Pregnancy Complications.ppt

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  • 1. PREGNANCY COMPLICATIONS
  • 2. GESTATIONAL DIABETES MELLITUS [GDM]
  • 3. GESTATIONAL DIABETES
    • Gestational diabetes is a type of diabetes that occurs only during pregnancy.
    • Like other forms of diabetes, gestational diabetes affects the way the body uses blood sugar (glucose).
    • As a result, the blood sugar level is too high.
    • If untreated or uncontrolled, gestational diabetes can result in a variety of health problems to fetus and mother.
    • The good news is that controlling the blood sugar can helps ensure a healthy pregnancy and a healthy start for the baby.
  • 4. SIGNS AND SYMPTOMS
    • Most women don't experience any signs or symptoms of gestational diabetes.
    • When they do occur, signs and symptoms may include:
      • Excessive thirst
      • Increased urination
  • 5. CAUSES
    • During digestion, body breaks carbohydrates into simple sugar molecules that it can eventually use for energy.
    • One of these sugar molecules is glucose, the main energy source for the body.
    • Glucose is absorbed directly into the bloodstream after eating, but it can't enter the cells without the help of insulin.
  • 6.
    • Pancreas – a gland located just behind the stomach – produces insulin continuously.
    • The insulin "escorts" sugar into the cells, providing the body with energy while maintaining a normal level of sugar in the blood.
    • Liver also plays a key role in maintaining a normal blood sugar level.
    • If presence of more glucose than the cells need for energy, the body can remove that excess from the bloodstream and store it in the liver as glycogen.
  • 7.
    • When runs low glucose – for example, if not eaten for a while – body can tap into that stored glucose and release it into the bloodstream.
    • The amount of glucose in the blood fluctuates in response to a number of factors, including the food eat, exercise, stress and infections.
    • Yet the complex relationship among insulin, glucose and the liver ensures that the blood sugar stays within set limits.
  • 8.
    • During pregnancy, the placenta – the organ that supplies the baby with nutrients through the umbilical cord – produces hormones that prevent insulin from doing its job.
    • These hormones, which include estrogen, cortisol and human placental lactogen, are vital to preserving the pregnancy.
    • Yet they also make the cells more resistant to insulin.
  • 9.
    • As placenta grows larger in the second and third trimesters, it secretes even more of these hormones, further increasing insulin resistance.
    • Normally, the pancreas responds by producing enough extra insulin to overcome this resistance.
    • But may need up to three times as much insulin as normal, and sometimes the pancreas simply can't keep up.
  • 10.
    • When this happens, too little glucose gets into the cells and too much stays in the blood.
    • This is gestational diabetes. It usually occurs about the 20th to 24th week of pregnancy and can be measured by the 24th to 28th week of pregnancy.
    • After the baby is born and placental hormones disappear from the bloodstream, blood sugar levels should quickly return to normal.
  • 11. NORMAL METABOLISM
    • Normally, the sugar (glucose) in the food is absorbed into the bloodstream during digestion.
    • Insulin from the pancreas escorts glucose into the cells, where it provides energy for the body.
    • Excess glucose is stored in the liver.
  • 12. RISK FACTORS
    • Any woman can develop gestational diabetes, but some women are at greater risk than are others.
    • Risk factors – increases:
    • Age . Women older than age 25 are more likely to develop gestational diabetes.
    • Family or personal history . Chances of developing gestational diabetes increases if a close family member, such as a parent or sibling, has type 2 diabetes. And also more likely to have gestational diabetes if presence in a previous pregnancy.
  • 13.
    • Weight . Being overweight before pregnancy makes it more likely that develops gestational diabetes. However, gaining weight during the pregnancy doesn't cause gestational diabetes.
    • Race . For reasons that aren't clear, women of some races are more likely to develop gestational diabetes than are others. Black’s, Hispanic or American Indian are increased risk.
    • Previous complicated pregnancy . Unexplained stillbirth or a baby who weighed more than 9 pounds, may screened more closely for gestational diabetes the next time becomes pregnant.
  • 14. WHEN TO SEEK MEDICAL ADVICE
    • Health care provider will address gestational diabetes as part of regular prenatal care.
    • If develops gestational diabetes – regular checkups.
    • Depends on the severity of the diabetes and other complications – recommends follow up.
    • Office visits with the health care provider are especially important during the final three months of the pregnancy, when he or she will carefully monitor the blood sugar levels.
  • 15.
    • In addition, the health care provider may refer to other health professionals who specialize in the management of diabetes, such as an endocrinologist, a registered dietitian or a diabetes educator.
    • They can help in learning to manage blood sugar during the pregnancy.
    • In some cases, the health care provider may refer to consult a doctor who specializes in high-risk pregnancies.
