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Pregnancy at Risk: Pregestational Onset. Alcohol Use in Pregnancy. Maternal effects: Malnutrition Bone-marrow suppression Increased incidence of infections Liver disease Neonatal effects: Fetal alcohol spectrum disorders (FASD). Cocaine Use in Pregnancy: Maternal Effects. - PowerPoint PPT Presentation
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Pregnancy at Risk: Pregestational Onset
Alcohol Use in PregnancyMaternal effects:Malnutrition Bone-marrow suppressionIncreased incidence of infectionsLiver diseaseNeonatal effects:Fetal alcohol spectrum disorders (FASD)
Cocaine Use in Pregnancy: Maternal EffectsSeizures and hallucinationsPulmonary edemaRespiratory failureCardiac problemsSpontaneous first trimester abortion, abruptio placentae, intrauterine growth restriction (IUGR), preterm birth, and stillbirth
Cocaine Use in Pregnancy: Fetal EffectsDecreased birth weight and head circumference Feeding difficulties Neonatal effects from breast milk:Extreme irritabilityVomiting and diarrheaDilated pupils and apnea
Heroin Use in PregnancyMaternal effects:Poor nutrition and iron-deficiency anemiaPreeclampsia-eclampsiaBreech positionAbnormal placental implantationAbruptio placentaePreterm labor
Heroin Use in Pregnancy (contd)Maternal effects:Premature rupture of the membranes (PROM)Meconium stainingHigher incidence of STIs and HIVFetal effects:IUGR Withdrawal symptoms after birth
Substance Use in Pregnancy: Maternal EffectsMarijuana: difficult to evaluate, no known teratogenic effectsPCP - maternal overdose or a psychotic responseMDMA (Ecstasy) - long-term impaired memory and learning
Pathology of Diabetes Mellitus (DM)Endocrine disorder of carbohydrate metabolismResults from inadequate production or utilization of insulinCellular and extracellular dehydrationBreakdown of fats and proteins for energy
Gestational Diabetes (GDM)Carbohydrate intolerance of variable severityCauses:An unidentified preexistent diseaseThe effect of pregnancy on a compensated metabolic abnormality A consequence of altered metabolism from changing hormonal levels
Effect of Pregnancy on Carbohydrate MetabolismEarly pregnancy:Increased insulin production and tissue sensitivitySecond half of pregnancy:Increased peripheral resistance to insulin
Maternal Risks with DMHydramniosPreeclampsia-eclampsiaKetoacidosisDystociaIncreased susceptibility to infections
Fetal and Neonatal Risks with DMPerinatal mortalityCongenital anomaliesMacrosomiaIUGRRDSPolycythemia
Fetal and Neonatal Risks with DM (contd)HyperbilirubinemiaHypocalcemia
Screening for DM in PregnancyAssess risk at first visit:Low risk - screen at 24 to 28 weeksHigh risk - screen as early as feasible
Risk FactorsAge over 40Family history of diabetes in a first-degree relativePrior macrosomic, malformed, or stillborn infantObesityHypertensionGlucosuria
Screening TestsOne-hour glucose tolerance test:Level greater than 130-140 mg/dl requires further testing3-hour glucose tolerance test:GDM diagnosed if 2 levels are exceeded
Treatment GoalsMaintain a physiologic equilibrium of insulin availability and glucose utilizationEnsure an optimally healthy mother and newbornTreatment:Diet therapy and exerciseGlucose monitoringInsulin therapy
Fetal AssessmentAFPFetal activity monitoringNSTBiophysical profileUltrasound
Nursing ManagementAssessment of glucoseNutrition counselingEducation about the disease process and managementEducation about glucose monitoring and insulin administrationAssessment of the fetusSupport
Iron-deficiency AnemiaMaternal complications:Susceptible to infectionMay tire easilyIncreased chance of preeclampsia and postpartal hemorrhageTolerates poorly even minimal blood loss during birth
Iron-deficiency Anemia (contd)Fetal complications:Low birth weightPrematurityStillbirthNeonatal death
Iron Deficiency Anemia (contd)Prevention and treatment:Prevention - at least 27 mg of iron dailyTreatment - 60-120 mg of iron daily
Folate DeficiencyMaternal complications:Nausea, vomiting, and anorexiaFetal complications:Neural tube defectsPrevention - 4 mg folic acid dailyTreatment - 1 mg folic acid daily plus iron supplements
