MWC02 2021 2022 Module 3

SOUTHERN LUZON STATE UNIVERSITY
COLLEGE OF ALLIED MEDICINE
MODULE 3: Managing complications in

pregnancy: third trimester
Diseases affecting pregnancy
Module 3
Course Description
This course deals with the concepts of

complications of pregnancy, labor and delivery, its
causes and management of childhood diseases
and family planning.
[Class schedule]
Wednesday | Thursday| Friday 8:00-12:00; 1:00- 5:00
Dear Students
This module is dedicated to the students of Southern
Luzon State University at College of Allied Medicine in
support to distant learning during this time of pandemic,
we hope that the students who read this book will prepare
you to shape your future in health care.
M- 102 ( Pathologic Obstetrics, Basic Gynecology, Family Planning Technology, Care Infants and Feeding)Prepared
by: Dr. Lorna L. Cano, RN, RM; MAN– SY 2021-2022
Module 3
Corner Villa Aurea

Subdivision, Barangay
Domoit Lucena City 4301
0943 070 6995
lornacano11@gmail.com
https://
classroom.google.com/ Overview
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MjM1NjAxODQwMTgw
This module highlighted the complications of pregnancy during third trimester, the different
diseases that affects the pregnant woman during pregnancy . The Center for Disease Control and
Prevention (CDC) , mentioned that complications of pregnancy are health problems that occur during
pregnancy. They said that, it involve mother’s health, the baby’s health or both. Some women have
health problems that arise during pregnancy and other women have health problems before they
become pregnant that could lead to complications. It is very important for women to receive health
care before and during pregnancy to decrease the risk of pregnancy complications.
CDC, stated that pregnancy and complications can range from mild and annoying discomforts
to severe, and sometimes life-threatening illness. They said that, problems during pregnancy may
include physical and mental conditions that affect the health of the mother and baby. These problems
can be caused by or can be made worse by being pregnant.
Keep in mind that there are ways to manage problems that come up during pregnancy.
Learning objectives
Module 3 have studied this module , you should be able to:

When you
● Define terms related to complications of pregnancy during third trimester , different diseases
that affect pregnancy.
● Enumerate general assessment of mother complications with confidence.
● Identify the different complications of pregnancy during third trimester and it’s diseases that
affect pregnancy.
● Differentiate signs and symptoms of the complication of pregnancy during first and second
trimester.
● Assess mother with complications of pregnancy during third trimester and it’s diseases that
affect pregnancy.
Discussion
Module 3 CARDIAC DISEASE
Rheumatic Heart Disease
This is the most common cardiac problem. It causes inflammation and scarring of the heart valves
and results in valve stenosis * namaga bag karuon ng bacteria. The mitral valve is most often affected with
stenosis, This condition classically remains asymptomatic and is often diagnosed for the first time during
pregnancy.
Most women with valvular heart disease can be managed medically with the use of or digoxin. drugs
such as: diuretics, beta blocker.
Those with more severe symptomatic disease may require surgical intervention such as valvoplasty or valve
replacement, although both of these procedure carry a degree of maternal and felt mortality.
These are the most common symptoms of rheumatic fever:
Fever
Swollen, tender, red and extremely painful joints — particularly the knees and ankles
Nodules (lumps under the skin)
● Red, raised, lattice-like rash, usually on the chest, back, and abdomen
● Shortness of breath and chest discomfort
● Uncontrolled movements of arms, legs, or facial muscles
● Weakness
Symptoms of rheumatic heart disease depend on the degree of valve damage and may include:
● Shortness of breath (especially with activity or when lying down)
● Chest pain
● Swelling
Some complications of rheumatic heart disease include:
● Heart failure. This can occur from either a severely narrowed or leaking heart valve.
● Bacterial endocarditis. This is an infection of the inner lining of the heart, and may occur when
rheumatic fever has damaged the heart valves.
● Complications of pregnancy and delivery due to heart damage. Women with rheumatic heart
Moduledisease
3 should discuss their condition with their healthcare provider before getting pregnant.
● Ruptured heart valve. This is a medical emergency that must be treated with surgery to replace or
repair the heart valve.
Along with a complete medical history and physical exam, tests used to diagnose rheumatic heart disease
may include:
● Echocardiogram (echo). This test uses sound waves to check the heart's chambers and valves.
The echo sound waves create a picture on a screen as an ultrasound transducer is passed over the
skin overlying the heart. Echo can show damage to the valve flaps, backflow of blood through a
leaky valve, fluid around the heart, and heart enlargement. It’s the most useful test for diagnosing
heart valve problems.
● Electrocardiogram (ECG). This test records the strength and timing of the electrical activity of the
heart. It shows abnormal rhythms (arrhythmias or dysrhythmias) and can sometimes detect heart
muscle damage. Small sensors are taped to your skin to pick up the electrical activity.
● Chest X-ray. An X-ray may be done to check your lungs and see if your heart is enlarged.
● Cardiac MRI. This is an imaging test that takes detailed pictures of the heart. It may be used to get a
more precise look at the heart valves and heart muscle.
● Blood tests. Certain blood tests may be used to look for infection and inflammation.
Rheumatic heart disease can be prevented by preventing strep infections or treating them with antibiotics
when they do occur. It’s important to take antibiotics as prescribed and to complete them as instructed, even
if you feel better after a few days.
The client will need to have ongoing follow-up with your healthcare provider to check the condition of your
heart. Depending on the amount of heart damage, you may have some activity restrictions. Your healthcare
provider may recommend that you take antibiotics for an extended period to prevent another infection of
rheumatic fever. ( https://www.hopkinsmedicine.org/health/conditions-and-diseases/rheumatic-heart-disease).
Congenital Heart Disease
https://speciality.medicaldialogues.in/standard-treatment-guidelines for congenital heart disease
The most common congenital heart defects found in pregnancy are atrial septal defect (ASD),
ventricular septal defect(VSD), patent ductus arteriousus (PDA), pulmonary stenosis, aortic stenosis, and
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tetralogy of Fallot. It can be treated surgically. if not corrected it may give rise to pulmonary hypertension,
cyanosis, and severe left ventricular failure.
Congenital Heart condition include:
1. Eisenmenger’s syndrome
� This condition caused by a right-left shunt of blood usually through a VSD, ASD or PDA.
This results in an increase in the pulmonary blood flow , which over time leads to fibrosis and
development of pulmonary hypertension and cyanosis.
� Women in this condition are advised against pregnancy as maternal mortality . The greater
risk to the fetus is prematurity, but because of the advances in neonatal care, the perinatal mortality
rate is low.
2.Marfan’s syndrome
my.clevelandclinic.org ghr.nlm.nih,gov mayoclinic.org

This is caused by an autosomal dominant defect on chromosome 15. It is a connective tissue
disease that affects the musculoskeletal system, the cardiovascular system and the eyes.
The cardiovascular abnormalities are the most life threatening as the elastic fibres in the media of the blood
vessels weaken. This results in dilatation of the ascending aorta, which may be followed by dissection or
rupture , or both. The mean age at which these events occur is 32 years and it often results in premature
death.
Pregnancy poses a significant risk because of the increased stress on the cardiovascular system;
also there is a 50% chance of a child inheriting Marfan’s syndrome if one parent is affected.
Women and their partner should be counselled carefully regarding these potential outcomes before
embarking on a pregnancy.
3.Ischaemic Heart Disease
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https://businessmirror.com.ph
This is uncommon cardiac complication of pregnancy, but is becoming more frequent with increasing
maternal age. Other risk factors include smoking, hypercholesterolemia, obesity and drug misuse.
The midwife is able to identify women who have risk factors associated with IHD and can encourage
them to make lifestyle changes. Smoking cessation programmes. Advice regarding diet and nutrition is
appropriate in women with a high BMI and referral to dietician maybe required.
4.Endocarditis
This is an inflammation of the heart usually involving the heart valves. It is caused by microorganism
such as bacteria and fungi. Streptococcal organisms are the most common cause and give rise to subacute
form of the disease.
The infection can be caused by bacteria introduced into the blood stream. Infection can result from
many sources, including poor dental hygiene, tooth brushing that causes minor injury to the lining of the
mouth or gums, dental procedures, implanted cardiovascular medical devices, chronic skin disorders and
infections, burns, infectious diseases and more. These bacteria can lodge on heart valves and cause
infection of the endocardium.( https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/)
5.Peripartum cardiomyopathy
healthxchange.com slideshare.net
Peripartum cardiomyopathy is a weakness of the heart muscle that by definition begins sometime during
the final month of pregnancy through about five months after delivery, without any other known cause. Most
commonly, it occurs right after delivery. It is a rare condition that can carry mild or severe symptoms.
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The exact3mechanism of disease is unknown; however, different hypotheses have been described regarding
its etiology comprising viral myocarditis, nutritional deficiencies, autoimmunity, microchimerism,
hemodynamic stresses, vascular dysfunction, hormonal insults, and underlying genetics ( Ateeq
Mubarik; Arshad Muhammad Iqbal. https://www.ncbi.nlm.nih.gov/books/NBK534770/ March 14, 2019.
This is relatively rare but potentially fatal disease, mortality rates range from 25-50% . Diagnosis is
made within a specific period of time, occurring between the last month of pregnancy and the first 5 months
postpartum. Commonly women have no previous history of heart disease and it has a higher incidence in
older and multiparous women, those with multiple pregnancies and those complicated hypertension.
The inflammation and enlargement of the myocardium (cardiomegaly) give rise to left ventricular
heart failure and thromboembolic complications.
Management on relieving the symptoms are with medications. As the cardiomegaly resolves there
should be a corresponding improvement in the woman’s condition but this process may take up to 6 months.
Some women who are severely affected by peripartum cardiomyopathy will require a transplant
Some of the most common risk factors for the development of postpartum cardiomyopathy are as follows:
● Advanced maternal age (more cases reported in both extremes of age)
● High parity (71% of women diagnosed with PPCM had three or more prior pregnancies)
● High gravidity
● Twin pregnancy (more endemic in women with twin pregnancies)
● Use of tocolytic therapy (greater than 4 weeks can cause silent ischemia)[20]
● African descent (more prevalent in the African population)
● Poverty
● Hypertension
● Cocaine abuse
Test include:
� 1. full blood count
� 2. electrocardiography
� 3.3chest radiograph to asses cardiac size and outline

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� 4. clotting studies
� 5. echocardiography
Risk to mother and fetus: 3 factors
� 1. The nature of the cardiac lesion
� 2. its affect on the functional capacity of the heart
� 3. development of pregnancy-related complications such as hypertensive disorders of pregnancy,

infection, thrombosis, and hemorrhage
Fetal Effects:
� 1. decreased systemic circulation or decreased oxygenation
� 2. if maternal circulation is compromised, reduction in the functional capacity of the heart and the
uterine blood flow will be affected that can be lead to spontaneous abortion, intrauterine growth
retardation, fetal hypoxia, and preterm birth.
� 3. If maternal oxygenation is impaired, as in cyanotic heart disease or acute pulmonary edema, fetal
oxygenation will be impaired leading to severe fetal hypoxia which may result in fetal loss
VI. Heart disease

