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I. Heart Disease
y Pregnancy results in increased cardiac output, heart
rate & blood volume. y Normal heart is able to adapt to these changes without difficulty. y Woman with heart disease has decreased cardiac reserve, making it more difficult for her to handle the higher workload of pregnancy. y Cardiac disease complicates about 1% of pregnancies.
1.Congenital Heart Defects
y Most commonly seen in pregnant women include:
Atrial septal defect y Patent ductus arteriosus y Coarctation of aorta y Tetralogy of fallot -impact of pregnancy depends on the specific defect. -if the heart has been surgically repaired & no evidence of heart disease remains, the woman may undertake pregnancy with confidence. -woman with CHD who experience cyanosis should be counseled to avoid pregnancy because the risk to mother & fetus is high.
2. Rheumatic Heart Disease
y Results from an infection (caused by the bacteria,
streptococci) known as rheumatic fever, which starts with a sore throat & leads to the scarring of one or more heart valves. y The injured valves are unable to open & close normally, resulting in obstruction to the flow of blood. y Is it possible to become pregnant?
Throat cultures. Rapid Antigen. y 2. . y Isolate the organism before the initiation of antibiotic therapy to help confirm a diagnosis of streptococcal pharyngitis & to allow typing of the organism if it is isolated successfully.for group A streptococcus usually are negative by the time symptoms of rheumatic fever or RHD appear.this test allows rapid detection of group A streptococcal antigen & allows the diagnosis of streptococcal pharyngitis & the initiation of antibiotic therapy while the patient is still in the physicians office.Laboratory tests for detecting RHD: y 1.
. Anti-streptococcal Antibodies y -this is useful for confirming previous group A streptococcal infection. Antibody titer should be checked @ 2-week intervals in order to detect a rising titer.y 3.
. you ma develop breathing difficulty(dyspnea). y Can also cause abnormal leaking of blood through the valve between the left chambers of the heart ( a condition called mitral regurgitation). y If you have mitral stenosis.RHD y Causes different types of heart valve defects. swelling of the ankle & feet (edema). & irregular heartbeats (arrythmia). y Commonly causes narrowing of the valve between the left chambers of the heart (a condition called mitral stenosis) in women of child bearing age.
General measures to be followed once you become pregnant: y Make sure to keep your follow-up appointments with your obstetrician throughout your pregnancy. y Watch your weight. y Take adequate rest. y Stop smoking. . y Avoid alcohol. y Plan regular follow-up visits with your cardiologist. y Carefully follow all the recommendations of the cardiologist. y The diet should be nutritious & fluid & sodium intake should be restricted.
II. . lowers blood glucose levels by enabling glucose to move from the blood into muscle & adipose tissue cells. y Insulin.produced by B cells of Islets of Langerhans in the pancreas. results from inadequate production or use of insulin. Diabetes Mellitus y An endocrine disorder of carbohydrate metabolism.
y Without insulin.fails to produce insulin or does not produce enough insulin to allow necessary carbohydrate metabolism. fat metabolism causes ketosis. y Blood glucose level remains high (hyperglycemia) & the cells breakdown results in a negative nitrogen balance. .Pathophysiology y Pancreas. glucose does not enter the cells & they become energy depleted.
Polyphagia y 4. Polydypsia y 3. weight loss .Signs & Symptoms y 1. Polyuria y 2.
Type I diabetes.results from insulin resistance. y 3. y 2.Three main types of Diabetes: y 1. who have never had diabetes before.results from the body s failure to produce insulin. sometimes combined wit an absolute insulin deficiency.Type II diabetes. have a high blood glucose level during pregnancy. a condition in which cells fail to use insulin properly. .is when pregnant women. & presently requires the person to inject insulin.Gestational diabetes.
Diabetes on pregnancy outcome y The pregnancy of a woman who has diabetes carries a higher risk of complications. especially perinatal mortality & congenital anomalies. y Tight metabolic control reduces the risk. .
2. . Preeclampsia-eclampsia . Hydramnios -increase in the volume of amniotic fluid.occurs more often in diabetic pregnancies than in normal pregnancies.a result of excessive fetal urination because of hyperglycemia. occurs in 10% to 20% of pregnant women with diabetes.Maternal Risks y 1. y . y PROM & onset of labor may occasionally be a problem with hydramnios.
appears to result from high levels of fetal insulin. y Ex. .Fetal-neonatal risk y 1. skeletal system 2. Heart. Respiratory distress syndrome . which inhibit some fetal enzymes necessary for surfactant production. CNS. Congenital anomalies y -incidence is 5% to 10% & is the major cause of death of infants born to women with diabetes.
y 3.excessive number of RBCs y -due to the diminished ability of glycosylated hemoglobin in the mother s blood to release oxygen. Polycythemia y . .
using a team approach to ensure an optimally healthy mother & newborn.the nurse-educator plays a major role in this counseling.the woman with pregestational diabetes needs to understand what changes she can expect during pregnancy.woman needs clear explanations & teaching to gain her cooperation in ensuring a good outcome. . .Management y Antepartal y Prenatal care. . .
