7

The tissue breakdown causes a state of starvation that compels the individual to eat excessive amounts of food

Question 8

Classification of Diabetes Mellitus

Answer 8

Type 1: Absolute insulin deficiency (10% of population)
Type 2: Insulin resistance (90% of population)
Gestational Diabetes Mellitus: Any glucose intolerance noticed in pregnancy

Question 9

Influence of Pregnancy on Diabetes

Answer 9

-Physiologic changes of pregnancy alter insulin requirements
- Decreased in first trimester
- Increased in second and third trimester
-Hormones -> insulin antagonist

Question 10

Influence of Pregnancy on Diabetes

Answer 10

-Physiologic changes of pregnancy alter insulin requirements
- Decreased in first trimester
- Increased in second and third trimester
-Hormones -> insulin antagonist
- HPL
- Somatotropin
- Accelerates progress of vascular disease
-More difficult to control pregnancy

Question 11

Maternal Risk for Diabetes

Answer 11

-Hydramnios
-Preeclampsia - eclampsia
- Hyperglycemia and Ketoacidosis
- C-Section
-Increased susceptibility to infections
-Worsening retinopathy

Question 12

Hydramnios

Answer 12

Too much amniotic fluid around the fetus

Question 13

Preeclampsia

Answer 13

High blood pressure during pregnancy ( after 20 weeks gestation with systemic features)
-Signs and Symptoms
- Proteinuria (high protein in urine)
- Rising BP
- Edema
-Risk Factors:
- Hx of preeclampsia in previous pregnancies
- Family history
- Obesity
- 1st pregnancy
- Very young (<18), Very old (>35… Advance Maternal Age)

Treatment: Magnesium Sulfate 4-7mg/dL (to prevent seizures during & after labor)

Question 14

HELLP Syndrome

Answer 14

Hemolysis
Elevated Liver enzyme
Low Platelet count (<100,00)

Associated with severe preeclampsia
Symptoms:
- Nausea
- Vomiting
- Malaise
- Epigastric Pain

Question 15

Sensitized Women

Answer 15

• Small amounts of fetal blood cross placenta
• Rh- mother, Rh+ fetus
• Maternal ism antibodies produced (RHOGAM will not help)

Question 16

Diagnosis of Preeclampisa

Answer 16

Systolic BP: greater than or equal to140mm Hg
Diastolic BP: greater than or equal to 90mm Hg
* on two occasion at least 4 hours apart after 20 weeks of gestation in a woman w/ previously normal BP

Question 17

Ectopic Pregnancy

Answer 17

Pregnancy outside the uterine cavity
- 2% of all pregnancies… implantation in Fallopian tubes

Signs and Symptoms:
- Dull abdomen pain
- Spotting
-Delayed menses

Treatment:
- Methotrexate: destroy/ stops cell growth
- Avoids surgery

Question 18

Molar Pregnancy (Hydatiform Mole)

Answer 18

Benign proliferation of trophoblasts (20% become malignant)
- 1:15000 pregnancies
- Increased incidence in:
- Women w/ low protein intake
- Asian women
- > 35 years old
- Prior miscarriage

Signs and Symptoms:
- N&V
- Vaginal Bleeding
-Abnormally high hCG levels
- Hypertension
- No fetus, only cysts

Management:
- Monitor for malignancy
-D&C
- No pregnancy for 1 year
-Emotional support

Question 19

Bleeding Disorders in Pregnancy

Answer 19

-Placenta Previa
-Placenta Abruption
-Vasa Previa

Question 20

Placenta Previa

Answer 20

Implantation in the lower uterine segment, over or near the cervical os
- Etiology is unclear

Risk Factors:
- From scarring: previous previa, prior C/S, abortion, multiparty
- Large placenta, multiple gestation
- Infertility
- > 35 years old

Signs and Symptoms:
-PAINLESS bright red bleeding
-Spontaneous bleeding after sex
- Breech baby
-Relaxed, soft uterus

AVOID VAGINAL EXAMS
- Monitor vital signs and pulse ox
- Monitor pads (weigh them for amount of blood)
- Measure urine output
- IV

Question 21

Placenta Abruption

Answer 21

Premature separation of a normal implanted placenta (BEFORE birth, typically after 20 weeks)
- Bleeding may be external or concealed
- Severity depends on degree of separation
- Partial Abruption (concealed hemorrhage)
- Partial Abruption… marginal (apparent hemorrhage)
- Complete Abruption (bleeding concealed but apparent)

Risk Factors:
-Maternal Hypertension (MOST COMMON)… >140/90
- Seizures
- Blunt trauma to abdomen
-Smoking/ cocaine usage
- Previous abruption history

Signs and Symptoms:
- Dark red vaginal bleeding
- Sharp abdominal pain
- Contractions

AVOID vaginal exams and sex
-Prepare mom for birth if active bleeding
- Assess urinary output
-IV Fluids and blood replacement
-Weigh pads to assess blood loss

Question 22

Polyhydramnios vs Oligohydramnios

Answer 22

Poly: Excessive amniotic fluids ~ >200mL
-Associated w/ fetal GI anomalies and maternal diabetes
- Treatment: watch and no nothing unless short of breath and in pain.. then do amniocentesis

Oli: Scanty amniotic fluid ~ <50mL
- Etiology unknown
- Risks: fetal adhesions and fetal malformations
- Treatment: amnioinfusion