MEDICAL CONDITIONS DURING
PREGNANCY
Diabetes Mellitus
- occurs before pregnancy
Gestational Mellitus
- occurs during pregnancy
● 50g of oral glucose
● GM Screening - 2nd trimester (24-28
weeks)
○ FBG - fast blood glucose
FUNCTIONAL CLASSIFICATION
GRAVIDO CARDIACS
Class I
● mother is asymptomatic
● mother can bear down
Class II
● slight limitation of activity
● anginal pain, & dyspnea
● ordinary activity causes fatigue
● decreased activity
Class III
● marked limitation of physical activity
● less than ordinary activity causes
fatigue, palpitation, dyspnea, or
anginal pain
Class IV
● inability to carry on any physical
activity without discomfort
● symptoms of heart failure or the
anginal syndrome may be present
even at rest
● If any physical activity is undertaken,
discomfort is increased.
COMPLICATIONS OF PREGNANCY
➔ Substance Abuse
➔ Alcohol
➔ Smoking
➔ Drugs
INFECTIONS
T - toxoplasmosis
O - other (sexually transmitted infections)
R - rubella
C - cytomegalovirus
H - herpes simplex virus
TOXOPLASMOSIS
● due to contaminated meat, feces of
animals: cats, rabbits, fowl, birds
● 1st trimester highest effects on the
fetus includes
OF ● early abortion
● asymptomatic at birth but later would
manifest
● inflammation of retina to
convulsions, coma, hydrocephalus,
blindness, deaf, retardation and
death
OTHER INFECTIONS
CHLAMYDIA / GONORRHEA
- doesn't pass the placenta only in vaginal
canal
- Ophthalmia Neonatorum can occur
- Prevention is by giving Crede's
Prophylaxis: administration of erythromycin,
terramycin, 2.5% povidone iodine
SYPHILIS
- affects the baby on the 2nd trimester or
16th weeks onwards
- Effect on fetus: craniotabes, Hutchinson's
teeth, mental retardation, neonatal mortality
- Treatment" 1st trimester --- Penicillin
AIDS
- mother (+) ; baby (-) = do not breastfeed
- mother and baby (+) = okay to breastfeed
INFECTION ON PREGNANCY
- infant born with infection are contagious
and need to be in isolation
- no harmful effects on the 3rd trimester
- fetotoxic
- give gamma globulin
RUBELLA ● incompetent cervix due to habitual
● German measles abortion (3-4x)
● teratonic on the 1st and 2nd ● trauma, injury
trimester causes PDA, cataract, ● congenital problem of the cervix
IUGR, mental retardation or cerebral
palsy, hyperbilirubinemia, SPONTANEOUS ABORTION
encephalitis THREATENED
- can still save the pregnancy
CMV (cyto-megalo-virus) - the cervix is not dilated, and the placenta
● relative of AIDS, herpes group is still attached to the uterine wall, but some
● most common cause of congenital bleeding occurs.
infection in the US infection 2% of all INEVITABLE/IMMINENT
newborns - can't save the pregnancy
STD ON PREGNANCY - placenta has separated from the uterine
- about 10% are affected wall, the cervix has dilated, and the amount
- crosses the placenta and cervical route of of bleeding has increased.
exposure
- get from kissing, breastfeeding, COMPLETE - oxytocin administration for
intercourse complete involution
- mortality rate of newborns with INCOMPLETE
symptomatic disease is 30% - D&C for RPF
- child may be SGA, microcephaly, - the embryo or fetus has passed out of the
hydrocephaly, cerebral palsy uterus, but the placenta remains
MISSED
