first vist purpose
-obtain maternal Hx and physical examination
-disorders that place pregnancy at risk
-followed by subsequent visits to identify new ricks that my need special interventions (gestational diabetes, pre eclampsia)
define pre-gestation diabetes and the maternal and fetal risk
-diabetes diagnosed BEFORE onset of pregnancy
- maternal risk:
-ketacidosis
-proliferative retinopathy
-preeclampsia/eclampsia
2.fetal risk:
-fetal death 3rd trimester
-major structural malformations (congenital heart defects, central nervous system defects)
define gestational diabetes and the concerns and risk associated with it
-abnormal glucose tolerance of variable degree that occurs DURING pregnancy
-test is done @ 24-28wks
-complications:
1.macrosomia-birth weight > 4000g(8.8lbs)- (should dystocia)
-risk of infants:
1.hypoglycemia
2.hypocalcemia
3.hyperkalemia
4.hyperbilirubinemia
treatment: glucose control (diet/insulin)
what are some infection diseases that can be concerning during pregnacy
-group B stretpococcus
1. found in mothers vaginal or rectal flora
2.if positive give antibotics during labor to prevent transmission
-Herpes simplex virus (HSV)
1.if baby exposed: neurological damage or death
2.to reduce risk give mother antiviral meds if active, C section recommended
-Human immunodeficiency virus (HIV)
1.high risk of transmission
2.antiretroviral therapy during pregnancy, delivery and postpartum for new born
3.mother should not breast feed
-Hep B virus (HBV)
1.liver infections
2.newborns should recieve hep B vaccine and hep B immunoglobulin Herbig w/in 12 hrs of delivery
what is the most dangerous substance a fetus can be exposed to? and what are the risk
alcohol- causes malformation of the fetus
-consequences: fetal alcohol syndrome: mental retardation, pre/post growth restrictions, brain, cardiac, spinal, and craniofacial anomalies
what are the consequences of smoking during pregnancy
- carbon monoxide and nicotine mediate effects by decreasing availabile O2 to fetus and placenta
-lower birth weight- 200g or less vs non smokers
-higher risk of :
1.preterm rupture of membrane
2.placenta abruption (separation of placenta before birth)
3.placenta previa (placenta covers the cervix)
4. sudden infant death syndrome (SIDS)
what are the effects of cocaine during prenancy
-potent sympathomimetic action- vasoconstriction
- maternal complications:
-restricts blood flow of mother and fetus
-myocardial infaction
-stroke
-seizure
-bowl ischemia - fetal complications:
-placental abruption
-growth restrictions
-congenital malformation
define hypertension and the complications that arise from it
- 12-22% of pregnancies
-Complications: IUGR,Placenta abruption, preterm delivery - most severe conditions associated with hypertension is : preclampsia
define preclampsia and the predisposing factors
higher BP and organ dysfunction often involving kidneys and liver
factors that increase risk of pre:
1. Nullparity
-women never given birth before
2.advanced maternal age
-over 35 yrs old
3.fetal hydrops
-accessive fluid accumulates in fetus
4.chronic renal disease
when to know when preeclampsia has become severe?
-BP > 160/100= headaches
-proteinuria >5 g in q24 hrs
-oliguria <500ml q24hrs
-pilmonary edema-fluid build up
only tx: delivery of the fetus
if to early can try : magnesium sulfate and antihypertensive
what does the amniotic sac do for the fetus why is it important
-fetus is contained in sterile filed amniotic sac
-cushions fetus
-maintain stable temperature
-allows for movement and lung development
what happens if rupture of membrane occurs before term
-fetal exposure to infection
-choriamnionitis- infection of the amniotic sac that can threaten both maternal and fetal health
-low fluid in sac compression of umbilical cord compromises blood flow bw placenta and fetus
- cause of 35-40% of preterm births
what effects can abnomalities of the umbilical cord have
1.normally: two arteries and one vein
2.3% of preg only have one artery and one vein
-single artery associated with fetal structural and chromosomal anomalies and fetal growth restrictions
3.short umbilical cord: placental abruption and uterine inversion
4.long umbilcal cord:
-cord prolapse-delivery of cord before infant-compromise blood flow
-cord knots
-nuchal cord- cord wrapped around infants neck
define placental abruption and the risk factors that can lead to it?