  • 16.
    • To make sure that the glucose level has returned to normal after the baby is born, blood sugar checking after delivery and again in six weeks.
    • And later tested at least once a year.
    • And continue healthy lifestyle habits to lessen the chances of developing type 2 diabetes.
  • 17. SCREENING & DIAGNOSIS
    • In some places, screening for gestational diabetes is a routine part of prenatal care for all women.
    • To screen for gestational diabetes, most doctors recommend a glucose challenge test.
    • This test is usually done between 24 and 28 weeks of pregnancy, because the condition usually can't be detected until then.
  • 18.
    • If patient is younger than 25 and have no other risk factors for gestational diabetes, there is some debate about whether to undergo the test.
    • Some doctors argue that younger women don't need this test.
    • Others say that screening all pregnant women – no matter their age – is the best way to catch all cases of the disease.
  • 19. What to expect from the test
    • At the time of arrival for a glucose challenge test, will be asked to drink a glucose solution that tastes like extra-sweet soda pop.
    • Then should wait for a one-hour, before a blood sample is drawn from a vein in the arm to determine the blood sugar level.
    • The glucose drink may makes feel nauseous or dizzy.
    • But the syrupy solution – and the wait – are necessary to tell how efficiently the body processes sugar.
  • 20.
    • A blood sugar level below 140 mg/dL is usually considered normal on a glucose challenge test.
    • Having a blood sugar level above 140 mg/dL doesn't necessarily mean presence of gestational diabetes.
    • To confirm the diagnosis –needs a second test.
    • For the follow-up test – asked to fast overnight.
    • Then given another sweet solution to drink – this one containing a higher concentration of glucose – and blood sugar levels are checked every hour for a period of three hours.
    • Having at least two instances of abnormally high blood sugar levels confirms the diagnosis of gestational diabetes.
  • 21. Why these tests?
    • Some women wonder why it's necessary to undergo these screening tests in addition to routine urine samples.
    • A urine sample isn't a reliable indicator of gestational diabetes because the amount of sugar in the urine can vary throughout the day and as a result of what you eat.
    • Screening tests are a much better way to identify women with gestational diabetes.
  • 22. COMPLICATIONS
    • Some women worry that having gestational diabetes will cause birth defects.
    • Fortunately, this usually isn't the case. In general, birth defects originate during the first three months of pregnancy, while gestational diabetes generally doesn't develop until the second or third trimester.
    • This means the blood sugar levels are normal during the first critical months.
    • Most women with gestational diabetes go on to deliver healthy babies.
    • Untreated or uncontrolled blood sugar levels can cause problems for both the mother and newborn.
  • 23.
    • Complications that affects the baby
    • Consistently keeping the blood sugar levels within a normal range can reduce these possible complications:
    • Macrosomia.
    • Shoulder dystocia.
    • Hypoglycemia.
    • Respiratory distress syndrome.
    • Jaundice.
    • Stillbirth or death.
  • 24.
    • Complications that may affect
    • Preeclampsia.
    • Operative delivery.
    • Gestational diabetes in another pregnancy.
    • Type 2 diabetes.
  • 25. PREGNANCY-INDUCED HYPERTENSION [PIH] PREECLAMPSIA
  • 26. PREGNANCY-INDUCED HYPERTENSION [PIH]
    • Hypertension (BP ≥ 140/90 mm Hg) during pregnancy can be classified as chronic or gestational.
    • Chronic hypertension is BP that is high before pregnancy or before 20 wk gestation. Chronic hypertension complicates about 1 to 5% of all pregnancies.
    • Gestational hypertension develops after 20 wk gestation (typically after 37 wk) and remits by 6 wk postpartum; it occurs in about 5 to 10% of pregnancies, more commonly in multifetal pregnancy.
  • 27. PREECLAMPSIA
    • Preeclampsia is a common problem during pregnancy, affecting up to one in seven pregnant women around the world.
    • This condition is defined by high blood pressure and excess protein in the urine after 20 weeks of pregnancy.
    • It may also be called toxemia or pregnancy-induced hypertension.
    • It can lead to serious, even deadly complications for the pregnant woman and the unborn baby.
  • 28.
    • Globally, preeclampsia and other high blood pressure disorders during pregnancy are a leading cause of maternal and infant illness and death.
    • The only cure for preeclampsia is delivery of the baby. After the baby is born, blood pressure usually returns to normal within a few days.
    • So delivery is the obvious solution when preeclampsia is found near the end of pregnancy, which is typically the case.
    • However, if diagnosed earlier, treatment is trickier.
    • Doctor will be faced with the delicate task of prolonging the pregnancy to allow the baby more time to mature, without putting the mother or unborn child at risk of serious complications.
