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Adv Practice Women’s Health 6032 Test 2 > Module 7: Primary Care Adaptations In Pregnancy - Chronic Conditions > Flashcards

Module 7: Primary Care Adaptations In Pregnancy - Chronic Conditions Flashcards

1
Q

Common Chronic Conditions in Pregnancy

A
  1. Asthma
  2. HTN
  3. DM
  4. Thyroid Disease
  5. Anxiety
  6. Substance Abuse
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2
Q

Managing Asthma in Pregnancy

A
  1. Stepwise therapy is recommended
  2. Uncontrolled asthma may adversly affect both maternal quality of life nad perinatal outcomes
  3. Pregnancy may be complicated by new onset or pre-existing asthma
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3
Q

Asthma Step-Wise Therapy in Pregnancy

A
  1. Mild intermittent — SABA PRN
  2. Mild Persistent — Low Dose ICS OR cromolyn, leukotriene, Theophylline
  3. Moderate Persistent — Low dose ICS + Salmeterol
    - Medium dose ICS
    - Medium dose ICS and Salmeterol
    - Low or medium corticosteroid, LRA, and Theophylline
  4. Severe Persistent
    - High dose ICS and Salmeterol and oral steroid (if needed)
    - Alt high dose ICS and theophylinne and oral steroid (if needed)
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4
Q

HTN in Pregnancy

A
  1. Common medical condition in pregnancy
  2. Managed in consultation w/ Women’s health provider
  3. Occur in 5-10% of pregnancies
  4. 5 types
    - Chronic HTN
    - Gestational HTN
    - Pre-eclampsia
    - Superimposed Pre-eclampsia on chronic HTN
    - Eclampsia
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5
Q

Diagnostic Criteria in HTN

A
  1. Chronic - Asymptomatic BP > 140/90 <20 wks w/ no proteinuria
  2. Gestational - Asymptomative BP > 140/90 >20 wks w/ no proteinuria
  3. Pre-eclampsia
    - Mild - BP >/= 140/90 w/ urin protein > 2g/24 hrs
    - Severe >/= 160/110 w/ urine protein > 5g/24 hrs, Platelets <100,000, elevated AST, ALT, LDH, and serum creatinine > 1.2mg/dl
    - Sx’s include: Headache, Altered mental status, visual changes
  4. Superimposed Pre-eclampsia
    - Sudden increase in BP >/= 140/90, proteinuria, and low platlets <20 wks
  5. Eclampsia - Seizures
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6
Q

Baseline HTN testing in Pregnancy

A
  1. Urine Dip for protein
  2. Hct, Hgb
  3. Plt count
  4. Serum Creatinine
  5. Electrolytes
  6. LFTs
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7
Q

HTN Medications Safe in Pregnancy

A
  1. Nifedipine
  2. Labetalol
  3. Methyldopa
  4. AVOID ACE and ARBs **
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8
Q

Diabetes in Pregnancy

A
  1. Approximately 6-9 % of pregnancies are complicated by DM - 90% by destational DM
  2. Fetal risk is dependent on how well BS is controlled in 1st trimester — PRE-CONCEPTION COUNCELING IS CRUCIAL**
  3. EVEN MILD LEVELS of hyperglycemia can cause anencephaly, microcephaly, and congenital heart disease
  4. Work with Womens health provider and endocrinology if necessary
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9
Q

Gestational Diabetes Diagnosis Criteria

A
  1. Typically diagnosed at 24-28 weeks gestation
  2. Women at HIGH RISK screened sooner
    - Previous GD
    - Previous large for gestational age delivery
    - Family Hx
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10
Q

Diabetes Treatment in Pregnancy

A
  1. Encourage TIGHT glycemic control
  2. Refer for a nutritional consult
  3. Managed w/ insulin if diet along is not helpful
  4. Test for DM post-delivery, every 1-3 yrs after diagnosis of GD
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11
Q