HERPES SIMPLEX - fetus dies in the utero
● can affect pregnant women because - may be due to DIC, abdominal, ectopic
their resistance is low; eruptions can pregnancy
occur Stage 1: Maceration - general
● HERPES SIMPLEX I - eyes softening of the skin
● HERPES SIMPLEX II - lips Stage 2: Mammification - leather
like skin
1st TRIMESTER COMPLICATIONS Stage 3: Lithopedion - stone hard
● Bleeding mass
● Abortion INDUCED ABORTION
○ Ectopic Pregnancy - therapeutic abortion happens when the life
○ Hyperemesis Gravidarum of the mother and the fetus is at stake (due
○ Hydatidiform Mole to ectopic pregnancy or cancer of the
reproductive structure)
ABORTION - termination of the pregnancy - criminal abortion is punishable by law
before the age of viability
Due to the ff factors: ECTOPIC PREGNANCY - pregnancy
● defective embryo outside the uterine cavity (tubal pregnancy)
● decreased progesterone S & S of pregnancy
● infection ● rupture at 6-12 weeks
 ● severe pain PREGNANCY INDUCED HYPERTENSION
● brownish discharge ➢ Pre-eclampsia - high blood pressure
● lower quadrant pain ➢ Eclampsia - pre-eclampsia with
● stabbing knife like pain convulsions/seizures
● shock
● Appears before 20th week of
Watch out for internal bleeding: pregnancy
● Cullen's sign - bluish discoloration ● HEPA - hypertension, edema,
around the umbilicus proteinuria, albuminuria
● Referred pain - due to compression ● Pre-eclampsia is due to generalized
of the phrenic nerve vasospasm
● Grand Mal Convulsion: Aura, Tonic,
HYPEREMESIS GRAVIDARUM Clonic, Coma
- persistent, uncontrolled vomiting on the 1st ● turn patient to side for convulsion to
trimester prevent aspirations (saliva)
- Cause: unknown, may be high hCG or Mild pre-eclampsia
psychological problem --- hydatidiform mole, ● Hypertension 140/90 or increase of
multiple pregnancy 30mmHg in systolic & 15mmHg
diastolic
BLIGHTED OVUM ● starts and ends with empty bladder -
- also called an anembryonic pregnancy, 24 hours urine collection (proteinuria
occurs when an early embryo never albuminuria) -- 300 mg/L or 3g/L
develops or stops - developing, is resorbedd Severe Pre-eclampsia
and leaves an empty gestational sac. ● BP 160/110 or higher
- May be due to chromosomal abnormalities ● Albumin in 24 hour urine collection
in the fertilized egg. — 5g/L
● HELLP - hemolysis, elevated liver
HYDATIDIFORM MOLE enzymes, low platelet
- anomaly in the development of the ● PIH Severe Preeclampsia
placenta wherein the chorionic villi is Management:
converted into vesicles. ○ dark light -
● CHORIOCARCINOMA extrauterine seizure/convulsions
malignant growth precaution
● Etiology: unknown, common among ○ quiet environment
Orientals (Filipino and Chinese) ○ activity restriction
● brownish discharge appears on the ○ Magnesium Sulfate —
12th week of pregnancy anticonvulsant &
antihypertensive
2nd TRIMESTER COMPLICATIONS ■ Acts as a CNS
● HYPERTENSIVE DISORDERS IN depressants,
PREGNANCY vasodilator, diuretic
● GESTATIONAL HYPERTENSION ○ MgSO4: bolus dose 10 gm is
● PREGNANCY INDUCED equivalent to 40mL given per
HYPERTENSION IM
 ■ Calcium Gluconate Types of Placenta Previa
(10 mg of 10% 1. Marginal
solution) - antidote for 2. Complete
MgSO4 3. Low-lying

