Book of Medical Disorders in Pregnancy - Tintash

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iron. Decrease in the number of granulocytes and platelets may also accompany these changes. The bone marrow is normoblastic with hypoplasia of the red cell precursors. The ratio of red cell series to white cells falls from the normal 1: 3 or 1:4 to 1:6. Treatment: The student should realize that Iron deficiency is not a feature of sickle cell disease therefore administration of iron will not influence the anemia. Folic acid deficiency is a common feature therefore supplementation with 5 mgm of this vitamin will go a long way in combating with this condition. Blood transfusion should not be given unless the hemoglobin falls below 6 g per cent. When painful infarct ive crisis are present, sodium bicarbonate in divided doses should be given. Intr-avenous injection of 2 ml of 50 per cent magnesium sulphate four hourly will usually relieve this pain. When infarction in any organ or tissue is suspected heparinization should be carried out without delay. Thalassemia: In this disorder there is a failure in the synthesis of either the or peptide chains from which the globin of adult hemoglobin (A) is formed. Depending on which chain is affected, two types of thalassemia are recognized i.e. the alpha thalassemia and Beta thalassemia. In the homozygous patient the disease presents as thalassemia major, where the pigment in the red cell is totally hemoglobin F or the fetal form of hemoglobin and thalassemia minor where adult hemoglobins A and A2 are present. 15 Clinical features - In this condition the life span of the red cells is greatly shortened therefore these patients present with severe hemolytic anemia. They are physically stunted, their spleen is enlarged and they have great tendency to acute infection. A few patients live be-yond the age of adolescence therefore pregnancy is very rarely seen amongst these women. Thalassemia minor - This is the heterozygous form of the disease. In this disorder some hemoglobin A is present with hemoglobin F and A2 in the red cells. The A2 hemoglobin does not normally exceed 2 to 3 per cent of the total pigment. Sometimes this may increase up to 10 per cent. Sickle cell trait and thalassemia minor may coexist in the same patient. Blood picture- The red cells are hypochromic unusually thin and mechanically fragile. This results in hemolytic anemia. Although hypoch-romia is present there is no iron deficiency. Serum iron is usually normal. If there is chronic blood loss from any cause then iron deficiency may exist. The hypochromia is due to failure to manufacture sufficient hemoglobin A. There is vigorous cellular activity of the bone narrow. The reaction is normoblastic. This activity may lead to depletion of the body's stores of folic acid. The cells are hypochromic, microcytic and show anisocytosis and poikilocytosis. Treatment: Treatment with blood transfusion is given when there is history of acute blood loss otherwise folic acid in large doses is usually sufficient. Iron is
generally useless because the patient is usually not deficient in iron. Management options: Thrombocytopenia: Gestational: Exclude pathological causes, Monitor platelet count, No specific management if >100 *10’/1 if rapid fall or count below 50*10’/1 reevaluate for pathological causes, cord blood at delivery and ensure maternal count returns to normal Autoimmune thrombocytopenia (AITP) Pre pregnancy: Optimize management, consider splenectomy. If all therapy fails counsel regarding risks in pregnancy Prenatal: Serial platelet counts. Treat if platelet count 50*10’/1. For delivery options for treatment. Steroids IVlg. Splenectomy Azathioprine if all else fails Labor and delivery: Avoid traumatic delivery, fetal scalp electrodes and Fetal scalp blood sampling, platelets available if count 80*109/1 prompt perineal repair. Postnatal: Cord blood for fetal platelet evaluation pediatrician at delivery, consider daily neonatal FBC if thrombocytopenic (nadir day 2-5). 16 Secondary Autoimmune: Thrombocytopenia: Antiphospholipid syndrome/systemic lupus erythematosus Manage thrombocytopenia as for AITP Screening, diagnosis and management of other complications HIV thrombocytopenia, platelet counts improved by IVIg, Zidovudine, and corticosteroids. (But secondary infection risk), cesarean section will need to be covered by IV Platelets if refractory thrombocytopenia Drug-induced thrombocytopenia stop drug and choose alternative. Alternatives for heparin-induced thrombocytopenia include danaparoid. Non-immune platelet consumption: Disseminated intravascular coagulation, Preeclampsia/HELLP. Thrombotic thrombocytopenic: purpura: Plasma exchange is first line treatment fresh frozen plasma infusion is second line treatment. Avoid platelet transfusion Management options acute leukemia: Hematological malignancies: Pre pregnancy: Counsel about prognosis, Advise against conception until in remission and not on chemotherapy. Prenatal: Start chemotherapy as for non pregnant supportive therapy (blood, platelets, antibiotics, etc.). Careful counseling, especially if treatment commenced in first trimester. Monitor fetal growth and health.
Page 2 and 3: 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:
Page 12 and 13: performance. Tiredness, listlessnes
Page 14 and 15: pregnancy and labour. The monthly b
Page 16 and 17: Fig 1.3: Shows developmental stages
Page 18 and 19: Prophylactic this includes routine
Page 20 and 21: granulocytes and thrombocyte is als
Page 22 and 23: or because the hemoglobin A is repl
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
Page 50 and 51: 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
Page 60 and 61: 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
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 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
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
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 222 and 223:
also affects depth resolution and t
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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Book of Medical Disorders in Pregnancy - Tintash

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