PREGNANCY INDUCED
theres a tendency for ur diet to
HYPERTENSION
→ Hypertension Drugs: Combination
Therapy; mas marami mas maganda
kasi yung RAAS pinipigilan niya.
→ Hydramnios is amnionic fluid
→ Increase amniotic fluid = lumalaki
ang tiyan ni nanay = increase fluid =
increase BP;
- just like RAAS, naactivate
RAAS dahil may increase
blood volume.
→ ↓ fluid vol. = Activation of RAAS
→ ↑ fluid vol. = Diuresis to normalize
BP
→ PROTEINURIA: the more na
maraming pressure sa dugo, the
more mas pipilitin na bumilis ang
blood flow. Pag pinilit, there will be
forceful vasodilation, leading to
Endothelial injury.
→ Kapag forceful vasodilation,
tuloy-tuloy pa rin ang pag-filter ng
dugo sa kidney, however, the
by-product of that
PROTEIN-ALBUMIN
→ HTN usually happens in 2nd and 3rd
trimester bcos mas lumalaki ang
bata,mas malakas ka kumain, and
increase ur BP
→ DM1 can’t be converted to DM2
bcos they r different:
- DM Type 1: Genetic
- DM Type 2: Diet
→ Can have both DM’s if bata palang
diagnosed na as DM 1, and noong
nabuntis at nagkaroon din ng DM 2
Common board question:
→ Antidote for Magnesium Sulfate IM:
Calcium Gluconate
→ Seizure precaution:
- If may seizure usually ulo
nagalaw, and yung px ay
naglalaway; pwede malulon
ang px sa laway, so possible
cause for obstruction
- Always side-lying position
bcos if yung laway nalululon,
it can cause obstruction
leading to Aspiration.
→ Ready suction machine bcos px can
have aspiration.
is
HYPEREMESIS GRAVIDARUM
→ Extreme

→ vomiting center in the brain: AREA

POSTREMA of your brain (induces
vomiting), but the hypothalamus
(master gland) controls it.
→ Nausea and vomiting due to
pregnancy, usually after the 1st
trimester.
→ IUGR (Intrauterine Growth
Restriction ): hindi tumutuloy ang
growth sa loob.

1. RAPID INCREASE AND

EXCESSIVE SECRETION OF
HUMAN CHORIONIC
GONADOTROPIN (HCG)
→ Kaya nagpapasitive sa pregnancy
kasi may present ng HCG. Dito may
*Palitan yung fluids ng isotonic solution*
excessive secretion ka that can
→ Pwede D5 fluid (hypertonic): fluid
cause H-mole.
retention.
→ Isa sa mga common cause of
- Hypertonic sucks water so
Hyperemesis Gravidarum is H-mole
pwedeng magretain ang
bcos every vesicle in H mole
water, and hindi agad
contains HCG, and it will contribute
matapon
to possible nausea and vomiting.
→ Pwede isotonic: fluid replacement
2. STIMULATION OF TSH (THYROID
STIMULATING HORMONE)
RECEPTOR
- Iniistimulate ang TSH para
lumabas ang thyroid
hormone to stimulate the
metabolism.
Indicators: - If there rapid increase in
→ Weight gain= fluid retention excessive secretion of hCG,
→ Weight loss = fluid loss it will trigger hypothalamus to
 release TSH for fever. After 3. Pampababa or taas ng acid
that, TSH will trigger thyroid material
hormone to release T3, and 4. Prevent excess adic to
T4. If may meron ka nito happen
magkakaroon ka ng → Kapag nawala ang bicarbonate,
nawawala ang acidity kaya nagiging
3. TRANSIENT HYPERTHYROIDISM alkalosis kaya para maging acidic,
OF HYPEREMESIS GRAVIDARUM maglagay ka ng bicarbonate
(THHG)
9. DEHYDRATION
The Hypothalamus also triggers the → If u have nause and vomiting,
4. STIMULATION OF AREA magkakaroon ka ng cell dehydration,
POSTREMA (AP) OR and pwedeng mangyari is lack of
CHEMORECEPTOR TRIGGER fluid volume leading to
ZONE (CTZ)
→ To induce 10. OLIGURIA
→ Compensatory mechanism:
5. NAUSEA AND VOMITING > 3 TO 4 - If u have n/v = cell
TIMES DAILY dehydration = lack of fluid vol
→ Suka ng suka ang px, so ang = oliguria (hirap umihi) =
nawawala ang kinakain mo na thirst mechanism = increase
nagcocontain ng vitamins, mineral, fluid vol = freq urination
and electrolytes. So magkakaroon
ng 11. STARVATION
→ Gutom si cell = lack of energy =
6. ELECTROLYTE IMBALANCE pwede mamatay DNA and
→ Pwede ka magkaroon ng kahit MITOCHONDRIA (called injury) =
anong deficiency but ang inflammatory response = liver injury
pinaka-common is Hypokalemia.
12. LIVER INJURY
7. METABOLIC ALKALOSIS pH>7.45 → kwento mo inflammatory response,
WITH HYPOKALEMIA dulo non, metaplasia leading to
→ Metabolic = Metabolism; Alkalosis = scarring so sa bawat peklat sa atay,
decrease sodium bicarbonate nagrerelease ito ng enzyme na
LIVER TRANSAMINASE na
8. COMPENSATORY INCREASE IN nagsasabing, “Ikaw ay may injury sa
HCO3 (BICARBONATE) liver”.
→ Ang compensation is itaas si Sodium
Bicarbonate. 13. INCREASE LIVER
→ Sodium bicarbonate main TRANSAMINASE
function: → Ang trabho ni liver is to releases bile
1. Decrease in acid content kung saan ito ang tumutunaw sa
2. Neutralize acid taba. Yung taba pagnatunaw, yung
bile magiging bilirubin. Yung bilirubin
 ireremanuacture sa liver, babalik
para possible na gamitin ulit para
maging bile, but the problem…….
→ Para kang nagtatapon sa basura,
kaso sarado ang tapunan ng basura
so no choice ka kundi iwan ito dun.
Mag-aaccumulate yung basura sa
isang area, so kapag walang
kumuha ng basura, maiipon iyon,
and ang tawag dito is Bilirubin

