include risk factors for complications during pregnancy Pre-existing maternal diseases physical and social characteristics age problems in previous pregnancies (z. B. spontaneous abortion) problems that develop during pregnancy problems that develop during labor and birth hypertension pregnant women are regarded as patients with chronic hypertension (chronic hypertension, CHTN) when (trans. note. d .: grafted pregnancy-induced hypertension, Pfropfgestose) hypertension was before pregnancy before hypertension develops before 20 weeks is between chronic hypertension (CHTN) and pregnancy-induced distinguished hypertension that occurs after the 20th week of pregnancy. In both cases hypertension is defined as a systolic blood pressure of> 140 mmHg or diastolic> 90 mmHg measured twice at an interval of> 24 hours. High blood pressure increases the following risks: Fetal growth restriction (by decreasing uteroplacental bleeding) Negative fetal and maternal results before women trying to get pregnant with hypertension, they should be enlightening advice on the risks of pregnancy. If they are pregnant, the prenatal care begins as early as possible and involves determining the basal renal function (eg., Serum creatinine, urea), an examination of the fundus and a specific cardiovascular study (auscultation and occasionally ECG [electrocardiography], echocardiography or both). In each trimester protein in 24-h urine, serum uric acid, and serum creatinine will be Hct (hematocrit) determined. To check the fetal size is in the 28th week of pregnancy, and every 4 weeks thereafter conducted a sonography. A delayed increase in size should be ascertained by vascular Doppler investigation, which performs a specialist for prenatal diagnosis (treatment of hypertension during pregnancy, hypertension in pregnancy: treatment). Diabetes overt diabetes mellitus occurs 6% of pregnancies and pregnancy-induced diabetes in approximately 8.5% of pregnancies in ?. The incidence is increasing as the incidence of obesity increases. Pre-existing insulin-dependent diabetes increases the risk of the following: pyelonephritis ketoacidosis preeclampsia Fetal death Major fetal malformations Fetal macrosomia (fetal weight> 4.5 kg) When a vasculopathy is present, fetal growth during pregnancy, insulin requirements normally rises. Gestational diabetes increases the risk of the following: Hypertensive disorders macrosomia A gestational diabetes is routinely in the 24th-28th SSW clarified and, if there is a risk factor for pregnant women, as early as the first trimester. Risk factors include: Earlier gestational A makrosomischer infant in a previous pregnancy Family history of non-insulin-dependent diabetes Unexplained miscarriage body mass index (BMI)> 30 kg / m2 Some doctors first perform a randomized plasma glucose test to Check whether gestational diabetes is possible. However, screening and confirmation based the diagnosis of gestational diabetes is best based on the results of the oral glucose tolerance test (OGTT-see table: Plasma glucose thresholds for diagnosis * of a pregnancy-induced diabetes mellitus in a 100-g oral glucose tolerance test). Based on a recommendation of the Conference of 2013 of the National Institutes of Health (NIH) consensus development, the screening begins with a 1-hour 50-g glucose load test (GLT); if the results are positive (plasma glucose> 135 mg / dl) is carried out a 3-h 100-g OGTT. Plasma glucose limits for the diagnosis * of a pregnancy-induced diabetes mellitus in a 100-g oral glucose tolerance test 100 g OGTT NDDG Carpenter and Coustan † temporal occurrence of the test plasma glucose (mg / dl) fasting ‡ 105 95 1 hour 190 180 2 hours 165 155 3 hours 145 140 * pregnancy-induced diabetes is diagnosed when at least 2 threshold values ??are reached or exceeded. † Vandorsten JP, Dodson toilet, Espeland MA, et al. National Institutes of Health (NIH) Consensus Development Conference Statement: diagnosing gestational diabetes mellitus. NIH Consensus State-of-the-science statements 29: 1-31, 2013. ‡ fasting provision is required in suspected unrecognized diabetes in order to avoid an unnecessary glucose load. NDDG = National Diabetes Data Group; OGTT = oral glucose tolerance test. Optimal treatment of pregnancy-induced diabetes (with diet, exercise and close monitoring of glucose levels and insulin when needed) reduces the risk of adverse consequences for mother, fetus and newborn. Limit values ??for the diagnosis of overt diabetes in pregnancy method * Limit fasting blood glucose 126 mg / dl HbA1C 6.5% plasma glucose 200 mg / dL to> 1 measurement * fasting blood glucose and HbA 1c can be determined if suspected diabetes is (z. B. in patients with risk factors such as obesity, Di abetes family history or gestational diabetes in a previous pregnancy). HbA1c = glycosylated hemoglobin. Women with gestational diabetes mellitus had undiagnosed diabetes before pregnancy. They should be tested for diabetes 6 to 12 weeks after birth, using the same tests and criteria to be applied for non-pregnant patients. STDs ( “Sexually Transmitted Diseases” STDs) (Overview of sexually transmitted diseases.) May utero Fetal Syphilisin cause fetal death, congenital malformations and severe disability. Without treatment, the risk of transmission of HIV from women is intrapartum his offspring at about 30% prepartum and at about 25%. Newborns receive antiretroviral treatment to minimize the risk of intrapartum transmission (infection with the human immunodeficiency virus (HIV) infection in infants and children) within 6 hours after birth. Bacterial vaginosis, gonorrhea and genital chlamydia infections increase the risk of preterm