� Moms with RHD at childhood
� Class I – no limit to physical activity
� Class II – slight limitation of activity. Ordinary activity causes fatigue & discomfort.
� Recommendation of class I & II
� sleep 10 hrs a day
� rest 30 minutes & after meal
� Class III - moderate limitation of physical activity. Ordinary activity causes discomfort
� Recommendation:
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� 1.) early hospitalization by 7 months
� Class IV. marked limitation of physical activity. Even at rest there is fatigue & discomfort.
� Recommendation: Therapeutic abortion
DIABETES MELLITUS
Byjus.com
registerdnursern.com
Diabetes mellitus (DM) describes a metabolic disorder of multiple etiology that affects the normal
metabolism of carbohydrates, fats, and protein. It is characterized by increasing levels of glucose in the
blood (hyperglycemia) and excretion of glucose in the urine (glycosuria) resulting from defects in insulin
secretion, or insulinaction, or both.
Refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in

insulin , insulin action , or both .Diabetes may caused by either impaired insulin secretion , when the beta
cells of the pancreas are destroyed by n autoimmune process, or by inadequate insulin action in target
tissues at one or more points along the metabolic pathway. (Lowdermilk Perry).
Four Classification of Diabetes
1. Type I diabetes
Those cases that are primarily caused by pancreatic islet beta cells destruction and that
prone to ketoacidosis. People with type 1 diabetes usually have an absolute insulin
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deficiency. It includes cases currently thought to be caused by an autoimmune process, as

well as those for which the cause is unknown.
2. Type 2 diabetes
The most prevalent form of the disease and includes individuals who have insulin resistance
and usually relative (rather than absolute) insulin deficiency. Cause still unknown. Often
goes undiagnosed for years because hyperglycemia develops gradually and often is not
Module 3 severe enough for the patient to recognize the classic signs of polyuria, polydipsia,and
polyphagia. Common to obese or have an increased amount of body fat distributed primarily
in the abdominal area. Other risk factors include aging, sedentary lifestyle, hypertension,
and prior gestational diabetes. Often has a strong genetic predisposition.(Expert Committee
on the Diagnosis and Classification of Diabetes Meliitus,2003)
3. Other specific types e.g. caused by infection or induced by drugs
4. Gestational diabetes mellitus
Pregestational diabetes mellitus is the label sometimes given to type 1 or type2 diabetes
that existed before pregnancy.
Gestational diabetes mellitus is any degree of glucose intolerance with the onset or first
recognition occurring during pregnancy. Women experiencing gestational diabetes should
be reclassified 6 weeks or more after the pregnancy ends.
During the first trimester of pregnancy the pregnant woman’s metabolic status is significantly
influenced by the rising levels of progesterone and estrogen. These hormones stimulate the
beta cells in the pancreas to increase insulin production, which promotes increased
peripheral used of glucose and decreased blood glucose, with fasting levels being reduced
by approximately 10%.
During the 2ng and 3rdtrimester , pregnancy exerts a “diabetogenic” effect on the maternal
metabolic status. Because of the major hormonal changes, there is decreased tolerance to
glucose, increased insulin resistance, decreased hepatic glycogen stores, and increased
hepatic production of glucose. Increasing levels of human chorionic somatomammotropin ,
estrogen, progesterone, prolactin, cortisol, and insulinase increase insulin resistance
through their actions as insulin antagonist. Insulin resistance is a glucose sparing
mechanism that ensures an abundant supply of glucose for the fetus. Maternal insulin
requirements gradually increase from about 18 to 24 weeks of gestation to about 36 weeks
of gestation. Maternal insulin requirements may double or quadruple by the end of the
pregnancy.
At birth, expulsion of the placenta prompts an abrupt drop in levels of circulating
placental hormones, cortisol, and insulinase. Maternal tissues quickly regain their
prepregnancy sensitivity to insulin. For the nonbreastfeeding mother’s insulin requirements
will remain low during lactation. On completion of weaning , th mother’s prepregnancy
insulin requirement is reestablished.
Alert: Uterine contractions may occur during exercise; the woman should stop
exercising immediately if they are detected.
Gestational diabetes mellitus is likely to recur in future pregnancies, and there is an

increased risk for development of overt diabetes in later life. (Moore,2004). This is especially
true of women whose GDM is diagnosed early in pregnancy or who are obese (Landon,
Catalano, and Gabbe,2002).
Classic risk factors include:

1. Maternal age over 25 years
2. Obesity
3. Family history of type 2 diabetes
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4. Obstetric history of an infant weighing more than 4500 g

5. Hydramnios
6. Unexplained stillbirth
7. Miscarriage
8. An infant with congenital anomalies(Moore,2004)
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Risk for:
Mother
1. Spontaneous abortion
2. hypertensive disorders
3. preterm labor
4. infection
5. birth complications
Fetal
1. hypoglycaemia
2. hyperglycemia
3. ketoacidosis
Hyperglycemic effects can include:
a. congenital defects
b. macrosomia- fetal birth weight more than 4500g.
c. intrauterine growth restriction
d. intrauterine fetal death
e. delayed lung maturity
f. neonatal hypoglycaemia
g. neonatal hyperbilirubinemia
Women at high risk for GDM are often screened at their initial prenatal visit and then rescreened
later. (at 24 to 28 weeks of gestation) in pregnancy if the initial screen is negative.
Symptoms of Gestational Diabetes
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1. Extreme fatigue
2. Excessive thirst
3. Frequent urination
Risks factors: Some of the risks a woman with gestational diabetes faces if she doesn’t treat her condition
includes:
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1. Excessive fatigue
2. High risk of getting infection
3. High risk of getting C-section
4. Higher risk of having a premature birth
Some of the risks her baby may face includes:
1.high birth weight
2. low blood sugar levels at birth
3. severe jaundice
4. infant respiratory distress syndrome
Risks after pregnancy: The blood sugar levels for women who have gestational diabetes usually returns to
normal. But, women who have had gestational diabetes during pregnancy have a higher risk of developing
type 2 diabetes during their lifetime and their baby also experiences a higher risk of developing this illness.
The long term effects are the development of macrovascular and microvascular disease producing
coronary heart disease, peripheral arterial disease, kidney disease, (diabetic nephropathy), loss of vision
( diabetic retinopathy) and nerve damage ( diabetic neuropathy
The diagnosis of gestational diabetes is usually made during the second half of pregnancy. A fetal
nutrient demands rise during the late second and the third trimesters, maternal nutrient ingestion induces
greater and more sustained levels of blood glucose .consequently , maternal insulin demands rise as much
as threefold.
Most pregnant women are capable of increasing insulin production to compensate for insulin
resistance and to maintain euglycemia. When the pancreas is unable to produce sufficient insulin or the
insulin is not used effectively , gestational diabetes can result.
Maternal –Fetal Risks
1. Hypertensive disorders(Moore,2004)
2. Fetal macrosomia- lead to perineal lacerations, episiotomy, cesarian birth(ADA,2004b)
Fetal macrosomia may be associated with shoulder dystocia, and birth trauma.
Neonate hypoglycemia, hypocalcemia, hyperbilirubinemia, thrombocytopenia, polycythemia and
respiratory distress syndrome(Moore ,2004)
Management
1. explain the effects of gestational diabetes on the mother and fetus
2. monitor blood glucose
3. diet
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4. emotional and psychological needs
5. fetal monitoring
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3.Diabetes absence of insufficient insulin (Islet of Langerhans of pancreas)
� Function: of insulin – facilitates transport of glucose to cell
� Dx: 1 hr 50gr glucose tolerance test GTT
� Normal glucose – 80 – 120 mg/dl < 80 – hypoclycemic
( euglycemia) > 120 - hyperglycemia
� 3 degrees GTT of > 130 mg/dL
Maternal effect DM
� Hypo or hyperglycemia – 1st trimester hypo, 2nd – 3rd trim – hyperglycemic
� Frequent infection- moniliasis
� Polyhydramnios
� Dystocia-difficult birth due to abnormalities in fetus or mom.
� Insulin requirement, decrease in insulin by 33% in 1st tri; 50% increase insulin at 2nd – 3rd trimester.
� Post partum decrease 25% due placenta out.
Fetal effect
� hyper & hypoglycemia
� macrosomia – large gestational age – baby delivered > 400g or 4kg
� preterm birth to prevent stillbirth
Newborn Effect : DM
� hyperinsulinism
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� hypoglycemia
� normal glucose in newborn 45 – 55 mg/dL
� hypoglycemic
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� Heel stick test – get blood at heel
Symptoms
� Hypoglycemia high pitch shrill cry tremors, administer dextrose
� hypocalcemia - < 7mg%
Symptoms:
� Calcemia tetany
� Trousseau sign
� Give calcium gluconate if decrease calcium
Recommendation
� Therapeutic abortion
� If push through with pregnancy
� antibiotic therapy- to prevent sub acute bacterial endocarditis
� anticoagulant – heparin doesn’t cross placenta
� Class I & II- good progress for vaginal delivery
� Class III& IV- poor prognosis, for vaginal delivery, not CS!
� NOT lithotomy! High semi-fowlers during delivery. No valsalva maneuver
� Regional anesthesia!
� Low forcep delivery due to inability to push. It will shorten 2nd stage of labor.
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Hypertension in Pregnancy
nature.com nurseslabs.com researchgate.net

