maternal

foods to avoid in pregnancy

foods high in mercury

• effects nervous systems

cold deli meats → high risk of infections

foods in pregnancy

300 more calories per day

• under could have 400-500 calories per day

• over 250 or less

drugs to avoid in pregnancy

no NSAIDs

• ace inhibitors/arbs (can cause decrease amniotic fluids oligohydramnios

• codeine

• caster oil/mineral oil

• drugs/alcohol

• warfarin

• ISOTRETINOIN

rh factors

if mom is rh negative and baby rh positive → risk for erythroblastosis fetalis

• treatment rhogam

• mom will have these antibodies for life

• if baby is rh negative than you don’t need to give anything

direct combs testing

fetal blood sample

• rh positive → reflex test to determine exposure

indirect combs

performed on moms blood sample

• rh negative then do a reflex tests

  • repeat test at 28 weeks (will get rhogam at this week)

  • or early pregnancy

glucose challenge

less than 140 than its fine

• over 140 → 3hr glucose test

  • if levels are within normal range for three hours = no gestational diabetes

  • if the levels are not within, confirmative test for gestational diabetes

GTPAL

G → gravidity number of pregnancies

T → term carried to full term

P → preterm

• between 20-36+6 weeks

A → abortions

• spontaneous, miscarriages or termination

• prior to 16+9

L → living children

preeclampsia

bp greater than >140/90

• protein in urine

• 2 readings

eclampsia → leads to seizures

• edema, increase weight gain, facial edema

management of preeclampsia

• delivery of baby and placenta

• prepare for preterm baby

  • mag sulfate (24hrs)

  • betamethasone → fetal lung maturity

eclampsia

at or above 34 weeks if mom not tolerating

antihypertensives

labetalol

nifedipine

hydralazine (2nd line)

HELLP syndrome

delivery right away

• hemolysis elevated liver enzymes and low platelet

• can happen after pregnancy too

• treatment

  • corticosteroids, antihypertensives, blood products and delivery

gestational diabetes

baby weight greater than 9lbs

pcos

overweight or obese

• once delivered return back to normal

• no more insulin

treated with diet/exercise or insulin

cholestasis

bile acids run through blood to the liver

• itching on the palms and sole of the feet

risk factors

• hx of cholestasis

• hx of liver damage or disease

• being a parent of multiples

complications of cholestasis

• severe itching

• disruption in fat absorption

• low vit k

for fetus

• stillbirths

treatment

• give ursodiol

• twice weekly nst before 36 weeks

• after delivery

ectopic pregnancy

abdominal pain

spotting

• prevent rupture

• methotrexate

• Rh immune globulin

  • given if they are neg