High Risks During Pregnangy

HIGH RISKS DURING PREGNANGY What is preterm birth? - Birth before 37 weeks is "preterm". Infants weighing less than 1500 grams are at great risk of what? - dying or living with neurological impairments Preterm birth is responsible for what percentage of all neonatal deaths? - 83% TORCH infections - Toxoplasmosis Other Rubella Cytomegalovirus Herpes T: - Toxoplasmosis: protozoan found in cat feces or undercooked meat, may cause SAB (spontaneous abortion) O: - Other infections: hepatitis B causes prematurity and fetal hepatitis; varicella causes SAB, fetal death, CNS damage, hydrocephalus; syphilis causes congenital syphilis R: - Rubella: causes SAB, congenital rubella syndrome C: - Cytomegalovirus: causes fetal or neonatal death, hydrocephaly, microcephaly, deafness H: - Herpes simplex: causes SAB, preterm labor Congenital rubella syndrome - Classic triad: congenital cataracts (white pupils), sensory-neural deafness, and patent ductus arteriosus (could be pulmonary artery stenosis as well) cCould potentially also result in microcephaly and mental retardation non-pregnant females should be vaccinated with the live MMR vaccine prior to pregnancy. Congenital herpes simplex - • If a Mom has active genital lesions at the time of a vaginal delivery, the newborn can potentially acquire herpes simplex and this can result in infant death • Women with active lesions at time of delivery are recommended to have a cesarian section • Newborns with herpes simplex are treated with IV acyclovir Congenital syphilis - a syphilis infection in a newborn baby resulting from transmission from an infected mother Blueberry muffin baby - hemorrhagic purpuric eruptions assoc. with TORCH infections fetal alcohol syndrome - physical and cognitive abnormalities in children caused by a pregnant woman's heavy drinking Rh Incompatibility - Rh factor is an antigen that causes antibody formation when the Rh negative body is exposed to it When a woman who is Rh-negative carries a fetus that is Rh-positive: - a blood incompatibility may occur Mixing of fetal blood with maternal occurs occasionally when: - villi rupture allowing a few drops of fetal blood into maternal blood stream At time of placental separation there is exchange of - maternal & fetal blood What does Rh incompatibility cause? - Causes erythroblastosis fetalis which is manifested by destruction of fetal RBCs when attacked by the Rh antibodies from mother When is RhoGam given? - Rho-immunoglobulin (RhoGam) given to Rh-negative woman at 28 weeks gestation if she does not have an elevated anti-D antibody titer and again within 72 hours after delivery of Rh-positive infant (Coomb's negative) If already sensitized - RhoGam won't help (Coomb's positive) How is rhogam given - RhoGam is an IM injection of passive antibodies to Rh factor What does rhogam do? - These antibodies do not cross placenta so do not attack fetal RBCs This prevents maternal production of natural Rh antibodies that will cross placenta Who gets Rhogam? - Mothers who are Rh- and if the RH+ blood cells leak into blood stream the mothers antibodies kill red blood cells in baby or future baby. RH pos mom - rh pos baby= NO RH pos mom - rh neg baby = NO RH neg mom - RH neg baby = NO RN neg mom - RH pos baby = YES Risk factors for Hypertensive disorders in pregnancy: - Primigravida Age under 19 and over 40 Multiple gestation pregnancy Molar pregnancy Familial tendency Chronic renal disease Chronic HTN Diabetes Severe malnutrition primigravida - a woman who is pregnant for the first time molar pregnancy - also known as gestational trophoblastic disease; abnormal proliferation of trophoblastic cells in the first trimester What are the classifications of Hypertensive disorders in pregnancy? - Gestational hypertension Preeclampsia Eclampsia HELLP syndrome Gestational hypertension (GH) - This disorder begins after the 20th week of pregnancy where BP s elevated at 140/90 mm Hg or greater recorded at least twice, 4-6 hours apart within a 1 week period preeclampsia - a complication of pregnancy characterized by hypertension, edema, and proteinuria eclampsia - true toxemia of pregnancy characterized by high blood pressure, albuminuria, edema of the legs and feet, severe headaches, dizziness, convulsions, and coma HELLP syndrome - hemolysis, elevated liver enzymes, low platelets preeclampsia vs eclampsia - preeclampsia = hypertension, proteinuria, and edema; eclampsia = precclampsia + seizures; caused by placental ischemia due to impaired vasodilation of spiral arteries, can be associated with HELLP syndrome What causes preeclampsia? - placental ischemia due to impaired vasodilation of spiral arteries resulting in increased vascular tone; What is gestational hypertension? - Hypertension occurring after the 20th week of gestation in a previously normotensive patient Systolic BP 140 mm Hg or diastolic 90 mm Hg Patient is usually asymptomatic otherwise What are some major symptoms of preeclampsia? - Hypertension same BP parameters as gestational hypertension Proteinuria Edema/Weight Gain late sign How often is preeclampsia seen in pregnancies? - 5-7% of all pregnancies What is Pre-e characterized by? - Hypertension When is the only time Pre-e develops? - develops ONLY during pregnancy or early puerperium What is the only cure of Pre-e? - Delivery of the infant When does Pre-e develop? - after 20 weeks gestation