Folate DeficiencyMaternal complications:Nausea, vomiting, and anorexiaFetal complications:Neural tube defectsPrevention - 4 mg folic acid dailyTreatment - 1 mg folic acid daily plus iron supplements
Sickle Cell AnemiaMaternal complications:Vaso-occlusive crisisInfectionsCongestive heart failureRenal failure
Sickle Cell Anemia (contd)Fetal complications include fetal death, prematurity, and IUGR.Treatment:Folic acidPrompt treatment of infectionsPrompt treatment of vaso-occlusive crisis
ThalassemiaTreatment:Folic acidTransfusionChelation
HIV in PregnancyAsymptomatic women - pregnancy has no effect Symptomatic with low CD4 count - pregnancy accelerates the diseaseZidovudine (ZDV) therapy diminishes risk of transmission to fetusTransmitted through breast milkHalf of all neonatal infections occurs during labor and birth
HIV in Pregnancy: Maternal RisksIntrapartal or postpartal hemorrhagePostpartal infectionPoor wound healingInfections of the genitourinary tract
HIV Effects on FetusInfants will often have a positive antibody titerInfected infants are usually asymptomatic but are likely to be:PrematureLow birth weightSmall for gestational age (SGA)
Treatment DuringPregnancyCounsel about implications of diagnosis on pregnancy:Antiretroviral therapyFetal testingCesarean birth
Cardiac Disorders in PregnancyCongenital heart diseaseMarfan syndromePeripartum cardiomyopathyEisenmenger syndrome Mitral valve prolapse
Less Common Medical Conditions in PregnancyRheumatoid arthritisEpilepsyHepatitis BHyperthyroidismHypothyroidismMaternal phenylketonuria
Less Common Medical Conditions in Pregnancy (contd)Multiple sclerosisSystemic lupus erythematosus Tuberculosis
Pregnancy at Risk: Gestational Onset
Spontaneous AbortionThreatened abortion Imminent abortion Incomplete abortion Complete abortion
Types of spontaneous abortion. A Threatened The cervix is not dilated, and the placenta is still attached to the uterine wall, but some bleeding occurs.
B Imminent. The placenta has separated from the uterine wall, the cervix has dilated, and the amount of bleeding has increased.
C Incomplete. The embryo/fetus has passed out of the uterus; however, the placenta remains.
Spontaneous Abortion (contd)Missed abortion Recurrent pregnancy lossSeptic abortion
Spontaneous Abortion: TreatmentBed restAbstinence from coitusD&C or suction evacuationRh immune globulin
Spontaneous Abortion: Nursing CareAssess the amount and appearance of any vaginal bleedingMonitor the womans vital signs and degree of discomfortAssess need for Rh immune globulin.Assess fetal heart rateAssess the responses and coping of the woman and her family
Ectopic Pregnancy: Risk FactorsTubal damage Previous pelvic or tubal surgeryEndometriosisPrevious ectopic pregnancyPresence of an IUDHigh levels of progesterone
Ectopic Pregnancy: Risk Factors (contd)Congenital anomalies of the tubeUse of ovulation-inducing drugsPrimary infertilitySmokingAdvanced maternal age
Ectopic Pregnancy: TreatmentMethotrexateSurgery
Various implantation sites in ectopic pregnancy. The most common site is within the fallopian tube, hence the name tubal pregnancy
Ectopic Pregnancy: Nursing CareAssess the appearance and amount of vaginal bleedingMonitors vital signsAssess the womans emotional status and coping abilitiesEvaluate the couples informational needs.Provide post-operative care
Gestational Trophoblastic Disease: SymptomsVaginal bleedingAnemiaPassing of hydropic vesiclesUterine enlargement greater than expected for gestational ageAbsence of fetal heart soundsElevated hCG
Gestational Trophoblastic Disease: SymptomsLow levels of MSAFPHyperemesis gravidarumPreeclampsia
Gestational Trophoblastic Disease: TreatmentD&CPossible hysterectomyCareful follow-up
Hydatidiform mole. A common sign is vaginal bleeding, often brownish (the characteristic prune juice appearance) but sometimes bright red. In this figure, some of the hydropic vessels are being passed. This occurrence is diagnostic for hydatidiform mole.
