Pregestational Conditions Flashcards
- Valve Damage
- Caused by recurrent episodes of Acute Rheumatic Fever (ARF)
– Heart has become inflamed
– Heart valves remain stretched and/or scarred normal blood flow is interrupted
Rheumatic Heart Disease
___ is damage to the heart that remains after an Acute Rheumatic Fever episode has resolved
Rheumatic Heart Disease
- Illness caused by “group A streptococcus”
- Causes acute, generalized inflammatory response
Acute Rheumatic Fever (ARF)
Recurrence of ARF = _____?
Cardiac Valve Damage
Acute Rheumatic Fever targets which specific parts:
- Heart
- Joints
- Brain
- Skin
(Leaves no damage on 2-4)
- Has persisting HEART damage (RHD)
Dyspnea (Normally During Pregnancy)
- Increase mother’s blood volume (30-50%)
– Half of this increase occurs during the 8th week of pregnancy - There is functional (innocent) or Transient heart murmurs
(transient = temporary) - Heart palpitations on sudden exertion
- Cardiac output falls (vital organs, placenta are no longer perfused adequately)
- Mother and Baby’s O2 and Nutritional req. are not met
Most dangerous time for mother’s with Dyspnea?
28-32 weeks
Dyspnea (Management)
-
Team approach
1. Internist-Cardiologist
2. Obstetrician
3. Nurse - Should visit Obstetrician before planning to get pregnant (baseline status)
–Advise to cease work
DIAGNOSTICS
- Echocardiography to assess valvular function
-
Successful completion of pregnancy
– Depends upon the type extent of disease -
Woman with artificial but well functioning heart valves
– Consistent prenatal and postpartum care
Preventing recurrences of ARF
Prophylactic treatment with penicillin
- An Endocrine Disorder in which the pancreas cannot produce adequate insulin to regulate body glucose levels
Diabetes Mellitus
Diabetes Mellitus affects ___% of all pregnancies
- 3-5% of pregnancies
Most frequently seen medical condition in pregnancy
- Diabetes Mellitus
Diabetes Mellitus (Classification)
- Type 1
- Insulin - dependent DM - Type 2
- Non-insulin - dependent DM
- Abnormal glucose metabolism that arises during pregnancy
- Symptoms fade again at the completion of pregnancy
Gestational Diabetes Mellitus
Gestational Diabetes Mellitus (Risk Factors)
- Obesity
- Age < 25 years
- History of Large Babies (10lbs or more)
- History of unexplained fetal or perinatal loss; congenital anomalies in previous pregnancies; polycystic ovary syndrome; diabetes
- Member of a population with a high risk for diabetes
- Native American
- Hispanic
- Asian
- A state between normal and diabetes
- Body is no longer using and/or secreting insulin properly
Impaired Glucose Homeostasis
Gestational Diabetes Mellitus (Normally)
- Develops insulin resistance (insulin seems to be ineffective during pregnancy)
- Placental insulinase may cause increased breakdown of insulin
– Helpful because it prevents blood glucose from falling to dangerous limits
– Insulin dosage is increased beginning about 24 weeks to prevent hyperglycemia
Insulin is ineffective during pregnancy due to?
- Presence of Human Placental Lactogen
- High levels of:
1. Cortisol
2. Estrogen
3. Progesterone
4. Catecholamine
Gestational Diabetes Mellitus (Signs and Symptoms)
- Hypoglycemia
- Continued use of glucose by the fetus
- Opt to occur overnight
- Ketoacidosis (during 2nd and 3rd Trimester) - Polyuria
- Excessive urination - Polydipsia
- Excessive thirst - Polyphagia
- Excessive or extreme hunger - Fatigue
- Blurred Vision
- Weight loss
Gestational Diabetes Mellitus (Primary Problem)
- Controlling the balance between insulin and blood glucose levels
– Prevent hyper and hypoglycemia
Gestational Diabetes Mellitus (Management)
Reproductive Planning
- Oral Contraceptives are NOT allowed
– Progesterone interferes with insulin activity (increases blood glucose levels)
– Estrogen has the potential for increasing cholesterol and lipid levels and blood coagulation - IUD
– Associated with Pelvic Inflammatory Disease (PID) (women with DM have difficulty fighting infections) - Subcutaneous implanted or IM injections of progestin are good choices
Gestational Diabetes Mellitus (Maternal and Fetal Risk)
Maternal Risk:
1. Maternal Pelvic Inflammatory Disease (PID)
2. Infection (Monilial Infection)
3. Spontaneous Miscarriage
Fetal Risk:
1. Growth Restriction
2. Asphyxia
3. Stillbirth
4. Macrosomic - Large for gestational age
- Possible problem with Cephalopelvic Disproportion (CPD)
- Increased risk for shoulder dystocia
5. Congenital Anomaly
- Caudal regression syndrome
– Failure of the lower extremities to develop
Gestational Diabetes Mellitus (Management)
- Keep woman from hyperglycemia
– Less chance for congenital anomaly
Substance Abuse results in?