3rd TRIMESTER COMPLICATIONS HYDRAMNIOS

- Pelvic ultrasound and amniotic fluid
PREMATURE RUPTURE OF index
MEMBRANES (PROM) - Polyhydramnios - excessive
● gestational age: more than 36 weeks amniotic fluid surrounding the fetus
deliver if: ● OLIGOHYDRAMNIOS - below 300
○ ripe cervix less than 2cm; less than 5 at AFI
○ abnormal FHT ○ Cord compression
○ meconium stained fluid ○ Fetal distress
○ possible infection ○ Fetal pulmonary hypoplasia
○ abnormal presentation ● POLYHYDRAMNIOS - above 2000
● gestational age: between 32-35 greater than 8cm; greater than 24 at
weeks deliver AFI
● diagnosis is made when there is ○ Preterm labor
cramping and vaginal discharge on ○ PROM
20 and 37 weeks gestation ○ Perinatal death
○ (tocolytics -acts by
depressing smooth muscle) PROLAPSE CORD
- Cord collapsed first before the
ABRUPTIO PLACENTA delivery
- normally implanted placenta - Trendelenburg, knee chest
- Sudden sharp pain at fundus, Types of Prolapse Cord
bleeding dark red 1. Occult Prolapse
- Couvallaire uterus-board like rigidity 2. Front Prolapse
Types of Abruptio Placenta 3. Vaginal Cord Prolapse
1. Concealed - center is separated first;
Shultz mechanism DYSTOCIA
2. Overt / Marginal - there is overt - Difficult labor
bleeding; Duncan mechanism Stage 1: from onset of labor until full dilation
of cervix
PLACENTA PREVIA ● Latent Phase: 0-4 cm
● Low lying placenta ● Active Phase: 4-8 cm
● Bright red bleeding, soft uterus, ● Transition: 8-10 cm
painless vaginal bleeding Stage 2: from full dilation of cervix to birth of
● Possible pregnancy outcome is baby
Preterm Stage 3: from birth of baby to expulsion of
● pale, cool and clammy (skin color) placenta
● Trendelenburg, left side lying Stage 4: time after birth (usually 1-2 hours)
of immediately recover
DURATION OF LABOR Cardinal Mechanism of Labor
- Regular, progressive uterine 1. Engagement / Descent
contractions 2. Flexion
- Progressive effacement and dilation 3. Internal Rotation
of cervix 4. Extension
- Progressive descent of presenting 5. External Rotation
part ○ If not able to rotate fully —
Average Length consistent occiput posterior
1. Primipara (COP)
○ Stage 1: 12-13 hours
○ Stage 2: 1 hour PASSAGEWAY
○ Stage 3: 3-4 minutes ● Small contracted pelvis
○ Stage 4: 1-2 hours ● Distance between the ischial spines
2. Multipara is equal to or less than 9 cm
○ Stage 1: 8 hours ○ head of baby - 11 cm
○ Stage 2: 20 minutes
○ Stage 3: 4-5 minutes PERSON/PSYCHE
○ Stage 4: 1-2 hours ● Preparation of the mother is
essential
POWER ● Prolonged labor can cause
● Primary - involuntary uterine Mother
contraction should be present during ○ Exhaustion
labor ○ Dehydration
● Secondary - abdominal contraction ○ Infection
which is voluntary and should be Fetus
present after labor is established ○ distress
Types of Uterine Contractions
1. Hypotonic contractions - late PRECIPITATE LABOR
contraction, slowed; infrequent; - labor that is quick and short
active (<10 mmHg) - Takes place 3 hours or less
2. Hypertonic contractions - tetanic - 2nd stage of labor: perform modified
contraction that is continuous and Ritgen’s maneuver by supporting the
fast; frequently; latent (30-40 mmHg) lower perineum with towel to prevent
3. Uncoordinated contractions - laceration
erratically
TWINS
PASSENGER ● IDENTICAL - MONOZYGOTIC
● Head is big ○ 2 amnion - 2 cord
● Heavy or big baby ○ 1 chorion - 1 placenta
● Breech presentation ● FRATERNAL - DIZYGOTIC
● Most favorable position for child is ○ 2 amnion - 2 cord
ROA/LOA (right occiput anterior & ○ 2 chorion - 2 placenta
left occiput anterior)
POSTPARTUM HEMORRHAGE
- one of the primary causes of
maternal mortality
- vaginal birth: more than 500mL of blood
loss
- cesarean birth: 1000mL blood loss
UTERINE ATONY - failure of the uterus to
contract following delivery.
LACERATIONS - small lacerations or tears
of the birth canal; large lacerations can be a
source of infection or hemorrhage.
RETAINED PLACENTAL FRAGMENTS -
placenta does not detach in its entirety;
fragments of it separate and are left still
attached to the uterus.
UTERINE INVERSION - uterus turning
inside out.
DISSEMINATED INTRAVASCULAR
COAGULATION (DIC) - deficiency in
clotting ability caused by vascular injury.
SUBINVOLUTION - incomplete return of
the uterus to its prepregnant state.
PERINEAL HEMATOMAS - collection of
blood in the subcutaneous layer of tissue in
the perineum.
PUERPERAL INFECTIONS - occurs when
bacteria infect the uterus and surrounding
areas after birth.
ENDOMETRITIS - infection of the
endometrium, the lining of the uterus.
PERITONITIS - infection of the peritoneal
cavity; occurs as an extension of
endometritis.
PHLEBITIS - inflammation of the lining of a
blood vessel.
THROMBOPHLEBITIS - inflammation with
the formation of blood clots.
● Femoral Thrombophlebitis - milk
leg or phlegmasia alba dolens
(“white inflammation”)
● Pelvic Thrombophlebitis - involves
the ovarian, uterine, or hypogastric
veins.
● Pulmonary Embolus - obstruction
of the pulmonary artery by a blood
clot.
MASTITIS - inflammation of breast tissue.
Classification of Mastitis
1. Lactational Mastitis - known as
puerperal mastitis; caused by either
prolonged engorgement or blockage
of milk ducts that could cause
infection.
2. Non-Lactational Mastitis - caused by
an abnormal growth of breast cell
tissues.
URINARY SYSTEM DISORDERS
● Urinary Retention
● Urinary Tract Infections
CARDIOVASCULAR SYSTEM
DISORDERS
● Postpartal Preeclampsia
REPRODUCTIVE SYSTEM DISORDERS
● Reproductive Tract Displacement
- no longer maintain the uterus in its
usual position or level after
pregnancy.
○ Cystocele (prolapse bladder)
○ Enterocele (prolase small
intestines)
○ Rectocele (prolapse rectum)
● Separation of the Symphysis
Pubis - ligaments of the symphysis
 pubis may be stretched by birth they
actually tear.

EMOTIONAL & PSYCHOLOGICAL

COMPLICATIONS OF THE PUERPERIUM

POSTPARTAL DEPRESSION - feelings of

sadness after birth (postpartal ‘blues’)

POSTPARTAL PSYCHOSIS - illness

coincides with the postpartum period or
occurs during the following year;
exceptionally sad (person has lost contact
with reality)