Concurrent disorders of pregnancy (unit 2) Flashcards
(76 cards)
1
Q
anemia during pregnancy
A
- Hgb < 11 g/dl in 1st & 3rd trimester
- Hgb < 10.5 in 2nd trimester
- Hct < 33%
2
Q
main consequence of anemia
A
•less O2 carrying capacity
•CO inc.
•inc. pressure in vessels
*can cause preeclampsia, CHF
3
Q
causes of anemia
A
- malnutrition
- hemolysis
- blood loss
4
Q
s/sx Fe deficiency anemia
A
•pallor •fatigue •lethargy •HA •pica *most common anemia
5
Q
fetal effects r/t Fe deficiency anemia
A
- unclear b/c fetus receives adequate stores at cost to mom
* anemia has to be profound for fetal O2 supply to be impacted
6
Q
FeSO4
A
- Fe replacement
- b/t meals on empty stomach
- take w/ vit. C
- avoid bran, tea, coffee, milk, egg yolks
7
Q
folic acid deficiency anemia
A
- causes slowing of DNA synthesis, resulting in many immature or decreased formation of RBCs
- needs double in PG
8
Q
fetal effects r/t folic acid anemia
A
- r/o SAb, placental abruption, cleft palate/lip
* r/o neural tube defects (biggest)
9
Q
folic acid sources
A
•liver •kidney/lima beans •dark greens •supplements (recommend 600 mcg/day in childbearing women) *extra need in multifetal PG
10
Q
causes of sickle cell anemia exacerbation in pregnancy
A
- low O2 sats- greater needs
- dehydration- morning sickness
- infection- suppressed so doesn’t attack baby
11
Q
maternal effects of sickle cell trait
A
- usually do fine in PG
- higher r/o UTI and Fe deficiency
- r/o UPI
- more prone to develop pyleonephritis, bone infection, heart dz
12
Q
sickle cell crisis in PG mom
A
- temporary cessation of bone marrow fxn
- hemolytic crisis
- massive erythrocyte dysfunction (-> jaundice)
13
Q
fetal effects of sickle cell anemia
A
- prematurity
- death r/t crisis
- possible SC anemia (autosomal recessive)
- intra uterine groth restriction (IUGR)
14
Q
sickle cell management
A
- freq. Hgb, Fe, IBC, folate labs
- close fetal surveillance
- assess/prevent crisis
- exchange transfusion
- prophylactic transfusion controversial
15
Q
exchange transfusion
A
•RBCs removed and replaced
16
Q
goals of sickle cell management
A
*adequate hydration/nutrition •good hygiene •adequate rest •prompt tx of infection *prevent crisis
17
Q
thalassemia
A
- genetic disorder affecting synth of hemoglobin
* causes short life span of RBC
18
Q
s/sx thalassemia in children
A
- none at birth
* become anemic b/t 3 and 18 months b/c can’t make enough Hgb
19
Q
anemia progression s/sx in thalassemia children
A
- failure to thrive/grow
- poor feeding/emesis
- irritability/crying
- pallor
20
Q
women w/ thalassemia trait
A
•typically have uncomplicated PG when seek genetic counseling
21
Q
women w/ thalassemia dz
A
•infertility common •50% of PG complicated -stillbirth -IUGR -preeclampsia -PTD
22
Q
maternal effects of thalassemia during PG
A
•mild anemia
*DONT give Fe supp. b/c they store Fe in excess and it’s hard to excrete
23
Q
fetal effects of thalassemia
A
- may/may not cause morbidity
* r/o inheriting dz or having problems associated
24
Q
asthma and pregnancy
A
- affects 1-4% of women
- ½ improve
- ¼ worsen
- ¼ stay same
- labor can exacerbate attack
25
cystic fibrosis and pregnancy
* if not advanced, tolerate PG well
| * if have advanced, often have PG hypoxia and pulmonary infections
26
pregnancy and SLE
* r/o exacerbation
* s/sx of joint pain, photosensitivity, butterfly rash
* if pass 1st trimester, 90% chance for live birth
27
fetal effects SLE
* congenital heart block
| * SAb in 1st trimester
28
rheumatoid arthritis and pregnancy
•symptoms usually greatly improved during PG
29
epilepsy and pregnancy
```
•increased r/o IUFD & PTL
•anti-convulsant tx controversial
-dec. clotting; inc. bleeding
-compete for Fe
-teratogenic
```
30
what dz could epilepsy during pregnancy be confused with?
•eclampsia
31
multiple sclerosis and pregnancy
•medications contraindicated in PG and BF, so may have bowel, bladder, ambulation, and fatigue issues
32
4 cardinal signs of diabetes
* polyuria
* polydipsia
* polyphagia
* weight loss
33
diabetes in 1st trimester
•usually not an issue b/c insulin needs are lower
34
diabetes in 2nd/3rd trimester
* insulin needs increase
| * pancreas can't respond sufficiently, so have hyperglycemia
35
pre-existing diabetes and PG
* difficult to control insulin
* N/V
* inc. energy needs
* vascular disorders can worsen
36
pre-existing diabetes increases risk of...
