Book of Medical Disorders in Pregnancy - Tintash

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to a large extent on the measure of control of diabetes. If properly controlled, the fetal complications may be eliminated. 1. Women should be encouraged and supported to monitor their blood glucose levels regularly and to adjust their insulin dosage, in order to maintain their blood glucose levels within the normal (non diabetic) range. The aim should be for the woman to maintain her HbA1c below 7.0%. Evidence Level = IV/C [Diabetes NSF – Intervention details] 28% of women who had a glycol ate hemoglobin (HbA1c) measurement before pregnancy had a value of less than 7%. 38% had HbA1c
Infant - There is an increase in rate of intrauterine as well as neonatal death. Neonatal morbidity increases due to prematurity, birth trauma, congenital anomalies, respiratory distress syndrome and hyperbilirubinemia. Carbohydrate metabolism alteration is associated with increased glucose environment in utero and sudden withdrawal of glucose at delivery produces subsequent hypoglycemia in the neonate with blood sugar less than 20 mgm per cent. Apneic spells, neuromuscular irritability and sepsis are common. The effect of pregnancy on diabetes: The most obvious change is the increase in endocrine activity. There is hyperactivity of the pituitary, adrenal, thyroid, parathyroid, pancreatic, ovarian and placental hormones. There are also alterations in hepatic chemistry which maintain the appropriate energy transformations, release of intermediary metabolites, and regulation of proper levels of circulating hormones. These metabolic adjustments induced by pregnancy are similar to the adaptive changes which occur when any urgent requirement for energy is presented to the body. The effect of diabetes on pregnancy can be summarized as follows: Mother - There is increased abortion rate which varies with duration of diabetes mellitus and vascular lesions. Hydramnios favors premature rupture of membranes, and incidence of premature delivery is increased, toxemia is also increased, and control of diabetic becomes considerably difficult during pregnancy. Ordinarily, most energy needs are provided by normal carbohydrate metabolism. However, demands of pregnancy 22 require addition of glucogenic mechanisms. These include increased secretion of adrenocorticoid trophic, growth, and thyroid hormones, as well as adrenal glucocorticoids. These factors may be regarded as glucogenic, ketogenic, and glycosuric in their activity and are therefore contra insulin in their effects. In the normal individual, the increase in contra-insulin factors is compensated by an increase in the secretion of insulin, as evidenced by the hypertrophy of the pancreas which occurs in the pregnant state. However, the individual with an inherent defect of the pancreas cannot adapt to the increased demand for insulin to counteract the effect of elevated contra insulin factors. As a result a reduced capacity for adjustment will be manifested by glycosuria and a reduction of glucose tolerance. The most obvious effect of pregnancy is the response of the diabetic to insulin. In the first trimester, sensitivity to insulin increases, and hypoglycemia readily occurs. The warning signs and symptoms diminish in intensity, and the patient fails to recognize reactions which may progress to unconscious state. With growth of the placenta, increasing quantities of antagonists to insulin are produced and degradation of insulin by the placenta becomes increasingly more effective. Fatty acid production increases and additional binding of insulin may occur. The average insulin requirement rises by 50 to 60% of the pre-pregnancy dosage. Exceptions occur with diabetic nephropathy. The shorter the duration of diabetes, the greater the insulin need during pregnancy. In pregnancy, short term diabetics are more susceptible to ketoacidosis than the growth onset patient. This state may be precipitated by the loss of carbohydrate through
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 24 and 25: 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 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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