Women’s health in pregnancy and post- partum Michelle Wise BSc MD FRCSC MSc Senior Lecturer,...
Transcript of Women’s health in pregnancy and post- partum Michelle Wise BSc MD FRCSC MSc Senior Lecturer,...
Women’s health in pregnancy and post-partumMichelle Wise BSc MD FRCSC MSc
Senior Lecturer, Department of Obstetrics & Gynaecology, U of AConsultant Obstetrician & Gynaecologist, National Women’s Health, ADHB
Outline
• Iodine supplements in pregnancy• Nausea and vomiting of pregnancy• First trimester screening• Gestational weight gain• Planning a VBAC• Postnatal contraception
Iodine supplement
• Essential for normal brain development• Moderate iodine deficiency and goitre found in
12/170 pregnant women nationwide (Pettigrew et al. 2006)
• Iodine levels of breast-fed infants < half that of formula-fed infants (Skeaff 2005)
• Choose iodised table salt at home
Nausea and vomiting of pregnancy
• Don’t forget vitamin B6 (pyridoxine)
First Trimester Screening (FTS)
• Offered routinely to all pregnant women regardless of age
• Combines: – Maternal age– Nuchal translucency at 11 - 13+6 weeks– PAPP-A and free βhCG at 9 – 13+6 weeks
Maternal Serum Screening, by age
Ontario Women’s Health Equity Report 2010
FTS
• 85-90% of Down syndrome pregnancies are detected using FTS, compared to:– 50% with age alone– 75% with MSS
• 5% of screening results will be “↑ risk”– To be followed by discussion of options for diagnostic
testing and clinical management
• 98% of “↑ risk” babies will be unaffected
RANZCOG “A Decision Aid: Testing in pregnancy for fetal abnormalities”
FTS
• If twins, need to know chorionicity to correct MoM values of blood tests
• Additional factors that modify aneuploidy risk assessment:– Previous pregnancy w T21 or T18– Assisted reproduction– Maternal weight
Obesity in Pregnancy
Obesity in pregnancy– Set goals for gestational weight gain– Early diabetes testing
• add HbA1c and fasting 2h OGTT to booking bloods to exclude T2DM
– Measure weight at each visit– Monitor for maternal and fetal complications
• GDM, HTN, stillbirth, C/S, PPH)– Timely referral
Centre for Maternal and Child Enquiries 2010: Guideline on management of women with obesity in pregnancy
Gestational weight gain
BMI Institute of Medicine 2009 guidelines
Normal 11-16 kg
25-29 7-11 kg
30 or more < 9 kg
Limited or no weight gain in obese women is associated with improved pregnancy
outcomes
Planning a VBAC
• What is the risk of uterine rupture in women having attempt at Vaginal Birth After Caesarean (VBAC)
Risk of uterine rupture with VBAC attempt
• Bujold et al. 2002 – 1,527 women w 1 prev C/S having TOL– Cohort study with chart review
• Bujold et al. 2010– 1,768 women w 1 prev C/S having TOL– Cohort study with chart review
Inter-delivery interval, months
Inter-delivery interval, months
Planning VBAC
• 2o analyses from two large multicentre studies further support ↑ risk for rupture with shorter inter-pregnancy intervals
• Conclusion: important to counsel and provide effective contraception post-caesarean
Lactational Amenorrhea Method (LAM)
• 98% effective during first 6 months if all 3 criteria met:– Menses have not returned– Exclusive breastfeeding– Baby feeding during the night (< 6 hrs)
• When to start COC
LAM Interagency Working Group www.irh.org
Planning VBAC
For more information:
• www.ranzcog.edu.au• www.rcog.org.uk• www.healthed.govt.nz• www.consensus.nih.gov/2010/vbac.htm• www.nationalwomenshealth.adhb.govt.nz• Or contact me [email protected]• Or attend:
– Update in Women’s Health for Primary Care (12 November 2011)
– Postgraduate diploma in Obstetrics and MedicalGynaecology