Book of Medical Disorders in Pregnancy - Tintash

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Immunoprophylaxis at birth followed by a hepatitis B vaccination series reduces vertical transmission of hepatitis B virus to less than 3 percent. Disseminated HSV infection is associated with prodromal systemic illness, vesicular skin rash and leukopenia. Maternal and fetal mortality rates reach 50 percent without treatment. Acyclovir (Zovirax) effectively treats early disseminated HSV infection. Hepatitis B virus: In the United States, 15,000 pregnant women who are hepatitis B surface an-tigen (HBsAg)positive deliver annua-lly. 6 Universal screening of pregnant wo-men for HBsAg is now performed to reduce per inata transmission of hepatitis B virus. The risk of hepatitis B virus transmission to the fetus is proportional to maternal hepatitis B virus DNA, as reflected in hepatitis B antigen (HBeAg) and antibody (HBeAb) status. The risk of hepatitis B virus vertical transmission is 10 percent in mothers with negative HBeAg and positive HBeAb and 90 percent in those with positive HBeAg. 3,6 The risk of chronic hepatitis B virus infection in a neonate who does not receive immunoprophylaxis and vaccination for hepatitis B virus is 40 percent. Infants of HBsAg-positive mothers’ should receive hepatitis B immune globulin immunoprophylaxis at birth and hepatitis B vaccine at one week, one month and six months after birth. This regimen reduces the incidence of hepatitis B virus vertical transmission to zero to 3 percent. In cases of acute hepatitis B virus infection complicating pregnancy, the prevalence of neonatal infection depends on the time during gestation that maternal infection occurs. 115 Neonatal hepatitis B virus infection is rare if maternal infection takes place in the first trimester. The infection occurs in 6 percent of neonates of women infected in the second trimester, in 67 percent of those infected in the third trimester and in virtually all of those infected in the immediate postpartum period. 12 Neo-nates of mothers experiencing acute hepatitis B virus infection should receive immunoprophylaxis and vaccination, as outlined above. Hepatitis C virus: Chronic hepatitis C virus infection affects 1.4 percent of the U.S. population the incidence of hepatitis C virus in-fection is raising most rapidly among persons 20 to 45 years of age. Therefore, an increasing number of patients with hepatitis C virus infection are requesting information about vertical transmission of the virus during pregnancy. Patients with risk factors for hepatitis C virus infection, such as intravenous drug use or other parenteral exposures, should undergo screening for hepatitis C virus infection before pregnancy with second- or third generation hepatitis C virus antibody assays to confirm exposure to the virus. Women with documented hepatitis C virus infection who are contemplating pregnancy should be encouraged to undergo human immunodeficiency virus (HIV) testing and repeated quantitative hepatitis C virus RNA measurements to determine their probable risk of hepatitis C virus vertical transmission. exposure, the risk of hepatitis C virus vertical transmission is zero to 18 percent.
HBsAg (+) Passive and active immunoprophylaxis of newborn Fever, leukocytosis RUQ pain with or without jaundice No Yes Exclude medications, hyperemesis gravidarum Alanine aminotransferase elevation during pregnancy A marked variation in vertical transmission rates of hepatitis C virus infection has been noted, with a range from zero to 36 percent. Vertical transmission is strongly sup-ported by the finding of identical hepa-titis C virus subtypes in mothers and infants infected with hepatitis C virus.14 In hepatitis C virus positive, HIV ne-gative mothers without a history of ac-tive intravenous drug use or transfusion prenatal transmission of hepatitis C virus is Rule out viral hepatitis* Yes Review clinical context Exclude Toxins (e.g, acetaminophen overdose), hypotensive episode liver infarction or rupture. Preeclampsia associated with hemolysis, DIC, thrombocytopenia Exclude cholelithiasis or liver abscess ALT
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MEDICAL DISORDERS IN PREGNANCY M. S
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PREFACE Almost all medical disorder
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Dedication This manuscript is dedic
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Uri. Elkayam MD Professor of Cardio
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Chapter No: 1 Anaemia in pregnancy:
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performance. Tiredness, listlessnes
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pregnancy and labour. The monthly b
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Fig 1.3: Shows developmental stages
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Prophylactic this includes routine
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granulocytes and thrombocyte is als
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or because the hemoglobin A is repl
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iron. Decrease in the number of gra
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Labor/delivery: Expedite for normal
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Risk factors: The risk of GDM incre
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to a large extent on the measure of
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vomiting, or through intercurrent i
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largely related to the problems of
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femoral epiphyses can help in asses
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in a randomized design the efficacy
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of the previous day’s dose of ins
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women with vascular disease are awa
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Chapter No 3 THYROID DISEASE IN PRE
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such as phenobarbitone 30 mg given
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REFERENCES: 1. Hawe, P. and Francis
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Incidence - Its incidence varies ac
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cerning the disturbance in the Reni
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Renal function: In normal pregnant
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severe pre eclampsia and eclampsia
