Pregestational Disorders Flashcards
Disorders that might cause complications during pregnancy
Pregestational Disorders
What components related to the heart is where a slight change of them might greatly affect the heart condition of a pregnant woman with heart disorders
Cardiac output, Heart rate, and blood volume
Cardiac dse complicates about how many percent of pregnancies
1%
Normal circulating blood volume
40-60%
Normal Cardiac output
25-50%
Normal cardiac rate
10-12%
What are the 2 types of congenital heart defects
Left and Right-sided heart failure
Damages heart muscle and heart valves
Congenital Heart Defects
What infection leads to injured heart or congenital heart defects
Group A beta-hemolytic streptococcal infections (GABS)
What does GABS do to heart tissue
Autoimmune reaction
Autoimmune reaction leads to what?
Permanent deformity of heart valves or chordae tendinae
What are the 3 conditions that might indicate a left-sided heart failure
- Mitral Insufficiency
- Mitral Valve Stenosis
- Aortic Coarctation
What condition is where blood builds up and is stuck at the left atrium
Mitral Insufficiency
What are the s/s of Mitral insufficiency?
- Decreased cardiac output
- pulmonary htn
- decreased systemic BP
- Pulmonary Edema
- Decreased O2 sat
What causes Pulmonary HTN during Mitral insufficiency?
Increased pressure between left atrium and pulmonary vein
What happens to the body if there is decrease in systemic BP when the patient has mitral insufficiency
Increased HR
Peripheral vasoconstriction
Na and H2O retention
What decreases when there is a decrease in systemic BP when the patient has mitral insufficiency
Decrease in placental profusion
What happens to the body if there is pulmonary edema when the patient has mitral insufficiency
Dyspnea
productive cough
orthopnea
paroxysmal nocturnal dyspnea
Why is there productive cough if the patient is suffering from pulmonary edema
The body’s response in trying to expel fluid build-up in the lungs
Can’t breathe properly in supine position
Orthopnea
DOB at night
Paroxysmal Nocturnal Dyspnea
Decreased O2 sat > _______________>______________________________________
Increased RR
Increased fatigue, weakness, dizziness
Narrowing of mitral valve
Mitral valve stenosis
What secondary problem can occur due to the difficulty of blood to leave the left atrium?
Thrombus formation
Mitral valve stenosis is a common complication of_____
Rheumatic heart dse
Blood in the phlegm
hemoptysis
Abnormal heart rhythm
Atrial fibrillation
infection on the lining of the heart
Endocarditis
What in general should be given to patients with MVS?
Antibiotics
What are the management of MVS?
Assess for hypothyroidism
Sodium restriction
Strict follow up for EKG to monitor atrial and ventricular size
What are ways to address atrial fibrillation and relax the heart
Give Verapamil
Do Cardioversion
Give Digitalis, beta-blockers, and anticoagulant
This procedure gives shock to the patient using a defibrillator in order to normalize the heart
Cardioversion
What Anticoagulants are give the mothers with atrial fibrillation
Heparin
This condition of the Left-sided heart failure causes circulation difficulty, dissection of the aorta from HBP
Aortic coarctation
Management of aortic coarctation
Give:
Antihypertensives
Diuretics
Betablockers
What are the 5 maternal and fetal effects of Aortic coarctation
Increase risk for spontaneous miscarriage
Preterm labor
IUGR
Poor placental perfusion
maternal and fetal death
IUGR?
Intrauterine Growth Retardation
LSHF Management
Serial UTZ
Balloon angioplasty
Anticoagulant
What weeks does the serial UTZ happen in managing LSHF
30-32 weeks
What conditions indicate RSHF
- pulmonary valve stenosis
- Atrial septal defect
- Ventral septal defect
In the management of mitral valve stenosis, what is the Digoxin levels at a therapeutic level and how many hours after the last dose
0.5 - 2 mg/mL
8 hours
What is considered as hypokalemia
<3.5 mEq/L
What should you monitor in the management of mitral valve stenosis
Digoxin levels
Hypokalemia
Strict monitoring of parenteral and oral fluid intake
Digitalis toxicity
What is the ideal potassium levels
3.5-5 mEq/L
What is Peak and Trough
Peak: extracting blood 30 mins to 1 hour after giving the medication
Trough: Extracting blood 30 mins before giving medication
What are the s/s of Digitalis toxicity
Bradycardia
Blurring vision
n/v
anorexia
What is the management of digitalis toxicity
decrease activity and bed rest
intake of potassium-rich foods
Hypertrophy of muscle tissue of the heart walls and septum
Hypertrophic cardiomyopathy
What does Hypertrophic cardiomyopathy might lead to
small chambers and causing impaired filling
What should you assess for in a hypertrophic cardiomyopathy
Angina
External Dyspnea
Dizziness
Syncope
This is a dse of the heart with no known cause before a delivery of baby
Idiopathic peripartum cardiomyopathy
What are pharmacologic regimens given to patients with IPC
Diuretics
Potassium Correction
Anticoagulants
Digitalis
What to do if a patient with IPC has severe CHF
