Health Education for Record Book

8/19/2019 Health Education for Record Book

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HEALTH EDUCATION:

Good pre-pregnancy nutrition not only helps prevent anemia, but also helps build other nutritional stores in the mother's

body. Eating a healthy and balanced diet before and during pregnancy helps keep up your levels of iron and other

important nutrients needed for your health and that of your growing baby.

Good food sources of iron include the following:

• Meats. Beef, pork, lamb, liver, and other organ meats.

• Poultry. hicken, duck, turkey, liver !especially dark meat".

• Fis. #hellfish, including !fully-cooked" clams, mussels, and oysters are good. #o are sardines and anchovies. $he

%& recommends that pregnant women eat ( to )* ounces per week of fish that are lower in mercury. $hese

include salmon, shrimp, pollock, cod, tilapia, and catfish. &on't eat the following fish because they are highest in

mercury: tilefish from the Gulf of +eico, shark, swordfish, and king mackerel. imit white !albacore" tuna to

only ounces per week.

• Lea!y "reens o! te #a$$a"e !amily. $hese include broccoli, kale, turnip greens, and collards.

• Le"umes. ima beans and green peas/ dry beans and peas, such as pinto beans, black-eyed peas, and canned

baked beans.

• %east&leavene' (ole&(eat $rea' an' rolls

• Iron&enri#e' (ite $rea') pasta) ri#e) an' #ereals

0itamin supplements containing at least 122 micrograms of folic acid are recommended for all women of childbearing age

and during pregnancy. %ood sources of folate include the following:

• eafy, dark green vegetables

• &ried beans and peas

• itrus fruits and 3uices and most berries

• %ortified breakfast cereals

•Enriched grain products

+anagement of F*+ depends on the severity of growth restriction, and how early the problem began in the pregnancy

Generally, the earlier and more severe the growth restriction, the greater the risks to the fetus. areful monitoring of a

fetus with %G4 and ongoing testing may be needed.

$reatments may include:

• Nutrition. #ome studies have shown that increasing maternal nutrition may increase gestational weight gain and

fetal growth.


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• ,e'rest. Bedrest in the hospital or at home may help improve circulation to the fetus.

• Delivery. 5f %G4 endangers the health of the fetus, then an early delivery may be needed.

%etal growth restriction may occur, even when the mother is in good health. 6owever, some factors may increase the risks

of %G4, such as cigarette smoking and poor maternal nutrition. voiding harmful lifestyles, eating a healthy diet, and

getting prenatal care may help decrease the risks for %G4. Early detection may also help with %G4 treatment and

outcome.

$reatment for preterm la$or may include:

• Bedrest !either at home or in the hospital may be recommended"

• 6ospitali7ation !as speciali7ed personnel and e8uipment may be necessary"

• $ocolytic medications--medications to help slow or stop contractions. $hese may be given in an in3ection under

the skin or intravenously !50". $ocolytic medications often used include indomethacin or nifedipine.

• orticosteroid medications--medications that may help mature the lungs of the fetus. ung immaturity is a ma3or

problem of premature babies.

• ervical cerclage--a procedure used to suture the cervical opening. erclage is used for women with an

incompetent cervi. $his is a condition in which the cervi is physically weak and unable to stay closed during

pregnancy.

• ntibiotics !to treat infection"

• &elivery--if treatments do not stop preterm labor or if the fetus or mother is in danger, delivery of the baby may

occur. esarean delivery may be recommended in certain cases

Because of the tremendous advances in the care of sick and premature babies, more and more babies are surviving despite

being born early and being very small. 6owever, prevention of early birth is the best way of promoting good health for

babies.

9renatal care is a key factor in preventing preterm births and low birthweight babies. t prenatal visits, the health of both

mother and fetus can be checked. Because maternal nutrition and weight gain are linked with fetal weight gain and

birthweight, eating a healthy diet and gaining weight in pregnancy are essential. 9renatal care is also important in

identifying problems and lifestyles that can increase the risks for preterm labor and birth. #ome ways to help prevent

prematurity and to provide the best care for premature babies may include the following:

• 5dentifying mothers at risk for preterm labor

• 9renatal education of the symptoms of preterm labor

• voiding heavy or repetitive work or standing for long periods of time which may increase the risk of preterm

labor

• Early identification and treatment of preterm labor


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#ome women at high risk for preterm birth may be candidates for treatment with the hormone progesterone. $his hormone

and its derivative, )-alpha hydroyprogesterone, are naturally produced by the placenta during pregnancy. 4ecent studies

have shown that progesterone supplements help reduce the risk for preterm birth in women who had a previous

spontaneous preterm birth. +ore research is needed for this and other ways to help reduce the incidence of prematurity.

$reatment for preterm premature rupture o! mem$ranes may include:

• 6ospitali7ation

• Epectant management !in very few cases of 994;+, the membranes may seal over and the fluid may stop

leaking without treatment, although this is uncommon unless 94;+ was from a procedure, such as

amniocentesis, early in gestation"

• +onitoring for signs of infection, such as fever, pain, increased fetal heart rate, and1 weeks if stable. 5f there are signs of abruption,

chorioamnionitis, or fetal compromise, then early delivery would be necessary."

?nfortunately, there is no way to actively prevent 94;+. 6owever, this condition does have a strong link with cigarette

smoking and mothers should stop smoking as soon as possible.

