Intercurrent Disease during Pregnancy

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Contents Heart disease in pregnancy Liver disease in pregnancy Chronic renal disease during pregnancy anemia during pregnancy

iron-deficiency anemia megaloblastic anemia

pulmonary tuberculosis and pregnancy

continue Carbohydrate metabolism in pregnancy renal disease in pregnancy sexually transmitted diseases in pregnancy

gonorrhoea syphilis

disorders of the thyroid gland hyperthyroidism

appendicitis appendicectomy

Orders of the causes leading to the maternal death

Obstetric hemorrhage cardiac disease PIH amniotic fluid embolism puerperium infection liver disease in pregnancy

Heart disease in pregnancy Although most patients with heart dis

ease go through pregancy and labour successfully if their management is conducted efficiently, that there is an added risk is shown by the fact that heart disease is the commonest ‘associated disease’ to cause meternal death.

ClassificationAtiology of heart disease in pregnancy

Congenital heart disease Rheumatic heart disease: mitral stenosis Cardic disorders due to PIH Cardiomyopathy of pregnancy Myocaiditis cardiac arrhythmias others:bacterial endocarditis, and coronary thro

mbosis,et al

Functional capacity of the myocardium Grade 1: no dyspnea or limitation of a

ctivity Grade 2: dyspnea, with some limitatio

n of activity Grade 3: severe dyspnea with limitatio

n of even ordinary activity Grade 4: dyspnea even at rest, or hist

ory of cardiac failure

Signs of early cardiac failure Chest distress,palpitation,short breat

h only after slight movement At rest, HR>110bpm,R>20 Persistant mild moist rales at the basi

s pulmonisis,can’t disappear after cough

Treatment A:During pregnancy Adequate rest avoidance of respiratory infection treatment of any dental sepsis prevention and treatment of anemia admission to hospital:2or 3 weeks rest

in hospital prior to labor is desirable for the more severe cases

heart failure: digitalis ,diuretics

B:At labor Grade 1,2 Vaginal delivery Grade 3,4 CS

C:puerperium Dangerous: within 3 days after

labor Prevention: heart failure infection Functional capacity>=grade 3 no breast feeding

Liver disease in pregnancypage171

Infective hepatitis viral heptitis

hepatitis A hepatitis B hepatitis C hepatitis D hepatitis E

Effects of hepatitis B on mothers Obvious early gestational reaction PIH Postpartium haemmorrhage DIC

Differential Diagnosis

Hyperemesis gravidarum PIH intrahepatic cholestasis of pregnancy acute fatty liver of pregnancy

acute hepatic failure during pregnancy cause is unknown and no effective treatment

toxic hepatitis caused by chemical agents

Carbonhydrate metabolism in pregnancy

Gestational diabetes mellitus gestation complicated with diabetes

mellitus glucosuria macrosomia

Sexually transmitted diseases Syphilis:early stage of syphilis---place

nta---fetus Gonorrhea Condyloma acuminata:rare intrauterus i

nfection,mainly transvaginal infection Cytomegalovirus(CMV) Genital herpes Chlamydia trachomatis(CT)