Day: May 11, 2024

There are several infections that can be transmitted from the mother to the fetus. This can be dangerous as the fetus does not have a fully developed immune system and is more susceptible to serious complications. – Methods of vertical transmission include transplacental (across placenta in utero), during childbirth (due to contact between maternal and foetal body fluids) and breastfeeding.   The  pathogens which can be transmitted from mother to fetus can be remembered by acronym TORCH:   Chorioamnionitis This describes inflammation of the foetal membranes (chorion and amnion) usually due to bacterial infection. – The major risk factor is

In the uterus, there are 3 variables that we monitor concerning the baby’s position.   Lie: – This is the relationship between the long axis of the fetus and that of the mother – It can be longitudinal, transverse or oblique   Presentation: – This describes the part of the fetus that first enters the maternal pelvis – Can be cephalic vertex (headfirst), breech, shoulder, face and brow   Position: – This describes the position of the foetal head as it exits the birth canal – Can be occipito-anterior (ideal), occipito-posterior or occipito-transverse   Abnormal lies, presentations and positions all

Post-partum Haemorrhage (PPH) This is defined as blood loss of >500mls after delivery and it is divided into two subtypes:   Primary: – This is blood loss which occurs within 24 hours of delivery: – The causes can be remembered by thinking of the 4 T’s   Causes: Tone (uterine atony most commonly) Trauma (large baby) Thrombus (clots) Tissue (fibroids) – In addition, it can be caused by abnormalities of the placenta (placenta previa/accrete)   Management: – 1st line –> Apply bimanual compression (pressure aims to compress uterine arteries) with fundal massage   – 2nd line is medical management –>

Gestational Thrombocytopaenia A condition which causes transiently low platelet levels in pregnancy, not associated with maternal/fetus risks. – It occurs due to plasma dilution as well as decreased production of platelets during pregnancy. – The problem is that it is similar to immune thrombocytopenia (ITP) which can lead to several problems – Therefore, one must rule out ITP as it can affect both the mother and fetus (as antibodies cross the placenta)   Symptoms – This is usually asymptomatic – Gives isolated decrease in platelet levels which return to normal levels after pregnancy – Woman has no medical history of

Pregnancy-induced hypertension This is defined as having a raised blood pressure which occurs after the 20th week of pregnancy without proteinuria. – If a woman has hypertension before, then this is counted as pre-existing hypertension. Whereas, if she develops other symptoms like proteinuria and oedema, this points to a diagnosis of pre-eclampsia – Gestational hypertension resolves after birth, but women have higher risk of pre-eclampsia in the next pregnancy – The major risk to watch out for is progression to pre-eclampsia (High BP with proteinuria)   The hypertension is defined as two separate readings confirming either: – Systolic >140mmHg or

Post-partum Haemorrhage (PPH) This is defined as blood loss of >500mls after delivery and it is divided into two subtypes:   Primary: – This is blood loss which occurs within 24 hours of delivery: – The causes can be remembered by thinking of the 4 T’s   Causes: Tone (uterine atony most commonly) Trauma (large baby) Thrombus (clots) Tissue (fibroids) – In addition, it can be caused by abnormalities of the placenta (placenta previa/accrete)   Management: – 1st line –> Apply bimanual compression (pressure aims to compress uterine arteries) with fundal massage   – 2nd line is medical management –>

Placenta Accreta This is a condition where the placenta attaches directly to the myometrium rather than the endometrium. – This is a problem as it gives a very high risk of heavy bleeding at time of vaginal delivery.   There are 3 different types of placenta accreta depending on the degree of invasion: i) Accreta –> Chorionic villi attach to the myometrium but will not invade into this layer ii) Increta –> Chorionic villi invade into the myometrium, the muscular layer of the uterus iii) Percreta –> Chorionic villi invade through the myometrium into the perimetrium   Risk factors: Anything which damages the lining of the

