RH Compatibility

Rh incompatibility is a condition that occurs during pregnancy if a woman has Rh-negative blood
and her baby has Rh-positive blood.
"Rh-negative" and "Rh-positive" refer to whether your blood has Rh factor. Rh factor is a protein
on red blood cells. If you have Rh factor, you're Rh-positive. If you don't have it, you're Rhnegative. Rh factor is inherited (passed from parents to children through the genes). Most people
are Rh-positive.
Whether you have Rh factor doesn't affect your general health. However, it can cause problems
during pregnancy.

It occurs when a mother is Rh-negative and her baby is Rh- positive. The Rh
factor is a specific protein found on the surface of your red blood cells. Like
your blood type, you inherit your Rh factor type from your parents.

DRUG AND LAB EXAM RESULTS

If this produces agglutination of RBCs, the direct Coombs test is

positive, a visual indication that antibodies (and/or complement proteins) are
bound to the surface of red blood cells. The indirect Coombs test is used in
prenatal testingof pregnant women and in testing blood prior to a blood
transfusion.
Coombs test -

Rhogam- The antibodies are derived from human plasma.

When RhoGAM Brand is injected into the muscle of an Rh-negative mother,
these antibodies circulate in her bloodstream and protect her against any Rhpositive red blood cells from the fetus. Her immune system then sees no need to
take further action.

MEDICAL AND SURGICAL

There are five main types of rhesus antigens( D, C, c, E, e) in humans and the D antigen is

the most immunogenic one. When blood passes from Rhesus(Rh) positive individual to Rh
negative individual there is formation of anti D antibodies in Rh negative persons. When this
happens in a Rh negative pregnant mother and during the subsequent pregnancies with a
Rh positive foetus, maternal anti D antibodies can pass into foetal circulation and can cause
destruction of the red blood cells. This condition is called Rh incompatibility. Therefore
maternal blood group is very important and if the mother is Rh negative paternal blood
group also important as if the father is Rh positive there is a chance of getting a Rh positive
foetus( homozygous- 100% chance, heterozyhous- 50% chance).

PHARMACOLOGIC MANAGEMENT

Prehospital Care
When possible, prehospital care personnel should direct their efforts on
stabilization of the mother and infant, followed by immediate transport to a
facility specializing in high-risk obstetric and neonatal care.
NNNNNNNNNNNCCCCCCCCCCCCPPPPPPPPPPPPPP

GDM

Gestational diabetes mellitus (GDM) is defined as any degree of glucose intolerance

with onset or first recognition during pregnancy (1). The definition applies whether
insulin or only diet modification is used for treatment and whether or not the condition
persists after pregnancy. It does not exclude the possibility that unrecognized glucose
intolerance may have antedated or begun concomitantly with the pregnancy.
Approximately 7% of all pregnancies are complicated by GDM, resulting in more than
200,000 cases annually. The prevalence may range from 1 to 14% of all pregnancies,
depending on the population studied and the diagnostic tests employed.

PF

Age greater than 25. Women older than age 25 are more likely to develop
gestational diabetes.

Family or personal health history. Your risk of developing gestational

diabetes increases if you have prediabetes slightly elevated blood sugar
that may be a precursor to type 2 diabetes or if a close family member,
such as a parent or sibling, has type 2 diabetes. You're also more likely to
develop gestational diabetes if you had it during a previous pregnancy, if you
delivered a baby who weighed more than 9 pounds (4.1 kilograms), or if you
had an unexplained stillbirth.

Excess weight. You're more likely to develop gestational diabetes if you're

significantly overweight with a body mass index (BMI) of 30 or higher.

Nonwhite race. For reasons that aren't clear, women who are black,
Hispanic, American Indian or Asian are more likely to develop gestational
diabetes.

DRUG AND LAB EXAM RESULTS

f you're being tested for type 2 diabetes, two hours after drinking the glucose
solution:
A normal blood glucose level is lower than 140 mg/dL (7.8 mmol/L).

A blood glucose level between 140 mg/dL and 199 mg/dL (7.8 and 11
mmol/L) is considered impaired glucose tolerance, or prediabetes. If you have
prediabetes, you're at risk of eventually developing type 2 diabetes. You're
also at risk of developing heart disease, even if you don't develop diabetes.

