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68wm6 p2 Oth Com Pre
Other Complications of Pregnancy
| Question | Answer |
|---|---|
| Define Teratogen: | Agents in the fetal environment that either cause or increase the likelihood that a birth defect will occur. Most agents cross the placenta and affect the developing fetus |
| List 3 types of teratogen | *Infections *Ionizing Radiation *Maternal Hyperthermia *Pollutants *Effects of Maternal Disorders |
| When does exposure to teratogens begin? | Before conception |
| Define Oligohydramnios: | an abnormally small volume of amniotic fluid reduces the cushion surrounding the fetus and may result in deformations |
| What can prolonged oligohydramnios can interfere with? | fetal lung developement |
| What do fibrous amniotic bands result from? | tears in the inner sac (amnion) of the fetal membranes |
| What can fibrous amniotic bands result in? | can result in fetal deformations or intrauterine limb amputations (sometimes confused with birth defects) |
| What is the most common form of substance abuse? | Tobacco |
| What percentage of women smoke? | 11% |
| What maternal effects can tobacco use cause? | *Decreased placental perfusion *Anemia *PROM (Premature Rupture Of Membranes) *Preterm labor *Spontaneous abortion |
| What fetal effects can tobacco use cause? | *Prematurity *LBW *Fetal demise *Developmental delays *Increased incidence of SIDS *Neurologic problems |
| What is the most commonly used drug? | Alchohol |
| True or False: Once the mother metabolizes the alchohol, the fetus is safe. | False. The fetus cant metabolize it as fast as the mother, and alchohol remains present in the amniotic fluid for prolongued periods. |
| What are the maternal effects of alcohol? | Spontaneous abortion |
| What are the fetal effects of alcohol? | *CNS impairment *Recognizable combination of facial features *Prenatal and postnatal growth restriction |
| What are the recognizable combination of facial features in FAS? | *Microcephaly *Short palpebral fissures (the openings between the eyelids) *Flat midface with a low nasal bridge *Indistinct philtrum (groove between the nose and upper lip) |
| What is the most commonly used illicit drug? | Marijuana |
| What are the fetal effects of marijuana? | (unclear, more study needed) *Irritability *Tremors *Sleep problems *Sensitivity to light |
| What is the second most commonly used illicit drug? | Cocaine |
| What are the maternal effects of cocaine? | *Hyperarousal state *Generalized vasoconstriction *Hypertension *Increased spontaneous abortion *Abruptio placentae *Preterm labor *Cardiovascular complications *Seizures *Increased STDs |
| What are the fetal effects of cocaine? | *Intracranial bleeding *Stillbirth *Prematurity *IUGR *Irritability *Decreased interaction with environmental *Poor feeding reflexes *Decreased intellegence *Prune-belly syndrome caused by absence of abdominal muscles |
| What are the maternal effects of amphetamines? | *Malnutrition *Tachycardia *Vasoconstriction |
| What are the fetal effects of amphetamines? | *Withdrawal symptoms (Lethargy, Depression) *IUGR (intrauterine growth restriction) *Fetal death |
| What are the maternal effects of opiods? | *Spontaneous abortion *PROM *Preterm labor *Increased incidence of STDs, HIV exposure, and hepatitis |
| What are the fetal effects of opioids? | *IUGR *Perinatal asphyxia *Intellectual impairment *Neonatal abstinence syndrome *Neonatal infections *Neonatal death (SIDS, child abuse and neglect) |
| Most traumas during pregnancy occur because of what reasons? | *Accidents *Assault *Suicide |
| Although trauma during pregnancy may not be fatal, what may be found after birth? | infant neurologic deficits |
| What is the most common cause of fetal death in regards to trauma? | Death of the mother |
| While a mother suffering trauma is in bed, what can be done to increase bloodflow to placenta? | Place a wedge under one of the woman’s hips |
| What is the Priority for management of trauma OB patients? | Stabilize mother first, then fetus |
| What is FDA Pregnancy Risk Category A? | no evidence of risk to the fetus exists. |
| What is FDA Pregnancy Risk Category B? | animal reproduction studies have not demonstrated a risk to the fetus. No adequate and well-controlled studies have been done in pregnant women. |
| What is FDA Pregnancy Risk Category C? | animal reproduction studies have shown an adverse effect on the fetus, but no adequate, well-controlled studies have been done in humans. Potential benefits may warrant use of drug in pregnant women despite fetal risks. |
| What is FDA Pregnancy Risk Category D? | positive evidence of human fetal risk based on adverse reaction data, but potential benefits may warrant use of drug despite fetal risks |
| What is FDA Pregnancy Risk Category X? | positive evidence of human fetal risk based on human studies and/or adverse reaction date. Risks of using drug clearly outweigh potential benefits. |