Gestational Trophoblastic Disease: Nursing CareMonitor vital signsMonitor vaginal bleedingAssess abdominal painAssess the womans emotional state and coping ability
Bleeding DisordersPlacenta previa - placenta is improperly implanted in the lower uterine segmentAbruptio placentae - premature separation of a normally implanted placenta from the uterine wall
Cervical Incompetence: TreatmentSerial cervical ultrasound assessmentsBed restProgesterone supplementationAntibioticsAnti-inflammatory drugsCerclage procedures
A cerclage or purse-string suture is inserted in the cervix to prevent preterm cervical dilatation and pregnancy loss. After placement, the string is tightened and secured anteriorly.
Hyperemesis Gravidarum: TreatmentControl vomitingCorrect dehydrationRestore electrolyte balanceMaintain adequate nutrition
Hyperemesis Gravidarum: Nursing CareAssess the amount and character of further emesisAssess intake and output and weight.Assess fetal heart rateAssess maternal vital signsObserve for evidence of jaundice or bleedingAssess the womans emotional state
Nursing Care of Clients with PROMDetermine duration of PROMAssess gestational ageObserve for signs and symptoms of infectionAssess hydration statusAssess fetal statusAssess childbirth preparation and coping
Nursing Clients with PROM (contd)Encourage resting on left sideProvide comfort measuresProvide education
Nursing Care of Clients with Preterm LaborIdentify risk for preterm laborAssess change in risk status for preterm laborAssess educational needs of the woman and her loved onesAssess the womans responses to medical and nursing interventionTeach about the importance of recognizing the onset of labor
Signs and Symptoms of Preterm LaborUterine contractions occurring every 10 minutes or lessMild menstrual like cramps felt low in the adbomenConstant or intermittent feeling of pelvic pressureRupture of membranesLow, dull backache, which may be constant or intermittent
Signs and Symptoms of Preterm Labor (contd)A change in vaginal dischargeAbdominal cramping with or without diarrhea
Classification of Hypertension in PregnancyPreeclampsia-eclampsia
Chronic hypertension
Chronic hypertension with superimposed preeclampsia
Gestational hypertension
Chronic Hypertension in PregnancyHypertension before 20 weeks without proteinurea or stable proteinureaAt a higher risk for adverse outcomesAt risk for development of pre-eclampsia
Chronic HypertensionIf target organ damage present, pregnancy can exacerbate the conditionLifestyle modifications: - Activity restrictions - Weight reduction - Sodium restriction - ETOH and tobacco strongly discouraged
Plan of Care Chronic Hypertension in PregnancyMedications can safely be withheld in patients:Without target organ damageBlood pressure less than 150-160 mmHg systolic and 100-110 diastolic
Pharmacological management: Chronic HTN in PregnancyMethyldopa (Aldomet) preferred alpha-2 adrenergic agonistLabetalol (normodyne, Trandate) beta blockerDiuretic, calcium antagonists, other beta blockers?ACE (angiotension converting enzyme) inhibitors are contraindicated in pregnancy IUGR, oligohydramnios, neonatal renal failure, and neonatal deathARB (angiotension receptor blockers)not researched in pregnancy but probably contraindicated
LabatalolBaby at risk for transient hypotension and hypogylcemia if mom on labatalolNo labatalol to clients with asthma or first degree heart block