$he following are the most common symptoms of high blood pressure in pregnancy:

• 5ncreased blood pressure

• bsence or presence of protein in the urine !to diagnose gestational hypertension or preeclampsia"

• Edema !swelling"

• #udden weight gain

•0isual changes such as blurred or double vision

• @ausea, vomiting

• 4ight-sided upper abdominal pain or pain around the stomach

• ?rinating small amounts

• hanges in liver or kidney function tests


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woman with "estational ypertension may not have any symptoms.

&iagnosis is often based on the increase in blood pressure levels, but other symptoms may help establish gestational

hypertension as the diagnosis. $ests for gestational hypertension may include the following:

• Blood pressure measurement

• ?rine testing to rule out preeclampsia

• ssessment of edema

• %re8uent weight measurements

• iver and kidney function tests to rule out preeclampsia

• Blood clotting tests to rule out preeclampsia

$he goal of treatment is to prevent the condition from becoming worse and to prevent it from causing other complications

$reatment for gestational hypertension may include:

• Bedrest, either at home or in the hospital, may be recommended

• 6ospitali7ation !as speciali7ed personnel and e8uipment may be necessary"

• +agnesium sulfate !or other antihypertensive medications for gestational hypertension if blood pressure readings

are in the severe range"

• %etal monitoring !to check the health of the fetus" which may include:

o Fetal movement #ountin". Aeeping track of fetal kicks and movements. change in the number or

fre8uency may mean the fetus is under stress.

o Nonstress testin". test that measures the fetal heart rate in response to the fetus's movements.

o ,iopysi#al pro!ile. test that combines nonstress test with ultrasound to observe the fetus.

o Doppler !lo( stu'ies. type of ultrasound that uses sound waves to measure the flow of blood through a

blood vessel.

• ontinued laboratory testing of urine and blood !for changes that may signal worsening of gestationa

hypertension or progression to preeclampsia"

• +edications, called corticosteroids, that may help to mature the lungs of the fetus if early delivery is likely !lung

immaturity is a ma3or problem of premature babies".

Early identification of women at risk for gestational hypertension may help prevent some complications of the disease.

Education about the warning symptoms is also important because early recognition may help women receive treatment

and prevent worsening of the disease.


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5n addition to a complete medical history and physical eam, other tests for 6E9 syndrome may include:

• Blood pressure measurement

• 4ed blood cell count

• Blood levels of lactate dehydrogenase !&6"

• Bilirubin level--a substance produced by the breakdown of red blood cells.

• iver function tests

• 9latelet count--cells found in the blood that are needed to help the blood clot to control bleeding.

• ?rine tests for protein

$reatment may include:

• Bedrest !either at home or in the hospital may be recommended"

• Blood transfusions !for severe anemia and low platelets"

• +agnesium sulfate !to prevent sei7ures"

• ntihypertensive medications !to reduce blood pressure"

• 6ospitali7ation and continuous fetal monitoring !to check the health of the fetus" may include:

o @onstress testing--a test that measures the fetal heart rate in response to the fetus' movements.

o Biophysical profile--a test that combines nonstress test with ultrasound to observe the fetus.

o &oppler flow studies--a type of ultrasound that uses sound waves to measure the flow of blood through a

blood vessel.

• ab testing of liver, urine, and blood !for changes that may signal worsening of 6E9 syndrome"

• +edications, called corticosteroids, that may help mature the lungs of the preterm fetus !lung immaturity is a

ma3or problem of premature babies"

• &elivery !if 6E9 syndrome worsens and endangers the well-being of the mother or fetus, then an early

delivery may be necessary". &elivery is the only cure for 6E9 syndrome.

Early identification of women at risk for 6E9 syndrome may help prevent some complications of the disease.

Education about the warning signs is also important because early recognition may help women receive treatment and

prevent worsening of the disease.

Amnioti# Flui' Pro$lems: Hy'ramnios an' Oli"oy'ramnios


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mniotic fluid is an important part of pregnancy and fetal development. $his watery fluid is inside a casing called the

amniotic membrane !or sac" and fluid surrounds the fetus throughout pregnancy. @ormal amounts may vary, but

generally, women carry about C22 to )222 ml of amniotic fluid. mniotic fluid helps protect and cushion the fetus and

plays an important role in the development of many of the fetal organs including the lungs, kidneys, and gastrointestinal

tract. %luid is produced by the fetal lungs and kidneys. 5t is taken up with fetal swallowing and sent across the placenta to

the mother's circulation. $oo much or too little amniotic fluid is linked to problems in development and pregnancy

complications. &ifferences in the amount of fluid may be the cause or the result of the problem.

6ydramnios is a condition in which there is too much amniotic fluid around the fetus. 5t occurs in about ) of all

pregnancies. 5t is also called polyhydramnios.

$here are several causes of hydramnios. Generally, either too much fluid is being produced or there is a problem with the

fluid being taken up, or both. %actors that are associated with hydramnios include the following:

• Maternal !a#tors:

o &iabetes

• Fetal !a#tors:

o Gastrointestinal abnormalities that block the passage of fluid

o bnormal swallowing due to problems with the central nervous system or chromosomal abnormalities

o $win-to-twin transfusion syndrome

o 6eart failure

o

ongenital infection !ac8uired in pregnancy"

$oo much amniotic fluid can cause the mother's uterus to become overdistended and may lead to preterm labor or

premature rupture of membranes !the amniotic sac". 6ydramnios is also associated with birth defects in the fetus. =hen

the amniotic sac ruptures, large amounts of fluid leaving the uterus may increase the risk of placental abruption !early

detachment of the placenta" or umbilical cord prolapse !when the cord falls down through the cervical opening" where it

may be compressed.

