High Risk pregnancy

A woman with left-sided heart failure

— Decreased cardiac output

— Insufficient ventricular emptying - backflows into lungs

— Increased pressure in the pulmonary circulation, leading to pulmonary congestion and shortness of breath.

A woman with right-sided heart failure

— Blood goes back to systemic circulation

RHD or Rheumatic Heart disease

— Heart valve defect

— Recurrent tonsillitis (streptococcus bacteria enters heart)

— Give anticoagulant - heparin

A woman with chronic hypertensive vascular disease

— Vasoconstriction '

— Does not perfuse body properly

— Give beta blockers - Vasodilators

Iron

— Binds oxygen to RBC - creates hemoglobin

Folic acid

— Helps develop brain and spinal cord of fetus

A woman with sickle cell anemia

— Decrease hemoglobin because sickle cells stick to RBC

— Blood transfusion for management

A woman with thalassemia

— An inherited blood disorder in which the body does not make enough hemoglobin, a red blood cell protein that carries oxygen to the cells in the body.

— Body creates antibodies against hemoglobin

— Needs BT every 2 weeks

The woman with malaria

— Targets RBC

— Sticks RBC to the blood vessel wall; causes blood clotting

— IM Quinine for medication

A woman with urinary tract infection

— Minimal glycosuria - minimal sugar in pee - bacteria

— Give antibiotics except sulfa antibiotics

— Sambong and buko juice - Natural diuretics

A woman with chronic renal disease

— No urine produced when kidneys doesn’t filter

— If creatinine is more than 2mg/dl - pregnancy is not allowed

— Hemodialysis - shorter but more frequent visits

Beclomethasone

— Anti inflammatory for woman with asthma

Budesonide

— Bronchodilators for woman with asthma

A woman with tuberculosis

— Rare airborne bacteria

— Isoniazide and ethambulol

— Doesn’t cross or affect the fetus

— Give baby isoniazide as prophylaxis if baby needs to go home

A woman with chronic obstructive pulmonary disease

— Once alveoli is destroyed, it stays destroyed

— Can only give 4-5 L/min pf oxygen Because they are used to low oxygen

A woman with cystic fibrosis

— Congenital disorder, born with it

— Thick natural fluid in the lungs

— Give high levels of oxygen

A woman with rheumatoid arthritis

— Lesser synovial fluid as we get older

— Joint pain

— NSAID, corticosteroids, Salicylates /Heparin

A woman with appendicitis

— Pain at upper right quadrant if pregnant

— Can perform appendectomy because fetus is protected by uterus

A woman with gastroesophageal reflux disease or Hiatal hernia

— Heartburn

— Acid goes up to esophagus

— Avoid fatty food, acidic foods

— Sit down 30-40 mins after eating

— Antacids as meds

A woman with cholecystitis and cholelithiasis

— High fat and cholesterol intake causing stones in gallbladder

— Cannot be operated on while pregnant because of risk of hemorrhage

— Change diet and strong pain meds

A woman with pancreatitis

— This organ gets overworked when pregnant

— Bowel rest, NPO - so pancreas doesn’t create insulin

— IV fluid for hydration and analgesia

A woman with a seizure disorder

— Can only take tridione or valproic acid

A woman with scoliosis

— Less than 45% - Normal delivery

— Cephalopelvic disproportion - cs only