high fiber carbohydrates. Approximately 40% to 50% of the calories came from complex.on the first trimester she needs about 35 kcal/day of ideal body weight.the food is divided into 3 meals & 3 snacks. Bedtime snack is the most important & should include both protein & complex carbohydrates to prevent nightime hypoglycemia. Dietary regulation y . y . y . 20% from protein.the pregnant woman with diabetes needs to increase her caloric intake by absent 300 kcal/day. .y a. & 30% to 40% from fats.
c.Many women with gestational diabetes need insulin to maintain normal glucose levels. Human insulin should be used because it is the least likely to cause an allergic reaction.not rarely used .is essential to determine the need for insulin & to assess glucose control. Glucose monitoring y .y b. . Insulin Administration . Oral hypoglycemics.given either in multiple injections or by continuous subcutaneous infusion.
y Cesarean birth maybe indicated if signs of fetal distress exist.y Intrapartal y a. regardless of the type are allowed to go to term. Timing of birth. with spontaneous labor.most pregnant women with diabetes. y Some clinicians opt to induce labor in a woman at term to avoid problems related to an aging placenta. .
y Primary goal is to prevent neonatal hypoglycemia. y The saline solution is for piggybacking insulin or if a bolus is needed. y IV insulin is discontinued @ the end of the third stage of labor. Labor management y . one wit a 50% dextrose solution & one with a saline solution.y b. . y Often given two IV lines are used.maternal glucose levels are measured hourly to determine insulin need.
y The woman should be reassessed 6 weeks postpartum to determine whether her glucose levels are normal. If the levels are normal. she should be reassessed at a minimum of 3-year intervals. women wit pre-existing diabetes typically require very little insulin.Post partal Management y First 24 hours postpartum. y Antihyperglycemics are contraindicated during breastfeeding. . y They are usually managed with a sliding scale specifying dosage based on blood glucose levels.
amphetamines. family. Substance Abuse y Occurs when a person experiences difficulties with work. y Drugs that are commonly misused includes: -tobacco. club drugs. alcohol. barbiturates. & health as a result of alcohol or drug use. cocaine. hallucinogens. social relations. . heroin and narcotics.III. marijuana.
Substances commonly abused during pregnancy y 1.is a central nervous system depressant & a potent teratogen. increased incidence of infections. y The incidence of alcohol abuse is highest among women ages 20 to 40 years although alcoholism is also seen in teenagers. & liver disease. y Chronic abuse of alcohol can undermine maternal health by causing malnutrition. bone marrow suppression. . Alcohol.
y Alcohol dependence. y Care includes sedation to decrease irritability & tremors. y Delirium tremens may occur in the postpartal period & the newborn may suffer a withdrawal syndrome. . seizure precautions. IV fluid therapy for hydration & preparation for an addicted newborn.result is that a woman may have withdrawal seizures in the intrapartal period as early as 12 to 48 hours after se stops drinking.
ecstasy. . Cocaine & crack y Nearly 3% of pregnant women use illicit drugs such as cocaine. other amphetamines & heroin. y Cocaine use during pregnancy tends to affect between 1% & 5% of newborns. marijuana.y The effect of alcohol on the fetus may result in a group of signs known as fetal alcohol syndrome (FAS). y 2.
y This can be taken by IV injection or by snorting the powdered form.acts as the nerve terminals to prevent the reuptake of dopamine & norepinephrine. & hypertension. y Crack. . and cocaine mixed into a paste and microwaved to form a rock. tachycardia. Smoking crack leads to a quicker.y Cocaine. which in turn results in vasoconstriction. more intense high because the drug is absorbed through the large surface area of the lungs. water.a form of freebase cocaine that is made up of baking soda. can be smoked.
Major adverse maternal effects of cocaine use includes: y Hallucinations y Pulmonary edema y Cerebral hemorrhage y Respiratory failure y Heart problems .
dilated pupils. y Cocaine crosses into breastmilk and may cause symptoms in the breastfeeding infant. including extreme irritability. y Thus.y Women who use cocaine have an increased incidence of spontaneous abortion. vomiting. . and stillbirth. women who continue to use cocaine after childbirth should avoid breastfeeding. abruptio placentae. and apnea. preterm birth. diarrhea.
y More than 25% women of reproductive age admit to current or past marijuana use. memory. the pregnant women or new mother who uses marijuana may be at risk if she tries to perform tasks that require complex mental activities. y Marijuana use is associated with impaired coordination. and critical thinking ability.y 3. Marijuana. . y As a result.is the most widely used illicit drug among women. both pregnant and non pregnant.
better known as Ecstasy. . so called because they have become popular among adolescents and young adults who frequent dance clubs and raves . is the most commonly used of a group of drugs referred to as club drugs. MDMA (Ecstasy) y Methylenedioxymethamphetamine (MDMA). It produces euphoria and feelings of empathy for others.y 4. y Is taken by mouth usually as a tablet.
