Salo, Redeemer Maagad February 1, 2024

NUR2A

Task 2: Gestational Diabetes/ RH Incompatibility / Anemia/ DIC

1. What effect will this have on the concentration of red blood cells and hemoglobin in the
pregnant woman’s blood, compared to her non-pregnant self?

- Gestational Diabetes, Rh Incompatibility, and Anemia can all have distinct

effects on the concentration of red blood cells (RBCs) and hemoglobin in a
pregnant woman's blood compared to her non-pregnant state. Gestational
Diabetes may not directly affect these parameters, but uncontrolled diabetes can
lead to changes in blood viscosity. Rh incompatibility does not necessarily
influence RBCs or hemoglobin in the pregnant woman but can result in
hemolytic disease of the newborn if not managed, impacting the newborn's
RBCs. Anemia, characterized by low RBCs and hemoglobin, is often more
prevalent during pregnancy due to increased blood volume and demands.
Iron-deficiency anemia is common, necessitating vigilant monitoring and
supplementation. Overall, while gestational diabetes and Rh incompatibility may
not directly impact these blood parameters, anemia is a common
pregnancy-related concern, emphasizing the importance of proper monitoring
and intervention to ensure maternal and fetal well-being.

2. Why is it important for pregnant women to have more iron-rich foods in their diet, or
take iron tablets?

- It is crucial for pregnant women to incorporate more iron-rich foods into their
diet or take iron supplements due to the increased demand for iron during
pregnancy. Iron is essential for the production of hemoglobin, the protein in red
blood cells responsible for transporting oxygen to cells and tissues, crucial for the
growing fetus and the mother. Pregnancy significantly expands blood volume,
and the developing fetus requires iron for its own blood supply. Inadequate iron
intake can lead to iron-deficiency anemia, associated with fatigue, weakness, and
an increased risk of preterm birth and low birth weight. To prevent these
complications and support optimal maternal and fetal health, healthcare
providers often recommend increased iron consumption or supplementation
during pregnancy. Regular prenatal care and adherence to nutritional
recommendations can help ensure that pregnant women meet their iron
requirements for a healthy pregnancy outcome.

3. What conditions are necessary for a woman to receive Rho(D) immune globulin? What
does each mean?

a. Rh factor of the woman

- Rho(D) immune globulin, also known as RhIg or Rhogam, is administered
to Rh-negative pregnant women during pregnancy and postpartum. It is
necessary when the woman is Rh-negative, and there is a possibility of Rh
incompatibility with an Rh-positive fetus. RhIg is typically given around
28 weeks of pregnancy and within 72 hours of childbirth, miscarriage,
abortion, or any event where there's a risk of Rh-positive fetal blood
 entering the Rh-negative mother's circulation to prevent the development
of Rh incompatibility issues in future pregnancies.

b. Rh factor of the fetus or newborn

- Rho(D) immune globulin, also known as RhIg or Rhogam, is administered
to Rh-negative pregnant women in the presence of specific conditions. It
is crucial when the mother is Rh-negative, and there is a risk of Rh
incompatibility with an Rh-positive fetus. RhIg is typically given around
the 28th week of pregnancy and within 72 hours after the delivery of an
Rh-positive baby, a miscarriage, induced abortion, or any other event
where fetal blood might mix with the mother's bloodstream to prevent the
mother from developing Rh antibodies that could affect subsequent
pregnancies with Rh-positive babies.

c. Indirect Coombs’ test (woman)

- A woman receives Rho(D) immune globulin if she has a negative indirect
Coombs' test and is Rh-negative. This situation typically arises when an
Rh-negative woman is carrying an Rh-positive fetus. Rho(D) immune
globulin, commonly administered around 28 weeks of gestation and
postpartum, helps prevent the development of Rh incompatibility issues
by suppressing the mother's immune response to Rh-positive blood cells,
reducing the risk of hemolytic disease of the newborn in subsequent
pregnancies.

d. Direct Coombs’ test (newborn)

- A woman will receive Rho(D) immune globulin (RhIg) if she is
Rh-negative and is carrying an Rh-positive baby. This is necessary to
prevent Rh isoimmunization, a condition where the mother's immune
system produces antibodies against the Rh-positive blood cells of the
baby, which can lead to hemolytic disease of the newborn (HDN). The
direct Coombs test for the newborn is performed if there are signs of
hemolysis, such as jaundice, to detect the presence of antibodies coating
the baby's red blood cells, which may indicate Rh isoimmunization and
the need for appropriate medical intervention.

