Pregestational Risks: Substance Abuse and Diabetes in Pregnancy

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. Fetal Alcohol Syndrome Retrieved from: http://www.aafp.org/afp/2005/0715/p279.html

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

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

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

10. MODULE 4 PART 1BPREGESTATIONAL RISKS: DIABETES

11. 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

12. 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

13. 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

14. 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

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

18. COMPARISON OF DIABETES MELLITUS AND GESTATIONAL DIABETES

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

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

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

22. MODULE 4 PART 1CPREGESTATIONAL RISKSINFECTIONS

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

24. TORCH • TOXOPLAMOSIS • OTHER • GBS • RUBELLA • CYTOMEGALIVIRUS • 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

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

35. Cerclage Retrieved from: www.drlindagalloway.wordpress.com

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

37. Positive Fern Test Retrieved from: commons.wikimedia.org

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

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

40. 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

41. Preeclampsia

42. 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

43. 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

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

45. H E L L P Syndrome • H – hemolysis- distortion and rupture of RBCs • E – elevated • L – liver enzymes- fibrin deposits obstruct blood flow • L – low • P – platelet count

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

50. 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