hypertensive disorders
What is chronic hypertension and what is the BP for it?
Hypertension preceded pregnancy or occurred prior to the 20th week of gestation or persists after 84th day post-partum
➢Systolic BP >/=140mmHg or
➢Diastolic BP >/= 90mmHg or both
➢Mild (>140/90), Severe (>/=180/110)
What are some infections in pregnancy? What is TORCH?
➢UTI
-Acute Cystitis, Acute Pyelonephritis
➢Group B Strep (GBS)
TORCH
➢Toxoplasmosis
➢Other (Hep B, syphilis, HIV)
➢Rubella
➢Cytomegalovirus
➢Herpes simplex virus type 2
What is hepatitis B? Should you screen a pregnant woman? What medication do you give the infant after delivery?
➢Increased incidence of prematurity, Low Birth Weight (LBW) and neonatal death
➢Screen all pregnant women
➢Meds for infant after delivery – Hep. B vaccine AND HBIG
➢Bathe infant immediately
What are the types of diabetes? If you have GDM type one how do you control it? Type two?
➢Type 1- Insulin deficient
➢Type 2- Insulin resistance and relative deficiency of insulin
➢Gestational Diabetes Mellitus (GDM) – Glucose intolerance with an onset during pregnancy.
➢GDM A1- diet controlled, GDM A2- insulin and diet controlled
What are the types of thromboembolic disorders?
➢Superficial and deep vein thrombophlebitis
➢Pulmonary embolism (PE)
➢HUGE cause of OB Morbidity
➢PE is main cause of mortality (17% of maternal deaths)
Psychiatric complications during pregnancy?
➢Exacerbate current problem, reoccurrence of old problems, appearance of new problems
➢Depression
➢Bipolar
➢Anxiety Disorders
➢Eating Disorders
What is preeclampsia and eclampsia?
Preeclampsia
➢BP>140/90 after 20 weeks
➢Proteinuria >0.3 g or more in 24 hours
Eclampsia
➢Occurrence of a grand mal seizure in a woman with preeclampsia (no other cause for seizure)
➢Seizures occur: 1/3 antepartum, 1/3 intrapartum, 1/3 post-partum
What is Group B strep? When should you scream for it it? What are some risk factors? What can it lead to?
➢Screen at 35-37 weeks (vaginal / rectal cultures)
➢Can lead to: Fetal sepsis, pneumonia, meningitis
➢Intrapartum Prophylaxis (PCN unless allergic)
Risk Factors
➢previous infant with GBS
➢GBS bacteriuria during current pregnancy
➢+ GBS screening
➢Unknown GBS status and:
-Delivery < 37 week, temp >=100.4 F. 38.0 C,
-Rupture > 18 hours
What is varicella zoster? When should you immunize infants?
➢Herpesvirus
➢First trimester - congenital varicella syndrome; can be life-threatening
➢Later pregnancy - usually protected by maternal antibodies
➢Immunize infants within 72 hours
What are the effects of pre-gestational diabetes on pregnancy?
➢Increased PIH, UTI’s,
➢Ketoacidosis at lower thresholds
➢Hydramnios (increased fetal diuresis)
➢Large OR Small fetal size r/t vascular involvement
➢PROM
➢Difficult labor/shoulder dystocia
-postpartum hemorrhage
Types of therapeutic management for thromboembolic disorders?
➢ - superficial venous thrombosis
➢ - deep venous thrombosis
➢ - pulmonary embolism- fragments of clot are carried to the lungs
What are some substance-abuse examples? Does the placenta protect from these substances?
Drinking, smoking, snorting, injecting
➢Fetus receives same substance
➢Interferes with fetal growth and development
NO.
What is the pathophysiology for preeclampsia/eclampsia
➢Generalized vasospasm, all organs affected
➢Brisk DTR’s, Possible Clonus (CNS irritability)
➢Headaches
➢Visual Changes (Scotomata- specks or spots in the vision- “blind spots”)
➢Epigastric Pain (liver)
—Can indicate impending convulsion!
➢Decreased urine output
What is toxoplasmosis? How is it transmitted?
➢Protozoan infection
➢Avoid contamination
➢raw, undercooked meat, cat feces, cat litter
➢ Neonatal effects depend on gestational age at exposure
What is the Paro virus be 19? What is another name for it? When is the greatest risk for the fetus?
➢Fifth Disease
➢Rash, fever, malaise, joint pain
➢Risk greatest first 20 weeks of pregnancy
-Fetal anemia, hydrops, heart failure
➢Symptomatic treatment
What are the effects of pregestational diabetes on the fetus?