Fetal AssessmentFetal growth restrictionUltrasound @ 18-20 weeks, 28-32 weeks & as needed thereafterNST or biophysical profile if growth restricted
Preeclampsia-eclampsiaIncreased blood pressure AND proteinureaHighly suspected if increased BP and headache, blurred vision, abdominal pain, low platelets and/or abnormal liver enzymes
MAPMean Arterial Pressure average of systolic and diastolic blood pressure readings SBP + DBP + DBP 3 ACOG states hypertension exists when there is an increase in the MAP of 20 mmHg, and if no baselines are known, a MAP of 105 mmHg is usedTwo readings 4-6 hours apart
Hypertension in PregnancyHypertension complicates 5-7% of all pregnanciesOne-half to two-thirds have preeclampsia or eclampsiaHypertension is a leading cause of maternal and infant morbidity and mortality
Normal Adaptations to PregnancyIncreased blood plasma volumeVasodilationDecreased systemic vascular resistanceElevated cardiac outputDecreased colloid osmotic pressure
Preeclamptic Changes in PregnancyRenal lesions are present, especially in nulliparous women (85%)
Arteriolar vasospasm: diminishes the diameter of the blood vessels which impedes blood flow to organs and raises blood pressure (perfusion to placenta, kidneys, liver, and brain can be diminished by 40-60%)
Etiology of HypertensionVasospasms are one of the underlying mechanisms for the signs and symptoms of preeclampsiaEndothelial damage (from decreased placental perfusion) contributes to preeclampsiaWith endothelial damage, arteriolar vasospasm may contribute to increased capillary permeability. This increases edema and decreases intravascular volume
Other Suspected CausesThe presence of foreign protein (placenta or fetus) may trigger an immunologic responseThis is supported by: - the incidence of preeclampsia in first-time mothers (first exposure to fetal tissue) - women pregnant by a new partner (different genetic material)
Pulmonary Preeclamptic ChangesAt risk for development of pulmonary edemaPulmonary capillaries susceptible to fluid leakage across membranes due to endothelial damageLeft ventricular failure from increased afterload leading to backup of fluid in pulmonary bed
Renal Preeclamptic ChangesReduced kidney perfusion decreases the glomerular filtration rate which lead to degenerative changes and oliguriaProtein is lost in the urine, sodium and water are retainedFluid moves out of the intravascular compartment resulting in increased blood viscosity and tissue edema
Vascular Preeclamptic ChangesHematocrit level rises as fluid leaves the cellsBlood volume may fall to or below prepregnancy levels; severe edema develops and weight gain is seenDecreased liver perfusion causes impaired function. Epigastric pain or RUQ pain
More Preeclamptic ChangesArteriolar vasospasms with decreased blood perfusion to the retina causes visual changes such as blind spots and blurringCNS changes caused by spasms as well as edema include headache, hyperreflexia, positive ankle clonus, and occasionally the development of eclampsia
Characteristics of PreeclampsiaMaternal vasospasmDecreased perfusion to virtually all organsDecrease in plasma volumeActivation of the coagulation cascadeAlterations in glomerular capillary endotheliumEdema
Characteristics of Preeclampsia Increased viscosity of the blood HyperreflexiaHeadacheSubcapsular hematoma of the liver
A In a normal pregnancy, the passive quality of the spiral arteries permits increased blood flow to the placenta.
B In preeclampsia, vasoconstriction of the myometrial segment of the spiral arteries occurs.