.
According to Mayo Foundation for Medical Education and Research https://medlineplus.gov/ that, High
blood pressure, or hypertension, is when this force against the artery walls is too high. There are different
types of high blood pressure in pregnancy:
● Gestational hypertension is high blood pressure that develop while the mother is pregnant. It
starts after 20 weeks of pregnancy. It is usually don't have any other symptom and does not harm
the baby, and it goes away within 12 weeks after childbirth. But it does raise your risk of high blood
pressure in the future. It sometimes can be severe, which may lead to low birth weight or preterm
birth. Some women with gestational hypertension do go on to develop preeclampsia.
● Chronic hypertension is high blood pressure that started before the 20th week of pregnancy or
before you became pregnant. Some women may have had it long before becoming pregnant but
didn't know it until they got their blood pressure checked at their prenatal visit. Sometimes chronic
hypertension can also lead to preeclampsia.
● Preeclampsia is a sudden increase in blood pressure after the 20th week of pregnancy. It usually
happens in the last trimester. In rare cases, symptoms may not start until after delivery. This is called
postpartum preeclampsia. Preeclampsia also includes signs of damage to some of your organs,
such as your liver or kidney. The signs may include protein in the urine and very high blood
pressure. Preeclampsia can be serious or even life-threatening for both you and your baby. The
cause is unknown.
.
Furthermore they mentioned that, the mother who are at higher risk of preeclampsia are the following:
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● Had chronic high blood pressure or chronic kidney disease before pregnancy
● Had high blood pressure or preeclampsia in a previous pregnancy
● Have obesity
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● Are over age 40
● Are pregnant with more than one baby
● Are African American
● Have a family history of preeclampsia
● Have certain health conditions, such as diabetes, lupus, or thrombophilia (a disorder which raises
your risk of blood clots)
● Used in vitro fertilization, egg donation, or donor insemination
Moreover , they stated that Preeclampsia can cause:
● Placental abruption, where the placenta separates from the uterus
● Poor fetal growth, caused by a lack of nutrients and oxygen
● Preterm birth
● A low birth weight baby
● Stillbirth
● Damage to your kidneys, liver, brain, and other organ and blood systems
● A higher risk of heart disease for you
● Eclampsia, which happens when preeclampsia is severe enough to affect brain function, causing
seizures or coma
● HELLP syndrome, which happens when a woman with preeclampsia or eclampsia has damage to
the liver and blood cells. It is rare, but very serious.
They also mentioned that, the possible symptoms of preeclampsia include
● High blood pressure
● Too much protein in your urine (called proteinuria)
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● Swelling in your face and hands. Your feet may also swell, but many women have swollen feet
during pregnancy. So swollen feet by themselves may not be a sign of a problem.
● Headache that does not go away
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● Vision
● Pain in your upper right abdomen
● Trouble breathing
Eclampsia can also cause seizures, nausea and/or vomiting, and low urine output. If you go on to develop
HELLP syndrome, you may also have bleeding or bruising easily, extreme fatigue, and liver failure.
Reference:
Mayo Foundation for Medical Education and Research https://medlineplus.gov/
National Institute of Child Health and Human Development. MEDLINE/PubMed (National Library of Medicine
SUBSTANCE ABUSE DURING PREGNANCY
cornerstonereoverycenter.com
According to Forray, Ariadna. (ncbi.nlm.nih.gov.) F1000Research, that prenatal substance use is a

critical public health concern that is linked with several harmful maternal and fetal consequences. It is said
that, women are at highest risk for developing a substance use disorder during their reproductive years (18-
44) , especially ages 18-29.
It is said that , when you are pregnant , you are not just :eating for two”. You also breath and drink
for two, so it is important to carefully consider what you give to your baby. If you smoke, use alcohol or take
illegal drugs , so does your unborn baby.
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Fetal Alcohol Exposure: It occurs when women drinks while pregnant . alcohol can disrupt fetal
development at any stage during a pregnancy- including at the earliest stages before a woman even knows
she is pregnant.
Fetal Alcohol Syndrome (FAS). It is the most serious consequence of heavy drinking during pregnancy,
aside from fetal death. An AFS diagnosis requires:
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1. A specific pattern of facial abnormalities, including wide-set and narrow eyes, a smooth ridge on the
upper lip, and a thin upper lip border.
2. Growth deficits both prenatally and after birth.
3. Central nervous abnormalities.- cognitive and behavioral problems ( ADHD, depression, increased
incidence of alcohol and other substance use disorder
4. Smaller than average size brains
5. Coordination problems
6. Abnormal formation of bones and some organs- heart , kidney, hearing and seeing
7. Reduced immunity
Effects on Fetal and Neonatal Health. Robin Suzanne .January
1. Constricted blood circulation and oxygen deprivation- may lead to limb reduction deformities
( missing fingers or toes)
2. Spontaneous abortion
3. stillbirth
The four general categories of substances abused by pregnant women are central nervous system
depressants, including alcohol, sedatives, anxiolytics, and hypnotics; stimulants, including cocaine and
amphetamines; opiates; and hallucinogens/psychotomimetics, including lysergic acid diethylamide (LSD)
and phencyclidine (PCP). With the exception of caffeine and nicotine, these substances are associated with
both abuse and dependence disorders.3
Intoxication and withdrawal represent the most common substance-related disorders. Intoxication, defined as
the development of a reversible substance-specific syndrome during or after substance use, becomes a
clinical problem when significant maladaptive patterns of behavior lead to distress and
impairment. Withdrawal, another substance-specific syndrome, occurs when the chronic intake of a
substance is abruptly discontinued. Tolerance is defined as the need to use an increasing amount of the
drug to attain the desired effects or the decreased intensity in effects experienced with the continued use of
the same amount of the substance. The term addiction combines the qualities of both tolerance and
withdrawal. Drug addiction, a primary disease with the potential to be progressive and life-threatening,
presents as a preoccupation with and inability to control substance use.
Substance dependence includes tolerance, withdrawal, taking the drug in larger amounts over longer periods
than originally intended, the desire or ineffective attempts to reduce or cease drug use, extensive amounts of
time involved with substance use, and persistent use despite problems attributed to the
substance. Substance abuse is a maladaptive pattern of use that results in clinically significant functional
impairment without satisfying the criteria for substance dependence. Abuse is indicated by any one of the
following: failure to fulfill reasonable obligations, drug use in dangerous situations, and continued use despite
recurrent legal, social, and psychological problems associated with the substance.
HIV/AIDS/STD
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blogspot. com Apple news
Throughout life, we all encounter many viruses and bacteria. As part of our defense mechanism, the body
makes antibodies to help fight infection.
If you have antibodies against a particular virus or bacteria, you are immune, and the antibodies help
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to prevent or reduce the impact of getting the infection again.
Infections that can affect the health of the pregnant woman, the pregnancy, and the baby after delivery
include (but are not limited to):
● Bacterial vaginosis is the most common vaginal infection in women of reproductive age. It
increases the risk of contracting sexually transmitted infections (STIs) and may play a role in preterm
labor. The condition results from a change in the balance of bacteria that normally live in the vagina.
Having unprotected sex and douching can increase the risk of bacterial vaginosis. The Centers for
Disease Control and Prevention (CDC) recommends that pregnant women get tested for bacterial
vaginosis if they have symptoms and get treated if necessary.
Stepwards.com health.innocations.com anejo,eu
Chlamydia infection during pregnancy is associated with an increased risk of preterm birth and its
complications.2 If the infection is present and untreated at the time of delivery, it can lead to eye infections or
pneumonia in the infant.1 In most hospitals, infants' eyes are routinely treated with an antibiotic ointment
shortly after birth. The ointment can prevent blindness from exposure to chlamydia bacteria during delivery in
case the pregnant woman had an undetected infection.
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● Cytomegalovirus (CMV) is a common virus present in many body fluids that can be spread
through close personal contact, such as kissing or sharing eating utensils, as well as sexual contact.
The virus usually does not cause health problems, but once it is in a person's body, it stays there for
life and can reactivate at different times. A pregnant woman may not even know she has the
infection, and she may pass the virus on to her fetus, causing congenital CMV infection. Most infants
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have health problems such as hearing or vision loss, seizures, or intellectual disabilities that are
apparent at birth or that develop later during infancy or childhood.3 Currently, routine screening for
CMV during pregnancy is not recommended.
● nejm.org epainassist.com dreamstime.com
● Researchers are working on treatments for CMV and vaccines to try to prevent new infections during
pregnancy and to reduce the risk of transmission to the infant.4Congenital CMV infection can be
diagnosed by testing a newborn baby's saliva, urine, or blood. Treatment with antiviral drugs may
decrease the risk of health problems and hearing loss in some infected infants.
● Fifth disease is caused by human parvovirus type B19. The virus causes a common childhood
disease that spreads easily from person to person. Children who get it usually have a fever and a red
rash on their cheeks. Parvovirus B19 usually does not cause problems for pregnant women or the
fetus, but in rare cases, the woman might have a miscarriage or the fetus could develop anemia.
There is no vaccine or treatment for fifth disease. You can reduce your chance of being infected with
parvovirus B19 or infecting others by avoiding contact with people who have parvovirus B19 and by
thoroughly and regularly washing your hands. Sometimes health care providers recommend testing
pregnant women to see if they are immune to the virus already.
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my health alberta.ca webmd.com medicaldaily.com
● Untreated gonorrhea infection in pregnancy has been linked to miscarriage, preterm birth and low
birth weight, premature rupture of the membranes surrounding the fetus in the uterus, and infection of
the fluid that surrounds the fetus during pregnancy. Gonorrhea can also infect an infant during
Module 3delivery as it passes through the birth canal. If untreated, infants can develop eye infections and
blindness. In most hospitals, infants' eyes are routinely treated with an antibiotic ointment shortly after
birth to prevent eye problems from exposure to gonorrhea during delivery, in case the pregnant
woman had an undetected infection. Treating gonorrhea as soon as it is detected in pregnant women
reduces the risk of transmission.
tes.com shutterstock.com
stdrapidtests.com
● Group B streptococcus (GBS) can cause serious health problems in infants. But giving antibiotics
during labor can prevent the spread of GBS, so it's important to get tested for the infection during
pregnancy. Learn more about GBS and pregnancy.
europepmc.org emerypharma.com isglobal.org
● Pregnant women who get infected with genital herpes late in pregnancy have a high risk of infecting
their fetus. The risk of infection is particularly high during delivery.1 Herpes infections in newborns are
serious and potentially life-threatening. Infection with the herpes virus during pregnancy or at the time
of delivery can lead to brain damage, blindness, and damage to other organs. Rarely, herpes
22
infection during pregnancy can lead to serious complications in the mother, including severe liver
damage and possibly death.
o If a pregnant woman has had genital herpes in the past, there are medications that she can
take to reduce the chance that she will have an outbreak, which also reduces the risk to her
fetus.
o If a woman has active herpes sores when she goes into labor, the infant can be delivered by
Module 3 cesarean section to reduce the chance that the infant will come in contact with the virus.
teachmeobgyne.com youmemindbody.com pedsinreview.aappublications.com
● If a woman is infected with hepatitis B virus (HBV) during pregnancy, the virus could infect her fetus.
The likelihood of transmission depends on when during pregnancy the mother was infected. If the
mother gets the infection later in her pregnancy, the risk that the virus will infect her fetus is quite
high. If the infection occurs early in pregnancy, the risk of the virus infecting the fetus is much lower.
For more information about Hep B during pregnancy, visit the Centers for Disease Control and
Prevention (CDC) website. In infants, HBV can be serious and can lead to chronic liver disease or
liver cancer later in life. In addition, infected newborns have a very high risk of becoming carriers of
HBV and can spread the infection to others.
o In some cases, if a woman is exposed to HBV during pregnancy, she may be treated with a
special antibody to reduce the likelihood that she will get the infection.
o All healthy infants should be vaccinated against HBV to give them lifelong protection.
o Infants born to women with evidence of ongoing HBV infection (HBV surface antigen
positive) should also receive hepatitis B hyperimmune globulin as soon as possible after
birth.
drugtargetreview.com pacificties.org medicinenet.com
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● Hepatitis C virus (HCV). CDC offers more information about HCV.
● HIV/AIDS. HIV can be passed from mother to infant during pregnancy before birth, at the time of
delivery, or after birth during breastfeeding.
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Slideshare.net
pngegg.com unicef.org
Human papillomavirus, or HPV, is the most common sexually transmitted infection (STI) in the
United States. About 80% of women will get at least one type of HPV at some point in their lifetime.1 It is
usually spread through vaginal, oral, or anal sex. Many women do not know they have HPV, because it
usually has no symptoms and usually goes away on its own. Some types of HPV can cause illnesses
such as genital warts or cervical cancer.
drsafehands.com omicsonline.com
webmd.com
How human papillomavirus (HPV) is spread
Many types of HPV affect the mouth, throat or genital area. They're easy to catch. Even if they do not have
penetrative sex. HPV can be get from:any skin-to-skin contact of the genital area
● vaginal, anal or oral sex
● sharing sex toys
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● Listeria or listeriosis is a serious infection usually caused by eating food contaminated with a
particular type of bacteria. Infection during pregnancy can lead to pregnancy loss, stillbirth, preterm
birth, or life-threatening infection of the newborn. Listeriosis is most often associated with eating soft
cheeses and raw milk, but recent outbreaks have been associated with fresh and frozen
produce. Prevention recommendations include checking food labels to avoid eating unpasteurized
Module 3 cheese (made from raw milk) and other actions. Learn more about preventing listeria during
pregnancy.
express.co.uk
genomenewsnetwork.org scheneidermedical.co,za
● Getting rubella (sometimes called German measles) during pregnancy can cause problems with the
pregnancy as well as birth defects in the infant. Health care providers recommend that women get
vaccinated against rubella before they get pregnant. Learn more about rubella and pregnancy.
Histopathology.india.net quora .com