labor and premature rupture of membranes. For routine prenatal care include the first visit to the doctor screening tests for evaluation of these infections. A study on syphilis is repeated at further risk existing during pregnancy and performed at birth in all women. Pregnant women who suffer from these infections are treated with antimicrobial drugs. The treatment of a bacterial vaginitis, gonorrhea or chlamydia infection lengthened in some cases, the interval between membrane rupture and birth and improves the chances of the fetus by a reduction in fetal infection. Get pregnant women with HIV infection zidovudine or nevirapine, the risk of transmission is reduced by two-thirds; with a combination of two or three antiviral agents, the risk is likely low (<2%) (infection with the human immunodeficiency virus (HIV) infection in infants and children: prevention). These drugs should be advised despite potentially toxic effects on the fetus and the pregnant woman. Pyelonephritis pyelonephritis increases the risk of: Premature rupture Preterm labor respiratory distress syndrome Pyelonephritis is the most common reason for hospitalization during pregnancy. Pregnant with pyelonephritis be hospitalized for diagnosis and treatment; there are important a urine culture and sensitivity testing of the i.v. Antibiotics (eg. As a cephalosporin of the third generation with or without aminoglycoside), antipyretics and fluid replacement. The switch to oral antibiotics that act specifically against the causative pathogen takes place 24-48 hours after the disappearance of fever, to complete the whole antibiotic treatment after 7-10 days. Treatment with antibiotics prophylactically effective (eg. B. nitrofurantoin, trimethoprim / sulfamethoxazole) is continued under regularly repeated urine cultures until the end of pregnancy. Acute surgical problems Large surgical, especially intra-abdominal, procedures increase the risk for the following: Preterm labor Fetal death Surgical procedures are, however, usually well-tolerated by the pregnant woman and the fetus if (when blood pressure and oxygen saturation for adequate supportive care and anesthesia are kept in the normal range) is taken care of, so doctors surgery over should not be restrained. delay the treatment of an abdominal emergency, is much more dangerous. After the operation, about 12-24 hours antibiotics and tocolytic acting medications are given. Is a non-emergency basis operation to be performed required in pregnancy, she carried the safest in the second trimester. increasing abnormalities of the female reproductive organs Structural abnormalities of the uterus and cervix (eg septate uterus, uterus bicornis.) the probability of the following: Fetal malpresentation Dysfunctional uterine contractions The need for a caesarean section, it is unusual that uterine fibroids placental abnormalities (eg, placenta previa. cause), premature birth and repeated abortions. Leiomyomas can grow or degenerate quickly during pregnancy. The degeneration of a fibroid often causes severe pain and signs of peritonitis. An incompetent cervix leads with increased likelihood of premature birth. In pregnant women with prior myomectomy, in which the uterine cavity was involved, a caesarean section is required because the risk of uterine rupture is during a vaginal delivery. Uterine abnormalities that may lead to pathological pregnancy outcomes that require surgical correction after pregnancy. Maternal age Young people at 13% of all pregnancies occur have an increased incidence of pre-eclampsia, premature labor and anemia, which often leads to fetal growth retardation. This is at least partly related to that teens usually go less often for prenatal care, often smoking and likely to suffer from sexually transmitted diseases. For pregnant women> 35 years is not only the incidence of preeclampsia is increased but also the incidence of gestational diabetes, impaired uterine contractions, placental abruption, stillbirth and placenta previa. These pregnant women pre-existing disease exists also more likely (eg. As chronic hypertension, diabetes). As with maternal age and the risk of fetal chromosomal abnormalities increases, genetic testing should be offered here. Maternal weight pregnant women whose BMI was <19.8 kg / m2 before birth are referred to as underweight, which predisposes to low birth weight (<2.5 kg). You should be advised to increase at least 12.5 kilograms of weight during pregnancy. Pregnant women whose BMI was before the birth of 25 to 29.9 kg / m2 (overweight) or ? 30 (obese), are at risk of maternal hypertension and diabetes, transmitted pregnancy, pregnancy loss, fetal macrosomia, congenital deformities, intrauterine growth restriction, pre-eclampsia and the need for a caesarean section. Ideally, the weight loss before pregnancy should start first to change (eg. As increased exercise, dietary changes) by attempting dieLebensweise. Women who are overweight or obese should be advised to limit their weight gain during pregnancy to <11.5 kg, ideally by changing their lifestyle. Clinical Calculator: Body Mass Index (Quetelet's index) Maternal size Little Women (ca. <152 cm) have rather a small basin, which may result in dystocia with fetopelvinem disproportion or shoulder dystocia. For small women, it is more likely to premature birth and intrauterine growth retardation. Exposure to teratogens Common teratogens (agents that cause fetal malformations) are infections, drugs and other chemical substances. Most likely malformations occur if exposure 2 to 8 weeks after conception (4.