Book of Medical Disorders in Pregnancy - Tintash

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also affects depth resolution and this may depend upon the energy with which the transducer is struck and the physical characteristics of the transducer backing. Finally the resolution of the cathode ray tube, the film which is used to photograph, and the electronic or mechanical calipers. Which are used to make the measurement will all affect the accuracy of the measurement. A realistic attitude toward the inherent limitations of measurements is extremely necessary and should be adopted by the practicing obstetrician. Applications in obstetrics - The results of ultra sonograms must be carefully correlated with clinical considerations in the individual patient. Like most diagnostic aids it is not fool proof. Estimation of gestational Age - Assessment of gestational age is the most common indication for ultrasound examination of pregnant women. An accurate estimation of gestational age is useful in very pregnancy. Some patients do not remember their last menstrual period correctly. They may conceive during post pill or lactational amenorrhoea or have irregular menstrual cycles. In cases where pregnancy is complicated with diseases such as nephritis, diabetes or hypertension, it is desirable to deliver the fetus at the earliest possible moment consist ant with fetal maturity. When intrauterine fetal growth retardation occurs, an earlier assessment of gestational age avoids confusion and on serial measurements assistant with dates i.e. those with hydramnios, oligohydramnios, multiple pregnancy or obese. Gestational age can be adequately determined by ultrasonography. 213 It has been suggested that all patients have a routine ultrasonic examination in the second trimester. So that an accurate assessment of gestational age is made and fetal and placental status can be studied. In may opinion this is not justified. Historically the gestational age was assessed by measurement of fetal sac volume in very early pregnancy. This has been largely abandoned in favour of measurement of crown rump length between 7 to 11 weeks which provides accuracy of plus minus four days. Unusual sources of error are over flexed fetal attitude when the gestational age may be under assessed and inclusion of yolk sac in the measurement when it may be over estimated. Early pregnancy - Diagnosis of pregnancy may be made from as early as 6 weeks. A round fluid containing sac is seen in the uterus which is often referred in books as the gestational sac. At about 8 weeks after the last menstrual period this is visible as disc like structure, one should be able to see the embryo in the amniotic cavity at this stage. The placenta can frequently be identified as early as the eighth week but is relatively easy to see by the 11 th to 12th week. By the 10th week it is possible to identify the fetal heart beat using high sped realtime equipment. Abortion - This may be threatened, missed, complete, or incomplete. All of these can be differentiated with the help of ultrasound. The absence of an embryo in the gestational sac after 8 weeks is a reliable finding. Similarly real time scanning which fails to show heart beat can heir to rule out viable pregnancy.
Even when an embryo is present it cannot be concluded that the gestation is viable unless the embryo is observed to move. If the uterus is empty the diagnosis of complete abortion can be made. Ectopic pregnancy - Sonar may help in detecting a chorionic plate at an ectopic site and the presence or absences of an intrauterine pregnancy. The accuracy with which the diagnosis of ectopic pregnancy can be made by ultrasound is controversial. The most common condition confused with ectopic pregnancy is an intrauterine pregnancy with a corpus luteum cyst of the ovary. In both conditions the patient presents with lower abdominal pain, positive pregnancy test and a tender adnexal mass. Even blood may be aspirated from the culdesac in some cases. If an intrauterine gestation can be demonstrated the diagnosis of ectopic pregnancy can be excluded with confidence. The diagnosis of an ectopic pregnancy cannot be excluded simply because an extrauterine gestation has not been identified. In about one third of ectopic pregnancies the urine pregnancy test is negative. However, analysis of serum beta sub unit of chorionic gonadotropin is always positive. Ectopic or intrauterine, gonadotropin activity can 'persist for weeks after abortion therefore this test is not very helpful in diagnosing ectopic pregnancy. Multiple pregnancy: This may be diagnosed from 8 weeks on wards. Two or more gestational sacs are seen on sonography. Fig16.4: Shows fetus in utero in ultrasound scan. 214 Hydatidiform mole - The ultrasonic appearance of a mole reflects the gross pathological appearance. The individual solid elements are separated by fluid space. The mole resembles an edematous placenta on ultrasonography. The fetal sac may be absent. An atypical mole can be differentiated from an incomplete abortion, with considerable difficulty. The history physical findings and chorionic gonadotropin levels should be reviewed before diagnosis of hydatidiform mole is made. Typical hydatidiform mole is sometimes easy to recognize. The hydropic villi in utero can be observed without difficulty. The enlarged uterine cavity is com-pletely filled with echoes resembling an extremely thick edematous placenta. Enlarged cystic ovaries (lutein cysts) may also be observed on either side of the uterus in these cases and thus make the diagnosis easy. Late Pregnancy - Ultrasonography can be very helpful in differentiating multiple pregnancy Poly-hydramnios and pelvic tumors. In these conditions the uterus is clinically larger than dates. Fetal biparietal diameter measurement:
