Pregnancy Hypertensive Disorders & Gestational Diabetes: Key Concepts and Management

What are the major health challenges in pregnancy?

Hypertension, Diabetes, Multiples, Obesity, Age Related issues, Substance Abuse, Infection.

What is Pregnancy Induced Hypertension (PIH)?

A hypertensive disorder that occurs during pregnancy, characterized by high blood pressure.

What is the incidence rate of hypertensive disorders in pregnancy?

Approximately 10%.

What defines Gestational Hypertension?

Systolic blood pressure ≥ 140 mmHg and/or Diastolic blood pressure ≥ 90 mmHg after 20 weeks of pregnancy.

What are the criteria for diagnosing Preeclampsia?

Systolic ≥ 140 mmHg and/or Diastolic ≥ 90 mmHg with proteinuria (2+ or greater) and/or severe complications.

What is Severe Preeclampsia?

Blood pressure ≥ 160/110 mmHg with heavy proteinuria and one or more severe complications.

What is Eclampsia?

A severe complication of Preeclampsia characterized by seizures.

List some adverse conditions associated with Preeclampsia.

Headache, visual disturbances, abdominal pain, nausea, chest pain, abnormal lab values, fetal morbidity.

What are some maternal consequences of Preeclampsia?

Stroke, pulmonary edema, hepatic failure, seizures, placental abruption, acute renal failure.

What fetal complications can arise from Preeclampsia?

Intrauterine growth restriction (IUGR), oligohydramnios, fetal compromise, prematurity, intrauterine death.

What are the risk factors for Gestational Hypertension?

Obesity, advanced maternal age (> 35), multiple gestation, diabetes, previous hypertension/preeclampsia.

What is the pathophysiology of Preeclampsia?

Vasospasm and hypoperfusion leading to multi-organ involvement.

How can Preeclampsia be prevented in high-risk patients?

By administering low-dose aspirin (75 - 162 mg/day) starting before 16 weeks of gestation.

What initial management strategies are recommended for Preeclampsia?

Stress reduction, assessment of mother and fetus, treating nausea, and monitoring blood pressure.

What medications are commonly used to manage hypertension in pregnancy?

Labetalol, Nifedipine, Hydralazine, and Aldomet (Methyldopa).

Why are ACE inhibitors contraindicated in pregnancy?

They can cause harm to the developing fetus.

What is Magnesium Sulfate used for in pregnancy?

As an anti-convulsant to prevent seizures in Preeclampsia.

What are the signs of Magnesium Toxicity?

CNS depression, respiratory rate <12, oliguria, diminished or absent deep tendon reflexes.

What is the recommended monitoring for a patient on Magnesium Sulfate?

Monitor reflexes, urine output, and watch for signs of respiratory depression.

What is the significance of fetal evaluation in severe hypertension?

To assess fetal well-being through movement counting, NST, and ultrasound.

What is the role of home care in managing non-severe hypertension during pregnancy?

Clients monitor their blood pressure, weight, and urine protein daily.

What is the importance of accurate blood pressure measurement in pregnancy?

It is crucial for diagnosing and managing hypertensive disorders effectively.

What is the first-line treatment for eclampsia?

Bolus of magnesium sulfate.

What medication is used for sedation in eclampsia?

Dilantin (Phenytoin).

What diuretic is used to treat pulmonary edema in eclampsia?

Furosemide (Lasix).

What is HELLP syndrome?

A severe form of pre-eclampsia characterized by Hemolysis, Elevated Liver Enzymes, and Low Platelets.

What platelet count indicates a need for platelet administration in HELLP syndrome?

If platelets are < 20 x 10^9/L.

What is DIC?

Disseminated Intravascular Coagulation, a condition caused by over-activation of the clotting mechanism.

What are common causes of DIC?

Pre-eclampsia, hemorrhage, intrauterine fetal demise, amniotic fluid embolism, sepsis, and HELLP syndrome.

What is gestational diabetes?

Glucose intolerance that occurs during pregnancy.

What percentage of non-Indigenous women experience gestational diabetes?

Approximately 3.5%.

What are the two ways pregnancy alters carbohydrate metabolism?

The fetus takes glucose from the mother, and the placenta secretes hormones that increase insulin resistance.

What is the recommended screening for gestational diabetes?

50 g glucose challenge test at 24-28 weeks of gestation.

What is the goal for managing blood sugar in gestational diabetes?

To maintain a euglycemic state with A1C less than 7%.

What are potential maternal effects of gestational diabetes?

Increased risk of preeclampsia, polyhydramnios, and type 2 diabetes later in life.

What are fetal effects of gestational diabetes?

