Maternal health conditions

Chronic HTN - definition

High blood pressure before pregnancy, or before 20w GA

Chronic HTN - Complications

-Gestational diabetes

-Placental abruption

-Stroke

-Preeclampsia/eclampsia

-HELLP syndrome

Preeclampsia

Elevated blood pressure and protein in urine after 20w

Symptoms: Headache, swelling, blurred vision

Eclampsia

Preeclampsia symptoms PLUS seizures

Could warrant early delivery

HELLP - abbreviation

Hemolysis

Elevated

Liver enzymes

Low

Platelet count

Chronic HTN - fetal risks

-Poor growth

-Preterm delivery

Chronic HTN - Recommended tests

-Regular blood pressure checks

-U/S's

Chronic HTN - Meds

-Beta blockers (safe)

-ACE inhibitors (not safe in 2nd tri)

Chronic HTN - GC agenda

Cause for the HTN, to rule out inherited causes and familial kidney disease

Diabetes - Definition

Unhealthy blood sugar (too high or too low)

Diabetes - Pregnancy complications

-Hypoglycemia

-Hyperglycemia

-Complications at delivery

-Increased risk of mortality

Diabetes (Type 1, Type 2, Gestational diabetes) - Fetal risks

-Birth defects

-Spina bifida

-NTDS

-Heart defects

-Large for GA fetus

-Increased need for C-section

-Risk for shoulder dystocia

-Caudal regression syndrome

Diabetes - Recommended tests

-HgA1C

-MSAFP

-U/S's

Diabetes - Medications

All safe:

-Insulin

-Metformin

-Glyburide

Diabetes - GC

-Encourage good glucose control

-Discuss background risk and increased risk for birth defects

-Discuss MSAFP and U/S

Seizures - Definition

Abnormal electrical signals in brain causing convulsions

Seizures - Pregnancy complications

-Preeclampsia

-Fetal death

-Increased seizures

-Sleep deprivation

-Increased maternal death

Seizures - Fetal risks

-Birth defects

-Heart most common

-CL/P

-Skeletal

-Urological

-NTDs

-Trauma or lack of oxygen secondary to maternal injury during seizure

Seizures - Tests

-Medication levels in blood

-U/S's

-Fetal echo

-MSAFP

Seizures - Medications

-Depakote (highest risk)

-Cabamazepine (Tegretol)

-Levetiracetam (Keppra) (Lowest risk)

Seizures - Preconception

-Folic acid

-Seizure control w/ one medication (neurologist)

Systematic Lupus Erythematosus - Definition

Body's immune system incorrectly attacks healthy body tissues

Systematic Lupus Erythematosus - Pregnancy complications

-Infections

-Thrombosis

-High blood pressure

-Stillbirth

-Preeclampsia

-Preterm birth

-Increased chance for C-section

-1st trimester SAB

-Maternal death

Systematic Lupus Erythematosus - Common fetal risks

-Neonatal lupus: Rash w/ or w/o complete congenital heart block (can lead to fetal death)

-Small for GA/IUGR

Systematic Lupus Erythematosus - Tests

-Fetal echo

-Blood tests

Systematic Lupus Erythematosus - Medications

-Plaquenal (relatively safe)

-Chemo (not recommended)

Systematic Lupus Erythematosus - GC

-Hx of symptoms

-Last flares

-Medications

-Family Hx

-Fetal risks

Antiphospholipid Antibody Syndrome - Definition

Body makes antibodies that attack phospholipids found naturally in blood cells and lining of blood vessels

Antiphospholipid Antibody Syndrome - Pregnancy complications

-Venous thromboembolism and thrombocytopenia

-Arterial clots (strokes)

-5x increased risk for preeclampsia!

-Placental insufficiency

-Miscarriage

-Preterm labor

Antiphospholipid Antibody Syndrome - Fetal risks

-IUGR

-Stillbirth

-Premature delivery

Antiphospholipid Antibody Syndrome - Recommended tests

-Serial U/S's

-Fetal heart rate monitoring

-Non-stress test

-Baseline preeclampsia labs

Antiphospholipid Antibody Syndrome - Medications

-Low dose aspirin (safe)

-Low molecular weight heparin (safe)

-Warfarin (NOT safe)

Antiphospholipid Antibody Syndrome - GC

-Encourage pt to keep all prenatal visits

-This is a high-risk pregnancy!

-Assess hx of blood clots

-Pregnancy hx

-Family hx

Rh sensitization - definition

Pregnant patient's immune system "sees" fetal blood as foreign and seeks to destroy it

Rh sensitization - Pregnancy complications

-Stillbirth

-Preterm delivery

Rh sensitization - Fetal risks

-Death

-Anemia

-Brain, heart damage

-Big spleen, liver

-Jaundice

-Hydrops fetalis

-Kernicterus

Rh sensitization - Tests

-Serial antibody titers

-U/S for fetal anemia (MCA dopplers)

-Paternal genotype

-Fetal genotype

Rh sensitization - Fetal treatment

If fetal anemia is severe enough, treat w/ fetal blood transfusions or early delivery

Rh sensitization - GC

-Last Ab titer (when and what was it?)

-Genetics of Rh disease, and risk for fetus to be Rh positive

-Medical/pregnancy hx

-Pregnancy management

-Tests to determine fetal genotype and risks/benefits of each option

• CVS/Amnio/prenatal cfDNA screening

Depression - Definition

Mood disorder that causes a persistent feeling of sadness and loss of interest

Depression - Pregnancy complications

-Preeclampsia

-Miscarriage

Depression - Fetal risks

-Low birth weight

-Preterm delivery

Depression - Tests

-Screening for depression (OB office)

Depression - Medications

-Antidepressants (safe, including SSRIs)

-Lithium (heart defect)

-Paxil (absolute risk very low)

Depression - GC

-Alert for signs of depression

-Medications

-Medicating w/ alcohol or other harmful stuff?

-How's the pt feeling?

-Risks/benefits of medications

-Therapist?

-Post-delivery developmental risk for offspring

-Increased risk for postpartum depression

Maternal Phenylketonuria (PKU) - Definition

AR metabolic disorder that causes phenyalanine to build up in the body and most often treated w/ low-Phe diet

If pregnant person does not follow low-Phe diet, fetus can be exposed to high levels of Phe before birth

Maternal Phenylketonuria (PKU) - Pregnancy complications

-Low birth weight

-Pregnancy loss

Maternal Phenylketonuria (PKU) - Fetal risks

-Significant risk of ID

-IUGR

-Heart defects

-Microcephaly

-Behavioral problems

-Seizures

Maternal Phenylketonuria (PKU) - Tests

-Serial titers to check Phe levels

-U/S

-Partner carrier screening

Maternal Phenylketonuria (PKU) - Medications

None!

But follow low-Phe diet

Amount of Phe per day may need to change during pregnancy

Maternal Phenylketonuria (PKU) - GC

-Review family hx

-Discuss risks of not following diet

-MRM consultation, at minimum

-Discuss carrier screening for partner