-10. Week after the last menstrual period) occurs at the time of organ formation. Other adverse pregnancy outcomes are also to be found more frequently. Pregnant women exposed to teratogens must be paid educated about the increased risks and to detect abnormalities in a detailed ultrasound examination. Among the common infections that can teratogenic include herpes simplex, viral hepatitis, rubella, varicella, syphilis, toxoplasmosis, cytomegalovirus and coxsackie virus infections. Common stimulants and drugs that may teratogenic, including alcohol, tobacco, cocaine (social recognized and illegal drugs during Schwamgerschaft) and some prescription drugs (see table: Some drugs with adverse effects during pregnancy). Exposure to mercury mercury in fish and seafood can be toxic to the fetus. The FDA (see Fish: What Pregnant Women and Parents Should Know) Recommends the following: Avoid tilefish from the Gulf of Mexico, shark, swordfish and king mackerel Avoid white tuna to 170g (one average meal) / week Prior to the consumption of fish from local lakes, rivers and coastal areas, the safety of such fish should be checked, and if it is not known whether the levels of mercury are low, consumption should be limited to about 170g / week at the same time avoiding other seafood with high mercury levels. Experts recommend that women who are pregnant or breastfeeding (and toddlers), about 230 to 340 g (2 or 3 average meals) / week of a variety of seafood, which have a lower mercury content, eat. Such seafood include flounder, shrimp, canned tuna, salmon, pollock, tilapia, cod, and catfish. Fish has nutrients that are important for fetal growth and development. Preceding stillbirth A stillbirth is the birth of a dead fetus in the> 20 weeks. The fetal death in late pregnancy may maternal, placental or fetal anatomic or genetic causes (see Table: Common causes of stillbirths). a history of increase stillborn or a later Abort (d. e. in the 16th-20th week of pregnancy) the risk of an intrauterine Fruchttods for subsequent pregnancies. The level of risk depends on the reason for the previous stillbirth. A monitoring of the fetus by the use of prenatal examinations (eg. As Nonstress test, biophysical profile) is strongly encouraged. The therapy maternal diseases (eg. As chronic hypertension, diabetes, infections) can reduce the risk of stillbirth in the current pregnancy. Preceding preterm premature birth is a birth before the 37th week of pregnancy. Caused by preterm labor previous preterm birth increases the risk of future premature births. If the previous premature babies weighed <1.5 kg and the risk of premature birth is the next pregnancy at 50%. Women with prior preterm birth every 2 weeks should be closely monitored by premature labor after 20 weeks. The monitoring comprises ultrasonic examination with determination of the cervical length and shape in the 16.-18. SSW monitoring of uterine contractions clarification of bacterial vaginosis determination of fetal fibronectin women with a previous preterm birth of premature labor, or with shortening (<25 mm) or funneling of the cervix should be 17-?-OH-progesterone (250 mg in 1 time / week) receive. Former Newborn With a Genetic or Congenital disease to get a fetus with a chromosomal disorder, the risk is for most couples who have had a newborn baby with a chromosomal disorder increases, (recognized or overlooked; Prenatal genetic counseling: Risk Factors). The recurrence risk is unknown for the majority of genetic diseases. Most congenital malformations are multifactorial. The risk that a fetus has the following defects, is ? 1%. When couples had a newborn baby with a genetic or chromosomal disorder, genetic screening is recommended. If couples have had a newborn with a congenital malformation, genetic testing, a high-resolution ultrasound examination and investigation by a specialist for prenatal diagnosis is recommended. Polyhydramnios (hydramnios) and oligohydramnios Polyhydramnios (excess amniotic fluid) can lead to severe shortness of mother and preterm labor. Risk factors Uncontrolled maternal diabetes include multiple pregnancy isoimmunization fetal malformations (z. B. esophageal atresia, anencephaly, spina bifida). often accompanied by congenital malformations of the urogenital tract and a severe fetal growth restriction and oligohydramnios (deficiency of amniotic fluid) occurs (<3rd percentile). a Potter syndrome with pulmonary hypoplasia or fetal structural abnormalities can also therefrom, usually in the second trimester, resulting compression and cause fetal death. Polyhydramnios or oligohydramnios is likely if the size of the uterus does not match the gestational age, or they are discovered incidentally during ultrasound which is diagnostically conclusive. Multiple pregnancy multiple pregnancy increases the risk of the following: Fetal growth restriction Preterm labor Premature separation of placenta Congenital malformations Perinatal Morbidity and Mortality After childbirth uterine bleeding and a multiple pregnancy is often at routine ultrasound in the 16th-20th SSW diagnosed. Advance Gone birth trauma Most cerebral palsy and disorders in the development of the nervous system caused by factors that have nothing to do with a birth trauma. Injuries such as damage to the brachial plexus may be derived by methods such as forceps or Saugglockenentbindung, but are often due to intrauterine forces during labor or a misalignment in the last weeks of pregnancy. A previous shoulder dystocia is a risk factor for future dystocia, and the records of birth should be evaluated in terms of the changing risk factors (eg. As macrosomia, operative vaginal delivery), which may have encouraged the violation.


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