TREATMENT OPTIONS
• Once the mother is stabilized safe delivery is the key to recovery 6, 1
• Vaginal birth is best if possible
• Caesarean birth is performed if the mother’s condition is deteriorating
• During the postpartum period, patients are at high risk of bleeding and coagulopathy
○ Transfusion of blood products may be needed
○ Patients may be at risk for pancreatitis
– Screening serum lipase and amylase will be needed for several days
○ In majority of cases delivery of the infant with supportive care allows the recovery of the mother from liver failure
○ Symptoms may resolve naturally in 3-4 days 10
○ In some women there may be a long cholestatic phase, requiring approximately 4 weeks for recovery 6
○ Liver
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acute lung injury and adult respiratory distress syndrome
○ Symptomatic cardiovascular support
– Maintain mean arterial pressure >75 mm Hg
– Monitor volume replacement, norepinephrine infusion, hydrocortisone, and possibly, vasopressin
○ Treatment of coagulopathy
– Intravenous vitamin K
– Multiple transfusions of blood products, cryoprecipitate, fibrinogen, and platelets may be required
– Intravenous bolus of recombinant activated factor VIIa may be helpful
○ Electrolytes, blood sugar
– Monitor of serum electrolytes once or twice daily and supplement as needed to avoid hyponatremia
– Frequent monitoring of serum blood glucose
– Parenteral fluids containing 5% glucose for several days
○ Continuous hemodialysis
– To prevent intracranial pressure especially in hemodynamically unstable patients
• Comorbidities
○ Chronic hypertension prior to pregnancy or during the first 20 weeks 15
– Monitor the occurrence of preeclampsia, intrauterine growth restriction and placental abruption
– Women in active labor with uncontrolled severe chronic hypertension require treatment with intravenous labetalol or hydralazine
○ Gestational hypertension
– Pregnant women who develop hypertension after 20 weeks and do not have significant proteinuria
– Some of these women may develop proteinuria and thus preeclampsia
– Severe intrapartum or postpartum hypertension
– Systolic blood pressure is greater than or equal to 160 mm Hg or if diastolic measurement is
A basic or complete metabolic panel which shows the serum concentration of electrolytes is sufficient to diagnose hyponatremia, however testing plasma osmolality and a urinalysis for sodium level may be useful in determining the cause the hyponatremia if it is not apparent (Goh, 2004). Treatments for hyponatremia are discussed in the section
Pregnancy induced hypertension (PIH) is defined as diastolic blood pressure >90mm Hg and systolic blood pressure >140mm Hg. It is a syndrome with either pre-eclampsia-eclampsia or gestational hypertension (figure1). (Sharma). Between these conditions Pre-eclampsia Is associated with higher mortality and morbidity rates in both mother and fetus and causes complications in 3% to 8% of the pregnant women (Jennifer), .The underlying pathogenesis for the development PIH is not clearly defined granger). Many studies hypothesized preeclampsia is mainly due to placenta ischemia leading to maternal endothelial dysfunction.(granger, granger). Although there are standard guidelines for the treatment of hypertension in non-pregnant patients but treatment modalities for treating hypertension in pregnant patients is not clearly defined (mgee) .Anti-hypertensive drugs remain the mainstay of treatment of PIH. Methyldopa, a centrally acting antihypertensive drug is a drug of choice for the treatment of PIH as it is most effective and well tolerated.(Sharma)
The main purpose of this article is to see what factors can contribute to the risk of induced Hypertension and Preeclampsia during a pregnancy. This article states that Preeclampsia and Hypertension can cause maternal morbidity. In this article they assess the exposure to chemicals or a physically demanding workload to the cause of a hypertensive disorder during a pregnancy.
Childbirth is one of the greatest privileges on the earth anyone could have and we, as women, should feel proud to be major contributors for it. Thus, a mother has to play a key role in aiding the healthcare workers to mitigate the health crisis associated with childbirth by performing her duties faithfully. One such associated health crisis is “Premature (preterm) birth” which occurs when the baby is born too early, before 37 weeks of gestational period (CDC, 2015). The rate of preterm birth ranges from 5% to 18% of babies born across 184 countries (WHO, 2015).
