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Pregnancy Physiology & Conditions

Pregnancy Physiology & Conditions. Dr Hadi Esmaily PharmD . Pregnancy Check. βhCG & αhCG Types Accuracy False negative: Done before the first day of a missed period Urine is not at room temperature Ectopic pregnancy History of ovarian cysts (PCOs)

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Pregnancy Physiology & Conditions

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  1. Pregnancy Physiology & Conditions Dr Hadi EsmailyPharmD.

  2. Pregnancy Check • βhCG & αhCG • Types • Accuracy • False negative: • Done before the first day of a missed period • Urine is not at room temperature • Ectopic pregnancy • History of ovarian cysts (PCOs) • Menotropins or chorionic gonadotropin

  3. Terminology • Parity: Number of deliveries after 20 weeks' gestation • Gravida: Number of pregnancies • Example: a Pregnant woman who has previously delivered one set of twins & had 1 abortions is described as a gravida 3, para 1 (G3, P1) • Perinatal period: 20th week of gestation -28th day after birth

  4. Terminology Cont. • Gestational age: the time from the start of the last menstrual cycle • Abortion: a delivery before 20 weeks' gestation • Preterm birth A fetus delivered between 20-37 weeks' gestation • Term infant: A fetus delivered between 37-42 weeks' gestation • Postmaturitybirth: A fetus delivered after 42 weeks' gestation

  5. Pregnancy Physiology • Conception begins after fertilization of an ovum • After 5-6 days, blastocyst adheres to the endometrium • It secretes hCG, maintains the corpus luteum so that menstruation is prevented & pregnancy can continue

  6. Pregnancy Physiology • 8-10 days after conception, hCG can be measured • Placenta serves as a strong barrier but a few cells are able to cross

  7. Date of Confinement • several methods: • LMp • Pelvic Examination • Uterine Size • Fetal parameters by ultrasound • Add 7 days to the first day of the LMp, subtract 3 m & add 1 y (Naegele rule)

  8. Vitamins & Minerals Supplementation • Nutritional status should be assessed preconceptionally with the goal of optimizing maternal, fetal, & infant health

  9. Iron • Iron requirements ↑ because: • Maternal blood volume expansion • Fetal needs • Placenta cord needs • Blood loss at the time of delivery • Some women may already have inadequate body stores of iron before pregnancy Iron supplementation is necessary • A pregnant woman needs about 18 to 21 mg iron/day(15-50% ↑Absorption)

  10. Anemia in Pregnancy • Anemia in Pregnancy: • 1st & 3rd Trimester: Hb<11 • Second Trimester: Hb<10.5 • The classic morphologic changes outside of pregnancy, are not prominent in pregnant women. • Women with iron deficiency needs 60-120 mg iron daily

  11. Folic Acid • The RDA of Folic Acid in pregnancy is 0.6 mg (0.4-0.8) • women who receive folic acid daily during the first trimester are less likely to have a child with neural tube defects (Spina Bifida & Anencephaly)

  12. Calcium • Ca is needed for adequate mineralization of skeleton & teeth, esp. in the 3rd trim. as teeth formed • The RDA in pregnancy • 1,000 mg/day for women >19 y • 1,300 mg/day for women <19 y

  13. Pregnancy-Induced Pharmacokinetic Changes • Physiologic changes can alter the absorption, distribution, metabolism, & elimination of drugs. • Factors influence pharmacokinetics of drugs: • Maternal physiologic changes • The effects of the placental-fetal compartment

  14. Nausea & Vomiting • 50-80% during 5-12 weeks of gestation • ~ 91% of cases will resolve by 20 w • Management: • Non Pharmacologic • Pharmacologic

  15. Non Pharmacologic Management • Smaller frequent meals consisting of a low-fat, bland, & dry diet (e.g., bananas, crackers, rice, toast) • Avoid spicy & highly aromatic foods • Take prenatal vitamins with iron at night • High protein meals • Rest • Avoidance of the sensory stimuli

  16. Pharmacologic Management • Moderate-Severe N/V that nonpharmacologic fails or threatens metabolic or nutritional status • H1 receptor blockers & Pyridoxine (B6) • (Diphenhydramine, Hydroxyzine, Dimenhydrinate) • Phenothiazines or Metoclopramideif antihistamines fail