health.nsw.gov.au.
Syphilis may pass from an infected mother to her fetus during pregnancy. The infection has been linked
to preterm birth, stillbirth, and, in some cases, death shortly after birth. Untreated infants who survive tend to
develop problems in many organs, including the brain, eyes, ears, heart, skin, teeth, and bones. All pregnant
women should be screened for syphilis during their first prenatal visit. Women considered to be high risk
should be screened again in the third trimester.
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Ntangakenet.blogspot.com. en.wekipedia.org. commons.wikimedia.org
● Toxoplasmosis is a disease caused by a parasite that can be present in cat feces or used cat litter.
Cats get the parasite from eating small animals or birds. In humans, the disease is usually mild, but if
the parasite passes from a pregnant woman to the developing fetus, it can cause intellectual
Module 3 disabilities, blindness, or other problems. Women who are trying to become pregnant or are pregnant
can take steps to prevent exposure to the parasite, such as having someone else clean or change the
cat litter box and wearing rubber gloves to handle cat litter or while gardening.
Vet.cornell.edu. researchgate.net
diamond pet.com
Trichomoniasis is a common sexually transmitted infection caused by a parasite. In women, trichomoniasis can cause a
foul-smelling vaginal discharge, genital itching and painful urination.
pinterest.com gettyimages.com
slideshare.net
Men who have trichomoniasis typically have no symptoms. Pregnant women
who have trichomoniasis might be at higher risk of delivering their babies prematurely.
To prevent reinfection with the organism that causes trichomoniasis, both partners should be treated. The most common
treatment for trichomoniasis involves taking one megadose of metronidazole (Flagyl) or tinidazole (Tindamax). She
can reduce risk of infection by using condoms correctly every time that they have sex.(
https://www.mayoclinic.org/diseases)
Trichomoniasis. CDC offers more information about trichomoniasis.
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● Zika is caused by a virus spread mainly by the bite of a certain type of mosquito, but it is also spread
through sexual contact. Although its symptoms are usually mild, Zika infection during pregnancy can
cause pregnancy loss and other pregnancy complications, as well as birth defects and other
problems for the infant.
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● Zik
a virus
disease
is
caused
by a
virus
transmitted primarily by Aedes mosquitoes, which bite during

the day.
● Symptoms are generally mild and include fever, rash, conjunctivitis, muscle and joint pain, malaise or
headache. Symptoms typically last for 2–7 days. Most people with Zika virus infection do not develop
symptoms.
● Zika virus infection during pregnancy can cause infants to be born with microcephaly and other
congenital malformations, known as congenital Zika syndrome. Infection with Zika virus is also
associated with other complications of pregnancy including preterm birth and miscarriage.
● An increased risk of neurologic complications is associated with Zika virus infection in adults and
children, including Guillain-Barré syndrome, neuropathy and myelitis
CDC provides additional information on infections during pregnancy and sexually transmitted infections
(STIs) and pregnancy.
According to https://www.healthychildren.org/from the American of Pediatrics that , a pregnant mothers need
to practice 11 things during pregnancy to protect herself and her baby from infections.
1. Maintain good hygiene and wash your hands often—especially when around or caring for children.
Regular handwashing, particularly before and after certain activities, is one of the best ways to
remove germs, avoid getting sick, and prevent infections. If soap and running water are not
available, she can use alcohol-based hand gel. Learn how clean hands save lives.
2. Cook your meat until it's well done. The juices should run clear and there should be no pink inside.
Do not eat hot dogs, luncheon meats, or deli meats, unless they are reheated until steaming hot.
These undercooked meats and processed meats might contain harmful bacteria. Learn more about
Listeria.
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3. Avoid unpasteurized (raw) milk and foods made from it. Do not eat soft cheeses such as feta, brie,
and queso fresco unless they have labels that say they are pasteurized. Unpasteurized products can
contain harmful bacteria. Learn more about raw milk dangers.
4. Ask the doctor about Group B streptococcus (GBS). About 1 in 4 women carry this type of bacteria,
but do not feel sick. An easy swab test near the end of pregnancy will show if you have this type of
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bacteria. If the mother do have GBS, talk to your doctor about how to protect your baby during
labor. Learn more about GBS infections.
5. Talk to the doctor about vaccinations. Some are recommended before she become pregnant, during
pregnancy, or right after delivery. Having the right vaccinations at the right time can help keep her
healthy and help keep her baby from getting very sick or having life-long health problems. Learn
more about vaccinations during pregnancy and why the flu and Tdap vaccines are essential for
pregnant moms.
6. Get tested for sexually transmitted infections (STIs), such as HIV and hepatitis B, and protect the
mother from them. Some people that have HIV, hepatitis B, or an STD do not feel sick. Knowing if
the mother have one of these diseases is important. If the mother do, talk to the doctor about how
she can reduce the chance that her baby will become sick. Learn more about preventing STIs.
7. Avoid people who have an infection. Stay away from people who have infections, such as
chickenpox or rubella, if the mother have not yet had it she or did not have the vaccine before
pregnancy. Learn more about the MMR vaccine and the chickenpox vaccine.
8. Protect against insects known to carry diseases. Stay abreast of developments in Zika virus in your
area or places you might be traveling to. When mosquitoes and ticks are active, wear long-sleeved
shirts and long pants when outside. Use Environmental Protection Agency (EPA) registered insect
repellents with one of the following active ingredients: DEET, picaridin, IR3535, or oil of lemon
eucalyptus (para-menthane-3,8-diol). Avoid travel to areas where infections can threaten you and
your baby. Learn more about the Zika virus and pregnancy.
9. Do not touch or change dirty cat litter and avoid contact with potentially contaminated soil. Have
someone else do it. If you must change the litter yourself, be sure to wear gloves and wash your
hands afterwards. Dirty cat litter and soil might contain a harmful parasite. Learn more about cats
and toxoplasmosis.
10. Stay away from wild or pet rodents, lizards and turtles, and their droppings. Have a pest control
professional get rid of pests in or around your home. If you have a pet rodent, like a hamster or
guinea pig, have someone else care for it until after your baby arrives. Some rodents might carry a
harmful virus. Learn more about lymphocytic choriomeningitis virus (LCMV).
11. Only take vitamins in the doses recommended by your doctor. The doctor may recommend a daily
prenatal vitamin pill, which includes folic acid, iron, calcium and other minerals, and the fatty acids
docosahexaenoic acid (DHA) and arachidonic acid (ARA). Make sure the doctor knows about any
other supplements the client may be taking, including herbal remedies. Learn more about the
benefits of folic acid.
Reference:
28
Centers for Disease Control and Prevention. (2016). STDs during pregnancy - CDC fact sheet (detailed).
Retrieved January 17, 2017, from https://www.cdc.gov/std/pregnancy/stdfact-pregnancy-detailed.htm
Forray, Ariadna. (ncbi.nlm.nih.gov.) F1000Research
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https://www.nichd.nih.gov/health/topics/pregnancy/conditioninfo/infections
https://www.healthychildren.org/from the American of Pediatrics
https://www.mayoclinic.org/diseases
The American College of Obstetricians and Gynecologists. (2011, August). Frequently asked questions.
FAQ093. Pregnancy: Hepatitis B in Pregnancy. Retrieved June 2, 2012,
Rh Sensitization During Pregnancy

As mentioned by Marshall (2019) that if the pregnant mother is Rh- negative , the red blood cells do
not have a marker called Rh factor on them . While if the blood mixes with Rh-positive blood, the immune
system will react to the Rh factor by making antibodies to destroy it. This immune system response is called
Rh Sensitization.
Rh sensitization can occur during pregnancy, like if the mother is Rh-negative, the mother with a
developing baby( fetus) who has Rh-positive blood. However, during her first pregnancy, the pregnant
mother will not mix with the baby’s blood until delivery and the baby probably would not be affected.
But if the mother got pregnant again with a Rh-positive baby, the antibodies that developed in her
blood during her first pregnancy will attack the baby’s red blood cells. So, because of incompatibility it may
cause the baby to have anemia, jaundice that may result to more serious problems. This may result to have
Rh disease.
The best way to avoid further problems, the mother should visit the doctor and do blood testing
during the first trimester of her pregnancy.
This Rh sensitization can only happen if a woman has Rh-negative blood and only if her baby has
Rh-positive blood. How this disease occur:
● If the mother is Rh-negative and the father is Rh-positive, there is a good chance the baby will have
Rh-positive blood. Rh sensitization can occur.
● If both parents have Rh-negative blood, the baby will have Rh-negative blood. Since the mother's blood
and the baby's blood match, sensitization will not occur.
Furthermore she stated that, if the mother have Rh-negative blood and Rh-sensitized.
If the mother have Rh-negative blood but are not sensitized:
● The blood test may be repeated between 24 and 28 weeks of pregnancy. If the test still shows that is
not sensitized, she probably will not need another antibody test until delivery.
● The baby will have a blood test at birth. If the newborn has Rh-positive blood, you will have an antibody
test to see if you were sensitized during late pregnancy or childbirth.
If the pregnant mother is Rh-sensitized, the doctor will monitor her pregnancy carefully. She may have:
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● Regular blood tests, to check the level of antibodies in your blood.
● Doppler ultrasound, to check blood flow to the baby's brain. This can show anemia and how severe it
is.
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● Amniocentesis after 15 weeks, to check the baby's blood type and Rh factor and to look for problems.
If the pregnant mother have Rh -negative blood but are not Rh-sensitized, the doctor will give one or
more shots of Rh Immune globulin (such as RhoGAM) . This prevents Rh sensitization in nearly all women
who use it. The mother may get shot of Rh immune globulin:
● If you have a test such as an amniocentesis.
● Around week 28 of your pregnancy.
● After delivery if your newborn is Rh-positive.