➢Large for Gestational Age (LGA)
➢Intrauterine Growth Restriction (IUGR)
➢Preterm labor, PROM
➢Premature birth
➢Anomalies
➢Fetal Death
What are the risk factors for thromboembolic disease in pregnancy
➢Inactivity
➢Obesity
➢Cesarean birth
➢Smoking
➢Hx of previous thrombosis
➢Varicose Veins
➢Diabetes mellitus
➢Prolonged time in stirrups (2nd stage)
➢Maternal age > 30
➢Increase parity
➢Preeclampsia
What are some maternal behaviors to look out for for substance abuse?
➢Defensive, hostile, severe mood swings
➢Anger, apathy about pregnancy
➢Delay prenatal care
➢Don’t keep appointments
➢Inconsistent follow-through
➢Poor grooming, inadequate weight gain
➢Needle punctures, thrombosed veins, cellulitis
Risk factors for preeclampsia?
➢First pregnancy
➢Age <17 or >35
➢Previous preeclampsia or family history (mother/sister)
➢Diabetes, obesity, multifetal gestation
➢Chronic hypertension, renal disease
➢African American ethnicity
What is rubella? When is the greatest risk for the fetus?
➢Greatest risk with 1st trimester exposure
—congenital heart disease, IUGR, cataracts, mental retardation, cerebral palsy, deafness
➢Third Trimester exposure – born with rubella
➢Check rubella titer, immunize post-partum, encourage contraception for at least 1 month after vaccination
What is RHO (D) isoimmunization?
➢Rh INCOMPATIBILITY:
➢Rh – Mom and Rh + Dad
➢Fetus could be Rh- OR Rh+
➢Rh + fetus can sensitize mother to make antibodies which fight Rh+ blood
➢RhoGAM (Intramuscular injection to mom) prevents this sensitization
What are the effects of pre-gestational diabetes on the neonate?
➢Hypoglycemia
➢Hypocalcemia
➢Hyperbilirubinemia
➢Respiratory Distress Syndrome (RDS)
What is shown in mild preeclampsia
➢Systolic BP >= 140 and <160
➢Diastolic BP >= 90 and <110
➢Proteinuria: > 0.3 g but < 2 g / 24 hours
➢Creatinine: normal
➢LFT elevation - minimal
➢no fetal growth restriction
➢no oliguria
➢mild edema
➢no headache, visual changes, abdominal pain
What is cytomegalovirus? What can it cause?
➢CMV – herpes virus group
➢fetal deafness, seizures, blindness, dental abnormalities, mental retardation
➢No current effective therapy
➢Risk greater if mother has CMV for first time in pregnancy. Most infants do fine but some have negative outcomes
What are some ABO blood type considerations? Is it as severe as Rh problems?
➢Maternal blood type – O
➢Fetal blood type – A, B, or AB
➢Mother can develop antibodies against fetal blood resulting in anemia
➢Not as severe as Rh problems
➢Direct Coombs checked at delivery
➢Infants watched for jaundice / bilirubin problems
How do you diagnose GDM??
➢Screening – 1 hour Glucose Tolerance Test (GTT)
➢Diagnosis – 3 hour GTT
•1 hour glucose
>140 mg/dL requires a 3 hour glucose test to be done
•3 hour glucose
Fasting <95
1 hour <140
2 hour <120
3 hour <95
**1 or more abnormal readings confirm a diagnosis of gestational diabetes
What is shown in severe preeclampsia
➢Systolic BP >=160
➢Diastolic BP>=110
➢Proteinuria
➢>5 g/24 hr
➢Creatinine: elevated
➢LFT elevated
➢Thrombocytopenia
➢Fetal growth restriction
➢Oliguria
➢ <500 ml/24hr
➢Generalized edema
➢Headache, visual changes, abdominal pain
What is herpes? Divisions, or an active outbreak, our present then what needs to happen?
Herpesvirus Type 2
➢genital herpes
➢transmission after ROM
➢no known cure
➢cesarean delivery if lesion present in labor
➢Use antivirals PO 3rd trimester to decrease chance of outbreak in labor
What is GDM? Risk factors?
➢Glucose intolerance during pregnancy
➢Changes in Insulin production - hPL
➢Risk factors
-LGA babies
-Obesity, chronic hypertension
-Family history
➢Follow-up
➢Glucose levels
➢Eyes and Urinary tract
-Retinal changes, UTIs
➢Fetal monitoring
-Ultrasound, amniocentesis (L/S ratio)
➢Delivery time
-Vaginal delivery
-Postpartum insulin requirements
Preeclampsia management for mild and severe
Mild
➢Bed rest with BRP
➢kick counts
➢BP, weight
➢urinalysis
Severe
➢Bed rest
➢hydralazine
➢Magnesium sulfate
➢close monitoring
➢induction
What is HELLP syndrome, what are some symptoms, are these like eclampsia symptoms?
HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets
➢Progression of symptoms
➢Seizure activity
➢Pain RUQ, lower chest or epigastric area
➢N&V, Edema
they are the same as ecclampsia symptoms