Parenting - Prenatal to preschool/Parenting_PrenatalToPreschool.bin/dp/0042/00428.txt

Text File | 1993-06-14 | 8KB | 141 lines

$Unique_ID{PAR00428}
$Pretitle{}
$Title{Pregnancy:  The Second Trimester:  Special Situations}
$Subtitle{}
$Author{
Editors of Consumer Guide
Ellis, Jeffrey W
Ellis, Maria}
$Subject{Second Trimester Special Situations chronic Hypertension chronic
Diabetes Heart Disease Pregnancy high blood pressure preeclampsia toxemia
eclampsia edema weight gain urine protein headache headaches dizzy dizziness
blurred vision nausea nauseated vomit vomits vomiting abdominal pain abdomen
Seizure Seizures coma uterus blood flow dietary deficiencies deficiency
diuretic diuretics antihypertensives antihypertensive drugs drug insulin
diabetic stillbirth gestational pregnancy-induced urine sugar heart muscle
valves}
$Log{}

Miracle of Birth


The Second Trimester:  Special Situations


Hypertension, Diabetes, and Heart Disease in Pregnancy


     The majority of women are healthy at the start of pregnancy and remain so
throughout labor and delivery.  Aside from experiencing minor
discomforts--such as backache, morning sickness, and constipation--most women
tolerate well the many physical changes that result from pregnancy.
     In some cases, however, a woman may enter pregnancy with a chronic
medical problem or may develop a problem during the course of pregnancy.  Some
of these conditions may affect only the mother, while others may affect both
mother and baby.

Hypertension

     One of the most serious and, unfortunately, most common medical problems
in pregnancy is hypertension (high blood pressure).  This condition may cause
complications in both the mother and the baby.  There are two forms of
hypertension that may occur in pregnancy:  preeclampsia and chronic
hypertension.
     Preeclampsia (often called toxemia) is a serious condition that develops
in the latter weeks of pregnancy.  In its most severe form, it is referred to
as eclampsia.
     The symptoms of this disorder are divided into three stages, each
progressively more severe.  Mild preeclampsia symptoms include edema
(puffiness under the skin due to fluid accumulation in the tissues, usually
noted around the face, hands, and ankles), mild elevation of blood pressure,
rapid weight gain.  and the presence of small amounts of protein in the urine.
     Severe preeclampsia symptoms include extreme edema, extreme elevation of
blood pressure, the presence of large amounts of protein in the urine, rapid
weight gain, headache, dizziness, blurred vision, nausea, vomiting, and severe
pain in the upper right portion of the abdomen.  Seizures and coma indicate
that eclampsia has developed.
     The causes of preeclampsia and eclampsia are not known.  However, they
tend to develop more often in mothers from lower socioeconomic groups and in
mothers at the extremes of childbearing age--that is, teenagers and women
over the age of 35.  One theory proposes that certain dietary deficiencies may
be the cause of some cases.  Also, there is a possibility that some forms of
preeclampsia and eclampsia are the result of a deficiency of blood flow in the
uterus.
     Preeclampsia and eclampsia cannot be completely cured until the baby is
delivered.  Before that time, treatment depends, in part, on the severity of
the disorder.  Mild preeclampsia may be treated with complete bed rest and
frequent monitoring.  In more severe cases, the woman may be admitted to the
hospital so that drugs to control high blood pressure and to prevent seizures
can be administered.  Drugs may also be given to stimulate the kidneys to
produce urine.  In some severe cases, early delivery of the baby is needed to
ensure the survival of both mother and baby.
     There is no known way to prevent preeclampsia or eclampsia.  Though
restriction of salt in the diet may help to reduce swelling, it will not
prevent the onset of high blood pressure or the appearance of protein in the
urine.  During prenatal office visits, the doctor will routinely check weight,
blood pressure, and urine.  If preeclampsia is detected early, complications
for the mother and the baby may be reduced.
     Another form of high blood pressure in pregnancy is chronic hypertension.
In this condition, high blood pressure usually develops before the fifth month
of pregnancy (it may also develop prior to pregnancy).  Unlike preeclampsia,
there are few if any other symptoms.
     Chronic hypertension is more of a threat to the baby than to the mother
(and, in general, it is less of a threat than is preeclampsia).  Since this
condition may cause the placenta to function abnormally, the baby may be
affected by a lack of oxygen.
     If the hypertension was detected before pregnancy, the doctor may have
the woman continue the therapy used to control the disease before pregnancy,
as long as it does not involve diuretics or certain types of antihypertensive
drugs that can harm the baby.  If the high blood pressure developed during
pregnancy, antihypertensive drugs may also be used.  In either case, both
the mother and the fetus will be monitored more closely.  Special tests may
also be used to determine if the high blood pressure is affecting the baby.
If the baby appears to be getting an insufficient supply of oxygen, he will
be delivered immediately.

Diabetes

     Before the discovery of insulin for the treatment of chronic diabetes,
women with this disease rarely became pregnant.  Today, a diabetic woman can
expect to become pregnant and, in most cases, deliver a healthy, normal baby.
     Even though medical care for chronic diabetes has greatly improved in the
last two decades, the pregnant diabetic is still at increased risk of
developing preeclampsia, having a stillbirth, and delivering an abnormally
small baby.
     For these reasons, a pregnant woman who has chronic diabetes should
expect more frequent prenatal office visits and more laboratory testing.  It
will also be important for her to maintain a strict diet, exercise
appropriately, and take her insulin at the prescribed times.
     In addition to chronic diabetes, there is a form of diabetes that occurs
only during pregnancy.  It is called gestational or pregnancy-induced
diabetes.
     During routine prenatal office visits, a pregnant woman's urine is always
tested for the presence of sugar (urine should normally contain no sugar).  If
sugar is detected in the urine, the doctor will do a series of blood tests to
check the woman's blood sugar level and determine if she is suffering from
gestational diabetes.
     In general, women with gestational diabetes are treated with a special
diet that restricts their intake of sugar and carbohydrates.  Insulin is
rarely necessary to bring the blood sugar down to normal.
     Since the woman with pregnancy-induced diabetes is at a higher risk of
developing preeclampsia and having a stillbirth, she can expect to have more
frequent prenatal visits and more laboratory testing.
     A woman who develops gestational diabetes also has a greater chance of
developing true diabetes during her lifetime.  For this reason, doctors
generally perform another blood sugar test several months after the woman
delivers.

Heart Disease

     Although the incidence of heart disease in women of childbearing age has
declined dramatically in recent years, it still remains one of the major
causes of death in pregnant women.
     Most women with known heart disease withstand pregnancy without any
problems.  However, in cases in which the heart muscle or valves are seriously
diseased, the added strain that is normally placed on the heart during
pregnancy may lead to heart failure and even death.
     For this reason, any woman who knows that she has a heart problem should
check with her doctor before attempting to become pregnant.  A pregnant woman
with diagnosed heart disease should expect her pregnancy to be monitored
more closely.