Complications of Pregnancy

Study Guide/Notes

A. Diabetes Mellitus
- Also called Gestational Diabetes Mellitus (GDM)
- Defined as glucose intolerance of variable degree with onset or first recognition during
pregnancy.
- Risk assessment for GDM should be undertaken during the first prenatal period.
- Associated with an increased frequency of maternal hypertensive disorders and the
need for cesarean delivery
- May result from fetal growth disorders and/or alterations in obstetric management

High risk:

Patient with:

 Marked obesity
 Personal history of GDM
 Glycosuria
 Strong family history of diabetes

Diagnosis
 One-step Approach
- Perform aa diagnostic Oral Glucose Tolerance Test (OGTT)
 Two-step Approach
- Perform an initial screening by measuring the plasma or serum glucose concentration 1h
after a 50g oral glucose load (Glucose Challenge Test [GCT]) and perform diagnostic
OGTT on that onset of women exceeding the glucose threshold value on the GCT.
Treatment
 Close monitoring
 Tight control of blood glucose
 Management of complications
Goals:
 Fasting blood glucose levels at <95 mg/dL (<5.3 mmol/L)
 No wide blood glucose fluctuations
 Glycosylated hemoglobin (HbA1c) levels at <6.5%

Insulin

- Traditional drug of choice because it cannot cross the placenta and provides more
predictable control
- - minimizes antibody formation

Oral Hypoglycemic drugs

 - Are being increasingly used to manage diabetes in pregnant women because of the ease
of administration, low cost, and single daily dosing.
- Provides control equivalent to insulin for women with gestational diabetes.
B. Heart Disease
- Maternal heart disease includes high defects that are present at birth and acquired
heart disease later in life.
Complications
 Irregular heartbeat, known as arrhythmias
 Heart valve issues caused by increased blood flow
 Increased risk of endocarditis, an infection of the lining of the heart and heart
valves.
 The risk of blood clots and stroke,, as blood thinner use is adjusted during
pregnancy
 Congestive heart failure
 A congenital heart defect in the baby
 Higher-than-average risk of miscarriage, premature birth and poor fetal growth.

Risk

 Heart rhythm issues

 Heart valve issues
 Congestive heart failure
 Congenital heart defect

Diagnosis

 Echocardiogram
-type of ultrasound that uses sound waves to produce images of the heart and
structures of the heart.
 Electrocardiogram
-records the heart’s electrical activity

Signs and Symptoms

 Difficulty breathing
 Shortness of breath with exertion or at rest
 Heart palpitations, rapid heart rate or irregular pulse
 Chest pain
 A bloody cough at night
C. Renal Disorders
- Can range from asymptomatic bacteriuria to end-stage renal disease requiring dialysis,
all being influenced by the physiologic changes of pregnancy
- Maternal renal insufficiency may cause:
 Fetal growth restrictions
 Stillbirth
- After kidney transplantation, full term uncomplicated pregnancy is often possible if
women have all of the following:
  A transplanted kidney that has been in place for >2 years
 Normal renal function
 No episodes of rejection
 Normal blood pressure
 Delivery is usually required before term to avoid the development of preeclampsia, fetal growth
restrictions, or uteroplacental insufficiency.
Causes
- Preeclampsia
- HELLP (Hemolysis, Elevated Liver Enzyme Levels, Low platelet Count) Syndrome
D. Common Infections
 Rubella
- Also called German Measles
- Contagious viral infection best known by its distinctive red rash
- Can be passed from person to person
- Can be spread when the infected person coughs or sneezes or by direct contact with an
infected person’s respiratory secretions, such as mucus.
Symptoms
- Appears between 2 to 3 weeks after exposure to the virus
 Mild fever of 102 F (38.9°C) or lower
 Headache
 Stuffy or runny nose
 Inflamed, red eyes
 Enlarged, tender lymph nodes at the base of the skull the back of the neck and
behind the ears
 A fine, pink rash that begins on the face and quickly spreads to the trunk and
then the arms and legs, before disappearing in the same sequence
 Aching joints, especially in young women

Complications (to the baby)

 Growth delays
 Cataracts
 Deafness
 Congenital heart defects
 Defects in other organs
 Intellectual Disabilities

Prevention

- MMR (Mumps, Measles, Rubella) vaccine is usually given to prevent this kind of
infection.

MMR (Mumps, Measles, Rubella) Vaccine

- Is given to the children between 12 and 15 months of age, and again between 4 and 6
years of age.
 - Not recommended for pregnant women or women who plan to get pregnant after the
next 4 weeks.
 Influenza
- Also called flu
- Virus that can cause serious illness
- Can be passed from person-to-person through cough, sneeze, or speaking (It can spread
through the air)
- Pregnant women who get this kind of virus are more likely to have a preterm labor or
premature birth.
Influenza (flu) vaccine –(flu shot)
- Is given to help protect both the pregnant parent and the baby from the flu.
Symptoms
 Fever
 Cough
 Sore throat
 Runny or stuffy nose
 Body aches
 Headache
 Chills
 Fatigue

When to seek emergency medical care?

- Pregnant women should seek medical care when she experiences:

 Difficulty breathing or shortness of breath
 Persistent pain or pressure in the chest or abdomen
 Persistent dizziness, confusion, inability to arouse
 Seizures
 Not urinating
 Severe muscle pain
 Severe weakness or unsteadiness
 Fever or cough that improve but return to worsen
 Decreased or no movement of the baby
 Tuberculosis
- Infection that is caused by inhalation of viable bacili, which may persist in an inactive
state (known as Latent TB Infection [LTBI]) or progress to active TB
- Caused by bacterium called Myobacterium Tuberculosis
Symptoms
Active TB diseases
 Loss of appetite
 Weight loss
 Fever
 Night sweats
 Chills
 Weakness
 Pulmonary TB

 Cough
 Chest pain
 Hemoptysis

Complications

 Spontaneous abortion
 Preterm labor
 Low birth weight
 Increased neonatal mortality
 Mother-to-child transmission of TB may occur in the uterus through hematogenous spread
through the umbilical vein aspiration or swallowing the injected amniotic fluid
 Sexually Transmitted Disease
- Also called STI (Sexually Transmitted Infection)
- Includes chlamydia, gonorrhea, trichomoniasis, genital herpes, genital warts (HPV),
hepatitis B, HIV/Aids
- Infection that can be spread by having sex with someone who has STD
Risk
 Premature labor
 Infection in the uterus after birth

Effects to the baby

 Low birth weight (less than 5 pounds)

 Eye Infection
 Pneumonia
 Infection in the baby’s blood
 Brain damage
 Lack of coordination in body movements
 Blindness
 Deafness
 Acute hepatitis
 Meningitis
 Chronic liver disease
 Stillbirth

Symptoms

 Skin rash with or without pain

 Bumps, sores, or warts near the mouth, anus, penis, or vagina
 Swelling or redness near the penis or vagina
 Painful urination
 Weight loss, loose stool, night sweats
 Aches, pains, fever, and chills
 Yellowing of the skin (jaundice)
  Discharge from the penis or vagina
 Painful sex

Treatment

 HIV/Aids
- Medication
- Taking medications to prevent transmitting the virus to the baby
 Herpes
- Doctors may prescribe antiviral pills
- C-sections is recommended to prevent the transmission of the virus to the baby
 Gonorrhea
- Antibiotics
 HPV (Genital Warts)
- Can be delayed until after the delivery
- Surgery or medications
 Chlamydia
- Antibiotics
 Syphilis
- Antibiotics
 Hepatitis B
- The newborn will be given an injection of antibodies
 Trichomoniasis
- Medications