The shots only work for a short time, so it will need to repeat this treatment each time if she get
pregnant again. (To prevent sensitization in future pregnancies, Rh immune globulin is also given when an
Rh-negative woman has a miscarriage, abortion, or ectopic pregnancy.)
The shots won't work if you are already Rh-sensitized.
● For severe anemia, a baby can have a blood transfusion while still in the uterus. This can help keep the
baby healthy until he or she is mature enough to be delivered.
● The mother may have an early C-section, and the baby may need to have another blood transfusion
right after birth.
In the past, Rh sensitization was often deadly for the baby. But improved testing and treatment mean that
now most babies with Rh disease survive and do well after birth.
Reference:
Sarah Marshall MD - Family Medicine & Kathleen Romito MD - Family Medicine & E. Gregory
Thompson MD - Internal Medicine & Adam Husney MD - Family Medicine & Elizabeth T. Russo MD -
Internal Medicine & Kirtly Jones MD - Obstetrics and Gynecology. : Healthwise Staff. May 29, 2019
ANEMIA
h3u.com
ffinetwork.com medicalnewstoday.com
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As stated by Johnson (2020) that, during pregnancy, the demand of iron and other vitamins is
increased.in order to have enough red blood cells for the fetus, the body starts producing more red blood
cells and plasma. The fetus starts to draw on maternal iron reserves around the 20th week. It has been
calculated that the blood volume increases approximately 50% during pregnancy, although the plasma
increase is disproportionately greater. This causes a dilution of the blood, making the hemoglobin
concentration fall. This is a normal process, with the hemoglobin concentration at its lowest between weeks
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25 and 30. The body produces more blood to support the growth of the baby. If the mother is not getting
enough iron or certain other nutrients, the body might not be able to produce the amount of red blood cells it
needs to make this additional blood. This will lead to have decrease hemoglobin count in general circulation
or called anemia.
Note: Need to review the learning in Nutrition and Dietetics:. Nutrition in Pregnancy and throughout the Life
span.
Several types of anemia can develop during pregnancy. These include:
● Iron-deficiency anemia
● Folate-deficiency anemia
● Vitamin B12 deficiency
Iron-deficiency anemia. This type of anemia occurs when the body doesn't have enough iron to produce
adequate amounts of hemoglobin. That's a protein in red blood cells. It carries oxygen from the lungs to the
rest of the body. This is the most common cause of anemia in pregnancy.
Folate-deficiency anemia. Folate is the vitamin found naturally in certain foods like green leafy vegetables
A type of B vitamin, the body needs folate to produce new cells, including healthy red blood cells.
During pregnancy, women need extra folate. But sometimes they don't get enough from their diet. When that
happens, the body can't make enough normal red blood cells to transport oxygen to tissues throughout the
body. Man made supplements of folate are called folic acid.
Folate deficiency can directly contribute to certain types of birth defects, such as neural tube abnormalities
(spina bifida) and low birth weight.
Vitamin B12 deficiency. The body needs vitamin B12 to form healthy red blood cells. When a pregnant
woman doesn't get enough vitamin B12 from her diet, her body can't produce enough healthy red blood
cells. Women who don't eat meat, poultry, dairy products, and eggs have a greater risk of developing vitamin
B12 deficiency, which may contribute to birth defects, such as neural tube abnormalities, and could lead
to preterm labor.
Blood loss during and after delivery can also cause anemia.
All pregnant women are at risk for becoming anemic due to the following conditions such as:
● Are pregnant with multiples (more than one child)
31
● Have had two pregnancies close together
● Vomit a lot because of morning sickness
● Are a pregnant teenager
Module 3 eat enough foods that are rich in iron

● Don't
● Had anemia before you became pregnant
Due to lack of hemoglobin count, there will be less oxygen supply in the general circulation
resulting to:
● Pale skin, lips, and nails
● Feeling tired or weak
● Dizziness
● Shortness of breath
● Rapid heartbeat
● Trouble concentrating
If Severe or untreated iron-deficiency anemia occurred during pregnancy this can increase the risk of having:
● A preterm or low-birth-weight baby
● A blood transfusion (if you lose a significant amount of blood during delivery)
● Postpartum depression
● A baby with anemia
● A child with developmental delays
Untreated folate deficiency can increase the risk of having a:
● Preterm or low-birth-weight baby
● Baby with a serious birth defect of the spine or brain (neural tube defects)
Untreated vitamin B12 deficiency can also raise your risk of having a baby with neural tube defects.
Blood tests typically include:
32
● Hemoglobin test. It measures the amount of hemoglobin -- an iron-rich protein in red blood cells that
carries oxygen from the lungs to tissues in the body.
● Hematocrit test. It measures the percentage of red blood cells in a sample of blood.
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Management
1. Folic acid supplement

2. Monitoring to hematocrit and hemoglobin count
3. Vitamins especially vitamin B12
4. Good nutrition such as to:
Aim for at least three servings a day of iron-rich foods, such as:
● lean red meat, poultry, and fish
● leafy, dark green vegetables (such as spinach, broccoli, and kale)
● iron-enriched cereals and grains
● beans, lentils, and tofu
● nuts and seeds
● eggs
Foods that are high in vitamin C can help your body absorb more iron. These include:
● citrus fruits and juices
● strawberries
● kiwis
● tomatoes
● bell peppers
Reference: Traci C. Johnson, MD, WebMD,LLC. Medical June 12, 2020
Note: Sometimes its to difficult to understand why a pregnant mother suffer from different illnesses, while we
all know that pregnancy is a normal process. But we can’t change the situation, what’s good, we are here to
take good care the mother and the baby. Try to make it more productive and substantial to your client
preparing and applying some interview with pregnant mothers. God bless…. to your journey as a successful
midwife.
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Module 3
THYROID DISORDERS
HYPERTYROIDISM
niddk.nih.gov
thyroidindia.com obgynekey.com
According to Alexander EK, Pearce EN, Brent GA, et al.( 2017), thyroid disease is the second most
common endocrine disorder affecting women of reproductive age, and when untreated during pregnancy an
increased risk of miscarriage, placental abruption, hypertensive disorders, and growth restriction will occur.
They mentioned that, it is crucial for normal development of the baby’s brain and nervous system. During the
first trimester—the first 3 months of pregnancy—the baby depends on mother’s supply of thyroid hormone,
which comes through the placenta. N At around 12 weeks, your baby’s thyroid starts to work on its own, but
it doesn’t make enough thyroid hormone until 18 to 20 weeks of pregnancy.
They said that there are two pregnancy-related hormones—human chorionic gonadotropin (hCG) and
estrogen—cause higher measured thyroid hormone levels in the blood. The thyroid enlarges slightly in
healthy women during pregnancy, but usually not enough for a health care professional to feel during a
physical exam.
Some signs and symptoms of hyperthyroidism often occur in normal pregnancies, including faster heart rate,
trouble dealing with heat, and tiredness.
Other signs and symptoms can suggest hyperthyroidism:
34
● fast and irregular heartbeat
● shaky hands
● unexplained weight loss or failure to have normal pregnancy weight gain