$he following are the most common symptoms of hydramnios:

• 4apid growth of uterus

• &iscomfort in the abdomen

• ?terine si7e !fundal height" greater than epected for gestational age

• ?terine contractions

$he symptoms of hydramnios may look like other medical conditions. lways consult your health care provider for a

diagnosis.


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5n addition to a complete medical history and a physical eam, hydramnios is usually diagnosed with ultrasound !a test

using sound waves to create a picture of internal structures" by measuring pockets of fluid to estimate the total volume. 5n

some cases, ultrasound is also helpful in finding a cause of hydramnios, such as multiple pregnancy or a birth defect.

#pecific treatment for hydramnios will be determined by your health care provider based on:

• Dour pregnancy, overall health, and medical history

• Etent of the condition

• 6ow well you can handle specific medications, procedures, or therapies

• Epectations for the course of the condition

• Dour opinion or preference

$reatment for hydramnios may include:

• losely monitoring the amount of amniotic fluid and fre8uent follow-up visits with the health care provider

• +edication !to decrease fetal urine production"

• mnioreduction--amniocentesis !inserting a needle through the uterus and into the amniotic sac" to remove some

of the amniotic fluid/ this procedure may need to be repeated.

• &elivery !if complications endanger the well-being of the fetus or mother, then an early delivery may be

necessary"

$he goal of treatment is to relieve the mother's discomfort and continue the pregnancy.

;ligohydramnios is a condition in which there is too little amniotic fluid around the fetus. 5t occurs in about 1 of all

pregnancies.

$here are several causes of oligohydramnios. Generally, it is caused by conditions that prevent or reduce amniotic fluid

production including:

• 9remature rupture of membranes !before labor"

•

5ntrauterine growth restriction !poor fetal growth"

• 9ost-term pregnancy

• Birth defects, especially kidney and urinary tract malformations

• $win-to-twin transfusion syndrome

mniotic fluid is important in the development of fetal organs, especially the lungs. $oo little fluid for long periods may

cause abnormal or incomplete development of the lungs called pulmonary hypoplasia. 5ntrauterine growth restriction


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!poor fetal growth" is also associated with decreased amounts of amniotic fluid. ;ligohydramnios may be a complication

at delivery, increasing the risk for compression of the umbilical cord and aspiration of thick meconium !baby's first bowel

movement".

$he following are the most common symptoms of oligohydramnios. 6owever, each woman may eperience symptoms

differently. #ymptoms may include:

• eaking of amniotic fluid when the cause is rupture of the amniotic sac

• &ecreased amount of amniotic fluid on ultrasound

• ?terine si7e !fundal height" smaller than epected for gestational age

$he symptoms of the oligohydramnios may resemble other medical conditions. lways consult your health care provider

for a diagnosis.

5n addition to a complete medical history and physical eam, a diagnosis is usually made using ultrasound. 9ockets of

amniotic fluid can be measured and the total amount estimated. ?ltrasound can also show fetal growth, the structure of the

kidneys and urinary tract, and detect urine in the fetal bladder. &oppler flow studies !a type of ultrasound used to measure blood flow" may be used to check the arteries in the kidneys, and the blood flow through the placenta.

$reatment for oligohydramnios may include:

• losely monitoring the amount of amniotic fluid and fre8uent follow-up visits with the health care provider

• mnioinfusion--instilling a special fluid into the amniotic sac to replace lost or low levels of amniotic fluid.

mnioinfusion may be given in a woman in labor whose membranes have ruptured. mnioinfusion will not be

given if the woman is not in labor.

• &elivery !if oligohydramnios endangers the well-being of the fetus, then an early delivery may be necessary"

,lee'in" in Pre"nan#y: Pla#enta Previa an' Pla#ental A$ruption

Bleeding may occur at various times in pregnancy. lthough bleeding is alarming, it may or may not be a serious

complication. $he time of bleeding in the pregnancy, the amount, and whether or not there is pain may vary depending on

the cause.

Bleeding in the first trimester of pregnancy is 8uite common and may be due to the following:

• +iscarriage !pregnancy loss"

• Ectopic pregnancy !pregnancy outside the uterus, usually in the fallopian tube"

• Gestational trophoblastic disease !a rare condition that may be cancerous in which a grape-like mass of fetal and

placental tissues develops"

• 5mplantation of the embryo in the uterus


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• 5nfection

• Bleeding between the uterine wall and placental membrane !subchorionic hemorrhage or hematoma"

• @ormal changes in the cells of the cervi due to pregnancy

Bleeding in late pregnancy !after about *2 weeks" may be due to the following:

• 9lacenta previa !placenta is near or covers the cervical opening"

• 9lacental abruption !placenta detaches prematurely from the uterus"

• 9reterm labor

• ?nknown cause

9lacenta previa is a condition in which the placenta is attached close to or covering the cervi !opening of the uterus".

9lacenta previa occurs in about one in every *22 live births. $here are three types of placenta previa:

• Total pla#enta previa. $he placenta completely covers the cervi.

• Partial pla#enta previa. $he placenta is partially over the cervi.

• Mar"inal pla#enta previa. $he placenta is near the edge of the cervi.