Macrosomia, intrauterine growth restriction (IUGR), and congenital anomalies.

What is the incidence of multiple births in 2014?

3.3 per 100 births.

What are risks associated with multiple births?

Preterm labor, anemia, hypertension, and abnormal presentation.

What is the mean gestational age for twins?

35.2 weeks.

What is the mortality rate for triplets?

62.2 per 1000 births.

What complications can obesity in pregnancy lead to?

Neonatal hypoglycemia, breastfeeding issues, and birth defects.

What is a significant risk factor for developing gestational diabetes?

Being 35 years of age or older.

What is the recommended duration for breastfeeding to prevent hypoglycemia in newborns?

At least 4 months.

What is the impact of excessive weight gain during pregnancy?

It is the most common cause of obesity in later life.

What is the relationship between obesity in pregnancy and childhood obesity?

Children born to obese mothers are at a higher risk of developing obesity.

What is the significance of insulin needs during pregnancy?

Insulin needs may decrease in the first trimester and increase in the second and third trimesters.

What is the recommended care for women with insulin-dependent diabetes during labor?

Balance insulin with energy needs and monitor blood sugars regularly.

What is the term for the loss of a fetus before the 20th week of pregnancy?

Spontaneous Abortion

What are the risks associated with adolescent pregnancy?

Increased risks include preterm birth, low birth weight, anemia, and psychosocial issues.

What is the recommended total weight gain during pregnancy for women with a BMI over 30?

7 kg according to SOGC guidelines.

What is macrosomia in the context of pregnancy?

A condition where a fetus is significantly larger than average, often leading to shoulder dystocia during delivery.

What are teratogens?

Substances that can cause congenital anomalies or developmental issues in a fetus.

What is the SOGC recommendation regarding caffeine intake during pregnancy?

Pregnant women should limit caffeine to no more than 300 mg per day.

What is the purpose of aspirin prophylaxis in pregnant women?

To reduce the risk of preeclampsia in women with risk factors.

What infections are included in the TORCH complex?

Toxoplasmosis, Other (STIs, HIV, Hepatitis B), Rubella, Cytomegalovirus, and Herpes Simplex.

What are the potential effects of cannabis use during pregnancy?

Can lead to preterm delivery, low birth weight, and developmental issues in children.

What is the significance of Group B Streptococcus (GBS) screening in pregnancy?

To prevent GBS infections that can lead to serious complications for the newborn.

What are the risks associated with older maternal age during pregnancy?

Increased risk of chronic diseases, infertility, and complications such as gestational diabetes and preterm labor.

What is the impact of COVID-19 on pregnant individuals?

Increased risk for severe outcomes, including hospitalization, ICU admission, and preterm birth.

What is the recommended approach for HIV-positive pregnant women to reduce mother-to-child transmission?

Use of combination antiretroviral therapy (cART) and careful monitoring during labor.

What is the role of prenatal education for adolescent mothers?

To promote physical health, provide support, and improve prenatal care engagement.

What are the potential consequences of substance abuse during pregnancy?

Higher rates of infectious diseases, complications, and adverse outcomes for both mother and baby.

What is the SOGC's stance on alcohol consumption during pregnancy?

Pregnant women are advised to abstain from alcohol due to risks of fetal alcohol spectrum disorders.

What is the significance of prenatal care for older gravidas?

To monitor for increased risks of complications and ensure appropriate interventions.

What is the recommended action for pregnant women who are HIV-positive?

They should receive antiretroviral therapy and be monitored closely throughout pregnancy.

What are the common bacterial infections that can affect pregnancy?

Urinary tract infections, bacterial vaginosis, and sexually transmitted infections.

What is the impact of maternal obesity on pregnancy outcomes?

Increased risk of gestational diabetes, hypertension, and complications during labor.

What is shoulder dystocia?

A delivery complication where the baby's shoulder gets stuck after the head is delivered.

What is the importance of folic acid during pregnancy?

To prevent neural tube defects and support fetal development.

What are the effects of methadone during pregnancy?

It can block withdrawal symptoms in opioid-dependent women but may lead to complications.

What is the significance of prenatal visits for adolescent mothers?

To ensure proper health monitoring and education throughout pregnancy.

What is the guideline for managing GBS in labor?

Administer antibiotics to GBS-positive women during labor to prevent neonatal infection.

What are the risks of maternal infections during pregnancy?

Can lead to spontaneous abortions, preterm delivery, and increased morbidity.

What is the recommended vaccination approach for pregnant individuals regarding COVID-19?

Vaccination is recommended at any time during pregnancy if no contraindications exist.

What are the common complications associated with older maternal age?

Increased risk of miscarriage, stillbirth, and congenital anomalies.