  • 29. SIGNS AND SYMPTOMS
    • The signs of preeclampsia are elevated blood pressure (hypertension) and the presence of excess protein in urine (proteinuria) after 20 weeks of pregnancy.
    • Other signs and symptoms aren't always noticeable, but may experience:
    • Severe headaches
    • Changes in vision, including temporary loss of vision, blurred vision or light sensitivity
    • Upper abdominal pain, usually under the ribs on the right side
    • Unexplained anxiety
  • 30.
    • Nausea or vomiting
    • Dizziness
    • Decreased urine output
    • Swelling (edema), particularly in the face and hands.
    • Gestational hypertension.
    • Chronic hypertension.
    • Preeclampsia superimposed on chronic hypertension.
    • Other high blood pressure disorders during pregnancy
  • 31.
    • Other high blood pressure disorders during pregnancy
    • Gestational hypertension.
    • Chronic hypertension.
    • Preeclampsia superimposed on chronic hypertension.
  • 32. CAUSES
    • Preeclampsia used to be called toxemia because it was thought to be caused by a toxin in a pregnant woman's bloodstream.
    • Today, doctors and researchers know preeclampsia isn't caused by a toxin.
    • They've replaced this debunked theory with lots of other theories about what may cause preeclampsia, but there's no clear answer yet, despite extensive research.
  • 33.
    • Possible causes include:
      • Insufficient blood flow to the uterus
      • Injury to the blood vessels
      • Damage to the lining of the blood vessels
      • A disruption in the hormones that maintain the blood vessels
      • A mistake by the immune system
      • Poor diet
      • Lack of magnesium or calcium
  • 34. RISK FACTORS
    • The biggest risk factor for preeclampsia is simply being pregnant.
    • Additional risk factors include:
      • History of preeclampsia.
      • First pregnancy.
      • Age – younger than 20 or older than 35.
      • Obesity.
      • Multiple pregnancy.
      • History of certain conditions.
  • 35.
    • In a 2006 study, pregnant women who had high levels of two specific proteins in their blood were found to be more likely to develop preeclampsia than were other women.
    • These proteins interfere with the growth and function of blood vessels.
    • Research to confirm the findings is needed — but the discovery suggests that a blood test may one day serve as an effective screening tool for preeclampsia.
  • 36. WHEN TO SEEK MEDICAL ADVICE
    • When pregnant, likely experiences some discomfort.
    • Headaches, nausea, and aches and pains can be common.
    • It's difficult to know when new symptoms are just part of being pregnant and when they may indicate a serious problem – especially if it's first pregnancy.
    • The best policy is to trust the instincts and see health care provider if don't feel right.
  • 37.
    • Call health care provider right away if having severe headaches, blurred vision or severe pain in abdomen.
    • But don't take a wait-and-see approach to other ailments.
    • Serious complications of preeclampsia can occur even before symptoms of preeclampsia, and don't get any points for toughing it out until the situation is serious.
  • 38. SCREENING & DIAGNOSIS
    • Preeclampsia usually shows up unexpectedly during a routine prenatal blood pressure check and urine test.
    • So, it's important to seek regular prenatal care throughout the pregnancy.
    • Diagnosed with preeclampsia if having an elevated blood pressure and protein in the urine after 20 weeks of pregnancy.
    • Normal blood pressure readings for pregnant women are below 130/85 mmHg.
    • A blood pressure reading of 140/90 mmHg or higher is considered above the normal range.
  • 39.
    • If presence of preeclampsia, doctor may want to do some blood tests to see how well the liver and kidneys are functioning and to see if the blood has the normal number of cells that help blood clot (platelets).
    • Doctor may also recommend close monitoring of the baby's growth – usually using ultrasound.
    • This test combines high-frequency sound waves and computer processing to generate pictures of the inside of the uterus.
  • 40.
    • Nonstress test (NST) or biophysical profile to make sure the baby is getting enough oxygen and nourishment, especially approach due date.
    • A nonstress test is just that – a noninvasive test that causes no stress to the baby.
    • In fact, it shouldn't be stressful either.
    • It's a simple procedure that checks how often the baby moves and how much his or her heart rate increases with movement.
    • A biophysical profile combines an ultrasound with a nonstress test to provide more information about baby's breathing, tone, movement and the volume of amniotic fluid in the uterus.
  • 41. COMPLICATIONS
    • Most women with preeclampsia go on to deliver healthy babies.
    • But preeclampsia is a serious condition that can lead to two serious conditions and some problems for the baby.
    • The more severe preeclampsia and the earlier it occurs in pregnancy, the greater the risks for mother and baby.