y The fetus of a heroin-addicted woman is at increased risk for IUGR.is an illicit CNS depressant narcotic that alters perception and produces euphoria. iron deficiency anemia. high-pitched cry. y The newborn frequently show signs of heroin addiction such as restlessness.y 5. and preeclampsia. irritability. fist sucking. and seizures. and hypoxia. vomiting. shrill. Heroin. meconium aspiration. . y Pregnancy in women who use heroin is considered high risk because of the increased incidence in these women of poor nutrition. It is an addictive drug that is generally administered IV.
y Prenatal exposure to methadone may result in reduced head circumference and lower birth weight. y Crosses the placenta and has been associated with preeclampsia. . placental problems. and abnormal fetal presentation.y 6. Methadone. y Blocks withdrawal symptoms and reduces or eliminates the craving for narcotics.is the most commonly used therapy for women dependent on opioids such as heroin.
Management y A team approach to the care of the pregnant woman with substance abuse problems ensures the management necessary to provide safe labor and birth for the woman and her child. . y Urine screening is also done regularly throughout the pregnancy if the woman has a known or suspected substance abuse problem. This testing helps to identify the type and amount of drug being abused. y The management of drug addiction may include hospitalization if necessary to start detoxification.
y Little is yet known about the effects of MDMA on pregnancy. However. jitteriness. y Infants exposed to ecstasy in utero may experience some of the same risks as infants exposed to other amphetamines during pregnancy. the timing of ecstasy used by the pregnant woman during fetal brain development may be critical issue. . including yhe possibility of withdrawal like symptoms such as drowsiness. and breathing problems.
y Women account for about 18% of cases in the U. .S. HIV/AIDS y Human immunodeficiency virus infection is one of today s major health concerns.IV. y It leads to a progressive disease that ultimately results in acquired immunodeficiency syndrome (AIDS).
. thereby decreasing the body s immune responses.Pathophysiology y HIV-1 enters the body through: Blood Blood products Or other body fluids such as semen. vaginal fluid and breastmilk .It affects T-cells.This makes the affected person susceptible to opportunistic infections such as Pneumocystis carinii .
. y Can be detected within 6 mos after exposure. the individual develops antibodies that can be detected with the enzymelinked immunosorbent assay (ELISA) & confirmed with the Western Blot test. y Asymptomatic lasting from a few mos to as long as 17 years.y Once infected with the virus. y Diagnosis of AIDS is made when a person is HIV positive & has one of several specific opportunistic infections.
Maternal Risks y Many women who are HIV positive choose to avoid pregnancy because of the risk of infecting the fetus & the possibility of dying before the child is raised. . that the use of antiretroviral (ARV) therapy during pregnancy significantly reduces the risk of transmitting the HIV-1 to the fetus. y Women who become pregnant should be advised that pregnancy is not believed to accelerate the progression of HIV/AIDS. and that most medications used treat HIV can be taken during the pregnancy.
usuall due to perinatal transmission. at birth when the infant is exposed to maternal blood and vaginal secretions.Fetal-Neonatal Risks y HIV/AIDS may develop in infants whose mothers are seropositive. via breastmilk. . y Perinatal transmission occurs transplacentally.
Management y Combination of ARV therapy suppresses viral replication. . y Usually consists of two nucleoside analogues reverse transcriptase inhibitors and a protease inhibitor. helps preserve immune function. and reduces the development of resistance. y Zidovudine (ZDV) is perhaps the best known of the nucleoside analogues.
and the risks of ARV therapy is not well known. y Because the fetus is most susceptible to teratogenic effects during the first 10 weeks of pregnancy. careful monitoring for pregnancy complications and possible toxicities.y Pregnant women who are currently on ARV therapy should continue their provider-recommended regimen and should receive regular. women in 1st trimester might elect to delay therapy until after 12 weeks gestation. .
y This regimen includes: 1.y To reduce the risk of perinatal transmission. all pregnant women with HIV infection should be offered the three-part ZDV prophylaxis regimen beginning after the first trimester. . Oral ZDV for the infant starting 8 to 12 hours after birth and continuing for 6 weeks. Oral ZDV daily 2. Intravenous ZDV during labor until birth 3.
HIV infected women are monitored for early signs of complications. the woman who is HIV positive should be assessed regularly for serologic changes indicating that HIV/Aids is progressing. y In addition to routine prenatal testing.y At each prenatal visit. asymptomatic. such as weight loss in the second or third trimester or fever. . y Each trimester the woman should have a visual examination and examination of the retina to detect such complications as toxoplasmosis.
. y Thus.y A pregnancy complicated by HIV infection. poor wound healing and infections of the genitourinary tract. and the fetus is monitored closely. y Women who are HIV positive are at increased risk for complications such as intrapartal or postpartal hemorrhage. postpartal infection. is considered high risk. even if asymptomatic. they need careful monitoring and appropriate therapy as indicated.
y HIV positive woman should be cautioned against breast feeding her infant. .
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