mHeart Diseases

mDiabetes Mellitus
mSubstance Abuse
mHIV/AIDS
mRh Sensitization
mAnemia
p

  
a ñregnancy results in increased cardiac output, heart
rate & blood volume.
a Normal heart is able to adapt to these changes without
difficulty.
a Woman with „

 has decreased cardiac
reserve, making it more difficult for her to handle the
higher workload of pregnancy.
a 


 complicates about 1% of pregnancies.
3
 


a Most commonly seen in pregnant women include:
a Atrial septal defect
a ñatent ductus arteriosus

a Coarctation of aorta

a Tetralogy of fallot

-impact of pregnancy depends on the specific defect.

-if the heart has been surgically repaired & no evidence of heart
disease remains, the woman may undertake pregnancy with
confidence.
-woman with CHD who experience cyanosis should be
counseled to avoid pregnancy because the risk to mother &
fetus is high.
2


  
a Results from an infection (caused by the bacteria,
streptococci) known as rheumatic fever, which starts
with a sore throat & leads to the scarring of one or
more heart valves.
a The injured valves are unable to open & close normally,
resulting in obstruction to the flow of blood.
a Is it possible to become pregnant?

 



a 1. Throat cultures- for group A streptococcus usually
are negative by the time symptoms of rheumatic fever
or RHD appear.
a Isolate the organism before the initiation of antibiotic
therapy to help confirm a diagnosis of streptococcal
pharyngitis & to allow typing of the organism if it is isolated
successfully.
a 2. Rapid Antigen- this test allows rapid detection of
group A streptococcal antigen & allows the diagnosis
of streptococcal pharyngitis & the initiation of
antibiotic therapy while the patient is still in the
physicians office.
a . Anti-streptococcal Antibodies
a -this is useful for confirming previous group A
streptococcal infection. Antibody titer should be
checked @ 2-week intervals in order to detect a rising
titer.

a Causes different types of heart valve defects.
a Commonly causes narrowing of the valve between the
left chambers of the heart (a condition called ÷


 in women of child bearing age.
a If you have mitral stenosis, you ma develop breathing
difficulty(dyspnea), swelling of the ankle & feet
(edema), & irregular heartbeats (arrythmia).
a Can also cause abnormal leaking of blood through the
valve between the left chambers of the heart ( a
condition called ÷
  

).
0
 







 
a Make sure to keep your follow-up appointments with your
obstetrician throughout your pregnancy.
a ñlan regular follow-up visits with your cardiologist.
a Carefully follow all the recommendations of the
cardiologist.
a The diet should be nutritious & fluid & sodium intake
should be restricted.
a Take adequate rest.
a Watch your weight.
a Avoid alcohol.
a Stop smoking.
pp


a An endocrine disorder of carbohydrate metabolism,
results from inadequate production or use of insulin.

a Insulin- produced by B cells of Islets of Langerhans in

the pancreas, lowers blood glucose levels by enabling
glucose to move from the blood into muscle & adipose
tissue cells.
ñ  
a ñ


- fails to produce insulin or does not produce
enough insulin to allow necessary carbohydrate
metabolism.
a Without insulin,  does not enter the cells &
they become energy depleted.
a u     remains high („   ÷
)
& the cells breakdown results in a negative nitrogen
balance; fat metabolism causes ketosis.
Ê 

Ê
a 1. ñolyuria
a 2. ñolydypsia
a . ñolyphagia
a 4. weight loss
î



 
a 1. î 
  - results from the bodyǯs failure to
produce insulin, & presently requires the person to
inject insulin.
a 2 î 
  - results from insulin resistance, a
condition in which cells fail to use insulin properly,
sometimes combined wit an absolute insulin
deficiency.
a 




  - is when pregnant women,
who have never had diabetes before, have a high blood
glucose level during pregnancy.


 

a The pregnancy of a woman who has diabetes carries a
higher risk of complications, especially perinatal
mortality & congenital anomalies.

a Tight metabolic control reduces the risk.


 
a 1. Hydramnios
-increase in the volume of amniotic fluid, occurs in
10% to 20% of pregnant women with diabetes.
a - a result of excessive fetal urination because of
hyperglycemia.
a ñROM & onset of labor may occasionally be a problem
with hydramnios.
2. ñreeclampsia-eclampsia
- occurs more often in diabetic pregnancies than in
normal pregnancies.
G
 
a 1. Congenital anomalies
a -incidence is 5% to 10% & is the major cause of death of
infants born to women with diabetes.
a Ex. Heart, CNS, skeletal system
2. Respiratory distress syndrome
- appears to result from high levels of fetal insulin,
which inhibit some fetal enzymes necessary for
surfactant production.
a . ñolycythemia
a - excessive number of RBCs
a -due to the diminished ability of glycosylated
hemoglobin in the motherǯs blood to release oxygen.
  
