Gestational Diabetes and Genital Tract Infections

• The study notes are for NCM 109 Care of Mother, Child at Risk or with Problems (Acute and Chronic)

Assessment of Risk Factors

• Demographic factors, socioeconomic status, obstetric history, current OB status, the mother's medical history, and habits are all risk factors.
• In recent years, high-risk pregnancies have increased by approximately 15-20%.
• Women aged 30-38 are typically at high risk during pregnancies.
• Causes of high-risk pregnancies include hypertension leading to pre-eclampsia, diabetes causing gestational diabetes, recurrent pregnancy loss, late pregnancy, assisted reproductive therapy, obesity, nutritional deficiency, autoimmune disease, and placental problems.

High-Risk Factors of Pregnancy and Management at Antenatal Clinic

• Complications during pregnancy can affect the health and survival of both the mother and the fetus.
• Every pregnant woman should have at least 4 checkups during pregnancy.
• The first checkup should occur by 12 weeks, with subsequent checkups at 14-26 weeks, 28-32 weeks, and 36-40 weeks.
• A complete medical history and physical, systemic, and abdominal examinations should occur during each antenatal care (ANC) visit.

High-Risk Conditions of Pregnancy

• Conditions not to be missed include severe anemia (Hb <7 mg/dL), pregnancy-induced hypertension, pre-eclampsia, pre-eclamptic toxemia, syphilis/HIV positive, gestational diabetes mellitus, hypothyroidism, young primi (less than 20 years), elderly gravida (more than 35 years), twin multiple pregnancy, malpresentation, previous lower segment cesarean section, low-lying placenta, placenta previa, positive bad OB history including history of stillbirth, abortion, congenital malformation, obstructed labor, premature birth
• The mother being RH negative
• A history of current systemic illnesses or past illnesses

Warning signs to be explained

• Fever >38.6C for more than 24 hours is a warning sign in pregnant women indicating possible infection.
• Intense headache with vision disturbances, or blurring of vision
• Other warning signs of a problem during pregnancy consist of generalized swelling of the body, puffiness of the face, palpitations, easy fatigability, breathlessness, pain in the abdomen, vaginal bleeding, watery discharge, and reduced fetal movements.

Prenatal Diagnostic Examinations

• Screening is identifying apparently healthy people at increased risk of a disease or condition.
• Screening includes providing information, further tests, and treatment to reduce risk and complications.
• Assessment is defining the nature of the problem, determining the diagnosis, and developing treatment recommendations.
• Diagnostic tests establish the presence or absence of disease to inform treatment decisions in symptomatic or screen-positive people.

Fetal Ultrasound

• A fetal ultrasound uses reflected sound waves to create a picture of the fetus, placenta, and amniotic fluid.
• The image can be in black and white or color and is also known as an echogram, sonogram or scan.
• The 1st trimester fetal ultrasounds is done to determine how the pregnancy is progressing, find out if pregnant with more than one fetus and estimate the age of the fetus and risk of chromosome defects, such as down syndrome.
• A check is also performed to look for any birth defects that affect the brain or spinal cord.
• The 2nd trimester fetal ultrasounds is done to estimate the age of the fetus and the size and position of the fetus, placenta, and amniotic fluid.
• A determination is made about the position of the fetus, umbilical cord, and the placenta during a procedure like amniocentesis.
• Any major birth defects, such as neural tube defects or heart problems, are detected.
• A third trimester fetal ultrasound is performed to make sure that the fetus is alive and moving.
• a third trimester fetal ultrasound also helps determine the size and position of the fetus, placenta, and amniotic fluid.

Cardiotocography (CTG)

• CTG is a technical method of recording the fetal heartbeat and uterine contractions during pregnancy, typically in the 3rd trimester.
• The monitoring machine is called a cardiotocography, commonly known as an electronic fetal monitor (EFM).
• During an NST (nonstress test), the baby's heart rate is monitored to see how it responds to the baby's movements to check a baby's health.
• NSTs are most often recommended for women at increased risk of fetal death after week 26 of pregnancy.
• Test results might indicate that the mother and baby need further monitoring, testing or special care.
• A contraction stress test (CST) is performed in the last few weeks of pregnancy to determine how well the fetus will cope with the contractions of childbirth.
• The aim is to induce contractions and monitor the fetus for heart rate abnormalities using a cardiotocograph.