A blood glucose level of 200 mg/dL (11.1 mmol/L) or higher may indicate
diabetes.
If the results of your glucose tolerance test indicate type 2 diabetes, your doctor
may repeat the test on another day or use another blood test to confirm the
diagnosis. Various factors can affect the accuracy of the glucose tolerance test,
including illness, activity level and certain medications.

PATHOPHY
PHOTO

MEDICAL AND SURGICAL

Most cases of GDM can be managed by lifestyle measures alone, including

careful attention to dietary principles and regular exercise during pregnancy.
Blood glucose is monitored before and one or two hours after meals backed by
regular measurement of HbA1c. Insulin is the recommended first line of treatment
if glycemic targets are exceeded, although there is increasing evidence that oral
agents (metformin or glyburide) are safe in this situation. The requirement for

insulin usually ends with delivery, but diabetes is likely to recur with subsequent
pregnancies or later in life, and appropriate advice and long-term monitoring are
needed.

PHARMA

Evidence shows that screening for and treating GDM lead to the reduction
of perinatal morbidity and the improvement of post-delivery outcomes
[19]. As in other types of diabetes, the cornerstone of GDM management
is glycaemic control [1]. Glycaemic control has been shown to reduce
adverse outcomes in pregnant women with GDM [20, 21].

The first line of management for women with gestational diabetes mellitus
is dietary modification, often called medical nutrition therapy [25].
Evidences indicates that nutrition therapy is effective in reducing
pregnancy and perinatal complications and also in attaining glycaemic
control
Insulin therapy is the most commonly used pharmacotherapy once MNT
fails to achieve desired outcomes. Insulin regimens often include
intermediate-acting insulins such as isophane and short-acting agents
such as regular recombinant insulin (Humulin R). Pharmacotherapy can
also involve the insulin analogues aspart and lisipro. Insulin therapy
decreases the frequency of fetal macrosomia and the risk of perinatal
morbidity [37]. Positive history of diabetes mellitus in a first-degree
relative and multiple abnormal values in the OGTT were strongly found to
predict the need for insulin management in women with GDM

PIH

Gestational hypertension, also referred to as pregnancy

induced hypertension (PIH) is a condition characterized
by high blood pressure during pregnancy . Gestational hypertension
can lead to a serious condition called preeclampsia , also

referred to as toxemia. Hypertension during pregnancy

affects about 6-8% of pregnant women.

PF
First-time moms
Women whose sisters and mothers had PIH
Women carrying multiples
Women younger than age 20 or older than age 40
Women who had high blood pressure or kidney disease prior
to pregnancy

PATHOPHYSIO
-

Drug and lab

PHOTO
MEDICAL AND SURGICAL MGT
If PIH is mild, it can be treated at home. If you have been diagnosed with PIH and your
doctor recommends home treatment, you will need to maintain a quiet, restful environment
with limited activity or bed rest on your left side.

It is important that you follow the diet and fluid intake guidelines from your health care
provider and maintain your scheduled appointments. Your perception of fetal movement
every three hours is also important. Any changes need to be reported to your health care
provider immediately.
If PIH becomes worse, you will need to be admitted to the hospital where you can be
closely monitored. Your health care provider will work with you to maintain the health of you
and your baby. In severe cases, the baby may have to be delivered. High blood pressure is
treated with medication, and magnesium is given through an IV to prevent seizures.

PHARMA
Methyldopa is a drug of first choice for control of mild to moderate hypertension in pregnancy
and is the most widely prescribed antihypertensive for this indication in several countries. During
long term use in pregnancy, methyldopa does not alter maternal cardiac output or blood flow to
the uterus or kidneys and for all these reasons is generally considered the agent of choice for
chronic blood pressure control in pregnancy.

ANEMIA
a condition marked by a deficiency of red blood cells or of hemoglobin in the blood,
resulting in pallor and weariness.

PF:

These factors place you at increased risk of anemia:

A diet lacking in certain vitamins. Having a diet that is consistently low in

iron, vitamin B-12 and folate increases your risk of anemia.

