MODULE 4 PREGNANCY, CHILDBIRTH, AND POSTPARTUM AT RISK

1. MODULE 4 PREGNANCY, CHILDBIRTH, AND POSTPARTUM AT RISK

2. PREGNANCY AT RISK • PREGESTATIONAL • GESTATIONAL CHILDBIRTH AT RISK • PRE—LABOR COMPLICATIONS • LABOR—RELATED COMPLICATIONS • POSTPARTUM AT RISK

3. MODULE 4 PART 1APREGESTATIONAL RISKSSUBSTANCE ABUSE

4. SUBSTANCE ABUSE DURING PREGNANCY • ALCOHOL • CNS DEPRESSANT • INCIDENCE OF ABUSE HIGHEST IN MOTHERS 20-40 YEARS OF AGE • PREGNANT WOMEN SHOULD AVOID ALCOHOL COMPLETELY DURING PREGNANCY—WHY? • ADVERSE MATERNAL EFFECTS • ADVERSE FETUS/NEONATAL EFFECTS

5. SUBSTANCE ABUSE DURING PREGNANCY • COCAINE AND CRACK • PREVENTS REUPTAKE OF DOPAMINE, NOREPINEPHRINE—LEADS TO VASOCONSTRICITION, TACHYCARDIA, HYPERTENSION • ADVERSE MATERNAL EFFECTS • ADVERSE FETAL/NEONATAL EFFECTS

6. SUBSTANCE ABUSE DURING PREGNANCY • MARIJUANA • NO STRONG RESEARCH INDICATING TERATOGENIC EFFECTS • SOCIAL FACTORS • HEROIN/METHADONE • ADVERSE MATERNAL EFFECTS • ADVERSE FETAL/NEONATAL EFFECTS

7. SUBSTANCE ABUSE DURING PREGNANCY • BARBITURATES • STIMULANTS • CAFFEINE • NICOTINE • PSYCHOTROPICS • METH

9. MODULE 4 PART 1BPREGESTATIONAL RISKS: DIABETES

10. DIABETES MELLITUS IN PREGNANCY • PATHOPHYSIOLOGY • INSULIN PRODUCTION DECREASE BY PANCREAS • WITHOUT ADEQUATE INSULIN, GLUCOSE DOES NOT ENTER CELLS, WHICH BECOME ENERGY DEPLETED • BLOOD GLUCOSE LEVELS INCREASE • CELLS BREAK DOWN PROTEIN AND FAT STORES FOR ENERGY

11. DIABETES MELLITUS IN PREGNANCY • EARLY PREGNANCY • ESTROGEN, PROGESTERONE, OTHER HORMONES RISE TO STIMULATE INCREASED INSULIN PRODUCTION AND INCREASED TISSUE RESPONSE TO INSULIN • STORAGE OF GLYCOGEN IN LIVER PRODUCES ANABOLIC STATE DURING IST HALF OF PREGNANCY

12. DIABETES MELLITUS IN PREGNANCY • 2ND HALF OF PREGNANCY PRESENTS WITH INCREASED RESISTANCETO INSULIN AND DECREASED GLUSOSE TOLERANCE DUE TO: • SECRETION OF Hpl (INSULIN ANTAGONIST) PROLACTIN, INCREASED CORTISOL AND GLYCOGEN LEVELS • RESULTS IN CATABOLIC STATE • DIABETOGENIC EFFECT

13. DIABETES IN PREGNANCY • CLASSIFICATIONS • ETIOLOGIC • TYPE I • TYPE II • TYPE III • TYPE IV • BASED ON CAUSE • WHITE’S • CLASS A-T • DESCRIBES EXTENT OF DISEASE

16. GESTATIONAL DIABETES • GESTATIONAL DIABETES • WHY DOES THIS OCCUR? • WHY DOES THIS OCCUR? • WHAT IS THE INCIDENCE OF THIS OCCURING DURING PRGNANCY? • HOW IS IT DIAGNOSED?

17. COMPARISON OF DIABETES MELLITUS AND GESTATIONAL DIABETES

18. DIABETES MELLITUS IN PREGNANCY • INTRAPARTAL MANAGEMENT • WHEN TO DELIVER • LABOR MANAGEMENT, INSULIN REQUIREMENTS • POSTPARTAL MANAGEMENT • INSULIN REQUIREMENTS • BREAST FEEDING

19. DIABETES IN PREGNANCY • CHALLENGES, INFLUENCES • MATERNAL RISKS • FETAL, NEWBORN RISKS

20. DIABETES MELLITUS IN PREGNANCY • CLINICAL TREATMENT • GTT CRITERIA • LAB ASSESSMENT • ANTEPARTAL MANAGEMENT • DIET • GLUCOSE MONITORING • INSULIN REQUIREMENTS • FETAL EVALUATION

