Prenatal Care: Problem Flashcards
Alcohol: Maternal effects in pregnancy
PEC, placental abruption, placenta previa, SAB, ectopic pregnancy, PROM
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
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?
Smoking (Nicotine/Tobacco): Maternal effects
PEC, placental abruption, placenta previa, SAB, ectopic, PROM
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!
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,
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
General effects of drugs on infant
birth defects
low birth weight
PTB
small head circumference
SIDs
Marijuana
Safety of use not proven in pregnancy
avoid while planning, during and BFing
Not to be used for a nausea tx
Which drugs are stimulants
cocaine and meth
Stimulant effects on mother
migraines
seizures
PROM
Placental abruption
HTN crisis
SAB
PTL
METH: PEC, PTB, abruption
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meth: increased emotional reactivity, anxiety and depression, withdrawn, cognitive problems
Ecstasy
Limited research: avoid
exposure in utero may cause learning, memory, motor problems
Heroin
passes through placenta to fetus
NAS
Goals for substance abuse in pregnancy
Ideal: stop
if can’t decrease quantity and # of substances
What does TORCH stand for?
Toxoplasmosis
Other (hep b, syphilis, varicella, parvo)
Rubella
Cytomegalovirus
Herpes (HSV)
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