Maternal Thyroid Changes

A
  1. Maternal Thyroid changes are SUBSTANTIAL
    - Structure — Mild increase in size
    - Function — Changes in thyroiglobulin concentrations and a diluted blood volume lead to TSH/T4 level alterations
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12
Q

Thyroid Lab Values

A
  1. TSH is the most reliable indicator of hypo and hyperthyroid
  2. Most labs do NOT provide trimester specific reference ranges for pregnancy
    - Reference ranges are generally lower during pregnancy
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13
Q

Hypothyroidism in Pregnancy

A
  1. There is an increased need for T4 as early as 4-6 weeks
  2. Most common cause is Hashimoto’s thyroiditis
  3. 5-8% increased incidence w/ Type 1 diabetes

Other causes:

  • Thyroidectomy
  • Ablative radioactive therapy
  • Iodine deficiency
  • Subacute thyroiditis
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14
Q

Hypothyroidism Maternal/Fetal Risks

A
  1. Stillbirth
  2. Spontaneous abortion
  3. Pre-eclampsia
  4. Gestational HTN
  5. Placental abruption
  6. Low birthweight
  7. Preterm labor
  8. With iodine deficiency, there can be congenital cretinism and mental defects
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15
Q

Hyperthyroidism in Pregnancy

A
  1. Prevalence is 0.05 - 0.02%
  2. Graves disease is the most common cause (up to 95%)

Other causes include:

  • Toxic multinodular goiter
  • Pituitary Tumor
  • Metastatic Disease
  • Exogenous T4 and T3
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16
Q

Hyperthyroid Maternal/Fetal Risks

A
  1. Spontaneous AB
  2. Premature birth
  3. Low-birth weight
  4. Stillbirth
  5. Preeclampsia
  6. High output heart failure
  7. Thyroid storm
17
Q

Hyperthyroidism Treatment in Pregnancy

A
  1. Anti-Thyroid medications cause congenital abnormalities and neonatal hypothyroidism
  2. Radio-Active ablation can cause
    - Neonatal Goiter or hyperthyroidism
  3. Thyroidectomy*
18
Q

Anxiety in Pregnancy

A
  1. Non-pharmacological treatemtns such as cognitive behavioral therapy should be employed whenever possible for tx of anxiety disorders during pregnancy
19
Q

Anxiety Medications in Pregnancy

A
  1. Based on severity, two classes of drugs are prescribed
    - SSRIs — Fuoxetine, sertraline, citalopram
    - Severe cases - Benzodiazapines (Let psych or womans health prescribe this)*** Don’t give from FNP standpoint
20
Q

Substance Abuse in Pregnancy

A
  1. The 5 P’s is an effective tool of engagement for use with pregnant women who may use alcoholr or drugs
    - Poses questions r/t substance use by womens Parents, Peers, Partner, during past Pregnancy and in her Past
  2. Alcohol and cigarettes are most used substances in pregnancy
  3. Screen ALL pregnant women for substance use w/ validated screening tool
21
Q

Tobacco and pregnancy

A
  1. Risk is dose dependent and can cause
    - Pre-term birth
    - Placental abruption
    - Low birth weight
  2. Treatment
    - Nicotine patch +/- gum or lezenge
    - Offer tools/therapy
22
Q

Alcohol and Pregnancy

A
  1. There is NO safe amount of alcohol
  2. Risk for Fetal Alcohol Syndrome is Dose dependent
    - Can lead to physical, behavioral, and learning disabilities
  3. Risk for withdrawal syndrome — refer for counseling and treatment ASAP
23
Q

Illicit Drugs in Pregnancy

A
  1. Refer for specialized care

2. Mothers are at risk for avoiding prenatal care, overdose and death

24
Q

Points to Remember

A
  1. Primary Care Clinicians MUST focus on chronic disease management in the PRE-CONCEPTION period
  2. Primary Care clinicians MUST work with women’s health providers and specialists in concert to prevent chronic illnesses that occur before during and after delivery

Adv Practice Women’s Health 6032 Test 2 (6 decks)

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