High risk (1)

• Risk Factors for a High-Risk Pregnancy

  • Advanced maternal age
  • Lifestyle choices
  • Medical History
  • Underlying conditions
  • Pregnancy complications
  • Overdue pregnancy
  • Multiple pregnancy
• Signs and Symptoms of a High-Risk Pregnancy

  • Vaginal bleeding
  • Persistent headaches
  • Pain or cramping in the lower abdomen
  • Watery vaginal discharge (gush or a trickle)
  • Regular or frequent contractions (tightening sensation in the abdomen)
  • Decreased fetal activity
  • Pain or burning with urination
  • Changes in vision, including blurred vision
• Assessment and Screening Procedures

  • Specialized or targeted ultrasound
  • Amniocentesis
  • Chorionic villus sampling (CVS)
  • Cordocentesis
  • Cervical length measurement
  • Laboratory tests
  • Biophysical profile
• Steps to Promote a Healthy Pregnancy

  • Schedule a preconception appointment
  • Be cautious when using ART (Assisted Reproductive Technology)
  • Seek regular prenatal care
  • Eat a healthy diet
  • Gain weight wisely
  • Avoid risky substances
• Rheumatic Heart Disease (RHD)


  A condition in which permanent damage to heart valves is caused by rheumatic fever
• Rheumatic Heart Disease


  • The heart valve is damaged by a disease process that generally begins with a strep throat caused by bacteria called Streptococcus that leads to rheumatic fever
• Symptoms of Rheumatic Heart Disease

  • Chest pain
  • Heart palpitations
  • Breathlessness on exertion
  • Breathing problems with lying down
  • Waking from sleep with need to sit or stand
  • Swelling
  • Fainting
• Management of Women with Rheumatic Heart Disease

  1. A woman should receive antenatal care at an appropriate referral center with an experienced obstetrician, in collaboration with a cardiologist

  2. The nature and site of planned delivery should occur before or early in pregnancy

  3. During pregnancy, women with valvular heart disease should be reviewed regularly by a cardiac specialist if there is a change in symptoms
• Diabetes Mellitus (DM)


  An endocrine disorder in which the pancreas cannot produce adequate insulin to regulate body glucose levels
• Diabetes Mellitus affects 3% to 5% of all pregnancies
• Normal blood sugar levels

  • Fasting: 80-120mg/dl
  • Non-fasting: 70-140mg/dl
• Infants of diabetic women are 5x more apt to be born with heart abnormalities
• Infants of women with poorly controlled diabetes tend to be large (more than 10lbs) - macrosomia/Macrosomic baby
• Oral Glucose Tolerance Test

  1. Fasting: 95mg/dL

  2. 1 hour: 180mg/dL

  3. 2 hours: 155mg/dL

  4. 3 hours: 140mg/dL
• Clinical Manifestations of Diabetes Mellitus

  • Glycosuria
  • Polyuria
  • Dehydration
  • Metabolic acidosis
• Management of Women with Diabetes Mellitus

  1. Woman with pregestational diabetes (Type 1 and 2) should go to her obstetrician for care before getting pregnant

  2. Glycosylated hemoglobin is used to detect the degree of hyperglycemia present

  3. A urine culture may be done each trimester to detect asymptomatic UTI

  4. Ophthalmic examination should be done once during pregnancy for the woman with gestational diabetes and each trimester for women with known diabetes

  5. Early in pregnancy, a woman with diabetes may need less insulin because the fetus is using so much glucose for rapid cell growth

  6. Women with gestational diabetes will be started on insulin therapy if diet alone is unsuccessful in regulating glucose values

  7. Oral hypoglycemia agents are not used for regulation because, unlike insulin, they cross the placenta and are potentially teratogenic

  8. Short-acting insulin (regular) combined with an intermediate type: 2/3 of the total amount of day's insulin is given in the morning and the other third is given in the evening

  9. A woman should maintain a consistent rotating injection routine (such as using all sites in one limb before using another or rotating limbs)
• Substance Abuse


  Inability to meet major role obligations

  A person is substance dependent when he/she has withdrawal symptoms following discontinuation of the substance
• As many as 10% to 20% of pregnant women use illegal drugs during pregnancy
• Illicit drugs tend to be of small molecular weight, so they readily cross the placenta
• A fetus of an addicted mother has a drug concentration of about 50% that of the mother
• Substance abuse can account for fetal abnormalities or preterm birth
• If a woman uses injected drugs, the risk for hepatitis B or human immunodeficiency virus (HIV) infection increases
• A woman may earn money to buy drugs through prostitution, which increases the risk for STI and poses an additional threat to a fetus
• Cocaine


  One of the most frequently abused drugs during pregnancy

  It is exceptionally harmful during pregnancy because the extreme vasoconstriction that occurs can severely compromise placental circulation, leading to premature separation of the placenta – which then results in preterm labor or fetal death
• Effects of Cocaine on Infants


  • Intracranial hemorrhage
  • Withdrawal syndrome of tremulousness
  • Irritability
  • Muscle rigidity
• Management of Cocaine Use During Pregnancy

  1. Counseling women to discontinue cocaine use during pregnancy is often disappointing, however psychosocial interventions are being implemented: cognitive-behavioral therapies, community reinforcement approach, seeking safety and motivational interviewing

  2. Reinforce cocaine abstinence and encourage compliance with prenatal care

  3. Cocaine use can be detected by urinalysis because the metabolites of cocaine can be detected in urine up to 1 week after use
• Phencyclidine (PCP)


  An animal tranquilizer that is a frequently used street drug in polydrug abuse

  It concentrates in fetal cells making it injurious to a fetus

  It causes increased cardiac output, sense of euphoria and causes long-term hallucinations
• According to studies PCP is excreted into the breastmilk
• Narcotic Agonists


  They are used for treatment of pain and cough suppression but are also widely abused because of their potent analgesic and euphoric effect
• Pregnancy Complications Related to Narcotic Agonist Use

  • PIH (because narcotics are often injected with shared needles)
  • Phlebitis
  • Subacute bacterial endocarditis
  • Hepatitis B and HIV infection may occur
• Withdrawal symptoms may begin as soon as 6 hours after the last drug dose and can continue for several days
• Infants of opiate-abusing women tend to be small for gestational age and have an increased incidence of fetal distress and meconium aspiration
• Fetal liver is forced to mature faster than normal, a reason why hyperbilirubinemia is rarely a problem
• Management of Narcotic Agonist Use During Pregnancy

  If possible, an opiate-dependent woman should be enrolled in a methadone maintenance program during pregnancy

  If methadone program is not available, women may be treated buprenorphine
• Inhalants


  The sniffling or huffing of aerosol drugs

  Most of the substances contain freon that can lead to severe respiratory and cardiac irregularities

  The effect of these drugs during pregnancy is not well documented, but they appear to have effects similar to alcohol abuse
• Fetal oxygen supply can be compromised through the use of inhalants
• Alcohol


  It is just as detrimental to fetal growth as illegal drugs

  Excessive use tends to occur in women with impulsive personalities
• Fetal Alcohol Syndrome (FAS)


  A syndrome with significant fetal features, possible cognitive challenges and memory deficits
• Management of Alcohol Use During Pregnancy

  When discussing alcohol ingestion with young adults, be certain to talk about binge drinking to be certain a woman does not believe this type of occasional drinking is safe

  Encourage pregnant mothers to comply to their prenatal visits and educate them with risk of alcohol consumption during pregnancy
• Smoking


  Smoking can cause serious health conditions including cancer, heart disease, stroke, gum disease and blindness

  It makes a woman hard to get pregnant