Intestinal disorders. ...

Menstruation. ...

Pregnancy. ...

Chronic conditions. ...

Family history. ...

Other factors. ...

Age.
Diet. You may have low iron levels if you dont eat enough foods high in iron. This is mostly a
problem for children, young women who follow fad diets and people who dont eat meat.
Inability to absorb iron. The iron in your food is absorbed by the body in the small intestine.
Diseases that affect your small intestines ability to absorb nutrients, such as Crohns disease or
celiac disease, may cause low iron levels in your body. Some foods or medicines, including
milk, antacids or stomach acid-lowering medicines, also can prevent your body from absorbing
iron.
Growth spurts. Children younger than 3 years of age grow so fast that their bodies may have a
hard time keeping up with the amount of iron they need.

PATHOPHYSIOLOGY
DRUG AND LAB EXAM RESULTS

A complete blood count (CBC), to look at the shape,

color, number, and size of your blood cells.
Iron tests, which measure the amount of iron in your
blood, to help determine the type and severity of
anemia.

 Reticulocyte count, to help determine the cause of

anemia. Reticulocytes are immature red blood cells
produced by bone marrow and released into the
bloodstream. Levels of reticulocytes are lower in iron
deficiency anemia.
A ferritin level test, which reflects how much iron may
be stored in the body. Abnormally low ferritin levels
may point to iron deficiency anemia. This is one of the
first tests to be abnormal when you have iron
deficiency.
If your doctor suspects that bleeding in your stomach or
intestines is causing your anemia, you will have tests to
determine the cause of the bleeding. These may include:
A fecal occult blood test (FOBT), which looks for blood
in stool samples.
A colonoscopy. This test inspects the entire large
intestine (colon) using a long, flexible, lighted viewing
scope to look for polyps or other sources of bleeding.
An upper gastrointestinal (GI) endoscopy. This test,
which uses a thin, flexible, lighted viewing instrument,
can help identify stomach ulcers or other causes of
irritation or bleeding.
Video capsule endoscopy. For this test, you swallow a
capsule that contains a tiny camera. As the capsule
travels through your system, the camera takes
pictures of your small intestine that can show where
bleeding is occurring.

 X-ray tests such as an upper GI series or barium

enema.
MEDICAL AND SURGICAL MGT.

Anemia treatment depends on the cause.

Iron deficiency anemia. Treatment for this form of anemia usually

involves taking iron supplements and making changes to your diet.
If the underlying cause of iron deficiency is loss of blood other than from
menstruation the source of the bleeding must be located and stopped.
This may involve surgery.

Vitamin deficiency anemias. Treatment for folic acid and B-12 deficiency
involves dietary supplements and increasing these nutrients in your diet.
If your digestive system has trouble absorbing vitamin B-12 from the food
you eat, you may need vitamin B-12 shots. At first, you may receive the
shots every other day. Eventually, you'll need shots just once a month,
which may continue for life, depending on your situation.

Anemia of chronic disease. There's no specific treatment for this type of

anemia. Doctors focus on treating the underlying disease. If symptoms
become severe, a blood transfusion or injections of synthetic erythropoietin,
a hormone normally produced by your kidneys, may help stimulate red
blood cell production and ease fatigue.

Aplastic anemia. Treatment for this anemia may include blood

transfusions to boost levels of red blood cells. You may need a bone marrow
transplant if your bone marrow is diseased and can't make healthy blood
cells.

Anemias associated with bone marrow disease. Treatment of these

various diseases can include medication, chemotherapy or bone marrow
transplantation.

Hemolytic anemias. Managing hemolytic anemias includes avoiding

suspect medications, treating related infections and taking drugs that
suppress your immune system, which may be attacking your red blood cells.
Depending on the severity of your anemia, a blood transfusion or
plasmapheresis may be necessary. Plasmapheresis is a type of bloodfiltering procedure. In certain cases, removal of the spleen can be helpful.