      • HELLP syndrome – is one of two serious complications of preeclampsia. HELLP stands for: H emolysis – the destruction of red blood cells; E levated L iver Enzymes; L ow P latelet Count
      • Eclampsia
  • 42. The warning signs and symptoms of ECLAMPSIA include:
    • Pain in the upper right side of the abdomen
    • Severe headache
    • Vision problems, including seeing flashing lights
    • Change in mental status, such as decreased alertness.
  • 43. Problems for baby
    • Preeclampsia affects the arteries carrying blood to the placenta.
    • If placenta doesn't get enough blood, the baby may receive less oxygen and nutrients.
    • This can cause slow growth or a low birth weight.
    • Preeclampsia is also a leading cause of preterm birth.
  • 44.
    • In addition, preeclampsia increases the risk of placental abruption – in which the placenta separates from the inner wall of the uterus before delivery.
    • Severe abruption can cause heavy bleeding, which can cause the mother to go into shock.
    • This condition is rare, but it's life-threatening for mother and baby.
    • It requires immediate medical attention.
    • Rarely, preeclampsia may affect the fetus earlier and more severely than it affects the mother.
    • So it's important for the doctor to monitor the unborn baby carefully even if preeclampsia seems mild.
  • 45. INTRAUTERINE GROWTH RETARDATION [IUGR]
  • 46.
    • Intrauterine growth retardation (IUGR) means the unborn baby is not growing properly.
    • The baby's weight is lower than it should be for its stage of the pregnancy.
    • The baby's growth and weight are important.
    • Small babies are more likely to have problems near the time of birth and after delivery.
  • 47. How does it occur?
    • women who do not have a balanced diet or whose health is poor
    • women who drink alcohol during the pregnancy
    • teenagers
    • women who smoke
    • who weigh very little before they become pregnant
    • with a history of small babies in other pregnancies
    • who take certain medicines or use illegal drugs
    • who have a multiple birth, such as twins or triplets.
    Women whose babies are more likely to have this problem include:
  • 48. Some of the conditions that can cause IUGR include:
    • a placenta that is unable to provide proper nourishment to the baby
    • birth defects or inherited problems, such as heart, kidney, or chromosome problems in the baby
    • high blood pressure
    • infections
    • physical defects in the uterus
    • too little or too much fluid in the baby's sac
    • exposure to radiation or chemicals
    • chronic illness in the mother, such as heart, kidney, or lung disease, or lupus.
  • 49. SIGNS AND SYMPTOMS
    • The only symptom might be that not gaining as much weight as expected.
    • Health care provider may find that the uterus is smaller than expected for stage of pregnancy.
  • 50. DIAGNOSIS
    • Health care provider will examine and measure the size of the uterus.
    • The exam of the uterus may show that it is not growing as fast as it should.
    • Provider will also estimate the size of the baby.
    • Ultrasound scan is to measure the baby.
    • Sometimes the uterus is smaller because not as far along in the pregnancy as thought.
  • 51.
    • Provider will try to determine the baby's correct age.
    • Provider may do blood tests or other tests to see if presence of genetic problem, infection, or other medical problem that may be slowing the baby's growth.
  • 52. TREATMENT
    • When IUGR is suspected:
    • Ultrasound scans done at regular intervals to check the growth of the baby.
    • May be told to stop working or work less, rest more often or stay in bed, stop smoking, or talk to a dietitian about how to improve the diet.
    • Nonstress tests or biophysical profiles may be done once or twice a week during the last 2 months of the pregnancy to check on the baby's condition.
  • 53. How long will the effects last?
    • The risk of problems for the baby will exist as long as the baby's growth problems continue, or until some form of treatment or delivery takes place.
  • 54.
    • Some of the possible problems for the baby are:
    • not getting enough oxygen
    • pneumonia after birth because meconium got into the baby's lungs (meconium is a substance from the baby's bowels)
    • trouble holding a normal body temperature
    • high levels of bilirubin in the baby's blood (bilirubin is a substance made from the breakdown of blood cells)
    • problems at the time of delivery
    • death, in extreme cases.
  • 55. SELF - CARE
    • Early and regular prenatal visits with health care provider allow this condition to be discovered early. Then carefully checked throughout the rest of the pregnancy.
    • Pay attention to the baby's movements. If the baby does not move very often, call the healthcare provider because the baby may be sick.
    • The best way – self-care – is to remain calm and follow the provider's directions. The baby may be perfectly normal. Keep all the appointments with provider. Be sure to discuss the provider if any concerns.
  • 56. YOGA PRACTICES
    • YOGA IS BALANCE (SAMATVAM)
    • I A Y T CORRECTS IMBALANCES
    • AIMS :
    • STRESS REDUCTION
    • RELIEF OF PAIN
    • MEDICATION REDUCTION
  • 57. Thank You