Health Challenges in Pregnancy - University of Saskatchewan PDF

Health Challenges in Pregnancy: Hypertension, Diabetes, Multiples, Obesity, Age Related, Substance Abuse, Infection Jill Zdunich, RN, BA, BSN, MN Content developed by: Cheryl Besse, BScN, RN, MN and Jill Zdunich RN, BA, BSN, MN ...

Health Challenges in Pregnancy: Hypertension, Diabetes, Multiples, Obesity, Age Related, Substance Abuse, Infection Jill Zdunich, RN, BA, BSN, MN Content developed by: Cheryl Besse, BScN, RN, MN and Jill Zdunich RN, BA, BSN, MN  Outline  Hypertension  Diabetes  Multiples  Obesity  Age Related  Substance Abuse  Infection nursing.usask.ca  Allwomen with chronic and acute medical conditions need increased vigilance during pregnancy Box 19.1 Webster  Most medical conditions Will have some effect on the mother May increase risks to the newborn nursing.usask.ca Hypertensive Disorders of Pregnancy AKA:  Pregnancy Induced Hypertension - PIH  Gestational Hypertension – GH (may see GHTN)  Pre-eclampsia  Toxemia  Incidence ~ 10% nursing.usask.ca   Webster Box 19.3 Classification Pre-Existing predates pregnancy or before 20 weeks Gestational Systolic ≥ 140 mmHg and/or Diastolic ≥ 90 mmHg After 20 weeks and up to 12 weeks PP nursing.usask.ca https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1701 216322002341?returnurl=null&referrer=null  Classification  Preeclampsia Systolic ≥ 140 mmHg and/or Diastolic ≥ 90 mmHg Proteinuria (2+ or greater) and/or 1 or more adverse conditions or severe complications  Severe Preeclampsia ≥160/110 mmHg Heavy proteinuria (3-5 g/24 hrs) 1 or more adverse condition / severe complications  Eclampsia = seizure nursing.usask.ca Adverse Conditions  Headache*  Visual Disturbances*  Abdominal/Epigastric/RUQ Pain*  Nausea/Vomiting  Chest pain/SOB  Abnormal maternal lab values  Fetal morbitity  Edema / Weight gain?  Hyperreflexia? nursing.usask.ca  Consequences of Preeclampsia Maternal: Fetal:   IUGR Stroke   Oligohydramnios Pulmonary edema  Absent or reversed end diastolic  Hepatic failure umbilical artery flow by Doppler  Jaundice  Placental abruption  Seizures  Prematurity (iatrogenic)  Placental abruption  Fetal compromise (metabolic  acidosis) Acute renal failure  Intrauterine death  HELLP syndrome & DIC SOGC CPG, MOREOB, nursing.usask.ca Webster – Comparison Chart 19.2  Risk Factors Gestational Hypertension Cause ?? Nullipara or first Obesity pregnancy with a new Ethnicity partner Advanced maternal age Previous pregnancy with (> 35) hypertension/preeclamp Multiple gestation (i.e. sia twins, triplets) Personal or family history of hypertension Diabetes nursing.usask.ca Poor nutrition Etiology? → Multi-organ involvement Abnormal placentation OR Excessive fetal demands Mismatch between uteroplacental supply and fetal demands Maternal endothelial cell dysfunction (Decreased plasma volume / Vasospasm) Maternal & Fetal manifestations of Preeclampsia nursing.usask.ca Pathophysiology Vasospasm and Hypoperfusion nursing.usask.ca Prevention - Low Dose Asprin  In patients with increased risk  “Low-dose aspirin (75 – 162 mg/day) (III-B) should be administered at bedtime (I-B), starting pre-pregnancy from diagnosis of pregnancy but before 16 weeks’ gestation (III-B), and considered for continuionuntil delivery(I-C).” nursing.usask.ca Initial Management  Stress reduction/reduced activity  Assessment of mother and fetus  Treat nausea & vomiting  Treat epigastric pain  Treat blood pressure  Consider seizure prophylaxis  Consider timing / mode of delivery nursing.usask.ca Management Home care if non severe hypertension Client monitors her blood pressure Measures weight and tests urine protein daily NST’s performed daily or bi-weekly Advised to report signs of adverse conditions nursing.usask.ca Management In-patient hospital care if severe hypertension / preeclampsia Fetal evaluation: Fetal movement counting, NST, Biophysical profile, ultrasound, measurement of AFI, serial U/S to assess growth, umbilical artery doppler flow, Hourly intake and output Frequent BP, pulse, resp Blood work (liver enzymes, platelets, Hct) Monitor for Adverse Conditions nursing.usask.ca Medications Webster Drug Guide 19.2 Anti-Hypertensives  Labetalol –  adrenergic blocker  Nifedipine (Adalat) – calcium channel blocker  Hydralazine (Apresoline) - Arteriolar dilators  Aldomet (Methyldopa)-Centrally-acting sympatholytic nursing.usask.ca ACE inhibitors contraindicated in pregnancy Medications Anti-Convulsant Magnesium Sulfate MgSO4  Tachycardia  Muscleweakness  NB to test reflexes  Lack of energy and  Monitor urine output drowsiness (excreted by kidneys)  Respiratory  Can slow labour depression  Lower blood pressure nursing.usask.ca Magnesium Toxicity Central Nervous System Depression  Respiratory rate