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Tuesday, April 14, 2009

Managing Chronic Diseases During Pregnancy

2:54 PM
Description

Clinicians should monitor diseases that can get worse with pregnancy (examples: systemic lupus erythematosus, asthma, sickle cell disease, rheumatic heart disease, bleeding disorders, etc.).

1. Prenatal monitoring, as well as genetic counseling, is needed if a family history of congenital deformities or chromosome abnormalities exists.
2. Ask about family history of diabetes and high blood pressure.
3. Ask if the patient has or had been exposed to infectious diseases, like tuberculosis, hepatitis, or acquired-immune deficiency syndrome.
4. The likelihood of multiple pregnancy increases if there is a family history of multiple pregnancy.

Heart disease

The burden on the heart increases with pregnancy. After the second trimester, women frequently notice shortness of breath and faster heartbeat. This is because the amount of blood and heart activity increases 30-50% at weeks 28-32. After that, it becomes temporarily comfortable, but it increases again at delivery, and then returns to normal 10-14 days later. In the case of rheumatic and acquired heart disease, the mother may experience difficulty breathing. And because not enough oxygen is supplied to the fetus, fetal death or handicap can be caused by this lack of oxygen. Women with heart disease should consult an expert to determine if the severity of their heart disease will allow pregnancy and childbirth. The most difficult time for a pregnant woman with heart disease is around 28-36 weeks, when the fetus is positioned at the upper part of the stomach and applying pressure to the heart.


Nephritis

Pregnancy can affect urinary system diseases, burden the urinary system, and make existing diseases worse. Women with chronic nephritis experience a worsening of the disease with every pregnancy. Therefore, women with nephritis need to be assessed before getting pregnant. If the last incident of acute nephritis was more than 2 years ago, or if the disease has been stable and latent for more than 2 years, then it is possible to carry a pregnancy to full term; if the function of the kidneys becomes worse, the mother must consider giving up the pregnancy. Pregnancy has a profound effect on chronic nephritis. Although symptoms may be mild initially, the symptoms can become serious after the middle stage of pregnancy.


High blood pressure

Three types of high blood pressure occur as complications of pregnancy: essential hypertension (thought to be genetic) and high blood pressure from gestosis aftereffects and nephritis aftereffects. Essential hypertension does not cause blood pressure to rise substantially early in pregnancy and proteinuria and edema rarely occur, but during the latter half of pregnancy blood pressure becomes very high and tends to cause gestational toxicosis. This tendency becomes stronger with every pregnancy. Nephritis- or gestosis-related high blood pressure causes the blood pressure to rises as the pregnancy progresses and often causes severe proteinuria and edema. If blood pressure does not rise substantially with essential hypertension, the growth of the fetus may not be impacted greatly; however, nephritis- and gestosis-related high blood pressure impair the placenta's function, hindering fetal growth and causing immature infant birth, fetal death, or premature birth.


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