Module 7: (b) Primary Care Adaptations In Pregnancy - Acute Flashcards
1
Q
Respiratory Conditions in Pregnancy Background
A
- Mucosa of Nasopharynx becomes edematous
- Hypersecretion of mucus occurs secondary to an increase in estrogen
- Nasal congestion secondary to hyperemia
- Dyspnea is common 60-70%
- Throughout Pregnancy, a woman, breaths in MORE AIR with each breath
2
Q
Examples of Respiratory Conditions in Pregnancy
A
- Upper Respiratory tract
- Allergic Rhinitis — URI - Lower Respiratory Tract
- Bronchitis, PNA, Asthma - Systemic Conditions
- Influenza, COVID
3
Q
Clinical Management of Respiatory Conditions
-Approved Medications
A
- Treat w/ approved OTC Medications
- Sudafed
- Allegra
- Claritin, Claritin D
- CHlor-Trimeton D/Chlor-Trimeton DM - Approved Antibiotics
- Amoxicilin, first-generation Cephalosporins,
- Azythromycin
4
Q
GERD
A
- Occurs in 30-50% of pregnancies
- Sx’s
- Dysphagia & Reflux - Prevention
- Avoid food triggers, excessive weight gain, increase water consumption between meals
- Smoking cessation
- Elevate HOB during sleep
5
Q
Treatment of GERD
A
- Calcium Carbonate - MAX 1000 mg/day
- Famotidine (Pepcic) — 20-40 mg BID
- Lansoprazole (Prevacid) 15 mg daily
6
Q
Constipation
A
- Extremely common in pregnancy
- S/Sx’s
- <3 stools per week
- Hard stools w/ straining
- Incomplete evacuation
- Rare SBO (more common w/ bowel or gastric bypass Sx
7
Q
Constipation Treatment
A
- Prevention
- Fiber, fluids, physical activity, and probiotics - Treatment
- Milk of magnesia
- Senokot
- Biscadoyl
- Colace
8
Q
Hemorrhoids
A
- Caused by increase blood flow to the pelvic region and straining secondary to constipation
- Sx’s typically most painful 1-2 days post-partum
9
Q
Hemorrhoid Treatment
A
- Fiber, fluids, activity
- Stool softeners (Colace) - Prevent straining during stools
Treatments
- Warm soaks
- Witch hazel pads
- Hydrocortisone-pramoxine cream of suppository BID —NO MORE THAN 7 days
10
Q
Nausea and Vomiting
A
- Caused by delayed gastric emptying and relaxed gastroesophageal sphincter
- Most prevelant in 1st trimester but may persist into 3rd trimester
- Treatment
- Maintain adequate hydration and nutrition
- Doxylamine (Unisom) and Vitamin B6
- Emetrol
- Antiemetics — Promethazine (Caution d/t neonatal resp depression) , metoclopramide (reglan)
- Rehydrate and correct electrolyte imbalances (IV may be needed)
11
Q
Food Cravings
A
- COMMON in pregnancy
- Some have PICA
- Dirt, Ice, laundry or corn starch, coffee grounds, paint chips, rocks
12
Q
UTI’s
A
- Occur in up to 20% of pregnancies
- 10 % of antepartum hospital admissions
- Increased incidence of Pyelonephritis (20-30 fold)
- Risk for Pre-term labor
- Caused by
- Reduced bladder tone
- Ureteral and renal pelvis dilation
- Decreased ureteral peristalsis and incomplete bladder emptying
- OBstruction of ureters d/t mecahnical compression
FOLLOW UP CULTURE to make sure infection is resolved
13
Q
Dermatologic Complaints Treatments
A
- Antihistamines
- Topical steroids
- Oral steroid tapers for severe cases
REFER to dermatology
14
Q
MATERNAL MORTALITY AND PREGNANCY COMPLICATIONS
A
MATERNAL MORTALITY AND PREGNANCY COMPLICATIONS
15
Q
Maternal Mortality Definitions
A
- Pregnancy associated death — Death of a person occuring while pregnancy or w/in 1 yr of pregnancy regardless of cause
- Pregnancy associate but not related death —Ex: pregnannt person dies in an earthquake
- Pregnancy Related death TEST
- Person who dies from preganncy complication, chain of events initiated by pregnancy, or aggravation of an unrelated condition by physiology effect of prenangy - Eclampsia
16
Q
Pregnancy Complications
-Chronic HTN
A
- HTN presenting <20 weeks gestation or persisting for more than 6 wks postpartum
- 1/3 of women w/ chronic HTN will develop superimposed pre-eclampsia
- Fetal risk are secondary to poor vascular development
- Growth restriction, placental abruption, premature delivery - Management
- Baseline labs at 1st prenatal visit — CMP, CBC, baseline 24 hr urine protein, creat, ECG
- Treat BP >160/105 — Labetalol and nifedipine** preferred
- AVOID ACE/ARBs
- Low dose ASA after 12 wks to prevent pre-eclampsia
17
Q
Pregnancy Complications
-Pre-eclampsia
A
- Involves maternal and fetal factors resulting abnormal devleopment of placental vasculature and maternal systemic endothelial dysfunction
- Fetal hypoxia, growth restriction, stillbirth placental abruption, preterm labor
- Maternal HTN, prteinuria, organ damage
- Increase risk of CV disease in the future - Risk Factors — Hx of pre-eclampsia, chronic HTN, pre gestational DM, Renal disease, autoimmune dz. (Ie lupus)
18
Q
Pre-Eclamspia Diagnostic Criteria
A
- Blood pressure
- BP >140/90 on more than 2 occasions at least 4 hrs apart after 20 wks
- BP> 160/110
AND
- Proteinuria
- 300mg or more per 24 hr urine collection
- Protein/creatinine dipstick ration of 0.3mg/dL or more
- Dipstick reading of 2+ (only if other methods not available)
OR
- Thrombocytopenia (PLT <100k)
- Renal insufficiency (Creatinine >1.2mg/dL)
- Impaired liver function (LFT 2x higher than normal)
- Pulmonary edema
- New HA unresponsive to meds OR visual sx’s
19
Q
Eclampsia
A
- New onset of tonic-clonic, focal, or multifocal seizures in the absence of epilepsy, cerebral arterial ischemia, drug use, intracranial hemorrhage
- Significant cause of maternal death
- Treatment
- Seizure mgmt
- Magnesium sulfate for prophylaxis
- manage HTN
- Delivery once stabalized
20
Q
Placenta Previa
A
- Painless bright red vaginal bleeding**TEST
- Abnormal implantation of placenta over the internal cervical os
- Diagnosed with Transvaginal US
- AVOID vaginal exam
- REFER
21
Q
Placental Abruption
A
- Premature seperation of the normally implanted placenta from the uterine wall
- 50% occur prior to labor
- High fetal/neonatal mortality rate - Risk factors
- HTN, Cocaine, prior abruption, tobacco, abdominal trauma - Sx’s
- Sudden onset of DARK red vaginal bleeding with PAIN - Tx - stabalize, fetal monitoring, prepare for hemorrhage, delivery