$he cause of placenta previa is unknown, but it is associated with certain conditions including the following:

• =omen who have scarring of the uterine wall from previous pregnancies

• =omen who have fibroids or other abnormalities of the uterus

• =omen who have had previous uterine surgeries or cesarean deliveries

• ;lder mothers !over age >C"

• frican-merican or other minority race mothers


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• igarette smoking

• 9lacenta previa in a previous pregnancy

• Being pregnant with a male fetus

$he greatest risk of placenta previa is bleeding !or hemorrhage". Bleeding often occurs as the lower part of the uterus thins

during the third trimester of pregnancy in preparation for labor. $his causes the area of the placenta over the cervi to bleed. $he more of the placenta that covers the cervical os !the opening of the cervi", the greater the risk for bleeding

;ther risks include the following:

• bnormal implantation of the placenta

• #lowed fetal growth

• 9reterm birth

• Birth defects

$he most common symptom of placenta previa is vaginal bleeding that is bright red and not associated with abdominal

tenderness or pain, especially in the third trimester of pregnancy. 6owever, each woman may ehibit different symptoms

of the condition or symptoms may resemble other conditions or medical problems. lways consult your doctor for a

diagnosis.

5n addition to a complete medical history and physical eamination, an ultrasound !a test using sound waves to create a

picture of internal structures" may be used to diagnose placenta previa. n ultrasound can show the location of the

placenta and how much is covering the cervi. vaginal ultrasound may be more accurate in diagnosis.

lthough ultrasound may show a low-lying placenta in early pregnancy, only a few women will develop true placenta previa. 5t is common for the placenta to move upwards and away from the cervi as the uterus grows, called placental

migration.

$here is no treatment to change the position of the placenta. ;nce placenta previa is diagnosed, additional ultrasound

eaminations are often performed to track its location. Bed rest or hospital admission may be necessary. 5t may be

necessary to deliver the baby, depending on the amount of bleeding, the gestational age, and condition of the fetus.

esarean delivery is necessary for most cases of placenta previa. #evere blood loss may re8uire a blood transfusion.

9lacental abruption is the premature separation of a placenta from its implantation site in the uterus. =ithin the placenta

are many blood vessels that allow the transfer of nutrients to the fetus from the mother. 5f the placenta begins to detach

during pregnancy, there is bleeding from these vessels. $he larger the area that detaches, the greater the amount of

bleeding. 9lacental abruption occurs about once in every )22 births. 5t is also called abruptio placenta.

;ther than direct trauma to the uterus such as in a motor vehicle accident, the cause of placental abruption is unknown. 5t

is, however, associated with certain conditions, including the following:

• 9revious pregnancy with placental abruption

• 6ypertension !high blood pressure"


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• igarette smoking

• +ultiple pregnancy

• #ickle cell anemia

9lacental abruption is dangerous because of the risk of uncontrolled bleeding !hemorrhage", with less oygen and

nutrients going to the baby. lthough severe placental abruption is rare, other complications may include the following:

• 6emorrhage and shock

• &isseminated vascular coagulation !&5"--a serious blood clotting complication.

• 9oor blood flow and damage to kidneys or brain

• #tillbirth

•

6emorrhage during labor

$he most common symptom of placental abruption is dark red vaginal bleeding with pain during the third trimester of

pregnancy. 5t also can occur during labor. 6owever, each woman may eperience symptoms differently. #ome women

may not have vaginal bleeding that is detectable, but there may be bleeding inside the uterus. #ymptoms may include:

• 0aginal bleeding

• bdominal pain

• ?terine contractions that do not rela

• Blood in amniotic fluid

• @ausea

• $hirst

• %aint feeling

• &ecreased fetal movements

$he symptoms of placental abruption may resemble other medical conditions. lways consult your doctor for a diagnosis.

$he diagnosis of placental abruption is usually made by the symptoms, and the amount of bleeding and pain. ?ltrasound

may also be used to show the location of the bleeding and to check the fetus. $here are three grades of placental abruption

including the following:


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• *ra'e . #mall amount of vaginal bleeding and some uterine contractions, no signs of fetal distress or low blood

pressure in the mother.

• *ra'e /. +ild to moderate amount of bleeding, uterine contractions, the fetal heart rate may shows signs of

distress.

• *ra'e 0. +oderate to severe bleeding or concealed !hidden" bleeding, uterine contractions that do not rela

!called tetany", abdominal pain, low blood pressure, fetal death.

#ometimes placental abruption is not diagnosed until after delivery, when an area of clotted blood is found behind the

placenta.

$here is no treatment to stop placental abruption or reattach the placenta. ;nce placental abruption is diagnosed, a

woman's care depends on the amount of bleeding, the gestational age, and condition of the fetus. 0aginal delivery may be

possible if the fetus is tolerating labor. 5f placental abruption is affecting the fetus, then cesarean delivery may be

necessary. #evere blood loss may re8uire a blood transfusion.

Disease

4h disease occurs during pregnancy when there is an incompatibility between the blood types of the mother and baby.

Every person has a blood type !;, , B, or B" and an 4h factor, either positive or negative. $he blood type and the 4h

factor simply mean that a person's blood has certain specific characteristics. $he blood type is found as proteins on red

blood cells and in body fluids. $he 4h factor is a protein that is found on the covering of the red blood cells. 5f the 4h

factor protein is present on the cells, the person is 4h positive. 5f there is no 4h factor protein, the person is 4h negative.

4h factors are genetically determined. baby may have the blood type and 4h factor of either parent, or a combination of

both parents. 4h factors follow a common pattern of genetic inheritance. $he 4h positive gene is dominant !stronger", and

even when paired with an 4h negative gene, the positive gene takes over. %or eample:

• 5f a person has the genes , the 4h factor in the blood will be positive.

• 5f a person has the genes -, the 4h factor will be positive.

• 5f a person has the genes - -, the 4h factor will be negative.

baby receives one gene from the father and one from the mother.


