Medical Disorders of Pregnancy

Medical disorders in pregnancy : , Medical disorders in pregnancy : , کتابخانه الکترونیک و دیجیتال - آذرسا

Progress in medical disorders in pregnancy has inevitably occurred over a wide front. Highlights of the past year include the use of real-time ultrasound rather than venography to diagnose deep vein thrombosis in pregnancy, the establishment of Doppler ultrasound for noninvasive measurement of cardiac output, better awareness of the risk to the fetus if the mother has immune thrombocytopenic purpura, the description of the maturation of fetal thyroid function, the problems of in utero treatment of congenital adrenal hyperplasia in the fetus, and an appreciation of the fetal risk if maternal phenylketonuria is not managed by strict dieting in pregnancy.

Introduction: The coiling of the umbilical vessels develops by about 28 days post-conception and is present in about 95% of foetuses by around nine weeks of conception. Umbilical coiling (UC) is associated with many maternal and fetal outcomes. The present study attempts to assess any associations between medical disorders of pregnancy with umbilical cord coiling. Methodology: This cross-sectional study was conducted in the Department of Obstetrics and Gynaecology, Gandhi Medical College δ Sultania Zanana Hospital, Bhopal, India, from January to December 2020. A total of 300 obstetric mothers were included in the study. Coiling of the umbilical cord numbers and pattern and umbilical coiling index was assessed at the time of delivery. Medical disorders such as diabetes mellitus, hypertension and thyroid disorders during pregnancy were evaluated at the time of delivery. Data was entered and analysed with Epi info software. Results:Gestational diabetes mellitus was seen in hyper-coiled and normocoiled, but not also in hypocoiled UC. Hypothyroidism with GDM was seen only in hypocoiled UC. A significant association was seen with selected endocrinal medical problems with umbilical cord coiling (P value <0.05). The most common blood pressure-related disorder identified in the present study is eclampsia (66.66%). Gestational hypertension was seen only in hypocoiled UC coiling. Conclusion:The most common endocrine disorder associated with umbilical cord coiling was gestational diabetes in hyper coiled and normocoiled UC. Hypocoiling and normocoiling have been found in medical disorders of pregnancy. Multicentric studies are required to identify the relationship between endocrine and blood pressure-related disorders and umbilical coiling.

Obstetricians are responsible for primary care of the pregnant woman. Some of the issues that obstetricians should be well versed with the physiological changes during pregnancy, effect of disease and effect on disease during pregnancy and rational use of drugs. This book provides fundamental information about the medical diseases that can complicate pregnancy. The book is a source of reference to postgraduate teachers and practising obstetricians.

Nowhere is the fate of two individuals more closely intertwined than that of the mother and her fetus. Pregnancy is a unique state where the physiology of the mother is greatly altered to accommodate the newly developing “organ”—the fetus.

Background: Pregnancy is a physiological state, but when associated with an underlying medical disorder, it has a large impact on the well‑being of a mother. The pattern of medical disorders has been documented to have changed over the years. Aim: This study seeks to retrospectively determine the incidence of medical disorders in pregnancy, and to determine the trend over a 5‑year period in Ebonyi State University Teaching Hospital (EBSUTH). Materials and Methods: This was a retrospective study of all medical cases in pregnancy managed in EBSUTH from 1st of January 2006 to 31st December 2010. Data were analyzed using Epi‑Info statistical package. The results were presented in simple tables. Test statistics was set at 95% confidence interval. Results: A total of 339 medical cases in pregnancy of 2117 admissions were managed during the study period (16.0%). Mean (SD) age of the women was 28.05 (5.36) years and age ranged 15‑45 years for about 314 cases that had the age documented. Of the 339 cases, a total of 149 cases of malaria occurred during the study period (149/339; 44%), out of which only 104 were malaria alone. The rest (45 in number) occurred with urinary tract infection, pregnancy‑induced hypertension, Diabetes mellitus, lobar pneumonia, and anemia in pregnancy. This was followed by hypertensive disorders which account for 29.2% of all cases of medical disorders. Urinary tract infection ranked third (20.7% of all medical disorder). The incidence of malaria was 7% (149/2117), that of hypertensive disorder was 4.7% (99/2117), and of Urinary Tract Infection was 3.1% (65/2117). Others include anemia in pregnancy 0.6% (13/2117), Diabetes mellitus 0.4% (9/2117), and Gastroenteritis 0.4% (9/2117). There is no statistical difference between the incidences of medical complications over the study period. Conclusion: There is relatively little change in the incidences of medical complication over the studied period. Malaria played a very important role in the prevalence of medical complications in pregnancy. Preventive strategies may have reduced the prevalence over the years. However, more effort is needed to markedly reduce the medical complications in pregnancy.