Low sodium
Fluid restriction
This occurs when the output of the right ventricle is less than the blood volume received by the right atrium from the vena cava
Right-Sided Heart Failure
S/s of RSHF (6)
- Congestion of systemic venous circulation and decreased cardiac output
- Decreased BP
- High pressure on the vena cava
- Jugular venous distention
- Liver and spleen enlargement
- Peripheral Edema
What is the result of increased portal circulation from the abdominal organs
Jugular vein distention
What are the 2 s/s of liver and spleen enlargement
dyspnea and pain ascites
This is the accumulation of water in the abdomen
Ascites
This dse results from an infxn which starts with a sore throat and leads to scarring of one or more heart valves
Rheumatic Heart Dse
What bacteria is causing Rheumatic Heart dse
Streptococci
What is rheumatic heart dse also known as
rheumatic fever
What causes the obstruction to blood flow in the rheumatic heart dse
Stiffness of valves making them unable to open and close normally
What infection causes rheumatic heart dse
Group A beta-hemolytic streptococcal infection
What are the lab tests for RHD
- Throat cultures
- Rapid antigen
- Anti-streptococcal antibodies
What is culture and sensitivity
Culture: Check what microorganism that causes the infection
Sensitivity: detect what antibiotic is effective in killing the certain microorganism
What are the 3 NY association classification of heart dse
Class I: Asymptomatic at normal levels of activity
Class II: Symptomatic with increased activity
Class III: Symptomatic with ordinary activity
Class IV: Symptomatic at rest
What are the 3 NY association classification of heart dse
Class I: Asymptomatic at normal levels of activity
Class II: Symptomatic with increased activity
Class III: Sypmtomatic with ordinary activity
Class IV: Symptomatic with ordinary activity
The main problem of this dse is the inability to control glucose level
Diabetes mellitus
When the mother has DM, she has 5 times more chances in developing what?
Cardiac Myopathy
This is an endocrine d/o of carb metabolism, results from inadequate production of use of insulin
DM
What are the 3 types of DM
Type 1 DM
Type 2 DM
Gestational DM
What is the other term for T1DM
Insulin Dependent Diabetes Mellitus
This DM results from the body’s failure to produce insulin and presently requires the person to inject insulin
T1DM
T1DM timing of onset
Usually during childhood or adolescence
Risk factors of T1DM:
___________ susceptibility combined with an ______________________, such as ______________________
genetic
environmental trigger
viral infection
Pathophysiology of T1DM:
Autoimmune destruction of __________, resulting in a complete lack of _________
B cells
insulin
What cells are responsible in making insulin
B cells
Long term effect of T1DM
Vascular dse
Vascular dse from T1DM might cause_____________________
kidney failure, blindness, stroke, and death
What races have a high risk of developing T1DM
Asian, Hispanics, Black Americans
This type of DM is where the body can’t use insulin that is produced
T2DM
Results from insulin resistance, a condition in which B cells fail to use insulin properly, sometimes combines with an absolute insulin deficiency
T2DM
What is the timing onset of T2DM
Typically middle age or older, but increasingly seen at a younger age
What are the risk factors of T2DM
Genetic predisposition
Obesity
Age
Sedentary lifestyle
Previous gestational diabetes
What is the pathophysiology of T2DM
Insulin resistance initially, usually combined with increasingly reduced insulin secretions
When can you diagnose a patient with GDM
If she has elevated BGL after 20 weeks of gestation
What is the timing of onset of GDM
During pregnancy (2nd or 3rd trimester)
What are the risk factors of GDM
Obesity
age
sedentary lifestyle
previous GDM
What are the long term effects of GDM to the mother
T2DM and CVD
What are the long term effects of GDM for the child
Obesity and T2DM
How many weeks to decide whether or not the mother has T2DM d/t GDM
After 6 wks after delivery
What is considered as high BGL in a FBS
125 mg/dL
How many hours is needed in fasting
8-12 hours
What is considered high BGL in a random plasma glucose?
> or = 200 mg/dL
What is considered high BGL in 2-hour plasma glucose
200 mg/dL
What are the 3 tests used to check the BGL of a patient
Fasting Blood sugar test
Random plasma glucose test
2-hour plasma glucose test
What is the flow chart of increase of BGL in a normal preganancy
- Increase placental hormones
- Diabetic effect
- Increase glucose supply to fetus
- Episodes of hyperglycemia
- pancreatic response
What are the two pancreatic responses and what are its effects
- Insufficient insulin production = hyperglycemia
- Increased insulin production = blood glucose homeostasis
What is IDM
Infant of Diabetic mother
What is macrosomia
Large baby
This is the frequent urination of the fetus with sugar content
Glycosuria polyuria
What is the infection of genitals
monilial infection
What are the 3 P’s of DM
Polyuria
Polyfagia
Polydypsia