Interpretation of CST (Contraction Stress Test)

• A negative CST indicates no late decelerations and adequate FHR recording.
• A positive CST indicates late decelerations present with the majority of contractions without excessive uterine activity.
• Equivocal tests results in suspicious, hyperstimulation, and unsatisfactory readings.

Invasive Pregnancy Diagnostic Tests

• Chorionic villi are small structures in the placenta that contain blood vessels containing cells from the developing fetus.
• Chorionic villi sampling (CVS) removes a sample of these cells through a needle to determine chromosomal or genetic disorders in the fetus.
• CVS usually takes place at 10-12 or before 15 weeks' gestation.
• Amniocentesis removes a small amount of fluid from the sac around the baby inside the uterus to determine birth defects and some genetic problems.
• • Amniocentesis is typically done between 14 and 20 weeks.
• CVS is offered to women who are at an increased risk for bearing a child with birth defects.
• Women older than 35 years of age, will be offered the test
• Those who have a family history of genetic abnormalities, have had babies with birth defect, have had a screen that showed there may be other problems
• Conditions that could be tested for: Down syndrome, Anencephaly
• Embryoscopy examines the embryo through the intact membranes at 9-10 weeks by introducing an endoscope into the exocoelomic space transcervically or transabdominally.
• Embryoscopy is used in early pregnancy management in selected families affected by recurrent genetic syndromes with recognizable external fetal abnormalities.
• The procedure-related risk of fetal loss is around 12 per cent.
• Fetoscopy examines the fetus after 11 weeks old

Other Diagnostic Tests and Procedures

• With cordocentesis, a diagnostic cord blood test is performed transabdominally with ultrasound at 10-14 weeks to confirm or rule out suspected fetal abnormalities.
• Cordocentesis (percutaneous umbilical cord blood sampling) tests blood from the fetus, using UTZ to guide a needle through the abdomen and uterine walls to the umbilical cord to check for abnormalities.
• Results are available within 72 hours.
• Cordocentesis is similar to amniocentesis, except it is done to analyze the fetal blood.
• Cordocentesis is performed if diagnostic information cannot be obtained through amniocentesis, CVS, or ultrasound when those results are inconclusive.
• It is performed after 17 weeks of pregnancy.
• Cordocentesis detects chromosome abnormalities and fetal malformations, such as fetal infection, platelet count, anemia, and isoimmunization.

Subfertility

• Infertility describes the inability to conceive after one year of unprotected sex.
• Factors affecting natural conception include age, smoking, and alcohol use.
• Many married couples and individuals who are single, planning to marry or same sex couples use fertility testing.
• Male causes of subfertility are 30%, female causes 30%, a mix is 30% and unexplained is 10%.

Classification of Subfertility

• Primary subfertility means couples have never conceived
• Secondary subfertility means they have previously conceived.

Other Factors Affecting Fertility

• Stress and Coital frequency: stress is a factor in subfertility that affects libido and coital frequency
• The recommended coital frequency is 2 to 3 times per week
• The Bodyweight and weight should be OVER or UNDER and can affect ovulation.
• A BMI of >29 or <19 may indicate the inability to conceive
• Non-steroidal anti-inflammatory drugs inhibit ovulation and some prescriptions can affect sperm quality
• Exposure to chemicals and radiation negatively affects male and female fertility.

Conception and Fertility

• The chance of conceiving in any given menstrual cycle is less than 20%.
• Events necessary for pregnancy: Ovulation, Fertilization, Implantation
• Infertility can result from any condition that interferes with the above.
• 1 time per week of intimacy yields a 17% chance of conception.
• 3 times per week of intimacy yields a 50% chance of conception.
• Sperm can survive up to 5 days in the female genital tract.