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Furthermore, they mentioned that, hyperthyroidism in pregnancy is usually caused by Grave’s disease and
occurs in 1 to 4 of every 1,000 pregnancies in the United States.1 Graves’ disease is an autoimmune
disorder. With this disease, the immune system makes antibodies that cause the thyroid to make too much
thyroid hormone. This antibody is called thyroid stimulating immunoglobulin, or TSI.
They said that, Graves’ disease may first appear during pregnancy. However, if the mother already have
Graves’ disease, the symptoms could improve in the second and third trimesters.
Untreated hyperthyroidism during pregnancy can lead to
● miscarriage
● premature birth
● low birthweight
● preeclampsia—a dangerous rise in blood pressure in late pregnancy
● thyroid storm—a sudden, severe worsening of symptoms
● congestive heart failure
An overactive thyroid in a newborn can lead to
● a fast heart rate, which can lead to heart failure
● early closing of the soft spot in the baby’s skull
● poor weight gain
● irritability
Hypothyroidism in Pregnancy
Moreover , hypothyroidism in pregnancy is usually caused by Hashimoto’s disease and occurs in 2 to 3 out
of every 100 pregnancies.1 Hashimoto’s disease is an autoimmune disorder .wherein the immune
system makes antibodies that attack the thyroid, causing inflammation and damage that make it less able to
make thyroid hormones.
Symptoms of an underactive thyroid are often the same for pregnant women as for other people with
hypothyroidism. Symptoms include
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● extreme tiredness
● trouble dealing with cold
● muscle cramps
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● severe constipation
● problems with memory or concentration
Untreated hypothyroidism during pregnancy can lead to
● preeclampsia—a dangerous rise in blood pressure in late pregnancy
● anemia
● miscarriage
● low birthweight
● stillbirth
● congestive heart failure, rarely
These problems occur most often with severe hypothyroidism.
Because thyroid hormones are so important to your baby’s brain and nervous system development,
untreated hypothyroidism—especially during the first trimester—can cause low IQ and problems with normal
development.
Reference: Alexander EK, Pearce EN, Brent GA, et al. 2017 guidelines of the American Thyroid
Association for the diagnosis and management of thyroid disease during pregnancy and the
postpartum. Thyroid. 2017;27(3):315–389.
Note: Now, we will discussed the most common cases of infection in urinary tract during pregnancy. Still, try
to differentiate the abnormal and normal anatomy and physiology of urinary system. You can apply
whatever you learn in actual situation with deeper understanding and skills. Hope you will enjoy our
discussions with commitment , perseverance to learn it by heart. Remember you will handle actual patient
and this is the best time for you to discover the goodness of being a midwife. Let’s begin………
URINARY TRACT INFECTION
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blog.preregistry.com pinterest.com slideshare,net
Urinary Tract Infection In Pregnancy
According to Habak and Griggs ( 2020) that, urinary tract infections (UTIs) are frequently
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encountered in pregnant women. During pregnancy, urinary tract changes predispose women to infection.
Ureteral dilation is seen due to compression of the ureters from the gravid uterus. Hormonal effects of
progesterone also may cause smooth muscle relaxation leading to dilation and urinary stasis, and
vesicoureteral reflux increases. Ureteral dilation may be marked. Decreased bladder capacity commonly
results in urinary frequency. Vesicoureteral reflux may be seen. These changes increase the risk of urinary
tract infections.
They said that, UTIs are a common cause of serious infection in pregnant women. In one study,
3.5% of antepartum admissions were due to UTI. [2] Pyelonephritis is the most common cause of septic
shock in pregnant women. Risk factors for UTIs in pregnancy include low socioeconomic status, young age,
and nulliparity. While Sissons (2019) stated that, during pregnancy, the uterus expands for the growing
fetus. This expansion puts pressure on the bladder and the ureters. The ureters are the tubes that carry
urine from the kidneys to the bladder. Another is the urine which is less acidic and contains more proteins,
sugars, and hormones during pregnancy. This combination of factors increases the risk of a UTI occurring.
A person who has a UTI may experience the following symptoms:
● urgent or frequent need to urinate
● burning sensation when urinating
● cloudy or strong smelling urine
● blood in the urine
● pain in the lower back, abdomen, and sides
People should tell their doctor straight away if they have blood in their urine, as this can be a sign of another condition.
In some cases, the bacterial infection causing a UTI can spread to the kidneys. A person who has a kidney
infection may experience the following symptoms:
● back pain
● fever
● chills
● nausea and vomiting
37
Pregnant women should see their doctor if they have any symptoms of a UTI. Without treatment, a UTI can cause
serious complications.
A 3-day course of antibiotics may be necessary to treat a UTI during pregnancy. A doctor may prescribe one of the
following antibiotics:
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● amoxicillin
● ampicillin
● cephalosporins
● nitrofurantoin
● trimethoprim-sulfamethoxazole
If pregnant women develop a kidney infection during pregnancy, they will need treatment in the hospital. This
treatment will involve antibiotics and intravenous fluids.
Women who are pregnant and have symptoms of a UTI should see a doctor. As well as medical treatment, they may
also wish to try the following at home to help speed up recovery:
● Drinking plenty of water: Water dilutes urine and helps flush bacteria out of the urinary tract.
● Drinking cranberry juice: According to a 2012 review, cranberries contain compounds that may help to stop
bacteria from attaching to the lining of the urinary tract. This action helps to prevent and eliminate infection.
● Urinating when the urge arises: This helps bacteria pass out of the urinary tract more quickly.
● Taking certain supplements: A 2016 study found that a combination of vitamin C, cranberries,
and probiotics may help to treat recurrent UTIs in women.
Without treatment, UTIs can cause serious complications during pregnancy. Complications may include:
● kidney infection
● premature birth
● sepsis
A baby born to a woman with an untreated UTI may also have a low birth weight at delivery.
38
If a UTI spreads to the kidneys, this can cause further complications, such as:
● anemia
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● high
● preeclampsia
● breakdown of red blood cells, or hemolysis
● low blood platelet count, or thrombocytopenia
● bacteria in the bloodstream, or bacteremia
● acute respiratory distress syndrome
In some cases, an infection may pass on to the newborn baby, causing a rare but severe complication. Attending
screenings for UTIs during pregnancy and getting prompt treatment when one occurs can help prevent these
complications.
The following tips may help to reduce a person’s likelihood of getting a UTI:
● drink plenty of water
● drink unsweetened cranberry juice or take cranberry pills
● wash carefully around the genitals and anus
● pass urine whenever the urge arises, and at least every 2-3 hours
● urinate before and after having sex
Pregnant women will usually attend a screening to check for UTIs in their early pregnancy. These checks are an
important step in helping to prevent UTI infections or detecting them early.
Reference:
Medically reviewed by Carolyn Kay, M.D. — Written by Beth Sissons on November 27, 2019.
https://www.medicalnewstoday.com/articles
39
Note: Now that we are facing the pandemic Covid 19, pregnant mother might be at an increased risk
for severe illness as compared to non-pregnant mother, Therefore , if you know that your
relatives ,friends, neighbors are pregnant, try to advise them to avoid crowded places and follow the
guidelines and protocols for the prevention of Covid 19-infection. You may help them if you read and
dig deeper the possible effect of this condition to our pregnant mother and their babies.
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INFLUENZA
shotofprevention.com feministmidwife.com sciencejournalforkids.com

As stated by Centers for Disease Control and Prevention (CDC), flu is serious for pregnant women
and their babies. Pregnant women who get the flu are at higher risk of hospitalization and even death.
Severe illness during pregnancy can also be dangerous to your developing baby because it increases the
chance of significant problems, such as premature labour and delivery.
Influenza (flu) is more likely to cause severe illness in pregnant women than in women of reproductive age
who are not pregnant. Changes in the immune system, heart, and lungs during pregnancy make pregnant women (and
women up to two weeks postpartum) more prone to severe illness from flu, including illness resulting in hospitalization.
A common flu symptom is fever, which may be associated with neural tube defects and other adverse outcomes for a
developing baby. Getting vaccinated also can help protect a baby after birth from flu. (Mom passes antibodies onto the
developing baby during her pregnancy.)
Flu symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills and fatigue.
Some people may also have vomiting and diarrhea, though this is most common in young children. People may be
infected with the flu and have respiratory symptoms without a fever.
Early Treatment is Important for Pregnant Women
● Treatment should begin as soon as possible because antiviral drugs work best when started early (within 48
hours after symptoms start).
● Antiviral drugs can make your flu illness milder and make you feel better faster. They may also prevent
serious health problems that can result from flu illness.
● Oral oseltamivir is the preferred treatment for pregnant women because it has the most studies available to
suggest that it is safe and beneficial.
● Antiviral drugs require a prescription from your doctor.
40
● Having a fever caused by flu infection or other infections early in pregnancy may be linked to birth defects in a
baby. In addition to taking antiviral drugs, pregnant women who get a fever should treat their fever with
Tylenol® (or store brand equivalent) and contact their doctor immediately.
● When to Seek Emergency Medical Care
Module
● If 3
the pregnant mother have any of these signs, need to visit or call her physician immediately:
● 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 then return or worsen
● High fever that is not responding to Tylenol® (or store brand equivalent)
● Decreased or no movement of your baby
Reference:
https//:www.cdc.gov/flu/highrisk/pregnant. htm
TUBERCULOSIS
parenting.firstcry.com
mhtf.org. childhoodtb.org
According to CDC, infants born to women with untreated TB may be of lower birth weight than those
born to women without TB and, in rare circumstances, the infant may be born with TB. Although the drugs
used in the initial treatment regimen for TB cross the placenta, the drugs do not appear to have
harmful effects on the fetus
41
About 1 million Filipinos have active TB disease. Every day more than 70 people lose their lives to
TB in the Philippines needlessly. Many of these patients develop drug resistant tuberculosis, which are more
expensive and difficult to treat.
Tuberculosis is an airborne disease This is the third highest prevalence rate in the world, after South Africa
and Lesotho. It is a highly curable disease. Yet, it is the number one killer among all infectious diseases
Module 3
Untreated tuberculosis (TB) disease represents a greater hazard to a pregnant woman and her fetus than
does its treatment. Treatment should be initiated whenever the probability of TB is moderate to high.
● Infants born to women with untreated TB may be of lower birth weight than those born to women
without TB and, in rare circumstances, the infant may be born with TB.
● Although the drugs used in the initial treatment regimen for TB cross the placenta, they do not appear
to have harmful effects on the fetus.
Diagnosis Treatment
Latent TB Infection
● Isoniazid (INH) daily or twice weekly for 9
months, with pyridoxine (vitamin B6)
supplementation
● 3HP INH and Rifapentine is not
recommended for pregnant women or
women expecting to be pregnant in the
next 3 months
TB Disease
● The preferred initial treatment regimen is
INH, rifampin (RIF), and ethambutol
(EMB) daily for 2 months, followed by
INH and RIF daily, or twice weekly for 7
months (for a total of 9 months of
treatment).
● Streptomycin should not be used
because it has been shown to have
harmful effects on the fetus.
● Pyrazinamide (PZA) is not recommended
to be used because its effect on the fetus
is unknown.
HIV-Related TB Disease Treatment of TB disease for pregnant women co-

infected with HIV should be the same as for
nonpregnant women, but with attention given to
additional considerations. For more information
please review the Guidelines for Prevention and
42
Treatment of Opportunistic Infections in HIV-