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Epipastic pain: It is also a late s
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arely occurs. However, if pregnancy
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differentiating between chronic hyp
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fetuses. Recent studies indicate th
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to procrastinate all available meth
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cases are said to occur up to 1 wee
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has been carried out. There can be
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intensive care room for the next 48
Page 74 and 75: Severe pre eclampsia at or remote f
Page 76 and 77: Chapter No: 5 HEART DISEASE IN PREG
Page 78 and 79: pregnancy. The increase in volume i
Page 80 and 81: Fourth Heart sound - This is rarely
Page 82 and 83: Class III - With cardiac disease pr
Page 84 and 85: differentiate from hemodynamically
Page 86 and 87: dominant). Jervell + Lange Nielson
Page 88 and 89: striking of which is stippling seen
Page 90 and 91: increase venous pressure and burden
Page 92 and 93: determine whether she will be safe
Page 94 and 95: supplemental 02. Fetal surveillance
Page 96 and 97: 11. Percutaneous transluminal angio
Page 98 and 99: ureter at the pelvic brim may play
Page 100 and 101: Fig6.3: Shows location of kidney in
Page 102 and 103: A clear cut history of streptococca
Page 104 and 105: (a) Polycystic renal disease - Fort
Page 106 and 107: with patients in this category. In
Page 108 and 109: 2. Beard, R.W.and Roberts, A.P. (19
Page 110 and 111: increases slightly. Arterial blood
Page 112 and 113: scan, 0.004 Gy; pulmonary angiograp
Page 114 and 115: CD4 + cell count (200/ml) should re
Page 116 and 117: embark upon a pregnancy. Severe air
Page 118 and 119: Chapter No: 8 LIVER DISEASE IN PREG
Page 120 and 121: owel, but conjugated bilirubin is n
Page 122 and 123: Hepatic causes - Viral hepatitis bo
Page 126 and 127: highest reported rate of vertical t
Page 128 and 129: curs in 60 to 70 percent of subsequ
Page 130 and 131: Chronic liver disease: An increased
Page 132 and 133: 22. Riely CA. Hepatic disease in pr
Page 134 and 135: ilirubin is transported across the
Page 136 and 137: when the titre is greater than 1: 3
Page 138 and 139: Induction of labour: When screening
Page 140 and 141: Blood brain barrier and bilirubin e
Page 142 and 143: place if the infant develops jaundi
Page 144 and 145: REFERENCES 1. UpToDate a. “Pathog
Page 146 and 147: of embolus formation is far less in
Page 148 and 149: Unfortunately this faculty is not a
Page 150 and 151: hours. The maximal effect takes 36
Page 152 and 153: may complain of constricting type o
Page 154 and 155: When the embolus is small and non f
Page 156 and 157: 3. Sukal S, Geronemus R. "Deep Veno
Page 158 and 159: damage specific cells in the tissue
Page 160 and 161: is capable of breaking off and deve
Page 162 and 163: Chapter No: 12 PARASITIC INFECTIONS
Page 164 and 165: sporozoite stage. The main characte
Page 166 and 167: insect repellents and insecticide s
Page 168 and 169: is 2 tablets i.e. (400 mgs) thrice
Page 170 and 171: Cardiac failure resulting from seve
Page 172 and 173: dysmenorrhea, dysuria, and even obs
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Chapter No: 13 VIRAL DISEASES IN PR
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after exposure favors but does not
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Fig13.4: shows CMV infection rash o
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three quarters of HYH strains isola
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where 'T' stands for toxoplasmosis
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Chapter No: 14 Introduction: The dr
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hexacyanoferrate (II) 2H2O (Prussia
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Restricted indications: Anti lepros
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potential Teratogen and inhibits ma
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placental abruption, and intrauteri
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Inhalation of volatile organic comp
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Chapter No: 15 Pregnancy is a norma
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time periods during the pregnancy f
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y the maternal kidney in urine or b
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continues after the end of the uter
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Amniography - In this technique rad
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at the cranial end of the neural tu
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least maceration: placenta, lung, a
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fetal hydrops with monosomy X, or T
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cause progressive renal failure as
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9. Papageorgiou, E.A.; Karagrigorio
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position of the head. The student s
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centimeter ruler is placed alongsid
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echoes in B mode. The operator appl
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also affects depth resolution and t
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From twelve week onwards the bipari
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tract. Normal kidneys can easily be
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3.19, 1.29 and 1.30, respectively [
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iodinated contrast during pregnancy
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Only tiny amounts of iodinated or g
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intraperitoneal hemorrhage, or inju
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REFERENCE: 1. Stewart A, Webb J, Gi
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cardiac defects 181, 200 cardiac di
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gestational age 26, 31, 40, 165, 19
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monitoring, invasive 83-6 monosomy
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sensitization 124-5 sepsis 22, 95-6
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Book of Medical Disorders in Pregnancy - Tintash

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