- Miscarriage
- Low Birth Weight (LBW)
- Premature Labor
- Placenta abruptio
- Fetal Death
- Maternal Death
Subtances Include:
- Marijuana
- pot, weed, grass and reefer - Cocaine (coca plant)
- bump, toot, C, coke, crack, flake, snow, and candy - Heroin
- horse, smack, junk, and H-stuff - Phencyclidine (PCP) and Lysergic Acid Diethyl-amide (LSD)
- PCP: angel dust, KJ (kristal joint), illy, or wet
- LSD: acid, tabs, sugar cubes, hits, or doses - Methamphetamine (Shabu)
- meth, speed, crystal, glass, and crank - Alcohol
Substances: Marijuana
- pot, weed, grass and reefer
- Crosses the placenta to your baby
– Contains toxins that keep your baby from getting the proper supply of oxygen
– Increases the levels of carbon monoxide and carbon dioxide in the blood
Substances: Cocaine (Coca Plant)
- bump, toot, C, coke, crack, flake, snow, and candy
- Crosses the placenta and enters your baby’s circulation
- The elimination of cocaine is slower in a fetus than in an adult
According to Organization of Teratology Information Services (OTIS)
- during the early months of pregnancy
– increase the risk of miscarriage - Later in pregnancy
– cause placental abruption
– can lead to severe bleeding, preterm birth, and fetal death
– There is a greater risk of birth defects - Learning difficulties may result as the child gets older
- Defects of the: genitals, kidneys, and brain are also possible
Cocaine: According to the American Congress of Obstetricians and Gynecology (ACOG)
- There is a __% increased chance of premature labor
25%
Babies born to mothers who use cocaine throughout their pregnancy:
- have a smaller head
- growth is restricted
Infants are born dependent on __ and suffer from withdrawal symptoms:
Cocaine
- Tremors
- sleeplessness
- muscle spasms
- feeding difficulties
Substances: Heroin
- Horse, smack, junk, and H-stuff
Mothers who inject narcotics are more susceptible to ___?
Human Immunodeficiency Virus (HIV)
Unborn baby can become dependent on the drug
Heroin
In terms of childbirth, heroin increases the chances of:
- premature birth
- low birth weight
- breathing difficulties
- low blood sugar (hypoglycemia)
- bleeding within the brain (intracranial hemorrhage)
- infant death
Mothers who have used heroin, the babies can suffer from withdrawal symptoms: which are?
- Irritability
- Convulsions
- Diarrhea
- Fever
- sleep abnormalities
- joint stiffness
Substances: Phencyclidine (PCP) & Lysergic Acid Diethyl-amide (LSD)
- hallucinogens
- (PCP): angel dust, KJ (kristal joint), illy, or wet
- (LSD): acid, tabs, sugar cubes, hits or doses
- Users can behave violently
Intaking Phencyclidine (PCP) and Lysergic Acid Diethyl-Amide (LSD) can lead to:
- Low birth weight (LBW)
- Poor muscle control
- Brain damage
- Withdrawal syndrome if used frequently
- Lethargy, alternating with tremors - Birth defects
Also called as: meth, speed, crystal, glass, and crank
Methamphetamine
Methamphetamine causes the heart rate of the mother and baby to _____?
Increase
Mothers who have used methamphetamine can result in the baby to get _____, which can lead to _____.
less oxygen, Low Birth Weight (LBW)
Mothers who have used methamphetamine can result in:
- Premature labor
- Miscarriage
- Placental abruption
When the mother consumed methamphetamine during her pregnancy, the child can experience these withdrawal symptoms:
- Tremors
- Sleeplessness
- muscle spasms
- feeding difficulties
- learning difficulties may result as the child gets older
Substances: Alcohol
- Cause miscarriages
- Premature birth
- Increase the risk stillborn baby
- Can permanently damage baby’s cells
An alcoholic mother can damage the baby’s ____?
Nervous system
If the mother is an alcoholic, the baby can develop _____?