Infected Adults and Adolescents.
The following antituberculosis drugs are contraindicated in pregnant women:
Module 3
● Streptomycin
● Kanamycin
● Amikacin
● Capreomycin
● Fluoroquinolones
Pregnant women who are being treated for drug-resistant TB should receive counseling concerning the risk
to the fetus because of the known and unknown risks of second-line antituberculosis drugs.
Breastfeeding should not be discouraged for women being treated with the first-line antituberculosis drugs
because the concentrations of these drugs in breast milk are too small to produce toxicity in the nursing
newborn. For the same reason, drugs in breast milk are not an effective treatment for TB disease or latent
TB infection in a nursing infant. Breastfeeding women taking INH should also take pyridoxine (vitamin B6)
supplementation.
Dr Gundo Weiler is the WHO Representative in the Philippines., stated that this year’s World Tuberculosis
(TB) Day theme is: “It’s time”. It is an urgent call for action to urge world leaders to keep the promises they
made at the first-ever UN high-level meeting on TB in New York last September. During that meeting,
Secretary of Health Dr Francisco Duque III had committed to the bold target of finding and treating 2.5 million
people with TB in 2017-2022.
The Philippines must rise to this challenge and deliver on the commitments that Secretary Duque made in
New York. For that, the country needs to run an aggressive and sustained campaign against TB. That is the
only way to bend the epidemic curve of TB towards its elimination.
Ending TB requires concerted action by all sectors and all care providers. Everyone has a role to play in
ending TB – individuals, communities, businesses, governments, societies. Everyone must join the race to
end TB by 2030. Can all readers of this article post their ideas on social media using the hashtag of
#RaceToEndTB? Can all readers also reach out to their local governments to advocate for adequate
financial and human resources to screen all high risk groups with chest X-ray annually and for TB symptoms
regularly?
In New York, Secretary Duque declared that he will focus on three game-changers: high level commitment,
massive screening, testing and treatment, and mandatory notifications by the private sector. He has
appealed to all of us to lend our full support to the Department of Health. Are we ready to join him in this
now-or-never fight to end TB once and for all?
The World Health Organization is committed to working side-by-side with the communities, the governments
and other partner agencies to wipe out this top killer. The clock is ticking. We cannot lose another day. It’s
43
time to ensure that no one dies of TB anymore. It’s time to find and treat the 2.5 million Filipinos with TB by
2022. It’s time to #EndTB!
Reference:
Module
Dr Gundo3 Weiler is the WHO Representative in the Philippines.
Versions of this commentary were published in the Philippine Star on 23 March 2019 and in Manila
Bulletin on 24 March 20
https://www.cdc.gov/tb/topic/treatment/pregnancy.htm
COVID 19
unicef.org healio.com who.int.
Note: Most of the topic written in this discussion is purely the description of the author for more
understanding and give proper insights of how Covid 19 affect and effect to our pregnant mothers
and their babies.
According to CDC, pregnant people might be at an increased risk for severe illness from COVID-
19 compared to non-pregnant people. Additionally, there may be an increased risk of adverse pregnancy
outcomes, such as preterm birth, among pregnant people with COVID-19. Therefore, if you are pregnant, be
mindful about reducing your risk of getting sick. If you are caring for children, you can teach them everyday
steps (such as proper handwashing ) to help them stay healthy and, in turn, help protect yourself and your
family.
It is especially important for people at increased risk for severe illness from COVID-19, and those who live
with them, to protect themselves from getting COVID-19.
The best ways to protect yourself and to help reduce the spread of the virus that causes COVID-19 are to:
Limit your interactions with other people as much as possible.
Take precautions to prevent getting COVID-19 when you do interact with others.
If you start feeling sick and think you may have COVID-19, call your healthcare provider within 24 hours.
Venturing out into a public setting? What to consider before you go.
As communities and businesses across the United States are opening, you may be thinking about resuming
some activities, running errands, and attending events and gatherings. There is no way to ensure you
have zero risk of infection, so it is important to understand the risks and know how to be as safe as
possible.
44
People who are pregnant, and those who live with them, should consider their level of risk before deciding to
go out and ensure they are taking steps to protect themselves and others. Consider avoiding activities where
taking protective measures may be difficult, such as activities where social distancing can’t be
maintained. Everyone should take steps to prevent getting and spreading COVID-19 to protect
themselves, their communities, and people who are at increased risk of severe illness.
Module
In general,3the more people you interact with, the more closely you interact with them, and the longer
that interaction, the higher your risk of getting and spreading COVID-19.
● If you decide to engage in public activities, continue to protect yourself by practicing everyday
preventive actions .
● Keep these items on hand and use them when venturing out: a mask, tissues, and a hand sanitizer
with at least 60% alcohol, if possible.
● If possible, avoid others who are not wearing masksor ask others around you to wear masks.
Related: How to protect yourself and others
COVID-19 and pregnancy considerations
Based on what we know at this time, pregnant people might be at increased risk for severe illness from
COVID-19 compared to non-pregnant people. Additionally, there may be an increased risk of adverse
pregnancy outcomes, such as preterm birth, among pregnant people with COVID-19.
Actions to take if you are pregnant
● Do not skip your prenatal care appointments.
● Limit your interactions with other people as much as possible.
● Take precautions to prevent getting COVID-19 when you do interact with others.
● Make sure that you have at least a 30-day supply of your medicines.
● Talk to your healthcare provider about how to stay healthy and take care of yourself during the
COVID-19 pandemic.
● If you don’t have a healthcare provider, contact your nearest community health center external icon
or health department.
● Call your healthcare provider if you have any questions related to your health.
● Seek care immediately if you have a medical emergency.
● You may feel increased stress during this pandemic. Fear and anxiety can be overwhelming and
cause strong emotions. Learn about stress and coping.
● Learn more about how to reduce your risk of getting COVID -19.
Vaccines during pregnancy
45
Although there is no vaccine available to protect against the virus that causes COVID-19, routine vaccines
are an important part of protecting your health. Receiving some vaccines during pregnancy, such as the
influenza (flu) and Tdap vaccines, can help protect you and your baby. If you are pregnant, you should
continue to receive your recommended vaccines. Talk with your healthcare provider about visits for vaccines
during pregnancy.
Module 3 postpartum care

Prenatal and
It is important to take care of yourself and your baby during pregnancy and after delivery.
Do not skip your prenatal care appointments or postpartum appointments. If you are concerned about
attending your appointment due to COVID-19, talk to your healthcare provider.
● Ask your healthcare provider how they are taking steps to separate healthy patients from those who
may be sick.
● Some healthcare providers might choose to cancel or postpone some visits. Others may switch
certain appointments to telemedicine visits, which are appointments over the phone or video. These
decisions will be based on the circumstances in your community as well as your individual care plan.
● Call your healthcare provider if you have an urgent medical question.
● In case of emergency, call 911 or go to your local emergency department. If you are not driving, call
the emergency department on the way to explain that you are pregnant and have an emergency.
They should have an infection prevention plan to protect you from getting COVID-19 if you need
emergency care. Do not delay getting emergency care because of COVID-19.
Delivery locations during the COVID-19 pandemic
Delivering your baby is always safest under the supervision of trained healthcare professionals. If you have
questions about the best place to deliver your baby, discuss them with your healthcare provider.
Newborns born to mothers with suspected or confirmed COVID-19
Much is still unknown about the risks of COVID-19 to newborns.
● Newborns can be infected with the virus that causes COVID-19 after being in close contact with an
infected person.
● Some babies have tested positive for the virus shortly after birth. It is unknown if these babies got
the virus before, during, or after birth.
● Most newborns who have tested positive for COVID-19 had mild or no symptoms and have
recovered fully. However, there are a few reports of newborns with severe illness.
● A small number of other problems, such as preterm (early) birth and other problems with pregnancy
and birth, have been reported in babies born to mothers who tested positive for COVID-19. We do
not know if these problems were related to the virus.
46
CDC recognizes that the ideal setting for the care of a healthy, full-term newborn during the birth
hospitalization is within the mother’s room. Temporary separation of the newborn from a mother with
suspected or confirmed COVID-19 should be considered to reduce the risk of spreading the virus to the
newborn. The risks and benefits of temporary separation of the mother from her newborn should be
discussed with the mother by her healthcare team. Decisions about temporary separation should be made
with respect to the mother’s wishes. If the mother chooses a temporary separation to reduce risk of
Module 3
spreading the virus and would like to breastfeed, she should express breast milk and have a healthy
caregiver who is not at high-risk for severe illness from COVID-19 bottle feed the newborn the expressed
breast milk if possible.
If the mother with suspected or confirmed COVID-19 does not choose temporary separation in the hospital,
she should take precautions to avoid spreading the virus to the newborn, including washing her hands and
wearing a mask when within 6 feet of her newborn. The newborn should be kept ≥6 feet away from the
mother, as much as possible, including the use of physical barriers (e.g., placing the newborn in an
incubator).
Mothers who are discharged from the hospital but have not met criteria to discontinue isolation may choose
to continue to separate from the newborn at home to reduce the risk of spreading the virus, if a healthy
caregiver is available. If a healthy caregiver is not available, a mother with COVID-19 can still care for her
infant if she is well enough while using precautions (for example, hand washing, wearing a mask).
Separation from the newborn may make it harder for some new mothers to start or continue breastfeeding.
Frequent hand expression or pumping, ideally with a hospital-grade pump, is necessary to establish and
build milk supply during temporary separation. Pumping every 2-3 hours (at least 8-10 times in 24 hours,
including at night), especially in the first few days, signals the breasts to produce milk and prevents blocked
milk ducts and breast infections. Mothers who are unable to establish milk production in the hospital after
birth, or who have to temporarily stop breastfeeding, can relactate with skilled assistance from a lactation
support provider. Additional information on relactation is available.
COVID-19 and breastfeeding
Mothers who choose to breastfeed:
● Breast milk provides protection against many illnesses and is the best source of nutrition for most
infants. Learn more about breastfeeding.
● You, along with your family and healthcare providers, should decide whether and how to start or
continue breastfeeding.
● We do not know for sure if mothers with COVID-19 can spread the virus to babies in their breast
milk, but the limited data available suggest this is not likely.
● If you have COVID-19 and choose to breastfeed:
o Wear a mask while breastfeeding and wash your hands with soap and water for at least 20
seconds before each feeding.
● If you have COVID-19 and choose to express breast milk:
o Use a dedicated breast pump (not shared).
o Wear a mask during expression and wash your hands with soap and water for at least 20
seconds before touching any pump or bottle parts and before expressing breast milk.
47
o Follow recommendations for proper pump cleaning after each use, cleaning all parts that
come into contact with breast milk.
o If possible, expressed breast milk should be fed to the infant by a healthy caregiver who
does not have COVID-19, is not at high-risk for severe illness from COVID-19, and is living
in the same home.
Module 3 and other caregivers should follow recommendations described in the Discontinuation of
● Parents
Isolation for Persons with COVID-19 Not in Healthcare Settings.
Additional CDC resources to support infant nutrition include:
● Breastfeeding
● Formula Feeding
● Feeding from a Bottle
● Vitamins and Minerals
Other Important Information for New Parents:
● Jaundice and Kernicterus
COVID-19 and children
There is much more to be learned about how this disease affects children. While some children and infants
have been sick with COVID-19, most illnesses have been among adults. Some reports suggest that infants
under 1 year old and those with underlying medical conditions might be at higher risk of serious illness from
COVID-19 than other children.
● Children with COVID-19 generally have mild, cold-like symptoms, such as fever, runny nose, and
cough. Vomiting and diarrhea have also been reported in some children.
● Children with certain underlying medical conditions, such as chronic lung disease or moderate to
severe asthma, serious heart conditions, or weak immune systems, might be at higher risk for
severe illness from COVID-19. Call your child’s healthcare provider if you are worried about your
child’s health or if your child has symptoms of COVID-19.
● In case of emergency, call 911 or go to your local emergency department. Emergency departments
have infection prevention plans to protect you and your child from getting COVID-19 if your child
needs emergency care. Do not delay getting emergency care for your child because of COVID-
19.
Related: Children and youth with special healthcare needs.
Face shields for newborns and infants
Plastic face shields for newborns and infants are NOT recommended. There are no data supporting the
use of infant face shields for protection against COVID-19 or other respiratory illnesses. An infant face shield
48
could increase the risk of sudden infant death syndrome (SIDS) or accidental suffocation and strangulation.
Infants, including newborns, move frequently, which could increase the possibility of their nose and mouth
becoming blocked by the plastic face shield or foam components. The baby’s movement could also cause
the face shield to become displaced, resulting in strangulation from the strap.
Information for how to protect newborns from becoming sick with COVID-19 while in the hospital can be
Module 3 Considerations for Inpatient Obstetrics Healthcare Settings. Additional information on how to
found in CDC’s
protect yourself and others, including newborns and infants, from COVID-19 illness is also available.
Masks for children, parents, and other caregivers
CDC recommends that everyone 2 years and older wear a mask that covers their nose and mouth when
they are out in the community. Because of the danger of suffocation, do NOT put masks on babies or
children younger than 2 years. Masks should also not be worn by anyone who has trouble breathing, is
unconscious, can’t move, or is otherwise unable to remove the mask without assistance.
Parents and other caregivers should keep in mind that wearing a mask is not a substitute for social
distancing, frequent hand washing, or other everyday preventive actions – please wear your mask in addition
to practicing other prevention steps. A mask is not intended to protect you, the wearer, but it may prevent
you from spreading the virus to others. This would be especially important if you are infected but do not have
symptoms of COVID-19. Please remember that medical facemasks and N95 respirators are reserved for
healthcare personnel and other first responders.
Safe sleep for infants during the COVID-19 pandemic
During the COVID-19 pandemic, parents of infants may experience increased stress and fatigue that could
affect their infants’ sleep practices. Safe sleep is an important part of keeping infants healthy, including
during the COVID-19 pandemic. If you have an infant, you can help reduce your baby’s risk of sudden infant
death syndrome (SIDS) and other sleep-related deaths by doing the following:
● Place your baby on his or her back for all sleep times – naps and at night.
● Use a firm, flat sleep surface, such as a mattress in a crib, covered by a fitted sheet.
● Have the baby share your room but not your bed. Your baby should not sleep on an adult bed, cot,
air mattress, or couch, or on a chair alone, with you, or with anyone else.
● Keep soft bedding such as blankets, pillows, bumper pads, and soft toys out of your baby’s sleep
area.
● Do not cover your baby’s head or allow your baby to get too hot. Signs your baby may be getting too
hot include if he or she is sweating or if his or her chest feels hot.
● Do not smoke or allow anyone to smoke around your baby.
Learn more about how to reduce the risk of SIDS.

