Prenatal Care: Problem Flashcards by Michele Labas

Alcohol: Maternal effects in pregnancy

PEC, placental abruption, placenta previa, SAB, ectopic pregnancy, PROM

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Alcohol: Fetal effects

-Fetal Alcohol Spectrum Disorders (FASDs) - physical intellectual, and behavioral disabilities that last a lifetime
-low birth weight and growth
-problems with heart, kidneys, other organs
-damage to parts of brain –> intellectual and behavioral disabilities like hyperactivity/attention problems

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Screening Tools for alcohol

CAGE
- felt need to Cut down drinking?
- people Annoyed you by criticizing your drinking?
- felt bad or Guilty about drinking
- Needed any Eye-opener?

TWEAK
-Tolerance: how many drinks can you hold?
-Worried: have people been worried or complained about your drinking?
-Eye-openers: drink 1st thing in am
-Amnesia: black outs?
-Cut Down: need to cut down?

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Smoking (Nicotine/Tobacco): Maternal effects

PEC, placental abruption, placenta previa, SAB, ectopic, PROM

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Smoking (Nicotine/Tobacco): Infant effects

IUGR, PTB, small for gestational age
- RISK OF STILL BIRTH is 1.8-2.8 times greater in smokers (higher for heavier smokers)
-RISK OF STILLBIRTH is 2.1 times greater for women exposed to second hand smoke!

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What is Neonatal Abstinence Syndrome (NAS)?

Infant goes through withdrawal at birth d/t opioids, barbituates, benzos
- severity of withdrawal symptoms depends on time of drug, quantity taken, length of abuse, GA at birth,

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S/S of NAS?

blotchy skin coloring
diarrhea
excessive high-pitched cry
abnormal suckling reflex
increased muscle tone
irritability
fever
hyperactive reflexes
poor feeding
rapid breathing
seizures
sleep problems
slow weight gain
nasal congestion and sneezing
sweating
trembling
vomiting

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General effects of drugs on infant

birth defects
low birth weight
PTB
small head circumference
SIDs

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Marijuana

Safety of use not proven in pregnancy
avoid while planning, during and BFing
Not to be used for a nausea tx

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Which drugs are stimulants

cocaine and meth

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Stimulant effects on mother

migraines
seizures
PROM
Placental abruption
HTN crisis
SAB
PTL
METH: PEC, PTB, abruption

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Stimulant effects on infant

Low birth weight
small head circumference
shorter length
irritability
hyperactivity
tremors
high-pitched cry
excessive sucking at birth
meth: increased emotional reactivity, anxiety and depression, withdrawn, cognitive problems

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Ecstasy

Limited research: avoid
exposure in utero may cause learning, memory, motor problems

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Heroin

passes through placenta to fetus
NAS

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Goals for substance abuse in pregnancy

Ideal: stop
if can’t decrease quantity and # of substances

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What does TORCH stand for?

Toxoplasmosis
Other (hep b, syphilis, varicella, parvo)
Rubella
Cytomegalovirus
Herpes (HSV)

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Toxoplasmosis clinical manifestation

most infections are asymptomatic

Toxoplasmosis effects on infant

10% of infected infants have damage resulting in lower IQ, deafness
can cause SAB, prematurity, IUGR

Toxoplasmosis Labs/Diagnosis

Universal screening is not recommended, test immunocompromised/suspected infection
Detection of toxoplasma-specific immunoglobulin (IgG, IgM, IgA, IgE)
Dx: direct observation of parasite in stained tissue secretions, CSF, etc
Toxoplasmosis is a protozoan

Toxoplasmosis Tx

MFM
There are meds to give depending on GA

How to prevent toxoplasmosis?

Fully cook meat to at least 145 F and poultry to 160 F
Do not drink or eat unpasteurized dairy
Avoid handling or changing cat litter because it is found in cat feces
Avoid drinking untreated water
Good hand-washing following gardening or wear gloves while gardening because soil might be contaminated with cat feces

Syphilis

Screened routinely in 1st and 3rd trimesters
Crosses placenta: 80% of infants born to syphilis mom will have congential syphilis, risk of vertical transmission decreases with amount of time mom has had it
can cause: PTB, LBW, congenital malformation, hepatic abnormalities, ascites, hydrops, still birth, long bone involvement

Varicella (chickenpox)

congenital varicella syndrome, greatest risk if infected in 1st 20 weeks
Maternal infection occurring from 6 days before to 2 days after delivery can be passed to newborn, causing serious infection (5% mortality)
Varicella infection causes varicella pna in 10-30% of pregnant adults

Herpes Zoster (shingles)

secondary infection that poses little risk to mom or baby

Varicella transmission

respiratory inhalation of virus particles, highly contagious

Varicella clinical s/s

Rash: maculopapular rash that becomes vesicles, new vesicles continue for 3-4 days, crusted by 1 week Prior to rash adults experience fever, malaise, myalgias, HA

Maternal complications of varicella

Pneumonia, 14% maternal mortality

Infant complications of varicella

- PTL and PTB, - maternal varicella 5-6 days prior and 2 days after birth may result in neonatal infection, fatality can be as high as 30% (due to fetal exposure to virus without benefit of maternal antibodies) -worst time of exposure is in first 20 weeks GA: limb hypoplasia, cataracts, microcephaly, IUGR

Treatment of Varicella for mom

Antiviral: IV acyclovir for severe maternal infection Give VZIG as early as possible to mom is exposed and susceptible

Treatment of Varicella exposure for baby

If infection in bother within 6 days prior to delivery: give varicella-zoster immunoglobulin (VZIG), prepare for tocolysis to delay delivery, give VZIG to infant If infection in pregnant patient within 3 days pp give VZIG to infant

Prevention of Varicella

Vaccination for all susceptible reproductive age women preconception (at least 4 weeks prior to pregnancy) or in postpartum period VZIG ASAP if pregnant patient is exposed and susceptible

Parvovirus B19 (Fifth Disease) Transmission

Through respiratory secretions such as saliva, sputum, nasal mucus (like when infected person coughs or sneezes Through blood or blood products Can be vertically transmitted to fetus

Clinical Manifestation of Parvo

asymptomatic in about 20% of people Healthy adults: mild rash and illness; slapped cheeks Immunocompromised: reticular rash in trunk, painful swollen joints, severe anemia

Complications of Parvo in fetus

SAB Severe fetal anemia (failure of fetal RBC production, attacks RBC) hydrops fetalis stillbirth heart failure

Parvo screening

routine screening is not recommended

What labs if suspect parvo infection/exposure

Parvo IgG, IgM IgG + --> exposed prior/immune IgM + and IgG neg --> active disease, no antibodies, 33% chance of hydrops/heart failure

Parvo treatment for mother

no antiviral drug can give acetaminophen if muscle/joint pain

Parvo exposure management of fetus

Fetal u/s to evaluate for s/s of fetal anemia or hydrops fetalis cord blood sampling to determine degree of fetal anemia doppler studies to assess anemia risk

Prevention of Parvo

No med or vaccine Handwashing with soap and water avoid touching eyes, nose, mouth avoid contact with sick people

Rubella Transmission

Direct contact with nasal or throat secretions of infected individual Droplets spread through sneezing or coughing

Clinical manifestation of Rubella

Discrete pinkish-red maculopapular rash, appears first on face, then trunk and extremities May also have lymphadenophathy, fever, arthralgias symptoms last 3 days