Baby develops Fetal Alcohol Spectrum Disorders (FASD)
- mild learning difficulties or social problems
- birth defects
Fetal Alcohol Syndrome (FAS)
- Facial defects
- Small (even as they age)
- Learning difficulties
- Poor muscle tone and coordination
- Behavioral problems
Fetal Alcohol Syndrome (FAS): Defects
- Small head
- Low nasal bridge
- Epicanthal folds
- Small eye openings
- Flat midface
- Short nose
- Smooth philtrum
- Thin upper lip
- Underdeveloped jaw
A virus that weakens the body’s immune system
Human Immuno-Virus (HIV)
HIV causes ____?
AIDS (Acute Immunodeficiency syndrome)
A disease that hurts the body’s ability to fight
infection and certain cancers
AIDS (Acute Immunodeficiency syndrome)
An HIV carrier should?
- Stay healthy
- Do not spread the virus
HIV spreads through what body fluids?
- Blood
- Semen
- Vaginal fluids
- Breast milk (minimal risk)
- Some body fluids that may be handled by health care workers
HIV: Common modes of transmission
- Sexual intercourse (vaginal, anal, or oral) with a person who has HIV
- Sharing needles with someone who has HIV, such as when using drugs
- Pregnancy, labor, birth, or breastfeeding if a mother has HIV (not anymore)
HIV: LESS Common modes of transmission
- Blood transfusion from an HIV positive blood donor
- Eating food that has been pre-chewed by an HIV-infected person
– The blood in a caregiver’s mouth can mix with food while chewing (very rare) - Using a dirty tattooing needle (if it was used before on someone with HIV)
– Make sure the needle is new - Sharing a toothbrush or razor with someone who has HIV
HIV is not spread through?
- Kissing (there is a small chance of getting HIV from open-mouthed or “French” kissing if there’s contact with blood)
- Touching, hugging, or handshakes
- Sharing food or drinks
- Sharing food utensils, towels and bedding, telephones, or toilet seats
- Donating blood
- Working with or being around someone with HIV
- Biting insects, such as mosquitoes
- Swimming pools or drinking fountains
- Playing sports
Risk of giving HIV to your newborn is below __%?
2 percent
- Mother and the baby must get the right HIV drugs at the right times
A mother with HIV; Breastfeeding is not allowed. TRUE or FALSE?
FALSE. Already allowed
Lowering the risk of giving HIV to babies
- Get as healthy as possible before becoming pregnant
- Let the baby is tested for HIV right after birth
– start treatment for the baby diagnosed with HIV
– may require a number of tests (done when baby is 2 to 4 months old)
– New research shows that putting a newborn on a 2- or 3-drug anti-HIV medicine plan cuts the infant’s risk of HIV by 50 percent (compared to using one drug only)
Start HIV treatment before pregnancy
- Start treatment during pregnancy
- If already on treatment, do not stop, but see the doctor right away
– Some HIV drugs should not be used during pregnancy
– For other drugs, a different dosage is needed
A protein present on the surface of RBC
Rh factor
A fetus can only inherit the Rh factor if the (parent) ___ is positive?
an Rh+ Father
If both parents are negative (-) with the Rh factor, the fetus will be?
The fetus will be negative (-)
What happens if the mother’s first delivery has the Rh factor?
The Rh positive (+) antigen is passed from baby to mother which will make an antibody resistant to Rh + red blood cells (RBC)
What happens if the mother’s second pregnancy has the Rh factor?
Antibodies created from the first delivery will make the mother Rh sensitized and destroy the second fetus’s Rh positive (+) red blood cells (RBC)
What preventive measure should be given to the Rh negative (-) mother before second pregnancy to prevent Rh disease
Antibody screening is done (blood test)
Destroys the fetal red blood cells (RBC)
Hemolytic anemia
Rh negative (-) mothers will be given _____ to prevent the production of Rh antibodies
Rh Immunoglobulin (RhIg)
Rh Immunoglobulin (RhIg) is made from?
Made from donated blood
Rh Immunoglobulin (RhIg) will not be helpful to mothers who are?
Already sensitized to Rh positive (+) blood
Rh Immunoglobulin (RhIg) is given to mothers in the following situations:
- At around ____ week of pregnancy
- Within ____ after delivery of an Rh positive (+) infant
- After ____, ____, ____, ____, ____
28th week
72 hours
after:
1. Miscarriage
2. Abortion
3. Ectopic Pregnancy (outside the main cavity of the uterus)
4. Amniocentesis
5. Chorionic villi sampling
What should the nurse do if the mother is Rh sensitized and fetus is Rh positive (+)
Monitor during pregnancy
What will happen if the fetus has severe anemia?
