mcn (high risk pregnancy)

• High-risk pregnancy is one in which a concurrent disorder, pregnancy-related complication, or external factor jeopardizes the health of the woman, the fetus, or both
• Psychological factors that categorize pregnancy as high risk include:

  • History of drug dependence (including alcohol)
  • History of intimate partner abuse
  • History of mental illness
  • History of poor coping mechanisms
  • Cognitively challenged
  • Survivor of childhood sexual abuse
• Cardiovascular disorders responsible for 5% of maternal deaths during pregnancy
• Blood volume and Cardiac Output increases approximately 30-50% during pregnancy
• Preconception counseling is imperative for women with cardiac disease
• Diagnostic tests for cardiac disease include:

  • Echocardiogram
  • Chest X-ray
  • Electrocardiogram (ECG)
  • Doppler studies
  • O2 saturation level
  • Physical activity assessment
• Pregnancy prognosis classification:

  • Class I: Uncompromised
  • Class II: Slightly compromised
  • Class III: Markedly compromised
  • Class IV: Severely compromised
• Rheumatic heart disease is a condition where heart valves are permanently damaged by rheumatic fever
• Peripartum cardiomyopathy is a rare syndrome of heart failure that occurs in late pregnancy or postpartum with no previous history of heart disease
• Subsequent pregnancy is strongly discouraged due to the risk of recurrence and worsening of the condition
• Anemia in pregnancy can lead to complications like early miscarriage, premature separation of placenta, and neural tube defects
• Megaloblastic anemia is characterized by RBCs that are larger than average and may result from folic acid deficiency
• True anemia is diagnosed when hemoglobin concentration is below specific levels during pregnancy
• high risk pregnancy

  • pregnancy with a high risk of complications
  • is one occurrence disorder pregnancy related complications or external factors jeopardize
• Diagnostic tests

  1. echocardiogram
  2. doppler studies
  3. chest xray
  4. 02 saturation level
  5. electrocardiogram (ECG)
  6. physical activity
• rheumatic fever

  • is an inflammatory connective tissue disease that can involve the heart, joints, central nervous system (CNS), skin, and subcutaneous tissue.
  • this condition may develop from untreated streptococcal infections.
• surgery - to replace or repair a badly damaged valve
• peripartum cardiomyopathy

  • rare syndrome of heart failure
  • dysfunction of left ventricle in late pregnancy or 5 months postpartum with no previous history of heart disease.
• peripartum cardiomyopathy mortality rate is 50%

  • occurs often in black multiparas with gestational hypertension.
• anticoagulant - to prevent thrombophlebitis
• heparin - antepartum

  coumadin - postpartum
• oral contraceptives are contraindicated because of the danger of thrombophlebitis
• Anemia is a blood disorder that results when the body has less red blood cells than normal.
• RBC’s acts by transporting oxygen throughout the body using a protein called hemoglobin.
• Megaloblastic Anemia - This type of anemia is most often secondary to folic acid deficiency.
• Diabetes Mellitus - An endocrine disorder in which the pancreas cannot produce adequate insulin to regulate body glucose levels.
• Classification of Diabetes Mellitus

  Type 1 - Characterized by the destruction of the beta cells in the pancreas that usually leads to absolute insulin deficiency.

  Type 2 - Usually arises because of insulin resistance combined with a relative deficiency in the production of insulin.

  Gestational - A condition of abnormal glucose metabolism that arises during pregnancy
• 50-g Glucose Challenge Test - done between 24-28 weeks gestation to determine if a woman is at risk for gestational DM
• 100g 3-Hour glucose tolerance test - if the result of 50-g Glucose Challenge Test is 140mg/dl
• HbA1c (glycosylated hemoglobin) - a measure of the amount of glucose attached to hemoglobin
• INSULIN THERAPY - Given subcutaneously at 90-degree angle to the skin.
• BLOOD GLUCOSE MONITORING - A finger is pricked and a glucometer is used to determine blood glucose.
• INSULIN PUMP THERAPY - An automatic pump with thin tubing, which is placed subcutaneously, on the woman’s abdomen.
• Substance Abuse - 10-20% of pregnant women are using illicit substances
• Commonly Abused Drugs

  1. Cocaine
  2. Amphetamines
  3. Marijuana
  4. Narcotic Agents (Opiates)
  5. Inhalants
  6. Alcohol
• Human Immunodeficiency Virus (HIV) - The organism responsible for acquired immunodeficiency syndrome (AIDS).
• 1%-2% of every 1000 women giving birth are HIV positive
• CD4 Cell Count - determines how many T Lymphocytes (T4 cells) are present and functioning.
• ELISA (Enzyme-linked immunosorbent assay) - this test is usually the first one used to detect infection with HIV.
• Western Blot test - an antibody test that's done on a blood sample. It's used to confirm or disprove the results of an earlier test for HIV.