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Pregnancy Physiology & Conditions Dr Hadi Esmaily PharmD.

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Presentation on theme: "Pregnancy Physiology & Conditions Dr Hadi Esmaily PharmD."— Presentation transcript:

1 Pregnancy Physiology & Conditions Dr Hadi Esmaily PharmD.

2 Pregnancy Check βhCG & αhCG Types Accuracy False negative: 1.Done before the first day of a missed period 2.Urine is not at room temperature 3.Ectopic pregnancy 4.History of ovarian cysts (PCOs) 5.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 Postmaturity birth: 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: 1.LMp 2.Pelvic Examination 3.Uterine Size 4.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 Vitamins & Minerals Supplementation Nutritional status should be assessed preconceptionally with the goal of optimizing maternal, fetal, & infant health

9 Iron Iron requirements ↑ because: 1.Maternal blood volume expansion 2.Fetal needs 3.Placenta cord needs 4.Blood loss at the time of delivery 5.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)


11 Anemia in Pregnancy Anemia in Pregnancy: ◦ 1 st & 3 rd 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

12 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)

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

14 Pregnancy-Induced Pharmacokinetic Changes Physiologic changes can alter the absorption, distribution, metabolism, & elimination of drugs. Factors influence pharmacokinetics of drugs: 1.Maternal physiologic changes 2.The effects of the placental-fetal compartment

15 Nausea & Vomiting 50-80% during 5-12 weeks of gestation ~ 91% of cases will resolve by 20 w Management: 1.Non Pharmacologic 2.Pharmacologic

16 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

17 Pharmacologic Management Moderate-Severe N/V that nonpharmacologic fails or threatens metabolic or nutritional status H 1 receptor blockers & Pyridoxine (B 6 ) (Diphenhydramine, Hydroxyzine, Dimenhydrinate) Phenothiazines or Metoclopramide if antihistamines fail

18 Dosing of Pharmacologic Management Medications Used for Nausea & Vomiting during Pregnancy DrugDosePregnancy Category Pyridoxine 10–25 mg PO three to four times daily A Diphenydramine25–50 mg PO, IV, IM every 4–6 hrsB Hydroxyzine25–50 mg PO every 6–8 hrsC Promethazine12.5–25 mg PO, PRN every 6 hrsC Metoclopramide5–10 mg PO, IM, IV every 8 hrsB Ondansetron4–8 mg PO, IV every 8 hrsB

19 Ginger (Zingiber Officinale) 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

20 Reflux Esophagitis Reflux esophagitis/heartburn is affecting 2/3 of women Enlarging uterus ↑Intra-abdominal pressure, & estrogen/progesterone relax the esophageal sphincter Management: 1.Lifestyle Modification 2.Calcium Carbonate 3.Aluminum Antacids 4.H2 Blockers 5.PPIs

21 Urinary Tract Infections It is one of the most common complications of pregnancy Changes leads to bacteriuria 1.Enlarged uterus (compress the ureters) 2.↑Progesterone → Relaxation of ureteral muscle 3.Urine alkalization 4.Glucosuria

22 Asymptomatic Bacteriuria Versus Acute Cystitis >10 5 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

23 Urinary Tract Infections Cont. If ASBs are left untreated lead to pyelonephritis, low-birth-weight infants, and premature delivery Most common pathogens: 1. E. coli 2. Klebsiella pneumonia 3. Proteus mirabilis, 4. Enterobarter species

24 Urinary Tract Infections Cont. Common Antibacterials : 1.Penicillins 2.Cephalosporins 3.Nitrofurantoin

25 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)

26 Diabetes Mellitus Pregestational Diabetes Gestational Diabetes Mellitus (GDM) Goal: 1.FPG: <90 mg/dL 2.Premeal <100 mg/dL 3.l-hour postprandial: 100-120 mg/dL 4.Hb-Alc levels in the normal range (4.5-5) Insulin Versus Oral Hypoglycemics

27 HTN Hypertension in pregnancy: 1.Systolic BP>140 mm Hg 2.Diastolic BP>90 mm Hg Management: 1.Methyldopa 2.Labetalol 3.Nifedipine

28 Prevention of RhD Alloimmunization Blood group incompatibility between a pregnant woman and her fetus Leads to alloimmunization of 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


30 Prevention of RhD Alloimmunization RhoGAM ® (300 mcg IM) Antepartum Prophylaxis ◦ Giving RhD Ig IM at 28 weeks' gestation Postpartum Prophylaxis ◦ A second dose of RhD Ig should be repeated within 72h of delivery

31 Drugs In Pregnancy and lactation Briggs  Pregnancy  Case Reports  Lactation  Clinical Management

32 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

33 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

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

35 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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