- Early delivery of the baby (before 37 weeks of gestation)
- Blood transfusion through the umbilical cord
What will happen if the fetus has mild anemia?
- Delivery at normal time
- Blood transfusion (BT) After delivery
- Most common
– Diet low in iron
– Heavy menstrual period
– Unwise weight reduction program
Iron-Deficiency Anemia
Small red blood cells
Microcytic
Less Hemoglobin red blood cell
Hypochromic
Hypochromic:
- Hemoglobin (Hgb), hematocrit (hct), serum transferrin level, transferrin saturation level, serum iron level, and mean copuscal level will ____?
- Iron-binding capacity will ___?
- Increase
- Decrease
Iron-deficiency Anemia is mildly associated with:
- low-birth weight
- preterm birth
Craving and eating of substances
Pica
Ineffective oxygen transport causes _____ and _____.
Extreme fatigue, and poor exercise
Prevention of Iron-deficiency Anemia include:
- Iron supplemental vitamins of _____
- Eating foods high in _____ and _____
- 60 mg of elemental iron (prophylaxis)
- Iron and vitamins
examples of food that are high in iron and vitamins:
- Green leafy vegetables
- Meat
- Legumes
- Fruit
A mother diagnosed with Iron-deficient Anemia should take:
120-200 mg elemental iron/day (ferrous sulfate/ferrous gluconate)
Elemental iron should be taken with the following instructions:
- Taken with acid (orange juice or vitamin C supplement)
- Increase roughage in the diet and take with food (prevent constipation)
- Caution women that stools stool turns black
- If with difficulty tolerating oral iron supplements
– Intravenous iron dextran
- Folacin
- One of B vitamins
- Necessary for normal formation of RBC
- Prevents neural defects in fetus
Folic acid
Folic acid-deficiency anemia is seen in _____% in pregnancies
1-5%
Folic acid-deficiency anemia occurs most often in women with the following:
- Multiple pregnancies (increased fetal demand)
- Secondary hemolytic illness (rapid destruction and production of new RBC)
- Taking hydantoin (anticonvulsant agent that interferes with folate absorption)
- Taking oral contraceptives
- Gastric bypass for morbid obesity
Folic acid-deficiency anemia results to:
Megaloblastic Anemia
- Enlarged red blood cell (RBC)
- Elevated mean corpuscular volume
Folic acid-deficiency anemia is apparent during the ___ timester
second (2nd)
- Take several weeks to develop
Contributory factor in early miscarriages and premature separation of placenta
Women expecting to be pregnant should do the following to PREVENT Folic acid-deficiency anemia:
- Take supplements of 400 microgram folic acid daily
- Eating of foods rich in folic acid
– Green leafy vegetables
– Oranges
– Dried beans
During pregnancy, folic acid supplement is increased to
___?
600 micrograms
Recessively inherited hemolytic anemia
Sickle-cell anemia
Sickle-cell anemia is caused by ___?
abnormal amino acid in beta chain of hemoglobin
- Abnormal amino acid replaces the amino acid valine—-sickle hgb (HbS) results
- If substituted for amino acid lysine—–non-sickling hgb (HbC) results
_____ (has only one gene in which the abnormal substitution has occurred
- has the sickle-cell trait (HbAS)
Heterozygous
____ (two genes in which the substitution has occurred)
- sickle-cell disease (HbSS) results
Homozygous
does a HbA - HbA child inherit the sickle-cell disease from their parents?
No. They are normal
does a HbA - HbS child inherit the sickle cell disease from their parents?
No. But they are a carrier of the sickle-cell trait
does a HbS - HbS child inherit the sickle cell disease from their parents?
Yes. They suffer from sickle-cell disease
Sickle-cell anemia: Majority of red blood cells (RBC) are irregularly shaped (____ shaped)
sickle shaped
Sickle-shaped red blood cells cannot carry as much of what?
Hemoglobin (hgb)
Sickle-cell anemia: Red blood cells (RBC) tend to ____?
Red blood cells (RBC) tend to clump
- Oxygen tension becomes reduced (high altitude)
- Blood becomes viscid than usual (dehydration)
- Results to vessel blockage——reduced blood flow to organs—hemolysis of cells—–severe anemia
If there is a blockage to placental circulation due to sickle-cell anemia, it can result to:
- Low-birth weight (LBW)
- Fetal death
Women with homozygous disease has a high incidence of:
- prematurity
- miscarriage
- perinatal mortality
Women with trait has a high incidence of?
