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Gestational Conditions: Comprehensive Overview, Summaries of Law

Law

A detailed overview of various gestational conditions that can occur during pregnancy, including hyperemesis gravidarum, pregnancy induced hypertension, gestational diabetes, rh incompatibility, iron deficiency anemia, folic acid deficiency anemia, and sickle cell anemia. It covers the predisposing factors, manifestations, therapeutic management, and potential complications associated with each condition. The comprehensive nature of the document makes it a valuable resource for healthcare professionals, students, and individuals interested in understanding the complexities of maternal health during pregnancy.

Typology: Summaries

2022/2023

Uploaded on 02/08/2023

Jhunerey
Jhunerey 🇵🇭

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GESTATIONAL CONDITIONS
Hyperemesis Gravidarum
-Pernicious or persistent vomiting
-Prolonged nausea and vomiting past week 12 of
pregnancy that may lead to:
Dehydration
Ketonuria
Significant weight loss -PRIORITY
measurement
Predisposing factors:
Hyperthyroidism (d/t thyroid stimulating
property of HCG)-Increase in thyroid
Helicobacter Pylori infection-peptic ulcer
Manifestations:
Elevated hematocrit(decreased Na, K, Cl)
Electrolyte imbalance
Polyneuritis (Vita. B12 deficiency)
Ketonuria
Intrauterine growth restriction (IUGR)
Preterm labor
Therapeutic management:
Hospital admission
IVF(3L of PLR w/ vitamin B
Metoclopramide- anti emetic pantigil ng
suka
Measure I&O
Food: Dry toast or cracker or cereals
Small quantity of clear fluid
PREGNANCY INDUCED HYPERTENSION
Vasospasm that occurs in pregnancy
resulting into proteinuria, edema, hypertension
Originally called Toxemia
Predisposing fx:
Multiple pregnancy
Multiparity
Primiparas (<20yo or > 40 yo)
Low socioeconomic background
Presence of underlying disease
Types:
Gestational hypertention—BP 140/90 that
returns to normal after delivery
Mild pre-eclampsia-BP 140/90 , proteinuria
+1-+2, mild edema, weight gain over 2 lbs/week (2nd
trimester), and over 1 lb/wk (3rd trimester)
Severe Pre-eclampsia-BP 160/110,
proteinuria +3-+4,edema, oliguria,
neuro/visual/cardio/hepatic-disturbances
Eclampsia-All about manifestations plus
Seizure
Maternal effects:
Abruptio placenta
Pulmonary edema (d/t left ventricular
hypertrophy)
Cardiopulmonary arrest
Disseminated intravascular coagulopathy
Stroke
Fetal effects:
Fetal growth restriction
Prematurity
Therapeutic management:
Bed rest, non-stimulating environment
Seizure precaution
Moderate-high protein
Moderate sodium diet
pf3
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GESTATIONAL CONDITIONS

Hyperemesis Gravidarum

  • Pernicious or persistent vomiting
  • Prolonged nausea and vomiting past week 12 of pregnancy that may lead to: Dehydration Ketonuria Significant weight loss - PRIORITY measurement Predisposing factors: Hyperthyroidism (d/t thyroid stimulating property of HCG )-Increase in thyroid Helicobacter Pylori infection- peptic ulcer Manifestations: Elevated hematocrit(decreased Na, K, Cl) Electrolyte imbalance Polyneuritis (Vita. B12 deficiency) Ketonuria Intrauterine growth restriction (IUGR) Preterm labor Therapeutic management: Hospital admission IVF(3L of PLR w/ vitamin B Metoclopramide- anti emetic pantigil ng suka Measure I&O Food: Dry toast or cracker or cereals Small quantity of clear fluid PREGNANCY INDUCED HYPERTENSION Vasospasm that occurs in pregnancy resulting into proteinuria, edema, hypertension Originally called Toxemia Predisposing fx: Multiple pregnancy Multiparity Primiparas (<20yo or > 40 yo) Low socioeconomic background Presence of underlying disease Types: Gestational hypertention— BP 140/90 that returns to normal after delivery Mild pre-eclampsia- BP 140/90 , proteinuria +1-+2, mild edema, weight gain over 2 lbs/week (2nd trimester), and over 1 lb/wk (3rd^ trimester) Severe Pre-eclampsia- BP 160/110, proteinuria + 3 - +4,edema, oliguria, neuro/visual/cardio/hepatic-disturbances Eclampsia- All about manifestations plus Seizure Maternal effects: Abruptio placenta Pulmonary edema (d/t left ventricular hypertrophy) Cardiopulmonary arrest Disseminated intravascular coagulopathy Stroke Fetal effects: Fetal growth restriction Prematurity Therapeutic management: Bed rest, non-stimulating environment Seizure precaution Moderate-high protein Moderate sodium diet