36 - Medical Disorders in Pregnancy

23 - Medical disorders in pregnancy

22 - Medical disorders in pregnancy

Comprehensive care of the pregnant woman involves a number of health professionals with a significant input from the woman and her family. The family physician, midwife and/or obstetrician may provide antenatal care through a variety of settings from hospital-based outpatient clinics or private surgeries to community centres or even the home. When pregnancy is complicated by a medical condition, either de novo or pre-existing, the number of interested parties may multiply exponentially. Who should be providing this additional care remains controversial. The history of obstetric medicine as practiced by physicians or internists is relatively brief. Many physicians are forced to care for pregnant patients as an extension of their care of adults, but without any specific training or expertise. Often this is accompanied by a high level of anxiety as the physician may be inexperienced in, or not familiar with, aspects of normal pregnancy, let alone abnormal pregnancy. In the case of pre-existing conditions, how is the underlying disease going to influence the pregnancy; is the current therapy suitable in pregnancy; and how is the pregnancy likely to effect the maternal condition? What about delivery, breastfeeding, the effects of poor sleep and postnatal mood disturbance? From this dilemma has evolved the role of the obstetric physician, a subspecialty dedicated to the prepregnancy, antenatal and postnatal care of women with medical disorders of pregnancy. Not surprisingly, as a new subspecialty evolves there may be new borders to be established. In the past, the obstetrician-gynaecologist was responsible for all aspects of obstetric care from diagnosing and managing infertility to resuscitating the neonate after a difficult delivery for shoulder dystocia. With improving knowledge and technology a number of subspecialties have evolved, including assisted conception, fetomaternal medicine, fetal surgery and perinatology. In many units, high-risk midwives play an active role in the monitoring, counselling and management of pregnant women with medical disorders. In addition, the general anaesthetist has been replaced by the obstetric anaesthetist, the intensivist and the neonatal anaesthetist. Each of these subspecialists may form part of a multidisciplinary team caring for a woman with a medical complication in pregnancy. So, to whom does obstetric medicine belong? The correct answer must be whoever has the expertise, experience and ability to work in a multidisciplinary team to provide the most appropriate care for that particular woman. This may involve a number of health professionals, the only prerequisite being that a model of care is established taking into account local resources and abilities. What is clear is that optimal care requires a continual updating of knowledge and skills. As we are all aware, it is very difficult to keep up to date in all fields of medicine. Given its complexities, we need to acknowledge the potential contribution of all of the specialists with an interest in the medical disorders of pregnancy. There is no place for ego or isolationism when caring for this special population of patients, and every reason to cooperate and learn from each other. In Obstetric Medicine: the Medicine of Pregnancy, we hope to stimulate and satisfy the interests of all those clinicians working with women with medical complications of pregnancy. In this issue we review the fascinating and unique physiology of calcium in pregnancy and lactation, highlighting the important role of parathyroid hormone-related protein (PTHrP) in this complex system. In contrast, mitral valve disease is an old disease revisited in the context of current practice. We examine two very different aspects of liver disease in pregnancy. Individual case reports remain an important mechanism for highlighting the diversity and difficulties of practice in the area of obstetric medicine, and the importance of multidisciplinary input and advice. We look forward to original contributions from all those committed to improving the care of women with medical disorders in pregnancy.

Chapter 14 - Medical disorders in pregnancy

The UK maternal death report.

Chapter 55 - Medical disorders of pregnancy

334. Obstetric Internal Medicine in Spain

OBJECTIVES This study aimed to determine the prevalence, type, and demographic makeup of pregnancy-related medical conditions among patients receiving treatment in a tertiary care facility. METHODOLOGY The Monocentric retrospective impact study was conducted in the Department of Obstetrics and Gynaecology of MTI, Hayatabad Medical Complex Peshawar, from January to December 2022. Case records of all pregnant women (n=1811) with previous or recently developed medical conditions treated during the study period were collected from the records / medical registers, and all the information was recorded in a pre-structured proforma. All women with previous or recently developed medical conditions treated during the study were included. All pregnant women without any medical conditions were excluded. Data was analyzed using simple statistical measures, and the results were presented as frequency percentages. Prior approval from the institution’s ethical committee was obtained to conduct the study. vRESULTSAmong 6327 antenatal admissions, 1811 (28.62%) women had medical disorders. The most common medical disorder was PIH, reported in 384 (21.20%) of the females, followed by RH incompatibility and Gestational Diabetes Mellitus (GDM) seen in 235 (12.98%) and 205 (11.32%) females, respectively. Other notable medical conditions include UTI in 170 (9.39%), Chronic HTN in 134 (7.40%), iron deficiency anemia in 122 (6.74%), and pre-eclampsia in 100 (5.52%) of women. CONCLUSION Pre-existing medical conditions in pregnancy are not uncommon. Early recognition of acute illness and treatment of chronic conditions in pregnancy is of clear benefit and needs to be managed to arrest any adversaries to the mother and fetus.