Asymptomatic bacteriuria
- increased incidence of pyelonephritis
Sickle-cell anemia (Management)
Assessment
- Clean-catch urine is collected periodically
- Monitor woman’s diet
- Monitor fluid intake (at least 8 glasses per day)
- Assess varicosities
- Fetal health monitoring (ultrasound) at 16-24 weeks
(Therapeutic) Sickle-cell anemia: Replace sickled cells with non-sickled cells throughout pregnancy
Periodic exchange transfusions
(Therapeutic) Sickle-cell anemia: During crisis
- Pain management
- Administer oxygen
- Increase fluid volume (lower viscosity)
(Therapeutic) Sickle-cell anemia: No iron supplements
- Sickled cells cannot incorporate iron—results to iron build up
- No need for folic acid supplements
(Therapeutic) Sickle-cell anemia: If there is infection
Hospitalization.
(rule out crisis and hemolysis of crowded cells)
(Therapeutic) Sickle-cell anemia: Mature fetus
- Individualized method of delivery
- Keep woman hydrated in labor
- Epidural anesthesia if operation is needed
– General anesthesia poses a possible risk of hypoxia
(Therapeutic) Sickle-cell anemia: Pospartum
- Early ambulation
- Wearing of pressure stockings
– Reduce risk of thromboembolism
Causative agent: Escherichia coli
Urinary Tract Infection (UTi)
Ureters _____ because of progesterone—results to stasis urine
dilate
Allows more than the usual number of organisms to grow
Minimal glucosuria
Asymptomatic infections are dangerous because?
- Can progress to pyelonephritis (infection of the pelvis of the kidneys)
- Associated with preterm labor
- Premature rupture of membranes
Urinary Tract Infection: Symptomatology
- Frequency
- Pain in urination
- Pain in lumbar region (right side) that radiates downward
– greater compression and urinary stasis on the right ureter from the uterus being pushed that way by the bulk of the intestines on the left side - Tender to palpation
- Accompanying nausea and vomiting
- Malaise
– A general feeling of discomfort, illness, or uneasiness - Pain
- Frequency of urination
- Elevated temperature
- Urine culture (over 100,000 organisms/ml)
(Management) Urinary Tract Infection: How to determine which antibiotic will best combat the infection?
By sensitivity testing
(Management) Urinary Tract Infection: _____, _____,and _____ are effective against most organisms causing UTI
Amoxicillin
Ampicillin
Cephalosporins
- Safe during pregnancy
(Management) Urinary Tract Infection: Cause retardation of bone growth and staining of fetal death
Tetracyclines
- Contraindicated in pregnancy
Sulfonamides can be used early in pregnancy. TRUE or FALSE?
True
Why can’t you give Sulfonamides near term?
Because it can interfere with protein binding of bilirubin which can lead to hyperbilirubinemia in newborn
Renal disease: Symptomatology
- Severe anemia
- Proteinuria
– Must be compared to woman’s individualized pre-pregnancy level too be meaningful) - Elevated blood pressure (BP)
– Should be compared with pre-pregnancy level
(Symptomatology) Renal disease: Diseased kidneys do not produce erythropoietin
Severe anemia
- Synthetic erythropoietin is available
(Physiology-Pregnancy) Renal disease: Glomerular filtration rate (GFR) is normally ____?
increased
(Physiology-Pregnancy) Renal disease: Is advised not to get pregnant (danger of kidney failure)
Women who have an increased serum creatinine
level of more than 2 mg/dl
(Physiology-Pregnancy) Renal disease: What is the normal value of serum creatinine level?
Normal: 0.7 mg/dl
Renal disease: Management
Corticosteroid (oral prednisone) level at a maintenance level
- Continued throughout pregnancy
- Infant maybe hyperglycemic at birth (because of suppression of insulin activity
Dialysis
-
Risk of preterm labor (progesterone is removed during dialysis)
– Progesterone is administered IM before the procedure - Scheduled frequently and for short duration
– Prevent acute fluid shifts
Heparin injected during hemo is safe (does not cross the placenta)
Nutrition consultation
- Low potassium diet (avoid buildup of potassium
that accumulates because their diseased kidneys
do not evacuate this well
Emotional support
- Being pregnant is risky
Caused by virus
- Type A, B or C
Spreads in epidemic form
Can cause preterm labor
Influenza
Influenza: Symptomatology
- High fever
- Extreme prostration (exhaustion)
- aching pains in the back and extremities
- sore, raw throat
Influenza: Treatment
Antipyretic
- acetaminophen-Tylenol
Oral antiviral drug
- Oseltamivir (TamiFlu)
Influenza vaccine immunization
- from killed virus
Lung tissue is invaded with Mycobacterium tuberculosis
Tuberculosis
An acid-fast bacillus
Mycobacterium tuberculosis
Tuberculosis: ____, _____ and a final ring of _____ develop
- Fibrosis
- Calcification
- Collagenous scar tissue develop
Tuberculosis: Antibodies produced will have a positive _____?