Na restriction for severe pre-eclampsia and eclampsia Monitor VS, FHT, and I&O Obtain daily weights Hydrazaline Hypotensive agent-vasodilator MgSo4 Drug of choice

  • Vasodilator and CNS depressant
  • Given slow IV push:can cause dysrhythmia Antidote: Calcium Gluconate
  • BP- withhold if BP <90/
  • UO - withhold if (+) oliguria
  • RR - withhold if bradypneic Patellar reflex- withhold if (+) hyporeflexia Digitalis Diazepam(IV) Potassium supplements Complication:HELLP SYNDROME H emolysis E levated L iver enzymes L ow P latelet Manifestations: Nausea General malaise Epigastric pain RUQ tenderness Therapeutic management: Fresh frozen plasma (FFP) Platelet concentrate Intravenou s dextrose infusion(if w/ hypoglycemia) IMMEDIATE delivery as soon as feasible Delivery of the baby-only cure for PIH **MAGNESIUM NORMAL LEVEL 5 - 8 --------GRAVIDO CARDIA-------
  • Existence of heart conditions during pregnancy** Heart failure (LEFT-SIDED/RIGHT SIDED) Rheumatic heart disease Rare perinatal cardiomyopathy Danger: Increased circulatory volume in pregnancy Usually dangerous in 28-32 weeks (blood volume peaks) Lung’s symptoms - left sided heart failure - lahat ng symptoms sa lungs, left sided HF Other symptoms - right sided heart failure
  • lahat ng symptoms sa ibang bahagi ng katawan, right sided HF Classification: Class 1 - can do task w/o discomfort Class 2 - can do task w/ less discomfort (can have normal pregnancy,labor and delivery) Class 3 - less than ordinary task causes discomfort (can complete pregnancy by maintaining bedrest) Class 4 - any activity cause discomfort (poor pregnancy)

Therapeutic management: Insulin Started if DIET alon is unsuccessful Regular insulin (short acting) combined w/ intermediate type BID before breakfast and dinner (instruct to EAT immediately after injections) Oral hypoglycemia agents (OHA)- not recommended in pregnancy as it crosses the placenta- TERATOGEN Teach on proper insulin injection Monitor blood glucose level RH INCOMPATIBILITY Occurs when an Rh(-) mother bars an Rh(+) fetus If the father is homozygous(DD), fetus is 100% Rh(+) If the father is heterozygous (Dd), fetus is 50% Rh(+)/RH(-) Assessment: Anti-D antibody titer(Coomb’s test) 0 - Normal, no antibodies(first pregnancy) 1:8-minimal antibodies, not enough to cause hemolysis 1:16-Rh sensitization(another test- spectrophotometry) Spectrophotometry- measure amniotic fluid density=birumin level) Zone 1 - no distress Zone 3-minimal distress Zone 3 - high fluid density Rh(-) women(commercial prep of Rhlg is administered at 28wks of pregnancy and 72hrs after birth Prevents the formation of natural anti bodies IRON DIFICIENCY ANEMIA Most common anemia during pregnancy Microcytic/hypochromic Predisposing fx: Low iron diet Short birth Assessment/manifestations: CBC Decreased hemoglobin, hematocrit, serum ferritin Pallor, fatigue, dizziness Pica - unusual craving for food Complication: Pre-term birth(d/t poor placental perfusion) Therapeutic management: DIET modifications Iron rich food Prophylactic mngmnt Therapeutic medications Folic Acid Deficiency Anemia MEGALOBLASTIC Predisposing fx: Multiple gestation Post gastric bypass surgery Women taking hydantoin

Complications: Early miscarriage/spontaneous abortion Abruptio placenta Assessment: CBC Mean corpuscular volume (MCV) elevated Therapeutic management: DIET modification-folic acid rich foods Folic acid supplement-600mcg daily beginning of pregnancy multi pregnancy 400mcg ecpecting to be pregnant Sickle Cell Anemia RBC becomes crescent shape that may cause clogging in blood vessels and can lead to poor O2 perfusion to organs Factors that lead to SICKLING: Elevated temperature Dehydration Low O2 tension Assessment: Hemoglobin- 6 - 8mg/dL 5 - 6 during sickle crisis CBC-sickled RBC Therapeutic management: Maintain hydration Dietary modification(high iron/folic acid) Elevate legs when resting Monitor fetal health Decrease O2 demand Periodic exchange transfusion Hypotonic fluid administration Method of delivery is individualized