* ABs
* congenital anomalies
* macrosomia (lots of sugar)
* shoulder dystocia (macrosomic)
* PIH
* C/S
* over dissension of uterus
* IUGR
* UPI (uterus is peripheral vascular site)
37
why does pre-existing diabetes increase r/o IUGR
•vasoconstriction @ uterus
38
influence of diabetes on newborn
* cardiac anomalies
* hypoglycemia (rebound)
* resp. distress syndrome (late surfactant development)
* birth trauma (macrosomia)
* hypocalcemia
* hyperbilirubinemia (r/t birth trauma)
39
screening for diabetes
* urine dip (prot, ket, WBC, sugar)
* Hgb A1c (2.5-5.9%)
* GCT (24-28 wk)
* OGTT (if GCT abnormal)
40
GDM diagnosis criteria
* must have 2/4 abnormal to be GDM
1. fasting- 95
2. 1 hr- 180
3. 2 hr- 155
4. 3 hr- 140
41
diabetes management
* 2200-2400 cal diet
* exercise
* SBGM 4-6x/day
* insulin admin/control
* monitor fetal status
42
why risk of macrosomia
•hyperinsulinemia
43
fetal lung maturity in DM mom
* surfactant development later
* inc. risk of respiratory distress
* ideal to have vag birth (squeeze lungs)
44
hyperemesis gravidarum
```
•excessive N/V past 12 wks
•leads to:
-5% wt loss
-electrolyte imbalance
-dehydration
-ketosis
```
45
hyperemesis gravidarum risk factors
* < 20 y/o
* obesity
* first PG
* multifetal
* gestation trophoblastic dz
* psych d/o
* hyperthyroidism
* vit. B deficiency
* high stress
46
hyperemesis gravidarum effect on fetus
* IUGR
| * preterm birth
47
mitral valve prolapse PG implications
•give abx before delivery
48
rheumatic heart dz
* occurs when strep throat proceeds into heart dz, causing scarring on heart and stenosis
* mitral valve stenosis inc. pressure in R atrium -> pulmonary HTN/edema -> HF
49
cardiomyopathy
•heart dz that begins last weeks of PG-20 wk PP
•s/sx same as HF
•tx: anticoag; antiarrhythmias, anti-infect; diuretics
*reoccurrence in subsequent PG, so contraindicated
50
class I heart dz
* uncompromised
* no limitation of physical activity
* 1% mortality
* Ex: MVP
51
class II heart dz
* slight limitation of physical activity d/t fatigue, dyspnea, palpitation, angina
* mortality 5-15%
52
class III heart dz
* moderated/marked limitation of physical activity
* symptoms w/ less than ordinary activity
* mortality 25-50%
53
class IV heart dz
* inability to carry on any physical activity w/o discomfort
* cardiac insufficiency even at rest
* CANNOT sustain PG
54
s/sx heart dz
* frequent cough
* dyspnea
* edema
* murmor
* palpitation
* rales
55
management of heart dz
* high iron/protein intake
* avoid excessive wt gain
* freq. rest
* prophylactic abx
56
Bell's Palsy
```
•sudden unilateral neuropathy of 7th CN (facial)
•paralysis/weakness on one side of face
•inc. risk during PG
•tx: steroids
*spontaneously resolves w/ time
```
57
TORCH
```
•Toxoplasmosis
•Other: gonorrhea, syphilis, varicella zoster, hep B, HIV
•Ruebella
•Cytomegalovirus (CMV)
•Herpes Simplex Virus
*infections during PG
```
58
toxoplasmosis
* protozoan transmitted through undercooked meat & contact with infected cat feces
* crosses placental barrier
* often subclinical (no s/sx)
* IgG/IgM confirm
59
toxoplasmosis in infant
* may be asymptomatic
* VLBW
* enlarged spleen/liver
* jaundice
* anemia
60
varicella-zoster virus
•chicken pox
•herpes thru resp. contact
•may cause PTL, encephalitis, pneumonia
*fetal effects uncommon after 20 wk b/c placental immunity protects
61
congenital varicella syndrome
* fetal effects if varicella in 1st 20 wks
* limb hypoplasia
* cutaneous scars
* microcephaly
62
hepatitis B transmission
* blood, saliva, vag secretions, seme, breast milk
| * crosses placental barrier
63
hep B s/sx
* emesis
* abd pain
* jaundice
* fever
* rash
* painful joints
64
HIV and PG
* infant has 20-30% r/o contracting form mom w/o tx
| * prevention is only tx
65
zidovudine
* PO medication given to HIV+ mom @ 14 wks to prevent vertical transmission
* IV during labor
* elixir for newborn up to 6 wk
66
preventing HIV transmission to newborn
* zidovudine
* DONT BF
* elective C/S @ 38 wk
* DONT want ROM
67
rubella
* crosses placental barrier
* greatest risk in 1st trimester (SAb)
* can cause fetal deafness, retardation, IUGR, cardiac comp, microcephaly
68
cytomegalovirus (CMV)
* herpes family
* can cause fetal deafness, retardation, seizure, blindness, dental d/o
* tx infant w/ Gancyclovir
69
herpes virus
* vertical transmission as fetus descends or during birth
* C/S if active lesions
* if contracted in 1st 20 wks, SAB, IUGR, PTL
* tx: mom w/ acyclovir
70
parvovirus B19 (fifths dz)
* transplacental and respiratory secretions (daycare)
* maternal effects of "slapped face", arthralgia, malaise, SAb
* fetal effect: hydrops (U/S)
71
fetal hydrops
* immature erythrocytes replace hemolyzed erythrocytes
* placenta and fetal face become edematous
* can lead to uterine rupture
72
group beta strep neo/infant effects
•spesis
•pneumonia
•meningitis***
*crucial to screen mom @ 36 wks (vag swab)
73
GBS abx tx if...
* hx of infant w/ GBS
* GBS during current PG
* preterm birth
* maternal fever during labor
* ROM > 18 hrs
74
tuberculosis
•rare perinatal (infant has to aspirate amniotic fld)
•s/sx of FFT, lethargy, resp. distress, fever, large spleen/nodes/liver
•tx w/ Rafampin, INH and B6
*antiviral drugs contraindicated
75
why fetus at risk later in PG when exposed to external trauma
* less amniotic:fetal ratio
| * less cushion
76
most important for trauma during PG
•left lateral position
