NURS113 Lecture 27: NURS113 - UNIT 12
14 Jun 2018
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UNIT 12: PREGNANCY, CHILDBIRTH AND POSTPARTUM COMPLICATIONS
Normal changes during pregnancy
- Body system alterations
- CV (cardiac output increases by 40%
because more blood volume, heart rate
increases, blood volume increases)
- Hematological (increase in RBC; can
also lead to anemia because baby strives
on YOUR RBC)
- Respiratory (increases in function by
20%)
- Breathe deeper
- GU (increase frequency of urination)
- Especially when it’s later on, the
baby is sitting on the bladder so
need to go to the bathroom more
- GI (increase saliva, nausea, vomiting,
heartburn, decrease GI motility)
- Breast (increase in size and vascularity)
- MSK (postural change (lumbar lordosis),
relaxation of pelvic joints so baby can come out with not a lot of pain from the pelvic
region)
- Pelvic joint relaxes to prepare for birth
- Endocrine (increase thyroid and parathyroid) → increased metabolic rate
- Skin (increase pigmentation, stretch of abdominal wall)
- Weight (increases by 20-35 lbs)
- Nutritional requirements increase to sustain for TWO (supporting another life!)
Putting it all together
- These NORMAL physiologic changes can lead to NORMAL symptoms like
- Nausea
- Constipation
- GI system tends to slow down when you’re pregnant
- Weight gain
- Lightheadedness or dizziness (because postural hypotension due to blood pressure being
lower → if higher can kill the baby)
- Hypotension
- Unfortunately, not every woman experiences a normal pregnancy; may develop complications
Complications of pregnancy
- Gestational diabetes
- Hypertension
- Preeclampsia
- Extremely high blood pressure
- Placenta previa
- Either the placenta is implanted too close to the cervical opening
- Abruptio placentae
- When the placenta abruptly comes off of the uterine wall
- Premature rupture of membranes (PROM)
- Premature labour and delivery
Hypertension of pregnancy
- Hypertensive disorders during pregnancy may cause maternal and fetal morbidity and are leading
sources of maternal mortality
- Problems with the mother can lead to other problems as well (you want to control the
blood pressure within the woman)
- Hypertension in pregnancy
- Chronic (before 20 weeks or just in general; not due to pregnancy; you just have
hypertension)
- Systolic blood pressure is greater than or equal to 140 mmHg, and diastolic is
greater than or equal to 90 mmHg (so hypertensive range) even before pregnancy
or before 20 weeks of gestation
- Increased risk of poor fetal growth and development
- Gestational (after 20 weeks of gestation; high blood pressure develops after you get
pregnant)
- New hypertension after 20 weeks of gestation
- Managed by pharmacotherapy (medications)
- Normalization of BP after delivery (90% of cases, it goes back to normal
after labour and delivery
Risk factors for hypertension problems
- History of HTN (high blood pressure BEFORE you
were pregnant, because you have increased CO, blood
volume, etc)
- History of DM
- History of kidney disease
- Teenage pregnancy, or pregnant over 35 years
- Multiple pregnancy (twins or triplets or quads)
- Monitor for preeclampsia (make sure the blood pressure
is controlled, and you will not develop other damages to
the mother or baby)
Preeclampsia
- 25% develop either preeclampsia or eclampsia
- Develops in the 2nd trimester
- The baby is getting bigger, blood volume increases and CO also increases
- Exact cause is unknown, but occurs with placental implantation (there is something wrong with
the way that the placenta is implanted in the uterine wall; so either placenta is weird or the
implantation is odd)
- The placenta produces proinflammatory proteins that cause the mother’s system to
respond by increasing blood pressure
- Sending out proinflammatory proteins cause the mother’s blood vessels to be
vasospastic, and you reduce blood flow to the baby, and reduced organ perfusion
to the mother as well
- Multisystem, vasospastic disease of placental endothelial dysfunction, leading to
vasospasm and reduced organ perfusion in mother
- Greater than or equal to 160/110 BP with new-onset of proteinuria
- When the glomerulus is under high pressure under high blood pressure,
mesangial cells regress to mesangiblasts to create extracellular matrix, causing
glomerulus to be thick, allow macrophage and foam cells and proteins into the
gaps, which causes proteinuria (and glomerulosclerosis)
- Maternal manifestations due to arterial constriction and reduced intravascular volume
- Vasospasm and reduced blood flow to the organ causes preeclampsia
- Fetus suffers as a result of decreased utero-placental blood flow (IUGR, fetal death)
- You can have intrauterine growth restriction; so the baby does not grow as much as it
should because not enough oxygen, or it dies
- Along a continuum from mild, to severe, to eclampsia and HELLP syndrome
- You can go from mild, just hypertensive, you have severe, which is when you have end
stage organs involved, and then you have eclamptic, which is brain involvement and you
get seizures due to high blood pressure and changes in brain, and then HELLP syndrome
(hemolysis, elevated liver enzymes, low platelets)
Risk factors
- Previous preeclampsia
- Pre-existing renal disease or DM type I (because your kidneys are already sacrificed; and they are
not working as well as they should. Hypertension can also cause the kidneys to not work well
even more, which causes more protein to enter filtrate)
- Maternal age less than or equal to 18, or greater than or equal to 40
- Obesity
- Family history of pre-eclampsia (mother or sister)
- Heritable thrombophilias (blood clotting; abnormal blood clotting)
- Cocaine and/or methamphetamine use
- Family history of early-onset CV disease
- Ethnicity
- Nordic, black, South Asian, Pacific Island
Document Summary
Cv (cardiac output increases by 40% because more blood volume, heart rate increases, blood volume increases) Hematological (increase in rbc; can also lead to anemia because baby strives on your rbc) Especially when it"s later on, the baby is sitting on the bladder so need to go to the bathroom more. Gi (increase saliva, nausea, vomiting, heartburn, decrease gi motility) Msk (postural change (lumbar lordosis), relaxation of pelvic joints so baby can come out with not a lot of pain from the pelvic region) Endocrine (increase thyroid and parathyroid) increased metabolic rate. Nutritional requirements increase to sustain for two (supporting another life!) These normal physiologic changes can lead to normal symptoms like. Gi system tends to slow down when you"re pregnant. Lightheadedness or dizziness (because postural hypotension due to blood pressure being lower if higher can kill the baby) Unfortunately, not every woman experiences a normal pregnancy; may develop complications.