-separation of placenta from implantation anytime before delivery
- partial or complete-abrupt cessation of gas exchange
-can lead to :
fetal hyopxia,acidosis,or death
mother-hemorrhage, coagulopathy
risk factors:
1.hypertenisve disorder
2.advance maternal age
3.multiparity
4.pretem premature of membrane
5.trauma
6.cigaretter smoking
7.cocain abuse
8.uterine leiomyoma- fibroids
define placenta previa and the risk factors that can lead to it
-occurs when the placenta implants over or close to the cervical opening
-complicates 1:300 deliveries
-c section is required
risk factors:
1.maternal age
2.multiparity
3.Prior c section deliveries
4.multiple gestations
define cervical insufficiency and the complications that occur from it and how to fix it
1.painless dilation of the uterine cervix in the 2nd trimester
complications:
1.infections
2.rupture of membrane
3.preterm labor
4. prolapse of fetal membrane through cervix into vagina ( amniotic sac bulge through dilated cervix)
fix: cervical cerclage: purse string suture placed high around cervix
define importance of amniotic fluid and what the normal AFI is and how its calculated
-provides protection,cushioning,support
-majority of fluid is fetal urination
-lungs help circulate it
normal AFI (8-18)
calculated: measure depth of largest vertical pocket of fluid at time of ultrasound
too much fluid=polyhydraminos
too little=oligohydramnios
define oligohyramnious
-low amniotic fluid
-AFI: < 5 cm
-associated with congenital anomalies
1.renal agenesis
2.Urinary tract obstruction
- cause:
1.lung hypoplasia (lung fail to develop properluy) and limb deformities
2. potter syndrome - no kidneys always fatal
define polyhydramnios
-overproduction of amniotic fluid
-AFI : >24cm
-cause:
1anencephaly: absence of major portion of brain,skull, scalp occurs during embryonic development
2. hydrops fetalis- fluid accumulation in atleast to fetal compartments
3.esophageal artesia- esophagus grows in two separate segments that do not connect
define preterm birth and the common complications associated with it
-delivery before 37 wks of gestation
-greatest cause for infant mortality
-major causes: premature rupture of fetal membrane (35-40%)
-12-14% experience complications including:
1.Bronchopulmonary dysplasia
2.IRDS
3.intraventricular hemorrhage (IVH)
4.retinopathy or prematurity (ROP)
5. necrotizing enterocolitis (NEC)
define fetal fibronectin and tocolytics
- glycoprotein produced in the chorion expressed in cervical and vaginal secretions
-acts as glue helping attach fetal sac to the uterine lining
-marker of preterm labor in symptomatic pt
-absence= preterm unlikely to happen w/in 1-2 weeks
-fix: tocolytic medications (helps prolong pregnancy)
what common and less common tocolytics are used for fetal fibronectin
common:
1.magnesium sulfate
2.b-mimetic agents (terbutaline)
3.indomethacine (prostaglandin inhibitor)
less common:
1.nifedipine
2.nitroglycerin
3.atosiban
why are corticosteroids the standard intervention of preterm labor, what are the commonly used one, and when are they recommended
-for induction of fetal lung maturity- accelerates lung development
-decrease incidence of intracranial hemorrhage
-induction of protein that regulate production of surfactant
-common steroids: betamethasone and dexamethasone
recommended:
1.bw 24-34 wks gestation with preterm labor and intact membrane
2.bw 24-32 wks gestation with ruptured membranes
define amniocentesis
-after 16 wks, this can be used to obtain amniotic fluid or genetic biochemical or other analysis
how its done:
- needle inset through skin and uterine wall
checks for:
1. fetal chromosomal abnormalities:
-trisomy 21-down syndrome
-SMN1 gene- spinal muscular atrophy
- fetal enzyme deficiencies
-tay sachs- disorder that affects nerve cells in the brain and spinal cord - fetal lung maturity (FLM)- babys lungs have developed enough to function outside womb