Mantoux test
Tuberculosis: PPD - Purified protein derivative
Mantoux test
Tuberculosis: Symptomatology
- Chronic cough
- Weight loss
- Hemoptysis
- Night sweats
- Low-grade fever
- Chronic fatigue
Tuberculosis: Management
(INH) Isoniazid and ethambutol hydrochloride (Myambutol)
- Drug of Choice (DOC)
- Non teratogenic
- INH
– Result in peripheral neuritis (if no supplement of pyridoxine-B6)
Ethambutol
- Optic nerve involvement
- Test with Snellen’s chart
Calcium supplements to ensure TB pockets are not broken down
How many years is it advised to wait before getting pregnant after treating tuberculosis?
1-2 years
Tuberculosis is transferred to the baby after birth
- Can care for the baby after ___?
Three (3) negative sputum cultures
(Management) Tuberculosis: If with active TB at home
- Infant given _____?
- Follow-up _____ at ____ interval
- Prophylactic Isoniazid (INH)
- Skin tests
- 3 months
(Management) Tuberculosis: If with active TB at home
- Mother taking Isoniazid (INH) should not _____?
Breastfeed
- or infants dosage should not be reduced
- German measles
- “Three-day measles”
Rubella
Rubella: Symptomatology
- Fever
- Headache
- Rash
- Eye pain
- Back pain
- Muscle aches
- Joint pain
Rubella is most dangerous to the baby in the first _____ of pregnnacy
First 16 weeks
Rubella can cuase?
- Miscarriage
- Stillbirth
Birth defects in unborn babies is called?
Congenital Rubella Syndrome
Congenital Rubella Syndrome include the following birth defects:
- Hearing loss
- Brain damage
- Heart defects
– Patent Ductus Arteriosus (PDA) - Cataracts
Rubella can be transmitted via:
- Coughs
- Sneeze
MMR vaccine means?
Measle, mumps, and rubella vaccine
Rubella: Management
- No specific treatment for Rubella
- Diminish discomfort
- Treatment of newly born babies is focused on management of the complications
– Congenital heart defects and cataracts can be corrected by direct surgery - Counseling
- Regular monitoring
Key Points: Cheat Sheet
Rh factor is only released from the Rh (+) fetus during breakdown of RBC
- Delivery of placenta
If mother is Rh (+) and fetus is Rh (-) no incompatibility will happen
- When a woman with preexisting disease become pregnant, it is crucial to obtain a thorough history and physical examination on the condition
- Documentation by a medication reconciliation form of any medication being taken is important to protect against adverse drug interactions and the possibility of teratogenic effects on the fetus - Teaching is an important nursing intervention because a woman with preexisting illness must *modify her usual therapy to adjust to pregnancy**.
- Because blood volume increases by as much as 50% during pregnancy, cardiac function may become inadequate if cardiovascular disease is present
- Cardiac illness that cause difficulty can be either acquired disorders (KAWASAKI; rheumatic fever) or congenital disorders (mitral valve stenosis; coarctation of aorta) - All forms of anemia can result to fetal distress because of inadequate oxygen transport
- UTI can lead to pregnancy complication (increase workload in the kidneys)
- Acute nasopharyngitis, asthma, pneumonia, influenza, and TB are common respiratory disorders seen in pregnancy
- Juvenile rheumatoid arthritis and systemic lupus erythematosus are example of rheumatoid disorders seen in pregnancy
- Require large doses of NSAIDS
- Those taking salicylates are advised to decrease use 2 weeks before birth (avoid bleeding) - If surgery is necessary during pregnancy (cholecystectomy/appendectomy), can be performed by laparoscopic technique but may result in preterm labor
- Recurrent seizures are the most frequently seen neurologic condition during pregnancy
- Major endocrine disorder seen in pregnancy is diabetes (Gestational diabetes)