| Fill in the blanks: The U.S. Food and Drug Administration (FDA) has assigned _______ ________ _______ to many drugs on the basis of their known relative safety or danger to the fetus | Pregnancy Risk Categories |
| What is A-1 gestational diabetes? | diet controlled |
| What is A-2 gestational diabetes? | diet and insulin controlled |
| In the case of pregnancy with pre-existing diabetes, there is increased incidence of what? | *Spontaneous abortions *Preeclampsia is 2x to 3x more likely *UTIs *Hydramnios and PROM *Injury to the birth canal *Cesarean birth rate *postpartum hemorrhage |
| Untreated ketoacidosis can lead to what? | fetal or maternal death. |
| The risk of congenital defects in infants is how much more likely in the diabetic population? | 2x to 6x more likely |
| What are the four major complications of pregnancy in the diabetic mother? | *Hypoglycemia *Hypocalcemia *Hyperbilirubinemia *Respiratory Distress Syndrome |
| If no history of pre-existing diabetes, when is a prenatal screening done for it? | Between 24 and 28 weeks of gestation? |
| How is a prenatal diabetes screening test done? | *Drink 50 gm of oral glucose solution (fasting isn't necessary) *Blood sample is taken one hour later *Blood glucose > 140 mg/dl, a 3-hour glucose tolerance test is done |
| In a pregnant woman with diabetes, how often are blood glucose levels taken? | 6 times a day and whenever symptoms of hypoglycemia are present. |
| In a pregnant woman with diabetes, how often is blood glucose checked during labor? | Every hour |
| What is the goal for glucose levels during labor? | between 80 and 110mg/dL |
| When are fetal assessments started in a pregnant mother with diabetis and why? | Started early since there is an increased risk of congenital abnormalities or fetal death |
| Heart disease complicates what percentage of all pregnancies? | 1% |
| What form of child delivery is recommended for a woman with heart disease? | Vaginal delivery |
| What can be used to mechanically assist with the birthing of the child? | Forceps or vacuum |
| What positions can the woman be placed in during labor to enhance respiratory effort and improve circulation? | semi-Fowlers or side-lying position |
| If the heart of a PT with pre-existing heart disease cannot meet demands of pregnancy, what heart condition can result? | cardiac decompensation and congestive heart failure |
| What is the hemaglobin level that is considered anemic during the 1st and 3rd trimester? | Less than 11g/dl |
| What is the hemaglobin level that is considered anemic during the 2nd trimester? | Less than 10.5g/dl |
| What is the total iron requirement during pregnancy? | 1000mg qDay |
| What are the S/Sx of maternal anemia? | *Pallor *Fatigue *Lethargy *Pica *RBCs are microcytic and hypochromic. |
| What does profound maternal anemia do to the fteus? | reduces fetal oxygen supplies. |
| What is folic acid important for in the developing fetus? | Folic acid is essential for synthesis of deoxyribonucleic acid (DNA), cell growth and duplication |
| What does a deficiency in folic acid result in? | a decrease in rate of DNA synthesis resulting in the presence of large immature RBCs (megaloblasts). |
| What are the best dietary sources of folic acid? | *Liver *Kidney beans *Lima beans *Fresh dark green leafy vegetables |
| Define Thalassemia: | Genetic disorder where there is an abnormality in one of two chains of hemoglobin, the alpha or the beta chain which leads to alterations in the RBC membrane and decreases the lifespan of the RBC |
| What are the two thalassemia traits? | *Beta Thalassemia Major (Cooley's anemia) trait: Usually fatal during young adulthood, survivors are usually sterile. *Beta Thalassemia Minor trait: These patients are only mildly anemic |
| What do woman with B-thalassemia cell disease need to be taught? | to seek care for infections promptly |
| What are the signs and symptoms of sickle cell crises? | severe pain, pyelonephritis and jaundice |
| What does TORCH stand for? | *Toxoplasmosis *Other diseases (hepatitis ect) *Rubella *Cytomegalovirus *Herpes simplex virus |
| Who are TORCH infections fatal to? | May not be serious for mom but devastating for fetus |
| What is Toxoplasmosis? | A protozoal infection (toxoplasma gondii) that is acquired by contact with cat feces, raw meat, or through placenta. It has mild flu like symptoms in the woman but is devastating for the fetus. |
| What are the fetal and neonatal effects of toxoplasmosis? | *Spontaneous abortion, still birth or neonatal death. *Blindness. *Retardation. *Congenital anomalies. *Enlarged liver and spleen. *Anemia. *Low birth weight. |
| What foods should a pregnant woman avoid to avoid toxoplasmosis? | *Avoid all undercooked meat. *Avoid uncooked eggs and unpasteurized milk. *Wash fresh fruits and vegetables before consuming. |