Sickle cell anemia. Treatment for this anemia may include the
administration of oxygen, pain-relieving drugs, and oral and intravenous
fluids to reduce pain and prevent complications. Doctors also may
recommend blood transfusions, folic acid supplements and antibiotics.
A bone marrow transplant may be an effective treatment in some
circumstances. A cancer drug called hydroxyurea (Droxia, Hydrea) also is
used to treat sickle cell anemia.

Thalassemia. This anemia may be treated with blood transfusions, folic

acid supplements, medication, removal of the spleen (splenectomy), or a
blood and bone marrow stem cell transplant.

PHARMACOLOGIC MANAGEMENT

Eculizumab
Eculizumab is a monoclonal antibody, which is prescribed for two conditions:
Paroxysmal nocturnal hemoglobinuria (PNH) in which red blood cells (RBCs) are broken
down resulting in anemia and decreased oxygen supply to the body. Atypical
hemolytic uremic syndrome (aHUS)

Darbepoetin alfa
Darbepoetin alfa is an erythropoiesis-stimulating agent, prescribed for anemia due to
chronic kidney disease.

Ferrous Fumarate

Ferrous Fumarate is an essential body mineral, used to treat iron deficiency anemia. It
replaces iron in the body when the body does not produce enough

GRAVIDO CARDIAC
Cardiovascular adaptations of pregnancy are generally well tolerated in the healthy gravida; however,
these changes can place undue stress on women with underlying cardiovascular disease and can result
in increased risk for morbidity and mortality. In this article, we will review issues related to preconceptional
counseling, cardiovascular adaptations of pregnancy, and the prognosis and management of the gravida
with cardiac disease in pregnancy.

PREDISCardiovascular risk factors

There are many risk factors associated with coronary heart disease and stroke. Some risk factors such as family
history, ethnicity and age, cannot be changed. Other risk factors that can be treated or changed include tobacco
exposure, high blood pressure (hypertension), high cholesterol, obesity, physical inactivity, diabetes, unhealthy diets,
and harmful use of alcohol.
Of particular significance in developing countries is the fact that while they are grappling with increasing rates of
cardiovascular disease, they still face the scourges of poor nutrition and infectious disease. Nevertheless, with the
exception of sub-Saharan Africa, cardiovascular disease is the leading cause of death in the developing world.
You will not necessarily develop cardiovascular disease if you have a risk factor. But the more risk factors you have
the greater is the likelihood that you will, unless you take action to modify your risk factors and work to prevent them
compromising your heart health.
Modifiable risk factors
Hypertension is the single biggest risk factor for stroke. It also plays a significant role in heart attacks. It can be
prevented and successfully treated but only if you have it diagnosed and stick to your recommended management
plan.
Abnormal blood lipid levels, that is high total cholesterol, high levels of triglycerides, high levels of low-density
lipoprotein or low levels of high-density lipoprotein (HDL) cholesterol all increase the risk of heart disease and stroke.
Changing to a healthy diet, exercise and medication can modify your blood lipid profile.

Tobacco use, whether it is smoking or chewing tobacco, increases risks of cardiovascular disease. The risk is
especially high if you started smoking when young, smoke heavily or are a woman. Passive smoking is also a risk
factor for cardiovascular disease. Stopping tobacco use can reduce your risk of cardiovascular disease significantly,
no matter how long you have smoked.
Physical inactivity increases the risk of heart disease and stroke by 50%. Obesity is a major risk for cardiovascular
disease and predisposes you to diabetes. Diabetes is a risk factor for cardiovascular disease.
Type2 diabetes a major risk factor for coronary heart disease and stroke. Having diabetes makes you twice as likely
as someone who does not to develop cardiovascular disease. If you do not control diabetes then you are more likely
to develop cardiovascular disease at an earlier age than other people and it will be more devastating. If you are a premenopausal woman, your diabetes cancels out the protective effect of estrogen and your risk of heart disease rises
significantly.
A diet high in saturated fat increases the risk of heart disease and stroke. It is estimated to cause about 31% of
coronary heart disease and 11% of stroke worldwide.
Being poor, no matter where in the globe, increases your risk of heart disease and stroke. A chronically stressful life,
social isolation, anxiety and depression increase the risk of heart disease and stroke.