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5f a father's 4h factor genes are , and the mother's are , the baby will have one from the father

and one gene from the mother. $he baby will be 4h positive.

5f a father's 4h factor genes are , and the mother's are - -, the baby will have one from the father

and one - gene from the mother. $he baby will be - 4h positive.

5f the father's genes are - 4h positive, and the mother's are - 4h positive, the baby can be:

• 4h positive

• - 4h positive

• - - 4h negative

5f the father's genes are - -, and the mother's are -, the baby can be:

• - 4h positive

• - - 4h negative

5f the father's genes are - -, and the mother's are - -, the baby will be:

• - - 4h negative


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9roblems with the 4h factor occur only when the mother's 4h factor is negative and the baby's is positive.

=hen an 4h negative mother has a baby that is 4h positive, problems can develop if the baby's red blood cells cross to the

4h negative mother. $his usually happens at delivery when the placenta detaches. 5t may also happen, however, anytime

blood cells of the two circulations mi such as during a miscarriage or abortion, with a fall, or during an invasive prenatal

testing procedure such as an amniocentesis or chorionic villus sampling.

$he mother's immune system sees the baby's 4h positive red blood cells as foreign. Fust as when bacteria invade the body

the immune system responds by developing antibodies to fight and destroy these foreign cells. $he mother's immune

system keeps the antibodies in case the foreign cells appear again, even in a future pregnancy. $he mother is now 4h

sensiti7ed.

lthough it is not as common, a similar problem of incompatibility may happen between the blood types !, B, ;, B" of

the mother and baby in the following situations:

Moter1s ,loo' Type ; B

,a$y1s ,loo' Type or B B

5n a first pregnancy, 4h sensiti7ation is not likely. ?sually it only becomes a problem in a future pregnancy with another

4h positive baby. &uring that pregnancy, the mother's antibodies cross the placenta to fight the 4h positive cells in the baby's body. s the antibodies destroy the red blood cells, the baby can become anemic. $he anemia can lead to other

complications including 3aundice, heart failure, and organ enlargement.

4h disease is also called erythroblastosis fetalis during pregnancy. 5n the newborn, the resulting condition is called

hemolytic disease of the newborn !6&@".

#ome of the more common complications of 4h disease for the fetus and newborn baby include the following:

• nemia !in some cases, the anemia is severe with enlargement of the liver and spleen"

• Faundice. $his is a yellowing of the skin, eyes, and mucous membranes.

• #evere anemia with enlargement of the liver and spleen

• 6ydrops fetalis. $his occurs as the fetal organs are unable to handle the anemia. $he heart begins to fail and large

amounts of fluid build up in the fetal tissues and organs. fetus with hydrops fetalis is at great risk of being

stillborn.

fter birth, the red blood cell destruction may continue. 9roblems may include the following:

• #evere 3aundice. $he baby's liver is unable to handle the large amount of a substance called bilirubin that results

from red blood cell breakdown. $he baby's liver is enlarged and anemia continues.

• Aernicterus. $he most severe form of too much bilirubin and results from the build up of bilirubin in the brain.

$his can cause sei7ures, brain damage, deafness, and death.

mother has no physical signs of 4h disease, but her 4h positive baby can have problems if the mother has developed

antibodies. $he following are the most common symptoms of 4h disease in the fetus. 6owever, each pregnancy may havedifferent symptoms of the condition. #ymptoms may include:


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• =ith amniocentesis, the amniotic fluid may have a yellow coloring and contain bilirubin.

• ?ltrasound of the fetus shows enlarged liver, spleen, or heart and fluid build up in the fetus' abdomen.

$he symptoms of 4h disease may resemble other conditions or medical problems. lways consult your doctor for a

diagnosis.

Early identification of the 4h negative mother is very important. $hen, the risks for the baby can be determined by blood

testing of both parents !4h negative mother, 4h positive father". $he disease may be diagnosed if a previous pregnancyresulted in an 4h positive baby. 5n addition to a complete medical history and physical eamination, diagnostic procedures

for 4h disease may include:

• $esting the presence of 4h positive antibodies in the mother's blood

• ?ltrasound to detect organ enlargement or fluid build up in the fetus. ?ltrasound is a diagnostic imaging

techni8ue that uses high-fre8uency sound waves and a computer to create images of blood vessels, tissues, and

organs. ?ltrasounds are used to view internal organs as they function, and to assess blood flow through various

vessels.

• mniocentesis. test performed to determine chromosomal and genetic disorders and certain birth defects. $he

test involves inserting a needle through the abdominal and uterine wall into the amniotic sac to retrieve a sampleof amniotic fluid.

• #ampling of some of the blood from the fetal umbilical cord, such as percutaneous umbilical blood

sampling, during pregnancy to check for antibodies, bilirubin, and anemia in the fetus.

Dour health care provider will figure out the best treatment for you and your baby based on:

• 6ow old you are

• Dour overall health and medical history

• 6ow well you and your baby can handle specific medications, procedures, or therapies

• Dour opinion or preference

$reatments for 4h disease may include:

• 5ntrauterine blood transfusion of red blood cells into the baby's circulation. procedure that is done by placing a

needle through the mother's uterus and into the abdominal cavity of the fetus or directly into the vein in the

umbilical cord. 5t may be necessary to give a sedative medication to keep the baby from moving. 5ntrauterine

transfusions may need to be repeated.