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MEDICAL DISORDERS IN PREGNANCY M. S
Page 4 and 5:
PREFACE Almost all medical disorder
Page 6 and 7:
Dedication This manuscript is dedic
Page 8 and 9:
Uri. Elkayam MD Professor of Cardio
Page 10 and 11:
Chapter No: 1 Anaemia in pregnancy:
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performance. Tiredness, listlessnes
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pregnancy and labour. The monthly b
Page 16 and 17:
Fig 1.3: Shows developmental stages
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Prophylactic this includes routine
Page 20 and 21:
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
Page 26 and 27:
Labor/delivery: Expedite for normal
Page 28 and 29:
Risk factors: The risk of GDM incre
Page 30 and 31:
to a large extent on the measure of
Page 32 and 33:
vomiting, or through intercurrent i
Page 34 and 35:
largely related to the problems of
Page 36 and 37:
femoral epiphyses can help in asses
Page 38 and 39:
in a randomized design the efficacy
Page 40 and 41:
of the previous day’s dose of ins
Page 42 and 43:
women with vascular disease are awa
Page 44 and 45:
Chapter No 3 THYROID DISEASE IN PRE
Page 46 and 47:
such as phenobarbitone 30 mg given
Page 48 and 49:
REFERENCES: 1. Hawe, P. and Francis
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Incidence - Its incidence varies ac
Page 52 and 53:
cerning the disturbance in the Reni
Page 54 and 55:
Renal function: In normal pregnant
Page 56 and 57:
severe pre eclampsia and eclampsia
Page 58 and 59:
Epipastic pain: It is also a late s
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arely occurs. However, if pregnancy
Page 62 and 63:
differentiating between chronic hyp
Page 64 and 65:
fetuses. Recent studies indicate th
Page 66 and 67:
to procrastinate all available meth
Page 68 and 69:
cases are said to occur up to 1 wee
Page 70 and 71:
has been carried out. There can be
Page 72 and 73:
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
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scan, 0.004 Gy; pulmonary angiograp
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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
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owel, but conjugated bilirubin is n
Page 122 and 123:
Hepatic causes - Viral hepatitis bo
Page 124 and 125:
Immunoprophylaxis at birth followed
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
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Induction of labour: When screening
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Blood brain barrier and bilirubin e
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place if the infant develops jaundi
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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
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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
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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
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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
Page 174 and 175: Chapter No: 13 VIRAL DISEASES IN PR
Page 176 and 177: after exposure favors but does not
Page 178 and 179: Fig13.4: shows CMV infection rash o
Page 180 and 181: three quarters of HYH strains isola
Page 182 and 183: where 'T' stands for toxoplasmosis
Page 184 and 185: Chapter No: 14 Introduction: The dr
Page 186 and 187: hexacyanoferrate (II) 2H2O (Prussia
Page 188 and 189: Restricted indications: Anti lepros
Page 190 and 191: potential Teratogen and inhibits ma
Page 192 and 193: placental abruption, and intrauteri
Page 194 and 195: Inhalation of volatile organic comp
Page 196 and 197: Chapter No: 15 Pregnancy is a norma
Page 198 and 199: time periods during the pregnancy f
Page 200 and 201: y the maternal kidney in urine or b
Page 202 and 203: continues after the end of the uter
Page 204 and 205: Amniography - In this technique rad
Page 206 and 207: at the cranial end of the neural tu
Page 208 and 209: least maceration: placenta, lung, a
Page 210 and 211: fetal hydrops with monosomy X, or T
Page 212 and 213: cause progressive renal failure as
Page 214 and 215: 9. Papageorgiou, E.A.; Karagrigorio
Page 216 and 217: position of the head. The student s
Page 218 and 219: centimeter ruler is placed alongsid
Page 220 and 221: echoes in B mode. The operator appl
Page 224 and 225: From twelve week onwards the bipari
Page 226 and 227: tract. Normal kidneys can easily be
Page 228 and 229: 3.19, 1.29 and 1.30, respectively [
Page 230 and 231: iodinated contrast during pregnancy
Page 232 and 233: Only tiny amounts of iodinated or g
Page 234 and 235: intraperitoneal hemorrhage, or inju
Page 236 and 237: REFERENCE: 1. Stewart A, Webb J, Gi
Page 238 and 239: cardiac defects 181, 200 cardiac di
Page 240 and 241: gestational age 26, 31, 40, 165, 19
Page 242 and 243: monitoring, invasive 83-6 monosomy
Page 244 and 245: sensitization 124-5 sepsis 22, 95-6
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