21. MODULE 4 PART 1CPREGESTATIONAL RISKSINFECTIONS

22. HIV/AIDS IN PREGNANCY • HIV • AIDS • PATHOPHYSIOLOGY • INCIDENCE

23. HIV IN PREGNANCY • RISKS TO MOTHER • RISKS TO FETUS/NEONATE • ANTEPARTUM, INTRAPARTUM, POSTPARTUM TREATMENT & CARE

24. TORCH • TOXOPLAMOSIS • OTHER • GBS • RUBELLA • CYTOPMEGLIVIRUS • HERPES

26. TORCH • MATERNAL RISKS • FETAL RISKS • ANTEPARTUM, INTRAPARTUM, POSTPARTUM TREATMENT AND CARE

27. GROUP B STREPTOCOCCUS • INCIDENCE • TESTING • TREATMENT • NURSING INTERVENTIONS

28. GESTATIONAL PREGNANCY RISKS • BLEEDING DISORDERS • HYPERTENSIVE DISORDER • Rh ALLOIMMUNIZATION • ABO INCOMPATIBILITY • DOMESTIC VIOLENCE • SURGERY, TRAUMA

29. MODULE 4 PART 2AGESTATIONAL ONSET COMPLICATIONS:BLEEDING DISORDERS

30. BLEEDING DISORDERS • ECTOPIC PREGNANCY • TREATMENT, RISKS • GESTATIONAL TROPHOBLASTIC DISEASE • HYDATIFORM MOLE • CHORIOADENOMA DESTRUENS • CHORIOCARCINOMA • TREATMENT, RISKS

31. BLEEDING DISORDERS • SPONTANEOUS ABORTION • MISSED ABORTION • THREATENED ABORTION

35. GESTATIONAL RISKS • INCOMPETENT CERVIX • CERCLAGE • HYPEREMESIS GRAVIDARUM • FLUID & ELECTROLYTE ISSUES • DEHYDRATION • RISKS TO FETUS • NURSING CARE

36. GESTATIONAL RISKS • PREMATURE RUPTURE OF MEMBRANES • PROM • PPROM • NST, BPP RISKS NURSING CARE

37. MODULE 4 PART 2B GESTATIONAL COMPLICATIONS AND RISKS:PREGNANCY REDUCED HYPERTENSION

38. PREGNANCY INDUCED HYPERTENSION--PIH • PREECLAMPSIA/ECLAMPSIA • CHRONIC HYPERTENSION • CHRONIC HYPERTENSION WITH SUPERIMPOSED PREECLAMPSIA OR ECLAMPSIA • TRANSIENT HYPERTENSION

39. PREECLAMPSIA • DISEASE OF THEORIES • MOST COMMON HYPERTENSIVE DISORDER IN PREGNANCY • PATHOPHYSIOLOGY • CAUSE UNKNOWN • 5-7% OF ALL PREGNANCIES • GENERALIZED VASOSPASM, DECREASE IN CIRCULATING BLOOD VOLUME

40. PREECLAMPSIA • PRENATAL FACTORS INCREASING RISK OF PIH • PRIMIGRAVIDA • ESSENTIAL HYPERTENSION • AGE EXTREMES (UNDER 17 OR OVER 35 YEARS OLD) • UNDERWEIGHT OR OVERWEIGHT • FAMILY HISTORY OF HYPERTENSION • DIAGNOSIS OF PIH IN PREVIOUS PREGNANCY • DIABETES MELLITUS

41. PREECLAMPSIA • CHARACTERIZED BY: • DEVELOPMENT OF HYPERTENSION • 30MM HG INCREASE IN SYSTOLIC AND 15 MM HG DIASTOLIC OVER BASELINE ON AT LEAST 2 OCCASIONS 6 OR MORE HOURS APART • PROTEINURIA • EDEMA • MATERNAL RISKS • FETAL/NEONATAL RISKS

42. PREECLAMPSIA • CLINICAL MANAGEMENT/CARE • ANTEPARTAL MANAGEMENT • MILD PREECLAMPSIA • SEVERE PREECLAMPSIA • INTRAPARTAL MANAGEMENT • POSTPARTAL MANAGEMENT • HELLP SYNDROME • ECLAMPSIA

47. MODULE 4 PART 2CGESTATIONAL RISKS & COMPLICATIONS: Rh ISOIMMUNIZATION

48. Rh SENSITIZATION • ANTIGEN-ANTIBODY RESPONSE • IF AN Rh-NEGATIVE WOMAN IS EXPOSED TO Rh POSITIVE BLOOD, EITHER THROUGH TRANSFUSION OR A PRIOR PREGNANCY, SHE PRODUCES IMMUNOGLOBULIN (Ig)G ANTIBODY (ANTIRhD) • INDIRECT COOMBS TEST • DIRECT COOMBS TEST

49. Figure 13–5d Anti-Rh-positive antibodies (triangles) are formed.

50. Figure 13–5b Pregnancy with Rh-positive fetus. Some Rh-positive blood enters the mother’s bloodstream.