• Early delivery, if the fetus develops complications !if the fetus has mature lungs, labor and delivery may beinduced to prevent worsening of the disease"

%ortunately, 6&@ is a very preventable disease. Because of the advances in prenatal care, nearly all women with 4h

negative blood are identified in early pregnancy by blood testing. 5f a mother is 4h negative, she will be tested for 4h

antibody titers. 5f she has not been sensiti7ed, she is usually given a drug called 4h immunoglobulin !4h5g", also known

as 4hoG+. $his is a specially-developed blood product that can prevent an 4h negative mother's antibodies from being

able to react to 4h positive cells. +any women are also given 4h5g around the *(th week of pregnancy, unless the mother

has vaginal bleeding, trauma, or an amniocentesis before *( weeks. fter the baby is born, a woman should receive a

second dose of the drug within * hours if the baby is 4h positive.


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4h5g destroys any anti-4h antibodies that enter in the mother's circulation before her immune system becomes sensiti7ed.

$his helps protect a future 4h positive baby.

Acquired Immune Defciency Syndrome (AIDS)/Human Immunodefciency Virus (HIV)

6uman immunodeficiency virus !650" causes ac8uired immune deficiency syndrome !5". $he virus destroys

or weakens the cells of the immune system. weak immune system reduces the body's ability to fight infections and

certain cancers over time. $he term 5 means the 650 infection is in its most advanced stages.

dults and teens most commonly get 650 through seual activity with someone who already has the virus. @early all

children under the age of )> are infected with 650 by their mothers. $his happens in the womb or as they pass through the

birth canal during labor. $he virus can also be passed to children through breastfeeding.

@ot every child born to a mother with 650 will get the virus. =ithout treatment, a woman with 650 has a one in four

chance of infecting her fetus. But, early testing and treatment can reduce the number of mother-to-child 650 infections. 5f

a test shows a woman has 650, she can take antiretroviral medications during pregnancy and labor. $hese medications can

also be used to treat the infant for a short time after birth.

$hese are the ways the 650 virus can be passed to another person:

• 2erti#al transmission. $his is when 650 is spread to babies who are born to, or breastfed by, mothers infected

with the virus.

• -e3ual #onta#t. 650 is spread in adults and adolescents most commonly by seual contact with an infected

partner. $he virus enters the body through the lining of the vagina, vulva, penis, rectum, or mouth through seual

activity.

• ,loo' #ontamination. 650 may also be spread through contact with infected blood. 6owever, due to the

screening of blood for the 650 virus, the risk of getting 650 from blood transfusions is etremely low.

• Nee'les. 650 is often spread by sharing needles, syringes, or drug use e8uipment with someone who is infected

with the virus. 5t is rare for patients to infect healthcare workers, or vice-versa, through accidental sticks with

contaminated needles or other medical instruments.

@o known cases of 650


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• Biting insects, such as mos8uitoes

#ome people may get a flu-like illness within a month or two after eposure to the 650 virus. $his flu-like illness is often

thought to be something else. +any people don't have any symptoms at all when they first become infected. ontinued or

severe symptoms may show up within * years in babies born with an 650 infection. ontinued or severe symptoms may

not surface for )2 years or more, after 650 first enters the body in adults, or within * years in children born with an 650

infection.

$he symptoms of 650 may seem like other conditions or medical problems. lways see your baby's health care

provider for a diagnosis.

&octors and 650 eperts agree that all pregnant women should get an 650 test. blood test is the most common way to

diagnose 650 in children over )( months, teens, and adults.

are that includes 650 counseling, testing, and treatment of infected mothers during pregnancy saves lives. 5

is recommended that 650-positive women take specific medications during pregnancy and during labor. Blood tests are

also done to check the amount of virus. 650-positive women should see a specialist during pregnancy.

@ewborn babies of 650-positive mothers may also receive medication to lower the chances of passing 650 on to the baby.

esarean delivery may be recommended for 650-positive women. $his also helps reduce the risk of transmission of the

virus to the baby, especially when the mother receives medications. 650 may also be transmitted through breast milk.

Because breast milk contains the virus, 650-positive mothers should not breastfeed their babies.

Post-Term Pregnancy

pregnancy that lasts more than 1* weeks !*H1 days since the first day of the last menstrual period" is considered post-

term. $he vast ma3ority of women deliver between > and 1* weeks of pregnancy. ;ther terms often used for this include

prolonged pregnancy, post-dates pregnancy !after the due date", and postmaturity.

5t is not known why some women carry a pregnancy longer than others. 5t is often due to a miscalculation of pregnancy

conception dates. woman is much more likely to have a post-term pregnancy if previous pregnancies went beyond 1*

weeks.

9ost-term pregnancy is associated with longer labors and operative delivery !forceps or vacuum-assisted birth". +others

are at increased risk for vaginal birth trauma due to a large baby. esarean delivery is twice as likely in a post-term

pregnancy because of the si7e of the baby. +others are also at increased risk for infection and wound complications, and

postpartum !after birth" hemorrhage.

$here are also risks for the fetus and newborn in a post-term pregnancy, including stillbirth and newborn death. $oward

the end of pregnancy, the placenta, which supplies the fetus with the nutrients and oygen from the mother's circulation,

begins to age and may not function as efficiently as before. mniotic fluid volume may decrease and the fetus may stop

gaining weight, or may even lose weight. 4isks can increase during labor and birth for a fetus with poor oygen supply.

Birth in3ury may also occur if the baby is large. Babies born after 1* weeks may be at risk for meconium aspiration, when

a baby breathes in fluid containing the first stool. 6ypoglycemia !low blood sugar" can also occur because the baby has

too little glucose-producing stores.

orrect pregnancy dating is important in accurately diagnosing and managing post-term pregnancy. $he si7e of the uterus

at various points in early pregnancy, the date the fetal heartbeat was first heard, and when a mother first feels fetal


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movement all help confirm pregnancy dates. ?ltrasound !a diagnostic imaging techni8ue that uses high-fre8uency sound

waves and a computer to create images of blood vessels, tissues, and organs" is often used in early pregnancy to establish

or confirm a due date.