Factors Affecting Fertility: STIs and Systemic Infections

• Gonorrhea and chlamydia can cause Pelvic inflammatory diseases which is a major cause of tubal infertility and cervicitis, and can cause Urethritis, Epididymitis and Accessory gland infections in men.
• Mumps can cause testicular atrophy and lead to secondary orchitis.
• Other infections include Tuberculosis, Toxoplasmosis, Malaria, Schistosomiasis, and Leprosy

Other Health Factors affecting Fertility

• General Health of the Male: Alternative therapies, 24 hour food intake, Alcohol and smoking is a problem here
• Congenital health problems, STDs and UTIs are a cause for concern
• Radiation to the testes is a problem, exposure to x-rays is negative here
• Job choices can also be a problem if a sedentary lifestyle is implemented
• Sexual Practices: Frequency of Coitus and Masturbation
• Health HIstory of Female:
  • • past, miscarriages or abortions
  • -Hx of contraceptive use
  • • reproductive tract problems

Factors That Cause Male Subfertility

• Disturbance in spermatogenesis (production of sperm cells)
• Inadequate amounts of FSH and LH in the pituitary, which stimulates the production of the sperm
• Obstruction in the seminiferous tubules, ducts, or vessels which prevents the movement of spermatozoa

Male subfertility Problems

• Coital problems, Inability to produce enough sperm
• Factors affecting sperm: exposure to X-rays and other substances and illness
• Factors that influence a significantly higher body temperature: Any condition that increases body temperature & chronic infection
• Congenital abnormalities: cryptorchidism
• Varicocele: varicosity of the spermatic vein
• Endocrine imbalances: Thyroid & pituitary glands
• Drug or Alcohol abuse: Has negative affects on spermatogenesis
• Male Subfertility: obstruction or blocked sperm can cause mumps, orchitis, epididymitis and infections such as Gonorrhea
• Benign hypertrophy: occurs around age 50
• Anomalies: hypospadias and extreme obesity are conditions which affect effective penetration and deposition
• Ejaculation: is when the semen exits the penis

Ejaculation Problems

• Erectile Dysfunction\Impotence causes are diseases such as cardiovascular problems, diabetes, and Parkinson's
• Use of certain antihypertensive agents known as beta blockers can constrict blood vessels, leading to decreased blood flow to the erectile tissues
• Discontinuing finasteride (drug used for male pattern baldness) may result in hormonal imbalance
• Premature ejaculation causes include psychological and physical factors

Factors That Cause Female Subfertility

• Limited production amounts of FHS or LH, which interefere with ova growth, Anovulation (faulty or inadequate expulsion of ova), or Problems with transportation of the oval down the fallopian tubes
• Uterine factors includes tumors or poor endometrial development.
• Factors that may lead to immobilization in the Spermatozoa: Poor nutrition, weight, and a lack of exercise can result in immobilization.

Additional Causes of Female Subfertility

• Tubal transport caused by PID, removed appendixes and history of surgeries can influence the uterus
• Fibroids are (leiomyomas) that can cause issues: this may cause the blocking of fallopian tubes
• Vagina and Cervical Problems: Infections, stenosis, previous procedures like D&C, and vaginal infections
• Some women appear to have sperm-immobilizing or sperm-agglutinating antibodies in their blood plasma

Fertility Workup

• Includes, Evaluating: The history, examining and testing the sperm, and looking for fallopian tube issues.
• General History of Female/Male, Occupation, Sexual, Obstetric, and Gynecological details.
• Tests: Urine, LH and hormonal
• Sperm testing and penetration

Treatment and Possibilities for Female Infertility

• Hormonal: Clomiphene citrate and gonadotropins help induce ovulation
• intrauterine can transfer and help the ovulation
• ART: Non-Coital methods of ART include (In vitro: the sperm helps a "pre-made' zygote down the tubes
• A success rate can vary based on the procedure with IVF at 15% and GIFT at 28%

Gynecology Problems and Issues

• Ovarian Cyst: is a Semi-fluid sac within the ovary walls
• Growth can be from many issues or related to the periods

