Georgetown ISD



PathophysiologyChapter 9 Potential Complications of PregnancyI. Fetal DevelopmentA. fertilization in fallopian tubeB. zygote formedC. implantation – 1 week laterD. differentiation E. organogenesis 1. heart beats at 4 weeks2. by 8 weeks all organs formedF. Teratogens (any substance/situation causing developmental abnormality)1. drugs2. viruses3. alcohol4. radiation5. smokinga. low birth weightb. increased irritabilityc. increased risk of placenta previa and abruptio placentaeG. Folic acid importance1. reduces incidence of spina bifida2. reduces incidence of anencephalyH. Fetus at 8 weeks1. continued growth/differentiation2. 3rd trimestera. weight gainb. maturation of organsc. viable at 22-23 weeksI. Twins1. identical – monozygotic2. fraternal - dizygoticII. Significant Physiologic Changes During Pregnancy - divided into trimestersA. Diagnosis of Pregnancy1. lab a. presence of hCG (human chorionic gonadotropin) in urine/plasmab. secreted by chorionic villi2. positive (absolute) signsa. fetal heart beatb. fetal movementc. ultrasound3. gestation - length of time since the 1st day of the LMP-='s 280 days (40 weeks; 10 lunar months)a. EDD or EDB -Nagele's rule-first day of last menstrual period-3 months subtracted from that date-then 7 days are added to that dateb. gestational age-2 weeks longer than actual age of child from time of fertilization - 266 days or 38 weeks4. gravidity - # of pregnancies- primigravida - 1st pregnancy 5. parity - # of pregnancies where fetus reached viability (22 weeks)- multipara - 2 or more pregnancies6. coding systems-five digit system: # of pregnancies, # of deliveries, # of premature deliveries, # of abortions, # of living childrenHistory of woman in her 2nd pregnancy who has 1 child living and no other experiences: 2-1-0-0-17. amniocentesisa. withdrawal of amniotic fluid after 14 weeksb. checking for chemical contentc. fetal cells cultured - check for chromosomal abnormalities8. chorionic villi testing a. chorionic villi - finger shaped growths in placenta; cells here same as fetal cellsb. done by catheter or needlec. checking for chromosomal abnormalitiesd. can be done earlier in pregnancyB. Physiologic changes and their implications1. hormonal changesa. increase in estrogen and progesterone-development of uterus-maintenance of pregnancy-preparation for lactationb. thyroid gland hyperplasia-increase thyroxine production-increases mom's metabolism2. reproductive system changesa. uterine hypertrophyb. uterine hyperplasiac. # of uterine blood vessels increasesd. increased vascularity of cervix/vagina-causes tissue to soften (Goodell's sign)-causes tissue to darken (Chadwick's sign)e. cervical mucus-more-thicker-forms cervical plugf. vaginal secretions -increase- pH lowers-increase glycogen content-due to all of above, yeast infections occur more easilyg. breasts-ducts/glands prepare for lactation-fatty deposits increase- veins more prominent3. weight gain and nutritiona. 25-30 lbs.-uterus-placenta-amniotic fluid-fetus-breasts-additional blood volume-stored nutrients (fat)b. most in last trimesterc. increase demand for protein, carbs, fats, mineralsd. increase in metabolism4. digestive system changesa. nausea/vomiting commonb. smooth muscle relaxes due to progesterone-slower emptying of stomach-decreased intestinal motility/constipationc. heartburnd. bloatinge. abdominal discomfort due to enlarging uterusf. hemorrhoids5. musculoskeletal changesa. pelvic joints relax-loss of stability-waddling gaitb. shift in center of gravityc. lordosis/backache6. cardiovascular changesa. blood volume increases (fluid and erythrocytes)-low hemoglobin (physiologic anemia)-must increase iron intake due to increased erythrocyte production-hematocrit decreases due to increase in blood fluids-leads to congestion/edemab. vascular resistance decreases (due to relaxation of smooth muscles)c. varicose veins-aching/fatigue in legs-result from restriction of blood flow to heart - due to pressure of uterusd. can only lie in certain positions or risk hypotension -uterus compresses blood vessels-less blood flow