5n a post-term pregnancy, testing may be done to check fetal well-being and identify problems. $ests often include

ultrasound, nonstress testing !how the fetal heart rate responds to fetal activity", and estimation of the amniotic fluid

volume.

$he goal of management of post-term pregnancy is to prevent complications and deliver a healthy baby. #pecific

management for post-term pregnancy will be determined by your doctor based on:

• Dour pregnancy, overall health, and medical history

• Etent of the condition

• Dour tolerance for specific medications, procedures, or therapies

• Epectations for the course of the condition

• Dour opinion or preferences

+aternal and fetal testing are often performed for a post-term pregnancy to monitor for signs of problems. #ome of the

ways to detect potential problems include the following:

• Fetal movement #ountin". Aeeping track of fetal kicks and movements. change in the number or fre8uency

may mean the fetus is under stress.

• Nonstress testin". test that watches the fetal heart rate for increases with fetal movements, a sign of fetal well-

being.

• ,iopysi#al pro!ile. test that combines the nonstress test with an ultrasound to evaluate fetal well-being.

• Ultrasoun'. diagnostic imaging techni8ue that uses high-fre8uency sound waves and a computer to create

images of blood vessels, tissues, and organs. ?ltrasounds are used to view internal organs as they function, and to

assess blood flow through various vessels. ?ltrasounds are used to follow fetal growth.

• Doppler !lo( stu'ies. type of ultrasound that uses sound waves to measure blood flow, commonly used in

intrauterine growth restriction !5?G4" babies.

5f tests determine that it is no longer healthy for the fetus to stay in the mother's uterus, labor may be induced, to deliver

the baby.

$he decision to induce labor for post-term pregnancy depends on many factors. &uring labor, the fetal heart rate may be

monitored with an electronic monitor to help identify changes in the heart rate due to low oygenation. hanges in a

baby's condition may re8uire a cesarean delivery.

&uring labor, continuous fetal heart rate monitoring is often used to help detect changes in the fetal heart rate. Because a

post-term fetus is more likely to pass meconium !the first stool" during labor, the risk of meconium aspiration is increased

$he baby may need suctioning and special care after delivery.


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mnioinfusion is sometimes used during labor if there is very little amniotic fluid or the fetus is compressing the

umbilical cord. 5n amnioinfusion, a sterile fluid is instilled with a catheter !hollow tube" into the broken amniotic sac to

help replace the low levels of fluid and cushion the fetus and cord.

5f labor does not progress or there is fetal distress, cesarean delivery may be needed. 0ery large babies may have difficulty

at delivery, and may have a greater risk of in3ury during forceps or vacuum-assisted delivery. linicians must proceed

with caution to prevent any harm to the baby.

Postpartum Hemorrhage

9ostpartum hemorrhage is ecessive bleeding following the birth of a baby. bout ) to C of women have postpartum

hemorrhage and it is more likely with a cesarean birth. 6emorrhage most commonly occurs after the placenta is delivered

$he average amount of blood loss after the birth of a single baby in vaginal delivery is about C22 ml !or about a half of a

8uart". $he average amount of blood loss for a cesarean birth is approimately ),222 ml !or one 8uart". +ost postpartum

hemorrhage occurs right after delivery, but it can occur later as well.

;nce a baby is delivered, the uterus normally continues to contract !tightening of uterine muscles" and epels the

placenta. fter the placenta is delivered, these contractions help compress the bleeding vessels in the area where the

placenta was attached. 5f the uterus does not contract strongly enough, called uterine atony, these blood vessels bleedfreely and hemorrhage occurs. $his is the most common cause of postpartum hemorrhage. 5f small pieces of the placenta

remain attached, bleeding is also likely.

#ome women are at greater risk for postpartum hemorrhage than others. onditions that may increase the risk for

postpartum hemorrhage include the following:

• 9lacental abruption. $he early detachment of the placenta from the uterus.

• 9lacenta previa. $he placenta covers or is near the cervical opening.

• ;verdistended uterus. Ecessive enlargement of the uterus due to too much amniotic fluid or a large baby,

especially with birthweight over 1,222 grams !(.( pounds".

• +ultiple pregnancy. +ore than one placenta and overdistention of the uterus.

• Gestational hypertension or preeclampsia. 6igh blood pressure of pregnancy.

• 6aving many previous births

• 9rolonged labor

• 5nfection

• ;besity

• +edications to induce labor

• +edications to stop contractions !for preterm labor"


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• ?se of forceps or vacuum-assisted delivery

• General anesthesia

9ostpartum hemorrhage may also be due to other factors including the following:

• $ear in the cervi or vaginal tissues

• $ear in a uterine blood vessel

• Bleeding into a concealed tissue area or space in the pelvis which develops into a hematoma, usually in the vulva

or vaginal area

• Blood clotting disorders, such as disseminated intravascular coagulation

• 9lacenta accreta. $he placenta is abnormally attached to the inside of the uterus !a condition that occurs in one in

*,C22 births and is more common if the placenta is attached over a prior cesarean scar".

• 9lacenta increta. $he placental tissues invade the muscle of the uterus.