This essay will examine the functions of the liver and discuss the role of bile acids in OC. The pathophysiology of OC will be explored. The role of the midwife within a multidisciplinary team, alongside the physical care that is offered to women
The advanced technology today makes it possible to fetus’s potential conditions when it is born. Not everything is perfect and sometimes we find out that a baby
The author is a nurse in a level two trauma facility in a community of approximately fifty thousand people in Oregon. The community is a college-town surrounded by a large agricultural area. There is a minimal ethnic diversity within the community. The diversity present occurs mainly from internationally students and faculty from the college. There is a growing population of women who desire low interventional births in the community. The author has worked on the labor and delivery unit of the hospital for the last 14 years. The hospital is the only one in the area to offer trial of labor services to women who have previously undergone a cesarean section. The unit on average experiences around 1000 deliveries annually.
Over the years birthing methods have changed a great deal. When technology wasn’t so advanced there was only one method of giving birth, vaginally non-medicated. However, in today’s society there are now more than one method of giving birth. In fact, there are three methods: Non-medicated vaginal delivery, medicated vaginal delivery and cesarean delivery, also known as c-section. In the cesarean delivery there is not much to prepare for before the operation, except maybe the procedure of the operation. A few things that will be discussed are: the process of cesarean delivery, reasons for this birthing method and a few reasons for why this birthing method is used. Also a question that many women have is whether or not they can vaginally
Imagine awaiting one's little miracle, and having to experience the complications of a premature birth. “A staggering 15 million babies are born premature each year around the world” (Mayo Clinic Staff). Of that number, 1 million of
Although the process of giving birth and recovery is different for every woman, the human body must withstand many physical and psychological changes after having a baby. The federal
Gestational diabetes is a disease that affects pregnant women it’s a glucose intolerance that is started or diagnosed during pregnancy. Based on recently announced diagnostic criteria for gestational diabetes, according to the American Diabetes Association, it is estimated that gestational diabetes affects 18% of pregnancies. Pregnancy hormones can block insulin therefore causing the glucose levels to increase in a pregnant woman’s blood. Gestational diabetes starts when your body is not able to make and use all the insulin it needs for pregnancy (American Diabetes Association). Without enough insulin, glucose cannot leave the blood and be changed to
A total of 90 patients were admitted to the ICU during the study period. This represents 0.65 percent of all deliveries during this time, an incidence of 6.5 percent obstetric admissions per 1000 deliveries. This rate was almost similar to studies done by other authors2, 5, and 6. But this rate is lower compared to some other studies 3, 7. In the present study post-partum admissions accounted for 62%. Several other studies have also reported a majority of postpartum admissions 15, 16, 17, 18 Several other studies have reported a majority of antepartum admissions 12, 19 and admissions on the delivery 3,20.
Preeclampsia is a condition that occurs only during pregnancy. Some symptoms of preeclampsia may include high blood pressure and protein in the urine, occurring after week 20 of pregnancy. Preeclampsia is often precluded by gestational hypertension. While high blood pressure during pregnancy does not necessarily indicate preeclampsia, it may be a sign of another problem. Preeclampsia affects at least 3-5% of pregnancies. If undiagnosed, preeclampsia can lead to eclampsia, a serious condition that can put pregnant women and their baby at risk, and in rare cases, cause death. Women with preeclampsia who have seizures are considered to have eclampsia. The exact causes of preeclampsia and eclampsia a result of a placenta that doesn't function properly
This essay will first describe partnership and how a midwife working in the continuity of care model develops and maintains it. Secondly, this essay will describe what a postnatal abdominal palpation is, why it is done and what the outcomes may be. It will also describe the anatomy and physiology of a uterus and involution. Lastly, a description of how the assessment is conducted and how during this partnership and cultural safety is maintained by the midwife.
A week after that, my blood pressure getting unstable. The reading always up and down. They not sure if it is the effect of the tablet, so they take 6 bottles of blood samples for further diagnose. The result of the scan also shows abnormally reading. This suggested the baby was in the distressing mode. For the safe precaution, I was admitted immediately for further assessment.