  17. Dosing of Pharmacologic Management

  18. Ginger (ZingiberOfficinale) • Randomized trials and controlled studies suggest that powdered ginger is more effective than placebo, and equivalent to vitamin B6 • ↑ Adverse effects on pregnancy outcome has not been reported, but larger studies are needed

  19. Reflux Esophagitis • Reflux esophagitis/heartburn is affecting 2/3 of women • Enlarging uterus ↑Intra-abdominal pressure, & estrogen/progesterone relax the esophageal sphincter • Management: • Lifestyle Modification • Calcium Carbonate • Aluminum Antacids • H2 Blockers • PPIs

  20. Urinary Tract Infections • It is one of the most common complications of pregnancy • Changes leads to bacteriuria • Enlarged uterus (compress the ureters) • ↑Progesterone → Relaxation of ureteral muscle • Urine alkalization • Glucosuria

  21. Asymptomatic BacteriuriaVersusAcute Cystitis • >105 CFU of bacteria, obtained by 2 consecutive clean-catch samples • If in the absence of any urinary symptoms Asymptomatic Bacteriuria • If with frequency, urgency, dysuria, and hematuria without fever Acute Cystitis

  22. Urinary Tract Infections Cont. • If ASBs are left untreated lead to pyelonephritis, low-birth-weight infants, and premature delivery • Most common pathogens: • E. coli • Klebsiella pneumonia • Proteus mirabilis, • Enterobarterspecies

  23. Urinary Tract Infections Cont. Common Antibacterials: • Penicillins • Cephalosporins • Nitrofurantoin

  24. Pyelonephritis in Pregnancy • 1-2% • Leads to sepsis • Parental Antibiotics: • Cefazolin 2 g IV every 8 hours • Gentamycin (targeted peak of 8 mcg/mL and trough less than 1 mcg/mL) • Continued for at least 48 hours after becoming afebrile • Then Continue orally cephalexin 500 mg PO four times daily for a total of 10-14 days of antibiotic therapy (PO+IV)

  25. Diabetes Mellitus • Pregestational Diabetes • Gestational Diabetes Mellitus (GDM) • Goal: • FPG: <90 mg/dL • Premeal<100 mg/dL • l-hour postprandial: 100-120 mg/dL • Hb-Alc levels in the normal range (4.5-5) • Insulin Versus Oral Hypoglycemics

  26. HTN • Hypertension in pregnancy: • Systolic BP>140 mm Hg • Diastolic BP>90 mm Hg • Management: • Methyldopa • Labetalol • Nifedipine

  27. Prevention of RhDAlloimmunization • Blood group incompatibility between a pregnant woman and her fetus • Leads to alloimmunizationof the mother and hemolytic anemia in the fetus • An Rh D-negative mother becomes immunized after exposure to fetal erythrocytes that carry the D antigen • As little as 0.1 mL of blood can immunize a human • The severity of HDN depends on the concentration of maternal antibodies

  28. Prevention of RhDAlloimmunization RhoGAM®(300 mcg IM) • Antepartum Prophylaxis • Giving RhDIg IM at 28 weeks' gestation • Postpartum Prophylaxis • A second dose of RhDIg should be repeated within 72h of delivery

  29. Drugs In Pregnancy andlactationBriggs • Pregnancy • Case Reports • Lactation • Clinical Management

  30. Drugs in Pregnancy • A: Safe • B: Human Studies Show No Risk • C: The Risk Can Not Be Ruled Out • D: Positive Evidence Of Risk • X: Contraindicated

  31. Drugs Suspected/Proven to be Human Teratogen • Alcohol • ACEIs, ARB • Aminopterin • Androgens • Bexarotene • Bosentan • Carbamazepine • Chloramphenicol • Cocaine • Corticosteroids • Cyclophosphamide • Danazol • Diethylstilbestrol (DES) • Efavirenz • Etretinate • Isotretinoin • Leflunomide • Lithium

  32. Drugs Suspected/Proven to be Human Teratogen • Methimazole • Methotrexate • Misoprostol • Mycophenolate • Paroxetine • Penicillamine • Phenobarbital • Phenytoin • Radioactive iodine • Ribavirin • Statins • Streptomycin • Tamoxifen • Tetracycline • Thalidomide • Tretinoin • Valproate • Warfarin

  33. Dear Passengers, So thanks for you’re your patience and please be ready for take off, we are going to “Supplements & Doping” Territory.

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