1 / 20

Medical complication of preg

Medical complication of preg. Diabetes in Pregnancy. Incidence – affects 1 in 300 pregnancies Maybe gestational or overt diabetes Increases the risks of perinatal mortality up to 40% Risks are greater with poor diabetic control

selena
Download Presentation

Medical complication of preg

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Medical complication of preg Mrs.Mahdia Samaha Kony

  2. Diabetes in Pregnancy • Incidence – affects 1 in 300 pregnancies • Maybe gestational or overt diabetes • Increases the risks of perinatal mortality up to 40% • Risks are greater with poor diabetic control • With good diabetic management the mortality rates decrease significantly Mrs.Mahdia Samaha Kony

  3. health history • Large birth weight babies (over 9 lbs.) • Unexplained fetal losses • Infants with anomalies • Family history of DM • Previous gestational diabetes (GDM) Mrs.Mahdia Samaha Kony

  4. Diagnostic Tests • Glucosuria – on 2 successive visits • Blood sugar levels • FBS of ^^ 140 • Random of ^^ 200 • Glucose Tolerance tests • At 24-28 weeks 1 hour screen ^^ 140 • 3-hour GTT with 2 elevated levels = GDM Mrs.Mahdia Samaha Kony

  5. Effects on the Pregnancy • Early (up to 18 weeks) glucose levels may decrease • Mother at risk for hypoglycemia • After 20 weeks • Placental hormones cause ^^ resistance to insulin utilization • Hyperglycemia • Ketoacidosis Mrs.Mahdia Samaha Kony

  6. Other maternal risks • Infections – pyelonephritis • Pregnancy induced hypertension • Polyhydramnios • DIC Mrs.Mahdia Samaha Kony

  7. Effects on the Unborn baby • Related to diabetic control • With chronic hyperglycemia, vascular changes which lead to placental insufficiency • First trimester = spontaneous abortion or fetal anomalies • Third trimester = Intrauterine fetal demise (Greatest risks after 36 weeks) Mrs.Mahdia Samaha Kony

  8. Effects on the Newborn • Large birth weights • Often large, immature pre-term babies • Neonatal hypoglycemia • Hyperbilirubinemia Mrs.Mahdia Samaha Kony

  9. Treatment and Nursing care • Frequent hospitalizations • Urine test for ketones • Frequent blood glucose levels • Insulin management • Diet Mrs.Mahdia Samaha Kony

  10. Fetal Evaluations • Ultrasound for size, growth • Daily kick counts • Non-stress tests • OCT • 24 hour urine for estriol levels • L/S ratio for surfactant levels Mrs.Mahdia Samaha Kony

  11. Delivery plans • Careful monitoring • Plan for delivery between 36 – 40 weeks • Goal is two-fold: • To proceed as close to term as possible • Monitor fetal condition to avoid fetal demise Mrs.Mahdia Samaha Kony

  12. Follow-up information • With Gestational Diabetes: • 7% may become overt Diabetic within 6 months •  28 – 40 % may become Diabetic with 5 to 5 ½ years Mrs.Mahdia Samaha Kony

  13. Rh Incompatibility • Antigen – antibody reaction • Mother is Rh negative • Usually no problem with first pregnancy • With subsequent pregnancies maternal antibodies destroy fetal RBCs Mrs.Mahdia Samaha Kony

  14. Symptoms • Low muscle tone (hypotonia) • Developmental delay • Polyhydramnios • Jaundice Mrs.Mahdia Samaha Kony

  15. Laboratory tests • A positive direct Coombs test result. • Higher levels of bilirubin in the baby's cord blood • Signs of red blood cell destruction in the infant's blood Mrs.Mahdia Samaha Kony

  16. Possible Complications • Hydrops fetalis (potentially deadly fluid buildup and swelling in the baby) • Kernicterus (brain damage due to high levels of bilirubin) • Neurological syndrome with mental deficiency, movement disorder, hearing loss, speech disorder, and seizures Mrs.Mahdia Samaha Kony

  17. Prevention • Rh-negative mothers should be followed closely during pregnancy. • Special immune globulins, called RhoGAM, used to prevent RH incompatibility. • If the father of the infant is Rh-positive or if his blood type cannot be confirmed, the mother is given a mid-term injection of RhoGAM and a second injection within 72 hours of delivery. • These injections prevent the development of antibodies against Rh-positive blood. Mrs.Mahdia Samaha Kony

  18. Women with Rh-negative blood type must receive this injection: • During every pregnancy • If they have a miscarriage or abortion • After prenatal tests such as amniocentesis and chorionic villus biopsy • After truma to the abdomen during a pregnancy Mrs.Mahdia Samaha Kony

  19. Infections During Pregnancy • Cytomegalovirus (CMV) is one of most common (up to 1 in 1000) • More common among women working with young children (frequent exposure to urine, saliva, respiratory secretions) • 99% can be prevented with Good Hand washing Mrs.Mahdia Samaha Kony

  20. Group B Streptococcus • 10 – 30 % of pregnant women carry bacterium in vaginal or rectal area • Causes 2/1000 babies to become sick or die in neonatal period • May be early (within 7 days) or late (from 7 days to 3 months) onset illness • 1/200 risk of infant becoming sick • Treated with IV antibiotics during L & D Mrs.Mahdia Samaha Kony

More Related