4. How does diabetes alter food metabolism during pregnancy?

a. Early pregnancy
- During early pregnancy, diabetes can alter food metabolism by affecting
insulin sensitivity and glucose regulation. In women with pre-existing
diabetes or gestational diabetes, insulin resistance may increase,
requiring higher insulin levels to manage blood glucose. This altered
metabolism can result in challenges with glucose utilization, potentially
leading to higher blood sugar levels and necessitating careful dietary
management and, in some cases, insulin therapy to support a healthy
pregnancy.
 b. Late pregnancy
- In late pregnancy, diabetes can alter food metabolism by leading to
insulin resistance, where the body's cells become less responsive to
insulin. As a result, higher levels of insulin are required to regulate blood
sugar. This insulin resistance can contribute to increased fat storage,
leading to elevated maternal glucose and triglyceride levels, potentially
impacting fetal growth and increasing the risk of complications such as
macrosomia (excessive fetal growth) and gestational diabetes.

5. Why is maintenance of a normal blood glucose level before and during early pregnancy
particularly important?

- Maintenance of normal blood glucose levels before and during early pregnancy is
crucial for several reasons. Firstly, elevated blood glucose levels in the early
stages of pregnancy, especially during organ development, can increase the risk
of birth defects. Secondly, poorly controlled blood sugar increases the risk of
miscarriage and preterm birth. Lastly, maintaining normal blood glucose levels is
essential for reducing the risk of gestational diabetes, a condition that can lead to
complications for both the mother and the developing fetus.

6. What routine assessments will be made at each prenatal visit for pregnancy client high
risk for gestational diabetes?
- For a pregnancy client at high risk for gestational diabetes, routine assessments
at each prenatal visit may include regular monitoring of blood glucose levels
through glucose tolerance tests. Additionally, healthcare providers will likely
assess weight gain, blood pressure, and check for signs of gestational
diabetes-related complications, such as excessive amniotic fluid or fetal growth
abnormalities. Close monitoring of the client's overall health and blood sugar
levels is essential to manage and mitigate the risks associated with gestational
diabetes.

7. Describe altered laboratory test results that may be seen in disseminated intravascular
coagulopathy (DIC).
a. Fibrinogen
- In disseminated intravascular coagulation (DIC), altered laboratory test
results related to fibrinogen include decreased levels. As DIC progresses,
widespread activation of the coagulation system leads to excessive
consumption of clotting factors, including fibrinogen, resulting in a
decline in its concentration. Monitoring fibrinogen levels is crucial for
diagnosing and managing DIC.

b. Platelets
- In disseminated intravascular coagulation (DIC), altered laboratory test
results related to platelets include decreased platelet counts. The
widespread activation of coagulation and consumption of platelets in the
formation of microthrombi contribute to thrombocytopenia, a
characteristic finding in DIC. Monitoring platelet counts is crucial in
assessing the severity of DIC and guiding treatment strategies to address
 both bleeding and thrombotic tendencies associated with this complex
coagulation disorder.

c. Prothrombin time (PT)

- In disseminated intravascular coagulation (DIC), altered laboratory test
results related to Prothrombin time (PT) typically show an elevated PT.
DIC is characterized by widespread activation of the coagulation system,
leading to the consumption of clotting factors, including prothrombin.
The increased PT reflects impaired blood clotting and is indicative of the
coagulopathy observed in DIC.

d. Activated partial thromboplastin time (aPTT)

- In disseminated intravascular coagulation (DIC), altered laboratory test
results related to activated partial thromboplastin time (aPTT) include
prolonged clotting times. DIC leads to the consumption of clotting
factors, resulting in insufficient levels for normal clot formation and
elongated aPTT values. Prolonged aPTT is indicative of the coagulation
system's dysregulation and is often observed in the context of DIC.

e. D-dimer
- In disseminated intravascular coagulation (DIC), elevated levels of
D-dimer are commonly observed. D-dimer is a fibrin degradation product,
and its increased concentration indicates ongoing activation of the
coagulation system and fibrinolysis, reflecting the widespread formation
and breakdown of blood clots seen in DIC. Elevated D-dimer levels are a
key diagnostic marker for DIC, aiding in its recognition and management.