What is the possible end result?Heart failure, caused by circulatory collapse and shockPulmonary edema, associated with severe generalized edema (weak, rapid pulse, lowered blood pressure, crackles)HELLP Syndrome: Multisystem disease in which hemolysis, elevated liver enzymes and low platelets are presentDisseminated Intravascular Coagulation: (DIC)Clotting factors are consumed by excess fluid, generalized bleeding occurs. Thrombocytopenia
Differential DiagnosisBP of > 160 systolic or > 110 diastolic Proteinurea of 1-2+ on 2 dipsticks at least 4 hours apart or .3 grams or more in 24 hoursIncreased serum creatinine > 1.2 unless prior elevationPlatelet count less than 100,000Elevated ALT or ASTPersistent headache or visual changesPersistent epigastric pain, nausea and vomiting
LabsHgb & Hct: hemoconcentration supports dx of preeclamsia and is an indicator of severity. Values may be decreased, however, if hemolysis accompanies the diseasePlatelets: thrombocytopenia suggests severe preeclamsiaQuantification of protein excretion: if proteinurea should consider preeclamsiaSerum creatinine: abnormal rising levels especially in conjunction with oligurea (thickening of the renal arterioles)Serum uric acid: increases as urate clearance decreases due to enlargement of glomerular endothelial cells and occlusions of capillary lumenSerum albumin: hypoalbuminemia indicates extent of endothelial leakCoagulation profile: coagulopathy including thrombocytopenia
Hypertensive Effects on FetusSmall for gestational ageFetal hypoxiaDeath related to abruptionPrematurity
Home ManagementMonitoring for signs and symptoms of worsening conditionFetal movement counts Frequent rest in the left lateral positionMonitoring of blood pressure, weight, and urine protein dailyNSTLaboratory testing
Management of Severe PreeclampsiaBed restHigh-protein, moderate-sodium dietTreatment with magnesium sulfateCorticosteroidsFluid and electrolyte replacementAntihypertensive therapy
Fetal Indications for Delivery Severe IUGRNonreassuring fetal surveillanceoligohydramnios
Maternal Indications for DeliveryGestational age of 38 weeks or greaterPlatelet count below 100K Progressive deterioration of hepatic functionProgressive deterioration of renal functionSuspected placental abruptionPersistent severe headache or visual changesPersistent severe epigastric pain, nausea, or vomitingeclampsia
Plan of Care for the PreeclampticComplete bedrestLeft lying position-increases kidney glomerular function and urine outputProvide darkened quiet roomLimit visitationFluid restriction (125-150ml/hr)Seizure precautionsMagnesium sulfateAntihypertensives
Preeclampsia AssessmentEdemaDTRs and clonusAssess fluid balance-strict I & OBreath sounds (pulmonary edema)Vital signs: BP, respiratory rate & SaO2LOCc/o HA or visual disturbancesProteinureaEpigastric pain
Edema1+ edema is minimal (2mm) at pedal and pretibial sites2+ (4mm) edema of lower extrmities is marked3+ (6mm) edema is evident in hands, face, lower abdominal wall and sacrum4+ (8mm) generalized massive edema is evident including ascites from accumulaton of fluid in the peritoneal cavity
Assessment of CNS ChangesDTRs and ClonusDTRs 0-4+ patellar and brachial0=no response1+=low normal2+=average3+=brisk4+=hyperactive
ClonusExtreme hyperreflexiaInvoluntary oscillations that may be seen between flexion and extension when continuous pressure is applied to the sole of the footCounted in beats
Plan of Care for the PreeclampticMagnesium Sulfate: used to prevent or control seizures-it is a CNS depressant and smooth muscle relaxant-increases blood flow to the fetusIt does not treat the BPInterferes with the release of acetylcholine at the synapses, decreases neuromuscular irritability
Magnesium SulfateLoading dose: 4-6 grams over 15-30 minutesMaintenance dose: 1-2 grams/hourTherapeutic levels: 4.8-9.6 mg/dlAlways IVPB to mainlineCalcium gluconate available as antidate
Renal InsufficiencyMagnesium sulfate is hazardous to women with severe renal failure and maintenance dose must be reduced
Assessment of Patients on Magnesium SulfateBP, pulse, and respiratory status should be monitored at least every 5 minutes with the loading dose, and every 15 minutes while on maintenance Continued the first 24 hours postpartum to prevent seizuresMonitor I & O 30ml/hrSerum levels every 4-6 hours therapeutic 4.8-9.6 mg/dl
Side Effects of Mag SulfateFlushingSweatingThirstDrying mucous membranesDepression of reflexesMuscle flaccidityNauseaBlurred visoinHAtachycardia
Clinicial Manifestations of HypermagnesemiaWeaknessParesthesiasDcreased deep tendon reflexesLethargy, confusion, disorientationHypoventilatoinSeizuresParalysisBradyarrythmiasHeart blockDecreased cardiac contractilityImpaired protein synthesisDecreased skeletal mineralizationHepatic dysfunction