Placenta Accreta This is a condition where the placenta attaches directly to the myometrium rather than the endometrium. – This is a problem as it gives a very high risk of heavy bleeding at time of vaginal delivery.   There are 3 different types of placenta accreta depending on the degree of invasion: i) Accreta –> Chorionic villi attach to the myometrium but will not invade into this layer ii) Increta –> Chorionic villi invade into the myometrium, the muscular layer of the uterus iii) Percreta –> Chorionic villi invade through the myometrium into the perimetrium   Risk factors: Anything which damages the lining of the

Hyperemesis Gravidarum This is a condition which causes nausea and vomiting in pregnant women and accompanied with weight loss – Nausea and vomiting is common during pregnancy, and so the term hyperemesis gravidarum is only used if this leads to complications like dehydration or >5% weight loss – This condition is experiences in the first trimester and usually resolves by week 20 – It is believed to be due to raised beta-hCG sensitizing the vomiting centre – Severe vomiting leads to dehydration and electrolyte abnormalities in the mother   Risk factors: This is anything which leads to raised b-hCG –

Hyperemesis Gravidarum This is a condition which causes nausea and vomiting in pregnant women and accompanied with weight loss – Nausea and vomiting is common during pregnancy, and so the term hyperemesis gravidarum is only used if this leads to complications like dehydration or >5% weight loss – This condition is experiences in the first trimester and usually resolves by week 20 – It is believed to be due to raised beta-hCG sensitizing the vomiting centre – Severe vomiting leads to dehydration and electrolyte abnormalities in the mother   Risk factors: This is anything which leads to raised b-hCG –

In the uterus, there are 3 variables that we monitor concerning the baby’s position.   Lie: – This is the relationship between the long axis of the fetus and that of the mother – It can be longitudinal, transverse or oblique   Presentation: – This describes the part of the fetus that first enters the maternal pelvis – Can be cephalic vertex (headfirst), breech, shoulder, face and brow   Position: – This describes the position of the foetal head as it exits the birth canal – Can be occipito-anterior (ideal), occipito-posterior or occipito-transverse   Abnormal lies, presentations and positions all

Bleeding in the first trimester of pregnancy is not an uncommon event but is a source of anxiety for mothers. – The reasons for this can range from idiopathic to serious conditions like an ectopic pregnancy. – In addition, it can also be due to gynaecological conditions like ectropion, trauma and polyps   If a woman has bleeding in the first trimester, management depends on the gestational age and her symptoms: If <6 weeks gestation: – Expectant management. Advise woman to repeat pregnancy test after 7-10 days – If this is positive then return to the clinic – If the

Hyperemesis Gravidarum This is a condition which causes nausea and vomiting in pregnant women and accompanied with weight loss – Nausea and vomiting is common during pregnancy, and so the term hyperemesis gravidarum is only used if this leads to complications like dehydration or >5% weight loss – This condition is experiences in the first trimester and usually resolves by week 20 – It is believed to be due to raised beta-hCG sensitizing the vomiting centre – Severe vomiting leads to dehydration and electrolyte abnormalities in the mother   Risk factors: This is anything which leads to raised b-hCG –

Pregnancy-induced hypertension This is defined as having a raised blood pressure which occurs after the 20th week of pregnancy without proteinuria. – If a woman has hypertension before, then this is counted as pre-existing hypertension. Whereas, if she develops other symptoms like proteinuria and oedema, this points to a diagnosis of pre-eclampsia – Gestational hypertension resolves after birth, but women have higher risk of pre-eclampsia in the next pregnancy – The major risk to watch out for is progression to pre-eclampsia (High BP with proteinuria)   The hypertension is defined as two separate readings confirming either: – Systolic >140mmHg or

This is the second most common medical complication in pregnancy after high blood pressure. – It is defined as any degree of glucose intolerance with onset/first recognition during pregnancy – In pregnancy, there is progressive insulin resistance which means a higher volume of insulin is needed to respond to a normal level of blood glucose – A woman with a borderline pancreatic reserve is unable to respond to the increased insulin requirement – This results in transient hyperglycaemia giving gestational diabetes – After the pregnancy, insulin resistance falls and the hyperglycaemia usually resolves – However, whilst it is usually asymptomatic