• 9lacenta percreta. $he placental tissues etend all the way through the uterine muscle.

lthough an uncommon event, uterine rupture can be life-threatening for the mother. onditions that may increase the risk

of uterine rupture include surgery to remove fibroid !benign" tumors and a prior cesarean scar. prior scar on the uterus in

the upper part of the fundus has a higher risk of uterine rupture compared with a hori7ontal scar in the lower uterine

segment called a lower transverse incision. 5t can also occur before delivery and place the fetus at risk as well.

Ecessive and rapid blood loss can cause a severe drop in the mother's blood pressure and may lead to shock and death if

not treated.

$he following are the most common symptoms of postpartum hemorrhage:

• ?ncontrolled bleeding

• &ecreased blood pressure

• 5ncreased heart rate

• &ecrease in the red blood cell count !hematocrit"

• #welling and pain in tissues in the vaginal and perineal area, if bleeding is due to a hematoma

$he symptoms of postpartum hemorrhage may look like other conditions or medical problems. lways consult

your doctor for a diagnosis.

5n addition to a complete medical history and physical eam, diagnosis is usually based on symptoms, with lab tests often

helping with the diagnosis. $ests used to diagnose postpartum hemorrhage may include:


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• Estimation of blood loss !this may be done by counting the number of saturated pads, or by weighing of packs and

sponges used to absorb blood/ ) milliliter of blood weighs approimately one gram"

• 9ulse rate and blood pressure measurement

• 6ematocrit !red blood cell count"

•

lotting factors in the blood

$he aim of treatment of postpartum hemorrhage is to find and stop the cause of the bleeding as 8uickly as possible.

$reatment for postpartum hemorrhage may include:

• +edication !to stimulate uterine contractions"

• +anual massage of the uterus !to stimulate contractions"

• 4emoval of placental pieces that remain in the uterus

• Eamination of the uterus and other pelvic tissues, and eamination of the vagina and vulva to look for areas that

may need repair.

• Bakri balloon or a %oley catheter to compress the bleeding inside the uterus. 9acking the uterus with sponges and

sterile materials may be used if a Bakri balloon or %oley catheter is not available.

• aparotomy. #urgery to open the abdomen to find the cause of bleeding.

• $ying-off of bleeding blood vessels using uterine compression sutures. $his is done during a laparotomy.

• 6ysterectomy. #urgical removal of the uterus/ in most cases, this is a last resort.

4eplacing lost blood and fluids is important in treating postpartum hemorrhage. 5ntravenous !50" fluids, blood, and blood

products may be given rapidly to prevent shock. $he mother may also receive oygen by mask.

9ostpartum hemorrhage can be 8uite serious. 6owever, 8uickly detecting and treating the cause of bleeding can often lead

to a full recovery.

Care an' Mana"ement o! Multiple Pre"nan#y

+anagement of multiple pregnancy may include the following:

• In#rease' nutrition

+others carrying two or more fetuses need more calories, protein, and other nutrients, including iron. 6igher

weight gain is also recommended for multiple pregnancy. $he 5nstitute of +edicine recommends that women

carrying twins who have a normal body mass inde should gain between > and C1 pounds. $hose who are

overweight should gain >)-C2 pounds/ and obese women should gain *C-1* pounds.

• More !re4uent prenatal visits

+ultiple pregnancy increases the risk for complications. +ore fre8uent visits may help detect complications early


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enough for effective treatment or management. $he mother's nutritional status and weight should also be

monitored more closely.

• +e!errals

4eferral to a maternal-fetal medicine specialist, called a perinatologist, for special testing or ultrasound

evaluations, and to coordinate care of complications, may be necessary.

• In#rease' rest

#ome women may also need bedrest--either at home or in the hospital depending on pregnancy complications or

the number of fetuses. 6igher-order multiple pregnancies often re8uire bedrest starting in the middle of the

second trimester. 9reventive bed rest has not been shown to prevent preterm birth in multiple pregnancy.

• Maternal an' !etal testin"

$esting may be needed to monitor the health of the fetuses, especially if there are pregnancy complications.

• To#olyti# me'i#ations

$ocolytic medications may be given, if preterm labor occurs, to help slow or stop contractions of the uterus. $hese

may be given orally, in an in3ection, or intravenously. $ocolytic medications often used include magnesium

sulfate.

• Corti#osteroi' me'i#ations

orticosteroid medications may be given to help mature the lungs of the fetuses. ung immaturity is a ma3or

problem of premature babies.

• Cervi#al #er#la"e

erclage !a procedure used to suture shut the cervical opening" is used for women with an incompetent cervi.

$his is a condition in which the cervi is physically weak and unable to stay closed during pregnancy. #ome

women with higher-order multiples may re8uire cerclage in early pregnancy.

&elivery of multiples depends on many factors including the fetal positions, gestational age, and health of mother and

fetuses. Generally, in twins, if both fetuses are in the verte !head-down" position and there are no other complications, a

vaginal delivery is possible. 5f the first fetus is verte, but the second is not, the first fetus may be delivered vaginally, then

the second is either turned to the verte position or delivered breech !buttocks are presented first". $hese procedures can

increase the risk for problems such as prolapsed cord !when the cord slips down through the cervical opening"

Emergency cesarean birth of the second fetus may be needed. ?sually, if the first fetus is not verte, both babies are

delivered by cesarean. +ost triplets and other higher-order multiples are born by cesarean.

0aginal delivery may take place in an operating room because of the greater risks for complications during birth and the


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potential need for cesarean delivery. esarean delivery is usually needed for fetuses that are in abnormal positions, for

certain medical conditions of the mother, and for fetal distress.

Documents

Health Education for Record Book