Well visits and routine vaccine visits for children during the COVID-19 pandemic
Routine well child visits and vaccine visits are still important during the COVID-19 pandemic.
Newborn visits. Ideally, newborn visits should be done in person so that your pediatric healthcare provider
can check your baby’s growth and feeding, check your baby for jaundice, make sure your baby’s newborn
screening tests were done, and get any repeat or follow-up testing, if necessary. At the newborn visit, your
49
pediatric healthcare provider will also check how you and your baby are doing overall. Newborn screening
tests include a bloodspot, hearing test, and test for critical congenital heart defects. Learn more
about newborn screening tests.
Well child visits. Your pediatric healthcare provider will check your child’s development at well child visits.
You can track your child’s developmental milestones with CDC’s free Milestone Tracker app.
Module 3
Vaccine visits. Vaccines are an important part of keeping your child healthy, especially if your child is under
2 years old. Vaccines help provide immunity before being exposed to potentially life-threatening diseases.
Although there is not yet a vaccine to help protect against COVID-19, vaccines for illnesses such as
measles, influenza (flu), whooping cough (pertussis), and other infectious diseases are important for your
child’s health. This will help to prevent outbreaks of vaccine-preventable diseases among young children
during the COVID-19 pandemic.
Ask your healthcare provider how they are taking steps to separate healthy patients from those who may be
sick. Some health care providers may choose to delay visits like well child checks and routine vaccine visits.
These decisions will be based on circumstances in your community and your child’s individual care plan. Call
your provider’s office to ask about any upcoming appointments or about when your child’s vaccinations are
due.
Coping with stress
Pandemics can be stressful for everyone. Fear and anxiety about a disease can be overwhelming and cause
strong emotions in both adults and children. Coping successfully with stress will make you, the people
you care about, and your community stronger.
Talk with your children about the pandemic. It is important to try to stay calm and to give children information
that is truthful and appropriate for their ages and developmental levels.Children respond differently to
stressful situations than adults . CDC offers resources to help you talk with your children about COVID-19.
Depression during and after pregnancy is common and can be treated. Postpartum depression is depression
that can happen after having a baby. If you think you may be experiencing depression, seek treatment from
your health care provider as soon as possible. Find more information on depression during and after
pregnancy.
Pregnant people and parents caring for young children may be experiencing increased stress due to the
COVID-19 pandemic. CDC offers resources to help with Stress and Coping.
50
Module 3
Evaluation
51
1. Identify the different complications of pregnancy during third trimester and it’s diseases
that affect pregnancy.
2. Differentiate signs and symptoms of the complication of pregnancy during first and
second trimester.
3. Assess mother with complications of pregnancy during third trimester and it’s diseases
Module 3 that affect pregnancy.
4. Formulate plan of care for the identified client with complications during first third
trimester , different diseases that affect pregnancy.
COMPETENCY DRILL
MWC02
Pathological Obstetrics,Basic Gynecological, Family Planning and Care of Infants and Feeding
Competency 3: Drill 3
Diseases Affecting Pregnancy
A. Define the following terms:

1. Rheumatic Heart Disease
2. Diabetes Mellitus
3. Substance Abuse
4. HIV/AIDS and STD
5. Rh Sensitization
6. Anemia
7. Thyroid disease
8. German Measles
9. Urinary Tract Infection
10. Rubella
11. Influenza
12. Tuberculosis
13. Covid 19
B. Multiple Choice
Circle the letter that corresponds to the best answer for each questions.
52
1. This is the most common cardiac problem. It causes inflammation and scarring of the heart valves and
results in valve stenosis.
a. Ischaemic Heart disease c. Congenital Heart disease
b. b. Influenza d. Rheumatic Heart Disease
Module 3
2. It is a metabolic disorder which is characterized by increasing levels of glucose in blood and excretion of
glucose in the urine.
a. Urinary tract infection b. diabetes mellitus c. anemia d. Thyroid Disease
3. This is found in different forms in raw meat, within cats that eat raw meat and their feces.
a. Toxoplasmois b. Rubella c. German Measles d. Influenza
4. It is a lack of red blood cells, which can lead to a lack of oxygen-carrying ability, causing unusual
tiredness.
a. Diabetes mellitus b. anemia c. tuberculosis d. rubella
5. Another name for German measles:
a. Rubella b. thrush c. syphilis d.scabies
C. Multiple –Answer Multiple –choice Questions

Circle the letter(s) corresponding to the appropriate answer(s). Select all that apply.
1. Being low in Iron can lead to: except
a. More fatigue than normal in pregnancy
b. Increased susceptibility to illness and infection
c. Pre-term delivery
d. Low birth weight of the baby
e. Big baby
2. Symptoms of Gestational Diabetes are:
a. Extreme fatigue
b. Excessive thirst
c. Frequent urination
d. Unexplained weight loss
e. All are correct
3. Signs and symptoms of impending convulsions or imminent eclampsia are:
a. Severe vomiting
b. Visual disturbances
c. Epigastric pain
d. Apprehension
e. E. irritability
f. Hyporeflexia
g. All are correct
D. True or False
Indicate if the following statements are true or false by placing a “T” or “F” in the space provided and then
write the correct answer if it is false.
1.Alcohol can disrupt fetal development at any stage during a pregnancy.
2. Clamydia and gonorrhea infections cannot pass to the baby during delivery.
53
3.Sexually transmitted diseases are mainly passed from one person to another during
Sexual intercourse.
4.Clamydia are caused by human papilloma virus.
Module5.3If a woman is Rh negative and the father is Rh positive, there’s a very good chance the baby will be Rh
positive as well.
E. ESSAY
1. Describe COVID 19, the effect and how it affects to mother, baby, family and to the community.
Make more readings to support your answer.
2. Make a narrative or journal of your experiences from the time that COVID 19 appears and become
pandemic. What is the effect of this pandemic to:
a. Yourself/study
b. Family
c. Community- Local and International
Exodus 15:26. “ Saying, “ If you will diligently listen to the voice of the Lord your God, and do
that which is right in his eyes, and give ear to his commandments and keep all his statutes, I will put
none of the diseases on you that I put on the Egyptians , for I am the Lord, your Healer.”
References
Reference:
Flagg-JoAnne Silbert, Pillitteri, Adele. Maternal and Child Nursing. 8 th Edition. Copyright @ 2018 Wolters
Kluwer
Lowdermilk D., Perry S. and Cashion MC. Maternity Nursing – Revised Reprint , 8 th Edition. Mosby.
November 25, 2013
https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/pregnancy-breastfeeding.html
https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/special-populations/pregnancy-data-on-covid-
19.html
54
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SOUTHERN LUZON STATE UNIVERSITY

COLLEGE OF ALLIED MEDICINE

MODULE 3: Managing complications in

This course deals with the concepts of

Wednesday | Thursday| Friday 8:00-12:00; 1:00- 5:00

Corner Villa Aurea

0943 070 6995

Module 3 have studied this module , you should be able to:

Module 3 CARDIAC DISEASE

Rheumatic Heart Disease

● Shortness of breath and chest discomfort

● Uncontrolled movements of arms, legs, or facial muscles

● Shortness of breath (especially with activity or when lying down)

Some complications of rheumatic heart disease include:

Congenital Heart Disease

https://speciality.medicaldialogues.in/standard-treatment-guidelines for congenital heart disease

Congenital Heart condition include:

my.clevelandclinic.org ghr.nlm.nih,gov mayoclinic.org

3.Ischaemic Heart Disease

● Advanced maternal age (more cases reported in both extremes of age)

● Twin pregnancy (more endemic in women with twin pregnancies)

● African descent (more prevalent in the African population)

� 1. full blood count

� 3.3chest radiograph to asses cardiac size and outline

Risk to mother and fetus: 3 factors

� 1. The nature of the cardiac lesion

� 2. its affect on the functional capacity of the heart

� 3. development of pregnancy-related complications such as hypertensive disorders of pregnancy,

� 1. decreased systemic circulation or decreased oxygenation

VI. Heart disease

� Class I – no limit to physical activity

� Recommendation of class I & II

� sleep 10 hrs a day

� rest 30 minutes & after meal

� Recommendation: Therapeutic abortion

Refers to a group of metabolic diseases characterized by hyperglycemia resulting from defects in

Four Classification of Diabetes

deficiency. It includes cases currently thought to be caused by an autoimmune process, as

Gestational diabetes mellitus is likely to recur in future pregnancies, and there is an

Classic risk factors include:

4. Obstetric history of an infant weighing more than 4500 g

Hyperglycemic effects can include:

b. macrosomia- fetal birth weight more than 4500g.

c. intrauterine growth restriction

d. intrauterine fetal death

e. delayed lung maturity

Symptoms of Gestational Diabetes

1.high birth weight

2. low blood sugar levels at birth

4. infant respiratory distress syndrome

Maternal –Fetal Risks

1. explain the effects of gestational diabetes on the mother and fetus

2. monitor blood glucose

4. emotional and psychological needs

� Function: of insulin – facilitates transport of glucose to cell

� Dx: 1 hr 50gr glucose tolerance test GTT

� Normal glucose – 80 – 120 mg/dl < 80 – hypoclycemic

( euglycemia) > 120 - hyperglycemia

� 3 degrees GTT of > 130 mg/dL

� Hypo or hyperglycemia – 1st trimester hypo, 2nd – 3rd trim – hyperglycemic

� Frequent infection- moniliasis

� Dystocia-difficult birth due to abnormalities in fetus or mom.