Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of...
Transcript of Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of...
![Page 1: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/1.jpg)
Medical disorders in pregnancy
Dr. Mrs. Choudhari
![Page 2: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/2.jpg)
Aims of teaching
• Overview of different medical disorders in pregnancy
• Discuss common medical disorders in pregnancy
![Page 3: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/3.jpg)
Types of medical disorders
• Hypertensive disorders in pregnancy• Heart Disease • Thromboembolic disease• Respiratory disease• Diabetes• Thyroid and parathyroid disease• Connective tissue disease• Neurological problems- Epilepsy
![Page 4: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/4.jpg)
Contd.
• Renal disease• Liver disease• Gastrointestinal disease• Haematological problems• HIV and other infectious diseases• Drug substance misuse & Alcoholism• Psychiatric Disorders • Obesity
![Page 5: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/5.jpg)
• Implications-Adverse effect on mother
-Adverse effect on fetus
-Disease
-Drugs-Prematurity
![Page 6: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/6.jpg)
Hypertensive disorders
• Chronic/Essential hypertension• Pregnancy induced
hypertension/Gestational hypertension• Pre-eclampsia• Superimposed pre-eclampsia
![Page 7: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/7.jpg)
Maternal complications
• Eclampsia• Cerebral Haemorrhage• Placental abruption• Renal failure• Pulmonary oedema• ARDS• Disseminated Intravascular coagulopathy• HELLP syndrome, liver haemorrhage and rupture• Thromboembolism• Cortical blindness
![Page 8: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/8.jpg)
Fetal effects
Fetal• Intrauterine growth restriction• Intrauterine death• Iatrogenic preterm delivery
![Page 9: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/9.jpg)
Diabetes in pregnancy
• Pre-existing diabetes• Gestational diabetes
Maternal Effect of diabetes-Increase in insulin requirements
-Hypoglycaemia-Deterioration of diabetic nephropathy and retinopathy
- Infections- UTI, Vaginal candidiasis, wound infection-Diabetic ketoacidosis is rare- but is a risk in the presence of hyperemesis, infection and corticosteroid therapy
![Page 10: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/10.jpg)
Fetal effects of Diabetis
Fetal/Neonatal effects• Miscarriage• Congenital anomalies- anencephaly spina bifida,
cleft lip/palate, GI atresias, heart defects and sacral agenesis.
• Large for gestational age/macrosomia• Birth injury:clavicle fracture, Erb’s palsy.• Hypoglycemia• Hypocalcemia• Respiratory distress syndrome
![Page 11: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/11.jpg)
Epilepsy in Pregnancy
• Maternal effect-Deterioration in seizure control (poor drug compliance, hyperemesisgravidarum)
- Anaemia secondary to folate deficiency
• Fetal effect-No increased risk of miscarriage-Increased risk of congenital anomalies (4%)-Increased risk of epilepsy in the child (4%) -All anticonvulsants cross the placenta and are teratogenic. Major malformations are neural tube defects, orofacial clefts and congenital heart defects. - Breast feeding is safe while taking anticonvulsant
![Page 12: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/12.jpg)
Renal diseases in pregnancy
• Asymptomatic Bacteriuria• Urinary Tract Infection
- Risk of Acute Pyelonephritis, Preterm labour- Amoxycillin and Cephalosporins are appropriate
• Chronic Renal DiseasesMaternal effects- Possible accelerated decline in renal
function, escalating hypertension, worsening proteinuria and pre-eclampsia.
Fetal effects- Miscarriage, Pre- eclampsia, IUGR, preterm delivery and intrauterine fetal death.
![Page 13: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/13.jpg)
Thyroid disorders
• Hyperthyroidism-Untreated hyperthyroidism is dangerous for mother and the baby
-lowest possible dose of antithyroid drug (≤ 15 mg Carbimazole and ≤ 150mg propylthiouracil) should be used as high doses may cause fetal hypothyroidism and goitre. Women may safely breast feed on these doses.
