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Pharmacotherapy in Pregnancy

Lecture 6

N. Petrenko, MD, PhD

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Uterine Sizing

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Uterine Sizing

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Ptyalism

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Fatigue

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Low Backache

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Urinary Frequency

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Heartburn

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Hemorrhoids

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Leg Cramps

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Dependent Edema

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Insomnia

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Round Ligament Pain

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Supine Hypotensive Syndrome

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miscarriagemiscarriage

missed.

• threatened

• inevitable

incomplete

complete

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Incompetent cervixIncompetent cervix

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Ectopic pregnancyEctopic pregnancy

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Ectopic pregnancyEctopic pregnancy

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Ectopic pregnancyEctopic pregnancy

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Placenta PraeviaPlacenta Praevia

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Placenta abruptioPlacenta abruptio

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MILD PREECLAMPSIA SEVERE PREECLAMPSIA

MATERNAL EFFECTS

Blood pressure BP reading of 140/90 mm Hg x2, 4-6 hr apart Rise to >160/110 mm Hg on two separate occasions 4-6 hr apart with pregnant woman on bed rest

Mean arterial pressure (MAP)

>105 mm Hg >105 mm Hg

Weight gain Weight gain of more than 0.5 kg/wk during the second and third trimesters or sudden weight gain of 2 kg/wk at any time

Same as mild preeclampsia

Proteinuria— Qualitative dipstick— Ouantitative 24 hr analysis

Proteinuria of 0.3 g/L in a 24 hr specimen or >0.1 g/L in a random day-time specimen on two or more occasions 6 hr apart (because protein loss is variable); with dipstick, values varying from 1+ to 2 +

Proteinuria of >0.5 g/L in 24 hr or >4+ protein on dipstick

Edema Dependent edema, some puffiness of eyes, face, fingers; pulmonary edema absent

Generalized edema, noticeable puffiness; eyes, face, fingers; pulmonary edema possibly present

Reflexes May be normal Hyperreflexia ≥3+, possible ankle clonus

Preeclampsia

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MILD PREECLAMPSIA SEVERE PREECLAMPSIA

MATERNAL EFFECTS

Reflexes May be normal Hyperreflexia ≥3+, possible ankle clonus

Urine output Output matching intake, ≥30 ml/hr or <650 ml/24 hr

<20 ml/hr or <400 ml to 500 ml/24 hr

Headache Absent/transient Severe

Visual problems Absent Blurred, photophobia, blind spots on funduscopy

Irritability/changes in affect

Transient Severe

Epigastric pain Absent Present

Serum creatinine Normal Elevated

Thrombocytopenia Absent Present

AST elevation Normal or minimal Marked

Preeclampsia

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MILD PREECLAMPSIA SEVERE PREECLAMPSIA

FETAL EFFECTS

Placental perfusion Reduced Decreased perfusion expressing as IUGR in fetus; FHR: late decelerations

Premature placental aging

Not apparent At birth placenta appearing smaller than normal for duration of pregnancy, premature aging apparent with numerous areas of broken syncytia, ischemic necroses (white infarcts) numerous, intervillous fibrin deposition (red infarcts)

Preeclampsia

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