Anemia in Pregnancy defined: 1.First trimester Decrease 11 gm/ dL Hgb and 37% Hct 2.Second trimester Decrease 10.

.5 gm/dL Hgb and 35% Hct 3.Third trimester Decrease 10 gm/dL Hgb and 33% Hct 4.High in altitude 5,000 ft. above sea level 14 gms/dL anemia hemoconcentration Common type of anemia: I. Iron deficiency Anemia Causes: Poor diet Unwise weight reduction program Heavy menstrual period Fetal Outcome: a.Decrease birth weight b.Prematurity Rx: Iron supplement FeSO4 0.3 gm TID or 1 gram OD If constipated, take Colace II. Folic Acid deficiency Anemia (Megaloblastic anemia [enlarged RBC]) Causes: Poor diet Cooking in large volume of water Malabsorption Effects: Early abortion Abuptio placenta

UTI RX: Folic acid supplement 150 ug OD; 5 mg OD maintenance dose 1. III. Sickle cell anemia Recessively inherited hemolytic anemia Chances: 1 out of 12 black American has the sickle cell trait which will predispose them to: polynephritis, bacteriuria, UTI, hematuria Occurrence: First trimester: Nausea/ vomiting Second trimester: pooling of blood in LE Third trimester: infection, fever, dehydration Assessment: Diet: decrease water Activity: prolong standing (Elevate legs, side lying position) Hgb: 6-8 mg/dL hemolysis can occur if hemoglobin falls to 5-6 mg/dL Hyperbilirubinemia no conjugation of bilirubin since RBC are quickly destroyed-jaundiced sclera Management: Oral contraception C/I No iron supplement oCells cannot incorporate iron-binding to iron-build-up 1.Prevent crisis exchange transfusion 2.Crisis throughout pregnancy 3.Sickle cell crisis a.control pain b.oxygen administration c.increase fluids 4.delivery nerve block not GA; avoid tissue anoxia 5.give folic acid prevent new cells to be megaloblastic 6.prevent infection

1. Alcohol in Pregnancy and the Newborn (Ethanol) substance Ethanol crosses the placenta (teratogenic) => result to: I.FAS (fetal Alcohol syndrome) Intake of 2 oz. Of alcohol/ day or increase level of alcohol ingestion during pregnancy Prominent nose and bird-like face Acetaldehyde S/S: post partum manifestation i.tremors ii.fidgety iii.irritable iv.weak suck reflex v.always awake or asleep vi.distinct facial feature as short palpebral fissures, hypoplastic upper lip (thinned upper lip), thin vermillion, short upturned noses and flattened nasal bridges and epicanthic folds vii.small eyes viii.flattened maxilla ix.hirsutism long term effects: a.mental retardation (pre-post natal) b.growth retardation c.central nervous system involvement (behavior problem hyperactive in school) d.microcephaly e.joint and cardiac anomalies II.Neuroblastoma a form of cancer III.Withdrawal symptoms (syndrome) Management: Advice mother to quit alcohol or avoid alcohol when pregnant Reasons of taking alcohol:

1.Social 2.Therapeutic ethanol has a tocolytic effect halt labor (stops prostaglandin production which is responsible for progress of labor) 1. Smoking, Pregnancy and Newborn Nicotine - >10cigarettes/ day Harmful to fetus because: 1.Carbon monoxide entrapment by the placenta decrease blood flow => uterine hypoxia 2.Vasoconstriction of the uterine vessels decrease tissue perfusion 3.Constriction of uterine arteries Effects: I. Fetus 1.Premature rupture of the membranes Vasoconstriction action of nicotine Increase level of CO in blood stream 2.Small for gestation age (SGA) 3.Underweight (IUGR) Intrauterine growth absorption Decrease supply of nutrient and oxygen Smokers eat less Nursing responsibilities: 1.Advice mother to quit smoking or < smoking less 10 cigarette/ day and none within 48O of delivery 2.Nutritional counseling avoid junk foods, nutritious food intake 3.Join non-smoking or stop smoking group. 4.Please No Smoking signs in areas of pregnant mothers 5.Health care provider to serve as model 6.Quit smoking not only for fetus but for self II. Mothers 1.Halitosis, stained teeth, lips and fingers 2.Habit forming

Drug Dependence, Pregnancy and the Newborn Drug abuse -overuse of one or more drugs without medical prescription Drug dependence -craving a particular drug for psychological and physical well-being (influenced) Drug addiction -using habitually or compulsively Drug tolerance -capacity to absorb a drug continuously in large dose without adverse effects Use of amphetamines, narcotics,barbiturates and alcohol-drug dependence CARR identified factors (3) why a woman becomes involved deeply in drug dependence 1.She is from a disrupted family background Left home as early as adolescent Few meaningful support people Few skills or little education 2.She had negative sexual experiences Victim of rape and incest 3.She has low self-esteem Ease psychological pain A sense of emptiness Promote social interactions Effects: I. Maternal PIH, phlebitis, sub-acute bacterial endocarditis, Hepa B, HIV (shared infected needle) II. Fetus 1.FOD (fetal opiate dependence) with following characteristics: Small for gestational age, fetal distress, meconium aspiration, SIDS, withdrawal symptoms 2.Physiologic advantages

liver forced to mature; decreased hyperbilirubinemia fetal lung to mature; decrease SIDS 3.S/S of withdrawal symptoms a.Sleep pattern disturbance b.Abrasions on knees, elbows and nose c.Others as: vomiting, high pitched cry, sneezing, diarrhea, poor feeding, excessive sweating, tachycardia Management: I. Mother 1.Enroll in a methadone maintenance program during pregnancy Supplied legally, readily available, aseptically administered, monitored, fetus assured of better nutrition 2.Reassurance Everything is doing well; emotional support 3.Anticipatory guidance throughout pregnancy (no one to share their problems) II. Infant 1.preserve heat 2.isolate the infant 3.prepare for NGT insertion if with poor sucking reflex 4.administer IVF for excessive vomiting and diarrhea 5.give sedation diazepam (valium) 6.high incidence of jaundice if not enrolled in methodone program skin care Thyroid Disease, Pregnancy and the Newborn Hypothyroidism rare condition in young adult Hyperthyroidism - common in pregnancy than hypo. - if untreated, woman is unable to - C/M: conceive- unovulatory *rapid heart rate -C/M: *Exopthalmos

*history of spontaneous bortion *easy fatigability *nervousness * obese, dry skin *palpitations (tachycardia) *weight loss *if undiagnosed may lead to: >HPN of >premature labor Management: Thyroxine prep. Diagnostic - To replace what is absent - radioactive uptake of 131I subtype during pregnancy, dose is increased to sustain pregnancy after delivery, dose is tapered back this procedure should not be used to pre-pregnant dose; if not then during pregnancy because fetal woman will develop hyperthyroidism thyroid incorporate this dr and results to fetal thyroid destruction Effects to fetus: RX: No known side effects to fetus if dose is - thioamides ( methimazole or Monitored accordingly propylthiouracil * reduce thyroid activity Management: Effects:

(myxedema) * cold intolerance pregnancy

1. Keep dose to the lowest; prevent omission *teratogenic enlarged thyroid and or duplication [goiter]) in the fetus 2. Should not Breastfeed as drug is excreted in * obstruct airway and make breast milk resuscitation difficult in Newborn Surgical Management: *potential for bleeding during - removal but preferably an interpregnancy delivery procedure