to heart-reduced cardiac outputIII. Potential Complications of pregnancyA. Ectopic Pregnancy1. tubal pregnancy2. outcomea. spontaneous abortionb. tube ruptures-severe hemorrhage-peritonitisB. Pregnancy-induced hypertension (PIH): preeclampsia and eclampsia1. PIH: state of persistently high blood pressure (greater than 140/90)a. develops after 20 weeksb. returns to normal after deliveryc. can lead to:-blood vessel damage to tissues (eyes, kidneys)-stroke-heart failure-due to decrease blood flow to uterus-premature degeneration of placenta2. preeclampsia (also called toxemia)a. bp higher than PIHb. more serious than PIHc. kidney dysfunction-excess protein in urine-edema-acute weight gaind. HELLP may develop-hemolysis-elevated liver enzymes-low platelets-can lead to coagulation disorders3. eclampsiaa. bp extremely highb. generalized seizuresc. comaC. Gestational diabetes mellitus1. increased glucose tolerance2. increase glucose levels3. dietary management or insulin4. within 1st trimester:-rise in fetal abnormalities-rise in stillbirths-large newborn5. can predispose mother to diabetes later in lifeD. Placental problems1. placental previaa. placenta implanted in lower uterus or over os (passage between uterus to cervix)b. placenta can tear with braxton-hicks contractions -painless uterine contractions - begin around 2nd trimester-increase oxygen/blood flow to uterus/placenta/fetusc. bleeding with bright red bloodd. painlesse. mother/infant placed at risk2. abruptio placentaea. premature separation of placenta from uterine wallb. bleeding with dark red blood- may not be visible due to location of tearc. abdominal paind. usually occurs in last trimesterE. Blood clotting problems1. thrombus - blood clot2. embolus - part of blood clot breaks awaya. travels to right side of heartb. travels to lung-pulmonary embolus-lodge in pulmonary artery-can affect respiratory and cardiovascular function3. Thrombophlebitis (phlebitis)`- inflammation of vein with formation of clot4. thromboembolism - clot blocking blood vessela. common after childbirthb. located in legs or pelvis3. disseminated intravascular coagulation (DIC)a. usually a complication of other problemsb. diffuse blood clots (many/all over)c. excessive consumption of all clotting factorsd. can lead to hemorrhage/organ damageF. Rh incompatibility1. Rh factor - antigen on RBC2. mom - Rh negative3. fetus - Rh positive 4. at delivery with tearing of placenta some fetal blood enters maternal circulation 5. antibodies formed against Rh factor6. with subsequent pregnanciesa. maternal AB cross placenta b. AB attack fetal RBCc. hemolysis of RBC-severe fetal anemia-low fetal hemoglobin-possible fetal heart failure-possible fetal death-high serum bilirubin levels in fetus - jaundiced-bilirubin -yellow pigment formed by breakdown of hemoglobin in RBC when they die-bilirubin enters brain tissue-potential neurologic damage (kernicterus)-if hemolysis severe:- early birth may be recommended -intratransfusion may be recommended-transfusion may be recommended after birth7. routine screening of maternal blood for Rh antibodiesa. no antibodies presentb. RhoGAM shots given within 72 hrs. of deliveryc. prevents "sensitization" and formation of AB by mother to Rh factorG. Jaundice1. phototherapy2. promotes conjugation (conversion )of bilirubin to water soluble form3. excreted in bileH. Infection1. puerperal infection (childbed fever)a. infection of reproductive tract up to 6 wks. after birthb. endogenous (from normal vaginal flora) or exogenous (from environment)c. any retained placental fragments 2. infection can spread to cause pelvic cellulitis (connective tissues or broad ligament of pelvis)3. infection can spread to cause peritonitis (peritoneal membranes)I. Adolescent pregnancy1. frequently riskya. little or no prenatal careb. nutrition ignoredc. no prenatal vitaminsd. no adequate pelvic development-causes difficult labor/delivery2. babies frequently weigh less3. babies frequently are preterm4. pregnancy induced hypertension common ................
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