Medical Disorders With Pregnancy PDF

1 Medical Disorders With Pregnancy BY PROF. DR. MOHAMED S. FAHMY PROFESSOR OF OBSTETRICS & GYNECOLOGY HEAD OF THE OBSTETRICS & GYNECOLOGY DEPARTMENT ASWAN UNIVERSITY  2 Hypertensive disorders with pregnancy  Hyper...

1 Medical Disorders With Pregnancy BY PROF. DR. MOHAMED S. FAHMY PROFESSOR OF OBSTETRICS & GYNECOLOGY HEAD OF THE OBSTETRICS & GYNECOLOGY DEPARTMENT ASWAN UNIVERSITY  2 Hypertensive disorders with pregnancy  Hypertensive disorders with 3 pregnancy  Classification:  Hypertension: BP ≥140/90 mm Hg measured two times with at least 6-hour interval  Proteinuria: Urinary excretion of ≥0.3 g protein/24 hours specimen or 0.1 g/L  Gestational hypertension: BP ≥140/90 mm Hg for the fi rst time in pregnancy after 20 weeks, without proteinuria  Preeclampsia: Gestational hypertension with proteinuria  Eclampsia: Women with preeclampsia complicated with grand mal seizures and/or coma  HELLP syndrome: Hemolysis (H) Elevated liver enzymes (EL) Low platelet count (LP)  Chronic hypertension: Known hypertension before pregnancy or hypertension diagnosed fi rst time before 20 weeks of pregnancy  Superimposed preeclampsia or eclampsia: Occurrence of new onset of proteinuria in women with chronic hypertension  Preeclampsia 4  DEFINITION:  Preeclampsia is a multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20th week in a previously normotensive and nonproteinuric woman.  The preeclamptic features may appear even before the 20th week as in cases of hydatidiform mole and acute polyhydramnios.  Incidence : 5-8%  Preeclampsia 5 Risk factors:  o Primigravida: Young or elderly (first time exposure to chorionic villi)  o Family history: Hypertension, preeclampsia  o Placental abnormalities:   Hyperplacentosis: Excessive exposure to chorionic villi—(molar pregnancy twins, diabetes)   Placental ischemia.  o Obesity: BMI >35 kg/m2, Insulin resistance.  o Pre-existing vascular disease.  o Thrombophilias: [antiphospholipid syndrome, protein C, S deficiency, Factor V Leiden]  Preeclampsia 6  Clinical types:  Mild:  Rise of blood pressure of more than 140/90 mm Hg but less than 160 mm Hg systolic or 110 mm Hg diastolic without significant proteinuria.  Severe:   A persistent systolic blood pressure above or equal to 160 mm Hg or diastolic pressure above 110 mm Hg.   Protein excretion of more than 5 g/24 h   Oliguria (10% → ↑ CFMF)   Control of Complications "as LASER for retinopathy" {advise against pregnancy if marked renal or retinal affection, ischemic heart, or HbA 1C >10%)   Shift to Insulin (Better control, less complications, Teratogenic )  Diabetes with pregnancy 33  o Ante-natal management:   Diet control:  Caloric intake 1800 - 2400 Kcal/d (30 Kcal/kg/d ± 300 Kcal in 3rd trimester) in the form of 20% proteins, 50% complex CHO, and 30% Polysaturated fat   Insulin therapy:   Hospitalization:  Early to adjust the dose, late (36 w) for planned delivery & any time of complication   Antenatal frequency:  Every 2wks till 32°d wk, then /wk till 36th wk then hospitalize.   Investigations to detect maternal complications:   Ante-natal fetal surveillance:  Assessment of development, malformations & growth  oU/S (18-20 w for CFMF), Echo (20 - 22 w for congenital heart diseases)  Assessment of fetal wellbeing: fetal kicks, Doppler, CTG & BPP (best)  Diabetes with pregnancy 34  o Intra-partum management   Control during labor:  IV drip of glucose if hyperglycemia occurred give insulin OR 5% glucose+ 5 units crystalline Insulin every 5 hrs   Timing of delivery:  At 38 - 40 wks after assessment of fetal maturity  In repeated unexpected IUFD → termination before date of IUFD by 1-2 w   Method:  If no macrosomia or other indications of CS → vaginal delivery   Care of newborn: (in NNICU +EXPERT NEONATOLOGIST)  35 Anemia with pregnancy  Anemia with pregnancy 36  Iron deficiency anemia with pregnancy  Physiology :  o This is the most common type of anemia, is the commonest pregnancy disorder  o "WHO recommended 30 - 60 mg/d for pregnancy with adequate Fe stores & 120 - 240 mg/d for pregnancy with inadequate Fe store"  o Daily absorption is 10% of supplied iron, 20% in pregnancy   Non-pregnant → l-2mg.   Early pregnancy → 2-5m.   Late pregnancy → 5-6mg.  Iron deficiency anemia with 37 pregnancy   Causes of iron deficiency anemia  o Increased demand: e.g. in pregnancy.  o Decreased intake: e.g. diet deficiency, vomiting  o Increased loss: e.g. parasitic infestations, piles.   Clinical picture  o Symptoms & signs :  Angular stomatitis, Red glazed tongue, brittle nails, splenomegaly, headache, fatigue Iron deficiency anemia with 38 pregnancy To diagnose anemia: Hb% < 10.5 g% To diagnose iron deficiency: Investigation Blood picture → Hypo chromic microcytic anemia. s: Serum iron: ↓ (N =60-180 µg/dl) Serum ferritin decrease (reflects BM stores) < l0 ng /ml (1st abnormal test)  Iron deficiency anemia with 39 pregnancy  Treatment  o Prophylactic:   Oral preparations (30 - 60mg/day) &eradicate any predisposing factors.   Forms: Fe++ fumarate, Fe++ gluconate, Fe++ sulfate  o Active TTT   Oral iron 120-240 mg/d (0.3-1 gm/wk)+ Folic acid [masked foliate deficiency].   Parental iron: If No response to oral therapy or intolerance (Nausea, vomiting, diarrhea). SC →allergy, IM →painful & sterile abscess, IV →thrombophlebitis   If failed or severe anemia →Transfusion of packed RBCs  40 THANK YOU