1 / 17

What’s new in obstetrics?

What’s new in obstetrics?. Miss Audrey Ryan Consultant Obstetrician & Gynaecologist Dorset County Hospital Foundation Trust November 2009. We’re all still having babies…. GPs and obstetrics?. Direct referral Antenatal day assessment. Messages from Confidential Enquiry.

emery
Download Presentation

What’s new in obstetrics?

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. What’s new in obstetrics? Miss Audrey Ryan Consultant Obstetrician & Gynaecologist Dorset County Hospital Foundation Trust November 2009

  2. We’re all still having babies…

  3. GPs and obstetrics? • Direct referral • Antenatal day assessment

  4. Messages from Confidential Enquiry • Pre-conception care – especially for ART and including obesity • Access to care – NB migrant women, social exclusion • Systolic hypertension requires treatment

  5. Optimise medical condition Medication review – ACE inhibitors, statins, antidepressants, Metformin Asthma Inflammatory bowel disease Epilepsy (5mg Folate) Mental health – suicide leading cause of maternal death ’97-’02

  6. Diabetes HbA1c: predictor of miscarriage, anomaly and adverse pregnancy outcome - <6 advised, 6-10 higher risk, >10 consider ToP 5mg Folate Medication review – Statins, ACE inhibitors, insulin regime, oral anti-diabetic agents

  7. Epilepsy • If seizure free at conception, 90% will stay seizure free • Fetal risks • Of seizures: IUD, CP, learning difficulties • Of medication: teratogenicity • Maternal risks • Folate • Vitamin K • Medication – avoid valproate and aim for single therapy (6% 1 drug, 10-15% 2 drugs)

  8. Depression • Examine reasons for starting in first place • Need to reduce dose gradually (liquid preps) • Untreated depression: low birthweight, preterm birth, low Apgars, problems in later life – best thing for baby is that mother is well • Which medication? TADs vs SSRIs Fluoxetine > Citalopram/Sertraline>Paroxetine – congenital anomalies, withdrawal

  9. Domestic violence • 30% begins in pregnancy • 40-60% continues in pregnancy • 19 women in last report murdered • “Have you ever been hit, punched, kicked or in any way abused by someone close to you?” • Preterm labour, perinatal death, obstetric haemorrhage

  10. The big issue……

  11. Obesity – BMI >35 – the risks Fetal: stillbirth tripled, anomalies at least doubled (so 5mg Folate), macrosomia (x4) Maternal: Gestational diabetes (x4), Hypertension and PET (x5), Thrombosis,infection Induction, Caesarean Section (x3) haemorrhage, 3rd and 4th degree tears Anaesthetic risks

  12. In the news… • Screening – the future: Non Invasive Prenatal Diagnosis (NIPD): free fetal nucleic acids in maternal blood • Current NHS use: fetal Rhesus status, fetal sex • ?Down’s syndrome (Trisomy 21) ?5 years • Sequenom Ltd (USA) – ‘data mishandled’

  13. Swine flu in pregnancy – the problem • Most make a good recovery, but higher risk of severe complications (esp respiratory, mostly in 2nd and 3rd T) • Risk of hospitalisation 3-4x higher • Co-morbidity increases risk (obesity, diabetes, chronic illness)

  14. Swine flu vaccination • Lancet 2008: evidence of excess mortality in 2 previous influenza pandemics supports vaccinating in any trimester during a pandemic • vaccine reduces risk of woman and neonate catching swine flu • no evidence of risk from vaccines (European Agency for the Evaluation of Medicinal Products) • Use Pandemrix (single dose)

  15. Swine flu - management in pregnancy • Fluids + paracetamol (not NSAIDS or OTC cold remedies), but watch for pneumonia • Early antivirals – zanamivir (Relenza) 1st choice; if complicated, oseltamivir (Tamiflu) • Antibiotics - if co-morbidity / LRTI signs / severe tonsillitis/sore throat, (Augmentin, 5/7) • Don’t forget differential diagnosis eg PE • UK Teratology Information Service asks for notification of pregnant women on antivirals

  16. Swine flu when breastfeeding • Breastfeeding should be continued if at all possible, even when the mother is affected by swine flu. • Treat breastfeeding mothers with oseltamivir (but don’t switch if started zanamivir prior to delivery)

  17. Summary • Midwifery guided care BUT • Prescription – pre and ante-natally • Pre-conception management • Pregnancy care – with support from secondary care

More Related