a Y
 


a ñrenatal care- using a team approach to ensure an
optimally healthy mother & newborn.
- woman needs clear explanations & teaching to gain her
cooperation in ensuring a good outcome.
- the nurse-educator plays a major role in this
counseling.
- the woman with pregestational diabetes needs to
understand what changes she can expect during
pregnancy.
a a. Dietary regulation
a - the pregnant woman with diabetes needs to increase
her caloric intake by absent 00 kcal/day.
a - on the first trimester she needs about 5 kcal/day of
ideal body weight. Approximately 40% to 50% of the
calories came from complex, high fiber carbohydrates,
20% from protein, & 0% to 40% from fats.
a - the food is divided into  meals &  snacks. Bedtime
snack is the most important & should include both
protein & complex carbohydrates to prevent nightime
hypoglycemia.
a b. Glucose monitoring
a - is essential to determine the need for insulin & to
assess glucose control.
c. Insulin Administration
- Many women with gestational diabetes need insulin to
maintain normal glucose levels. Human insulin should
be used because it is the least likely to cause an allergic
reaction.
- given either in multiple injections or by continuous
subcutaneous infusion.
Oral hypoglycemics- not rarely used
a 




a a. Timing of birth- most pregnant women with
diabetes, regardless of the type are allowed to go to
term, with spontaneous labor.
a Some clinicians opt to induce labor in a woman at term
to avoid problems related to an aging placenta.
a 
  maybe indicated if signs of fetal distress
exist.
a b. Labor management
a - maternal glucose levels are measured hourly to
determine insulin need.
a ñrimary goal is to prevent neonatal hypoglycemia.
a Often given two IV lines are used, one wit a 50%
dextrose solution & one with a saline solution.
a The saline solution is for piggybacking insulin or if a
bolus is needed.
a IV insulin is discontinued @ the end of the third stage of
labor.
ñ




÷

a Girst 24 hours postpartum, women wit pre-existing
diabetes typically require very little insulin.
a They are usually managed with a sliding scale specifying
dosage based on blood glucose levels.
a Antihyperglycemics are contraindicated during
breastfeeding.
a The woman should be reassessed 6 weeks postpartum to
determine whether her glucose levels are normal. If the
levels are normal, she should be reassessed at a
minimum of -year intervals.
ppp
Ê 
 
a Occurs when a person experiences difficulties with
work, family, social relations, & health as a result of
alcohol or drug use.
a Drugs that are commonly misused includes:
-tobacco, alcohol, cocaine, marijuana, amphetamines,
barbiturates, hallucinogens, club drugs, heroin and
narcotics.
Ê 

 


 
a 1. Y „ - is a central nervous system depressant & a
potent teratogen.
a The incidence of alcohol abuse is highest among
women ages 20 to 40 years although alcoholism is also
seen in teenagers.
a Chronic abuse of alcohol can undermine maternal
health by causing malnutrition, bone marrow
suppression, increased incidence of infections, & liver
disease.
a Alcohol dependence- result is that a woman may have
withdrawal seizures in the intrapartal period as early
as 12 to 48 hours after se stops drinking.
a Delirium tremens may occur in the postpartal period
& the newborn may suffer a withdrawal syndrome.
a Care includes sedation to decrease irritability &
tremors, seizure precautions, IV fluid therapy for
hydration & preparation for an addicted newborn.
a The effect of alcohol on the fetus may result in a group
of signs known as À

 

a 2. 



a Nearly % of pregnant women use illicit drugs such as
cocaine, marijuana, ecstasy, other amphetamines &
heroin.
a Cocaine use during pregnancy tends to affect between
1% & 5% of newborns.
a 

- acts as the nerve terminals to prevent the
reuptake of dopamine & norepinephrine, which in turn
results in vasoconstriction, tachycardia, & hypertension.
a This can be taken by IV injection or by snorting the
powdered form.
a 
- a form of freebase cocaine that is made up of
baking soda, water, and cocaine mixed into a paste and
microwaved to form a rock, can be smoked. Smoking crack
leads to a quicker, more intense high because the drug is
absorbed through the large surface area of the lungs.
 
! 





 
 

a Hallucinations
a ñulmonary edema
a Cerebral hemorrhage
a Respiratory failure
a Heart problems
a Women who use cocaine have an increased incidence
of spontaneous abortion, abruptio placentae, preterm
birth, and stillbirth.
a Cocaine crosses into breastmilk and may cause
symptoms in the breastfeeding infant, including
extreme irritability, vomiting, diarrhea, dilated pupils,
and apnea.
a Thus, women who continue to use cocaine after
childbirth should avoid breastfeeding.
a  