Calcium GluconateAntidote for mag sulfate1 g of 10% calcium gluconate is administered slow IV push over 3 minutes and repeated every hour until signs and sxs of toxicity have been resolvedShould be kept at the bedside
Control of BPAntihypertensives may be needed to lower the diastolic pressureThis reduces maternal mortality and morbidity associated with left ventricular failure and cerebral hemorrhagePlacental perfusion is controlled by maternal blood pressure, drug must be calibrated carefully
AntihypertensivesIf BP reaches 150/100 mmHg or higherLabatalol (alpha/beta adrenergic blocker)Begin with 20mg IVP slowly over 2 minutesOr continuous infusion of 1mg/kg can be usedMay double dose up to 80 mg every 15-20 minutesMaximum dose 220mgApresoline (vasodilator)Begin with 5-20 mg infused over 2-4 minutesMay be repeated every 20-30 minutesIf no success by 20 mg IV or 30 mg IM try another drug
EclampsiaDerives from the Greek word meaning like a flash of lightening a condition that seems to strike out of the blue75% of the time it occurs intrapartum
EclampsiaCharacterized by seizures or comaIs a major hazard with poor outcomes in: - gestations of less than 28 weeks - mothers older than 35 years of age - multigravidas - chronic HTN, renal disease or diabetes
EclampsiaRare in the Western world because doctors can diagnose the condition in its earliest phase (preeclampsia) and they are constantly on the alert for the warning signsEarliest signs: drowsiness, HA, dimness of vision, rising BP, protein in the urine, edema, RUQ pain
EtiologyCerebral vasospasm, hemorrhage or edema, platelet and fibrin clots occlude vasculature leading to seizureBlood vessels in the uterus go into spasm cutting blood flow to the babySpasms lead to kidney failureTissues become water-logged because of fluid retentionHemorrhages happen in the liverBrain oxygen levels are lowered causing heightened brain sensitivity which shows as seizures
Signs and Symptoms of Impending SeizuresExtreme hypertension 200/140 not uncommonHyperreflexia4+ proteinureaGeneralized marked edemaSevere headache with or without visual distrubances
Management of Care During a SeizureCALL FOR HELP!Immediate care; Take care of the mother first-patent airway-adequate oxygenation-turn on side to prevent aspirationMagnesium Sulfate administrationAssessment of the fetus, birth if threatenedSteroid administration if fetal lungs are not mature
PNEUMONICS safetyE establish airwayI IV bolusZ zealous observationU uterine activityR rapid resuscitationE evaluate fetus
Postictal StateCentral venous pressure monitoringEstablish second indwelling catheterBlood glucose level to rule out hypogylcemia due to liver not functioning properlyBlood should be available for emergency infusion due to abruptioDo not leave patient alone
REMEMBER!!!All medications and therapy are merely temporary measuresDelivery is the only cure
Signs and Symptoms of EclampsiaScotomataBlurred visionEpigastric painVomitingPersistent or severe headacheNeurologic hyperactivity Pulmonary edemaCyanosis
Management of EclampsiaAssess characteristics of seizureAssess status of the fetusAssess for signs of placental abruptionMaintain airway and oxygenationPosition on side to avoid aspirationSuction to keep the airway clear
Management of Eclampsia (contd)To prevent injury, raise padded side railsAdminister magnesium sulfate
Postpartum ManagementSymptoms usually resolve within 48 hours of birthLab abnormalities usually resolve from 72-96 hours after birthCareful assessment continues, mag sulfate may continue to be infused for 12-48 hours after the birthBleeding must be assessed
Hemorrhage & HypertensionNO MethergineCauses vasospasm and increases blood pressureCONTRAINDICATED in pts with HTNUse hemabate or cytotec for PPH
Comparison of Risk Factors for HELLP Syndrome and PreeclampsiaHELLP PreeclampsiaMultiparous NulliparousMaternal age >25 Maternal age45Hx of poor preg Family hxOutcome Poor PNC Diabetes Chronic HTN Multiple gestation
HELLPHemolysis, Elevated liver enzymes, Low platelet countPrevalence is higher among older, white, multiparous womenCarries a mortality rate of 2-24%Occurs in 4-12% of severe preeclampsia
DXPlatelet < 100,000Liver enzymes AST ALT elevatedEvidence of intravascular hemolysis must be present
Complications of HELLPRenal failurePulmonary edemaRuptured liver hematomaDICAbruptio placentaFetal deathPerinatal asphyxiaMaternal death
Sx of HELLPEpigastric painMailaiseNausea and vomitingMild jaundice often noted
Sound like the flu?