| How can Hepatitis B be transmitted? | *Blood *Bodily fluids *Breast milk *Readily crosses the placenta. |
| What are the fetal/neonatal effects of Hep B? | *Prematurity *Low birth weight *Chronic liver disease *Neonatal death |
| What is the supportive treatment of Hep B for the pregnant mother? | bedrest and a high protein, low fat diet |
| Infants born to women who are positive for hepatitis receives what within how long? | hepatitis B immune globulin followed by hepatitis B vaccine within 12 hours of birth |
| When do infants born to women who are positive for hepatitis receive vaccination? | *Within 12 hours of birth *At 1-2 months *At 6 months |
| How is rubella transmitted? | *Droplets *Contact with articles contaminated with nasopharyngeal secretions |
| When is rubella the greatest risk to the fetus? | during the first trimester |
| What are the fetal/neonatal effects of rubella? | *Spontaneous abortion *Deafness *Mental retardation *Congenital cataracts *Heart defects *Growth retardation *Microcephaly |
| Why is the newborn with rubella highly infectious? | because excretion of the virus is continuous for many months after birth and therefore poses a threat to other infants and susceptible adults |
| How long after rubella immunization should women not become pregnant, and why? | 2-3 months after immunization because of the risks to the fetus associated with the live vaccine |
| How is Cytomegalovirus transmitted? | *Bodily fluids *Breast milk *Stool *Crosses placenta |
| What are the fetal/neonatal effects of Cytomegalovirus? | *Mental retardation *Blindness *Seizures *Deafness *Enlarged spleen and liver *Jaundice *IUGR |
| What is the Tx of Cytomegalovirus? | No immunization or effective treatment is currently available |
| What must be done with infants with Cytomegalovirus? | Isolate infected infants because they continue to shed the virus in urine and saliva |
| How is herpes spread? | Transmitted by direct contact with infected lesions |
| What are the fetal/neonatal effects of herpes if mother has her first infection during pregnancy? | *Spontaneous abortion *Growth retardation *Preterm labor |
| Herpes infections at birth can result in what? | generalized infection with a 50% mortality rate |
| What are the S/Sx of herpes in the newborn? | *Unstable temperature *Lethargy *Poor feeding *Jaundice *Seizures *Lesions which resemble those of the adult |
| In the PT with herpes, what is necessary if there are active genital lesions at the time of labor? | C-section |
| True or False: Mothers with herpes should not breastfeed | False. Mothers may breastfeed as long as there are no active lesions on the breasts |
| What is the most common manifestation of maternal syphilis? | Chancre |
| What are the fetal/neonatal effects of syphilis? | *Spontaneous abortion *Pre-term labor *Stillbirth *Congenital defects |
| What STDs cannot be transmitted across the placenta, but instead require direct contact with vaginal fluids? | *Gonorrhea *Chlamydia *Trichomoniasis *Bacterial vaginosis *Candidiasis |
| gonorrhea eye infection can cause what? | Blindness (ophthalmia neonatorum) |
| What are the fetal/neonatal effects of gonorrhea? | Endocervicitis and weakness of the fetal membranes may cause premature rupture of the membrane or pre-term birth |
| What prophylactic Tx of Ghonorrhea and Chlamydia do ALL children get at birth? | Prophylactic eye treatment with erythromycin ointment at birth |
| What are the neonatal effects of chlamydia? | *Transmitted to the infant's eyes during birth resulting in neonatal conjunctivitis *Pre-term labor *Premature rupture of the membranes *Chorioamnionitis *Pneumonia |
| What are the neonatal effects of trichomoniasis? | Premature Rupture Of Membrane (PROM) |
| What are the fetal/neonatal effects of genital warts? | epithelial tumors of the mucous membranes of the larynx (Laryngeal papillomas) |
| What are the S/Sx of laryngeal papillomas in the neonate? | *Abnormal cry *Voice change *Hoarseness |
| What are the neonatal effects of candidiasis? | *Oral Thrush *Diaper rash *Edematous nails *Edematous tongue |
| What are the neonatal effects of bacterial vaginosis? | Fetus is usually unaffected |
| The pregnant woman with AIDS has what percentage of chance to transmit the virus perinatally? | 25%-35% |
| What are early S/Sx of AIDS? | *Weight loss and loss of appetite *Nausea/vomiting/diarrhea *Fever and night sweats *Cough, SOB and sore throat |
| What are the S/Sx of AIDS in the infant? | *Enlargement of the liver and spleen *Lymphadenopathy *Failure to thrive *Persistent thrush *Presence of chronic bacterial infections such as meningitis and pneumonia |
| What is the survival time of the infant with AIDS? | about 4 yrs |
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Shanejqb
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