Ovarian Cysts

• Some Symptoms: Include Bloating, Bowel issues, Pain, Tenderness and Nausea
• Analgesics: NSAIDS and opiods may be used to treat the issues
• 2 Types: are Funcitional which is most common and Pathological which is from abnormal cells in the ovarian walls
• Medical Management: is key with ultrasound assessment and hormonal regulation birth control pill

Endometriosis and Complications

• A disease in which tissue similar to the lining of the uterus grows outside the uterus.
• lesions or changes in the endometrial layer: Can caused a Chronic inflammatory reaction
• Symptoms can be pain and bleeding with these types of medical conditions
• Treatment to minimize: include meds, hormones and surgeries

Uterine Fibroids

Noncancerous growths in childbearing persons.

Polycystic Ovarian Syndrome (PCOS)

• Is a hormonal Imabalance that has Cysts in the ovaries.
• Diagnsis happens with: Ultrasound and blood test
• Can cause: Issues around the female sex cycle, weight issues and many problems to be diagnosed with PCOS

Additional PCOS Diagnosis Factors

• Can be seen from Hormone issues
• Can get a ultrasound and blood test for problems
• Lifestyle can be changed during pregnancy

Abnormal Uterine Issues

• Dysfunctional uterine bleeding
• Caused by hormonal imbalance
• Common in teenagers or in women approaching menopause
• Or cause Pregnancy or infections to happen
• Medications and Lifestyle treatment can improve the condition
• Treatment: BIrth control can help also

Genital Infections

• Can affect the skin or tubes for carrying the baby

Gestational Diabetes Mellitus (DM)

• Is an endocrine disorder
• That lacks Beta to get insulin the beta cells which can absorb glucose and metabolism
• Pancreas does not produce enough insulin, thus glucose is unable to enter the cells & accumulates in the bloodstream resulting in hyperglycemia
• High glucose in blood, → insulin → key para makapasok ang cells

DM Symptoms and Signs

• Glycosuria; When blood glucose levels goes beyond the renal threshold for sugar, glucose spills on the urine
• Polydipsia: The excretion of large amounts of fluid from the body leads to dehydration
• Ketoacidosis: Breakdown of proteins & fats result in excessive formation of ketone bodies that the body cannot excrete
• Blood Test and Urinalysis are use
• DM affects blood from the baby, Birth, Death, and other side issues
• So, it may be better to check if its under weight or normal to avoid issues
• Exercises, tests, and hormonal therapy may improve the issues

Anemia during Pregnancy

• Is defined as haemoglobin concentration less than 11 g/dl
• Can cause Haemolytic, Chronic, Folic acid, and Vit B12 issues
• To fix it: Test with a medical professional and take meds for it

Causes of Iron Deficiency Anemia

• Anemia is a problem as a mother can produce stress and cardiac issues
• Supplementation with iron and Folic acid may make the delivery better with a health baby

DM

• Can happen from multiple babies
• Twins, triplets and having high party can increase the infection risk and issues for multiple people
• May need treatments like with medication or surgery
• Blood or surgery is only in dire issues.
• Multiple causes can happen but genetics and family history are key

Multiple Pregnancies

• The chance of this happening is rare but older women or folks with history of this tend to have risker pregnancies so be careful
• You may reduce: Enjoyment and add pressure and problems to the birth and mother's life
• Treat and Manage everything with proper medicines

Complications due Incompatible Blood

• Can Affect the pregnancies
• Some mothers are given a RhIG and babies as well

Birth Defects

• Can happen if issues are not fixed it can become worse

Deliver

• With precaution and help is is best to remove and get out the baby but if not or if baby is dead then the problem may get worse

RH Negative

If pregnant, mothers with RH blood of a specific type can cause problems during pregnancy without proper care

This lesson covers the causes, effects, and complications of gestational diabetes, including hyperglycemia, ketoacidosis, and the importance of diet and exercise. It also addresses the common ways lower genital tract infections are acquired and their potential progression.