DICProthrombin time, partial thromboplastin time and fibrinogenlevels are normal in patients with HELLPIn a patient with a plasma fibrinogen level of less than 300 mg/dL, DIC should be suspected, especially if other laboratory abnormalities are also presentOozing from venipuncture sited, hemorrhage, uterine atony
DICSystemic thrombohemorrhagic disorder involving the generation of intravascular fibrin and the consumption of procoagulants and plateletsCauses in pregnancy: abruptio placenta, IUFD with retained dead fetus, AFE, endotoxin sepsis, preeclampsia with HELLP and massive transfusion
TX of DICReplacement of volume, blood products, and coagulation componentsCardiovascular and respiratory supportElimination of underlying triggering mechanismAnticoagulationReplace blood products as indicated-packed RBCs, platelets, FFP, cryoAntithrombin III concentrateHematology, transfusionist, critical care consultants.
Treatment for HELLPDelivery is the only cureAntenatal administration of dexamethasone (Decadron) 10 mg IV every 12 hoursMag Sulfate bolus of 4-6 g as a 20% soln then mainenance of 2 g /hrAntihypertensive therapy should be initiated if BP > 160/110
Rh IncompatibilityRh mother, Rh + fetusMaternal IgG antibodies producedHemolysis of fetal red blood cellsRapid production of erythroblastsHyperbilirubinemia
Administration of Rh Immune GlobulinAfter birth of an Rh+ infantAfter spontaneous or induced abortionAfter ectopic pregnancyAfter invasive procedures during pregnancyAfter maternal trauma
ABO IncompatibilityMom is type OInfant is type A or BMaternal serum antibodies are present in serumHemolysis of fetal red blood cells
Surgery During PregnancyIncidence of spontaneous abortion is increased in first trimesterInsert nasogastric tube prior to surgeryInsert indwelling catheterEncourage patient to use support stockingsAssess fetal heart tonesPosition to maximize utero-placental circulation
Trauma During PregnancyGreater volume of blood loss before signs of shockMore susceptible to hypoxemia with apneaIncreased risk of thrombosisDICTraumatic separation of placentaPremature labor
Battering During PregnancyPsychological distressLoss of pregnancyPreterm laborLow-birth-weight infantsFetal deathIncreased risk of STIs
Perinatal InfectionsToxoplasmosisRubellaCytomegalovirusHerpes simplex virusGroup B streptococcusHuman B-19 parvovirus
Fetal Risks: ToxoplasmosisRetinochoroiditisConvulsionsComaMicrocephalyHydrocephalus
Fetal Risks: RubellaCongenital cataractsSensorineural deafnessCongenital heart defects
Fetal Risks: ChlamydiaNeurologic complicationsAnemiaHyperbilirubinemiaThrombocytopeniaHepatosplenomegalySGA
Fetal Risks: HerpesPreterm laborIntrauterine growth restrictionNeonatal infection
Fetal Risks: GBSRespiratory distress or pneumoniaApneaShockMeningitisLong-term neurologic complications
Fetal Risks: Human B-19 ParvovirusSpontaneous abortionFetal hydropsStillbirth