Book of Medical Disorders in Pregnancy - Tintash

Recommendations

Info

of the previous day’s dose of insulin is given at 8.00 I.V. glucose, totalling 200 Grams per day is started at 8.00 a.m. i.e. (2000 mL 5% dextrose in water and 1000 mL of 10% dextrose in water run for 12 hours). No analgesia or sedation is given. After delivery, another dose of one quarter of the previous day's insulin is given. Continuous electronic fetal heart monitoring should be offered to all women with diabetes during labor and fetal blood sampling should be available if indicated. One day after delivery half of the Pre partum insulin dose is given. A diabetic fluid diet totalling 200 gms, carbohydrate is offered. In the event of nausea or vomiting, oral fluids are stopped, and 1000 mL 10% Dextrose in water is given. Cesarean section: 8.00 a.m. blood glucose is done. Insulin is withheld; narcotic premedi-cation is withheld, I.V. Glucose totalling 200 Gms. Per day is started at 8.00 a.m. For example, 1500 mL of 10% dextrose in water are run during operation, and 1500 mL of 10% Dextrose in water are run in 6 hours. Postoperatively half of the daily dose of insulin is given. If blood is required, it is given in a separate infusion to avoid possible hypoglycemia. One day after operation: At 8.00 a.m. blood glucose is done. Half of the predelivery dose of Lente insulin is given. I V. Glucose totalling 200 gms is given with 5-10 units of Semi Lente insulin. Per flask depending on the 31 morning blood glucose. On Second Post Op. Day - the total dose of Lente and Semilente insulin required on the previous day is given at 8.00 a.m. The neonate: The newborn of the diabetic mother should be treated as a premature infant, irrespective of his gestational age. There is increased incidence of respiratory distress syndrome, congenital anomalies, and neonatal hyperbilirubinemia, in these babies Anomalies such as tracheo-esophageal fistula, diaphragmatic hernia, malrotation of the bowel, and imperforate anus occur more frequently. Intravenous dextrose and insulin should be administered during labour and delivery following an agreed multidisciplinary protocol. The weight of the diabetic infant is similar to that of a nondiabetic infant up to 220 days of gestation, but in the last 60 days of gestation there is a significant increase in weight. It is known that there is hypertrophy of the islet tissue of the pancreas in the infant of both the established diabetic and the pre diabetic mother there is also a direct correlation between the amount of islet cell hypertrophy and the fetal weight. There is no increase in the total body water content, but an increase in skeletal growth does take place. It is likely that the fetal gigantism is due to the anabolic and lipogenic effects of fetal hyperinsulinism and this must be operative in the pre diabetic as well as the diabetic phase. The four possible reasons for fetal hyperinsulinism are maternal hyperglycemia increase in pituitary growth hormone, maternal adrenal glucocorticoids and the action of insulin antagonists. The care of these infants should be undertaken by a pediatrician who is familiar with the
special problems of the sick, premature and full term newborn. The infant should be placed in an incubator and receive oxygen therapy. Special care should be taken to clear the airway at birth and treat hypoglycemia, Hyperbilirubinemia or hypocalcemia w-hich may be present. Fig2.2: The looks of diabetic baby Constant nursing care is required during the first four days of life. Oral feedings are postponed until the infant is vigorous, and can start taking feeds without any problem. Babies blood glucose test < 4–6 hours before a feed [Diabetes NSF – Intervention details] Hypoglycemia diagnosed with ward based glucose electrode or laboratory method (not reagent strip) Babies should remain with mothers unless specific medical indication NNICU admission. [Diabetes NSF – Intervention details] Feed babies ASAP after birth & all should receive first feed
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 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 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
show all

Book of Medical Disorders in Pregnancy - Tintash

Create successful ePaper yourself

Delete template?

Save as template?