14. IMPAIRED BILIRUBIN

CLEARANCE
→ Kapag walang kumuha kay bilirubin
at naiwan sa dugo, and since its
color is yellow, it will lead to
jaundice.

15. JAUNDICE
→ phy ass/ clin manif: yellowish sclera,
yellowish nail beds, and other signs

16. WEIGHT LOSS (5% OF BODY

WEIGHT)
→ Weight loss = matic gets reserve
energy which is fats = body undergo
lipolysis [sa dm1, end product nito
ay ketones, which is ur reserve
energy but will form ketone leading
to ketonuria] = fat loss = presence of
ketone in urine + weakness.

17. SOME DIAGNOSTIC RESULTS:

1. ELEVATED KETONES IN
URINE
2.ELEVATED HCG,
3.HYPOKALEMIA, LOW
HCO3
4. DEHYDRATION
HYPEREMESIS
GRAVIDARUM

18. HYPEREMESIS GRAVIDARUM

- Placenta: rich in bv. If there is an
alteration in the placenta, the
manifestation is bleeding
- Placenta Previa: Position of
Placenta.
- Bata muna bago placenta

- Low lying: pwedeng normal

- Ready pa rin OR since this could still
move that can be partial or complete
placental previa
- *cervix can be further traumatized
when inserted with penis/finger
during ie. nabulabog placenta kasi
yun pala ung presenting
- Placenta may myoma sa loob, if part/nakaharang sya sa ulo ng bata.
lumalaki ang myoma, nauusog ang Tendency is mother will bleed but is
placenta. painless. Pero kung masakait, it
- BP increases bcos of smoking,. If means placenta is alr moving
there is pressure …. downwards. Matic CS pag partial or
- Mono: isa lang ang sex complete
- Kung sino ang unang kumapit, siya
ang magccause ng blockage sa
placenta

- Placenta previa is not a disease, a

condion only cause by several - Uterine atony: hindi nagccontract
factors. Ex. hypertension; dahil sa ang uterus
pressure, nagccause ng movement - Bed rest: to lessen the separation of
of placenta to low uterine segment. placenta
Nagkaroon ng hypertension dahil sa - Kapag ang previa presented is
DM. complete, automatically cs. But if
marginal pwede pa NSD
- Bright red; fresh blood: previa
- Dark red: abortion
- Pag pumutok ang plaenta,
malulunod ang bata. And
 macoconsider na foreign bodies na 10. PARTIAL PLACENTA PREVIA
itu. 11. MARGINAL LOW-LYING
PLACENTA PREVIA

1. ADVA……….
- These lead to
2. IMPLANTATION OF THE EMBRYO
IN THE LOWER (CAUDAL)
UTERUS
3. PLACENTAL GROWTH AND
ATTACHMENT
4. GROWTH OF THE PLACENTAL
TOWARD THE INCREASED
BLOOD SUPPLY AT THE FUNDUS
5. MIGRATION OF THE PLACENTA IN
THE LOWER UTERINE SEGMENT - Placenta previa + Hypertension =
6. INTERCOURSE, VAGINAL EXAM, abruptio
LABOR - Bright red: intact placenta /previa
7. PAINLESS VAGINAL BLEEDING - Dark red: abruptio placenta
(3R TRIMETER) - Considered foreign body that
8. TRANSVAGINAL ULTRASOUND could lead to
TO CONFIRM THE LOCATION OF
THE PLACENTA
9. TOTAL PLACENTA PREVIA
KALAT KALAT BV, NAGLATERNATE CLOT
AT BLEEDING