Cmca lec midterms

• Pregnancy Induced Hypertension (PIH)

  A condition wherein vasospasm occurs during pregnancy in both the small and large arteries in the body
• Gestational hypertension


  Also known as Pregnancy Induced Hypertension
• Toxemia


  Originally what Pregnancy Induced Hypertension was called
• Signs of Pregnancy Induced Hypertension are Hypertension, Proteinuria and Edema
• Pregnancy Induced Hypertension is a form of high blood pressure in pregnancy
• Pregnancy Induced Hypertension occurs in about 5 percent to 8 percent of all pregnancies
• Pre-eclampsia


  A disease of pregnancy characterized by a blood pressure of 140/90 mmHg or more on two separate occasions after the 20th week of pregnancy in previously normotensive woman, accompanied by significant proteinuria (300 mg in 24 hours)
• Risk Factors for Hypertensive Disorders

  • Women of color
  • Multiple pregnancies
  • Primiparas who are 20 years and older
  • Women from low socioeconomic backgrounds
  • Underlying disease (heart diseases, DM, renal involvement and essential hypertension)
• Classical Signs of Pregnancy Induced Hypertension

  • Hypertension
  • Proteinuria
  • Edema
• Gestational Hypertension


  A woman develops an elevated BP of 140/90mmHg but has no proteinuria or edema, perinatal mortality is not increased, no drug therapy is necessary
• Mild Pre-eclampsia


  Blood pressure rises to 140/90 mmHg, with proteinuria (1+ or 2+ on a reagent test strip on a random sample), and a weight gain of more than 2 lbs./week in the second trimester or 1 lbs./week in the third trimester

  
• Severe Pre-eclampsia


  Blood pressure has risen to 160 mmHg systolic and 110 mmHg diastolic or above, with marked proteinuria (3+ or 4+ on a random urine sample or more than 5 g in a 24-hour sample), extensive edema, oliguria, elevated serum creatinine, cerebral or visual disturbances, thrombocytopenia and epigastric pain
• Eclampsia


  The most severe classification of Pregnancy Induced Hypertension, where cerebral edema is so acute that seizure or coma occurs, with high maternal mortality
• Fetal Effects of Pregnancy Induced Hypertension

  • Reduced placental function resulting in low birth weight
  • Prematurity
  • Abruptio placenta
  • Intra-uterine fetal death (IUFD)
• Medical/Nursing Management of Pregnancy Induced Hypertension

  • Promote bed rest
  • Weight monitoring
  • Regular monitoring of blood pressure
  • Monitor fetal and maternal well being
  • Promote good nutrition
  • Daily examination of urine
  • Anti-hypertensive therapy
  • Provide emotional support
• Pregnancy Induced Hypertension may occur up to 10-14 days after birth but it usually occurs in the first 48 hours after birth
• HELLP Syndrome


  A syndrome characterized by Hemolysis, Elevated Liver enzyme levels and a Low Platelet count, considered a variant of pre-eclampsia
• Symptoms of HELLP Syndrome

  • Abdominal, chest or shoulder pain, especially in the right upper side
  • Nausea, vomiting, or indigestion
  • Headache that won't go away
  • Pain when breathing deeply
  • Bleeding
  • Changes in vision
  • Swelling, especially of the face or hands
  • Shortness of breath, difficulty of breathing, or gasping for air
• Diabetes Mellitus


  An endocrine disorder in which the pancreas cannot produce adequate insulin to regulate body glucose level

  
• Gestational Diabetes


  Any degree of glucose intolerance with onset or first recognition during pregnancy

  
• Pre-gestational Diabetes


  Diabetes diagnosed before pregnancy

  
• Diabetes during pregnancy increases the risk of serious injury at birth, likelihood of caesarean delivery, and incidence of neonatal intensive care unit

  
• Screening


  The purpose is to identify asymptomatic individuals with a high probability of having or developing a specific disease
• Risk Factors for Gestational Diabetes

  • Increasing maternal age and weight
  • Previous Gestational Diabetes
  • Previous macrosomic infant
  • Family history of diabetes among first-degree relatives
  • Ethnic background with a high prevalence of diabetes
  • Previous Gestational Diabetes or impaired Glucose Tolerance Test
  • Persistent glycosuria

  
• All pregnant women should undergo screening for Gestational Diabetes at first prenatal visit and after 26th week if negative on previous testing

  
• 50g Oral Glucose Challenge


  The screening test for Gestational Diabetes, a plasma value above 130-140 mg/dl one hour after is commonly used as a threshold for performing a 3-hour Oral Glucose Tolerance Test

  
• Oral Glucose Tolerance Test


  Measures the body's ability to use glucose, can be used to diagnose prediabetes and diabetes, most commonly done to check for gestational diabetes

  
• Interpretation of Oral Glucose Tolerance Test Results

  • Normal - fasting glucose <100; 2-hour glucose < 140
  • Pre-Diabetes - fasting blood glucose = 100-125 (IFG) or 2-hour result = 140-199mg/dl (IGT)
  • Diabetes (presumptive) - fasting glucose ≥126mg/dl or 2-hour result > 200

  
• Three Major Gestational Diabetes Symptoms

  • Polyuria - frequent urination
  • Polydipsia - excessive thirst
  • Polyphagia - excessive hunger

  
• Maternal Complications Associated with Gestational Diabetes

  • Pre-eclampsia
  • Polyhydramnios
  • Prolonged labour
  • Obstructed labour
  • Caesarean Section
  • Uterine atony
  • Postpartum hemorrhage
  • Infection