- Beta blockers are safe to use. - Neonatal or fetal thyrotoxicosis due to transplacental passage
of thyroid stimulating antibodies is rare.
![Page 14: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/14.jpg)
Hypothyroidism
• Hypothyroidism-Untreated hypothyroidism is associated with infertility, an increased risk of miscarriage , and fetal loss.
- For those on replacement therapy, maternal and fetaloutcome is usually good and unaffected by hypothyroidism.
- Very little thyroxine crosses the placenta and the fetus is not at risk of thyrotoxicosis from maternal T4 replacement therapy.
![Page 15: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/15.jpg)
Thromboembolic disorders
• Thromboembolism is commonest cause of death in pregnancy and puerperium in UK.
• Pregnancy is associated with increased risk of thrombosis. The risk increases with increasing maternal age. Emergency C.Section is associated with a greater than 20 fold increased risk of dying from pulmonary embolism compared to spontaneous vaginal delivery.
• Treatment is as for non-pregnant patient(Low molecular weight heparin). Warfarin is teratogenic and should be avoided in pregnancy, especially in first trimester. Heparin and Warfarin are safe to use in breast feeding mothres.
![Page 16: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/16.jpg)
Connective tissue disorders
• Systemic lupus erythematosus- Risk of flare during pregnancy. Disease flare must be actively managed.Corticosteroids are the drug of choice.
-Adverse outcome is related to the presence of renal involvement,hypertension, antiphospholipid antibodies and disease activity. Thesefactors increase the risk of miscarriage, fetal death, pre-eclampsia,preterm delivery and IUGR.
-Risk of transient cutaneous lupus and the risk of congenital
heart block in fetus.• Rheumatoid arthritis• Antiphospholipid antibody syndrome
![Page 17: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/17.jpg)
Haematological Disorders
• Anaemia
• Haemoglobinopathy
• Thrombocytopenia
![Page 18: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/18.jpg)
Obesity
• Maternal effects-Hypertension- Diabetes-Thromboembolism-Dysfunctional labour, increased intervention-Anaesthetic risk
• Fetal effects-Congenital anomalies (Neural tube defects)-Macrosomia-Birth injuries-Intrauterine fetal death
![Page 19: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/19.jpg)
Drug Misuse
• Congenital fetal anomalies• Low birthweight• Neurodevelopmental delay• Placental abruption and intrauterine death• Blood-borne virus infection• Difficult venous access• Increased risk of thromboembolism
![Page 20: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/20.jpg)
Maternal Infections
Maternal Infections• Cytomegalovirus• Toxoplasma gondii• Herpes virus• Parvovirus• Rubella• Syphilis• Group B Streptococcus• HIV• Hepatitis B & C• TB• Listeria monocytogenes• Malaria
![Page 21: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/21.jpg)
Fetal Effects
Intrauterine infections• Miscarriage or intrauterine death• Preterm delivery• IUGR• Haematological disorder- Thrombocytopenia, anaemia,
neutropenia• Congenital heart disease• Musculoskeletal disorder• Microcephaly and cerebral anomaly with
neurodevelopmental morbidity• Congenital cataract and visual impairment• Sensorineural deafness
![Page 22: Medical Disorders in Pregnancy - eastlancsdue.nhs.uk Disorders in Pregnancy.pdf · • Overview of different medical disorders in pregnancy ... • Placental abruption ... • Congenital](https://reader031.fdocuments.in/reader031/viewer/2022030503/5ab05f517f8b9aa8438e88c4/html5/thumbnails/22.jpg)
Overall Management
Multidisciplinary Management• Preconceptual counselling• Maternal monitoring , ideally in combined
medical – antenatal clinics (Obstetric Physicians)
• Fetal monitoring (Scans/Doppler)• Neonatologist to be informed early in pregnancy.• Optimisation of mode and time of delivery.• Breast feeding.• Postnatal Care.