- is the most widely used illicit drug
among women, both pregnant and non pregnant.
a More than 25% women of reproductive age admit to
current or past marijuana use.
a Marijuana use is associated with impaired
coordination, memory, and critical thinking ability.
a As a result, the pregnant women or new mother who
uses marijuana may be at risk if she tries to perform
tasks that require complex mental activities.
a ΠY

a Methylenedioxymethamphetamine (MDMA), better
known as Ecstasy, is the most commonly used of a
group of drugs referred to as , so called
because they have become popular among adolescents
and young adults who frequent dance clubs and
Dzravesdz.
a Is taken by mouth usually as a tablet. It produces
euphoria and feelings of empathy for others.
a   
- is an illicit CNS depressant narcotic that alters
perception and produces euphoria. It is an addictive drug
that is generally administered IV.
a ñregnancy in women who use heroin is considered high
risk because of the increased incidence in these women of
poor nutrition, iron deficiency anemia, and preeclampsia.
a The fetus of a heroin-addicted woman is at increased risk
for IUGR, meconium aspiration, and hypoxia.
a The newborn frequently show signs of heroin addiction
such as restlessness; shrill, high-pitched cry; irritability; fist
sucking, vomiting, and seizures.
a D  „

 is the most commonly used therapy
for women dependent on opioids such as heroin.
a Blocks withdrawal symptoms and reduces or
eliminates the craving for narcotics.
a Crosses the placenta and has been associated with
preeclampsia, placental problems, and abnormal fetal
presentation.
a ñrenatal exposure to methadone may result in reduced
head circumference and lower birth weight.
 
a A 
÷

„to the care of the pregnant woman
with substance abuse problems ensures the
management necessary to provide safe labor and birth
for the woman and her child.
a The management of drug addiction may include
hospitalization if necessary to start detoxification.
a Urine screening is also done regularly throughout the
pregnancy if the woman has a known or suspected
substance abuse problem. This testing helps to
identify the type and amount of drug being abused.
a Little is yet known about the effects of MDMA on
pregnancy. However, the timing of ecstasy used by the
pregnant woman during fetal brain development may
be critical issue.
a Infants exposed to ecstasy in utero may experience
some of the same risks as infants exposed to other
amphetamines during pregnancy, including yhe
possibility of withdrawal Ȃlike symptoms such as
drowsiness, jitteriness, and breathing problems.
p"
p"#pÊ
a ÷

÷÷
 
infection is one of
todayǯs major health concerns.

a It leads to a progressive disease that ultimately results

in
 ÷÷
 

÷ Y

a Women account for about 18% of cases in the U.S.

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a HIV-1 enters the body through:
u


u






 
 

 

  
 
  
- It affects T-cells, thereby decreasing the bodyǯs
immune responses.
- This makes the affected person susceptible to
opportunistic infections such as ñ
÷



a Once infected with the virus, the individual develops
antibodies that can be detected with the enzyme-
linked immunosorbent assay (ELISA) & confirmed
with the Western Blot test.
a Can be detected within 6 mos after exposure.
a Asymptomatic lasting from a few mos to as long as 17
years.
a Diagnosis of AIDS is made when a person is HIV
positive & has one of several specific opportunistic
infections.

 
a Many women who are HIV positive choose to avoid
pregnancy because of the risk of infecting the fetus &
the possibility of dying before the child is raised.
a Women who become pregnant should be advised that
pregnancy is not believed to accelerate the progression
of HIV/AIDS, that the use of antiretroviral (ARV)
therapy during pregnancy significantly reduces the
risk of transmitting the HIV-1 to the fetus, and that
most medications used treat HIV can be taken during
the pregnancy.
G$
 
a HIV/AIDS may develop in infants whose mothers are
seropositive, usuall due to perinatal transmission.
a ñerinatal transmission occurs transplacentally, at birth
when the infant is exposed to maternal blood and
vaginal secretions, via breastmilk.
 
a Combination of ARV therapy suppresses viral
replication, helps preserve immune function, and
reduces the development of resistance.
a Usually consists of two nucleoside analogues reverse
transcriptase inhibitors and a protease inhibitor.
a Zidovudine (ZDV) is perhaps the best known of the
nucleoside analogues.
a ñregnant women who are currently on ARV therapy
should continue their provider-recommended regimen
and should receive regular, careful monitoring for
pregnancy complications and possible toxicities.
a Because the fetus is most susceptible to teratogenic
effects during the first 10 weeks of pregnancy, and the
risks of ARV therapy is not well known, women in 1st
trimester might elect to delay therapy until after 12
weeks gestation.
a To reduce the risk of perinatal transmission, all
pregnant women with HIV infection should be offered
the three-part ZDV prophylaxis regimen beginning
after the first trimester.
a This regimen includes:
1. Oral ZDV daily
2. Intravenous ZDV during labor until birth
. Oral ZDV for the infant starting 8 to 12 hours after
birth and continuing for 6 weeks.
a At each prenatal visit, asymptomatic, HIV infected
women are monitored for early signs of complications,
such as weight loss in the second or third trimester or
fever.
a Each trimester the woman should have a visual
examination and examination of the retina to detect
such complications as toxoplasmosis.
a In addition to routine prenatal testing, the woman who
is HIV positive should be assessed regularly for
serologic changes indicating that HIV/Aids is
progressing.
a A pregnancy complicated by HIV infection, even if
asymptomatic, is considered high risk, and the fetus is
monitored closely.
a Women who are HIV positive are at increased risk for
complications such as intrapartal or postpartal
hemorrhage, postpartal infection, poor wound healing
and infections of the genitourinary tract.
a Thus, they need careful monitoring and appropriate
therapy as indicated.
a HIV positive woman should be cautioned against
breast feeding her infant.