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Intercurrent Disease during Pregnancy

Intercurrent Disease during Pregnancy. Page 166. 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.

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Intercurrent Disease during Pregnancy

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  1. Intercurrent Disease during Pregnancy Page 166

  2. 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

  3. continue • Carbohydrate metabolism in pregnancy • renal disease in pregnancy • sexually transmitted diseases in pregnancy • gonorrhoea • syphilis • disorders of the thyroid gland • hyperthyroidism • appendicitis • appendicectomy

  4. Orders of the causes leading to the maternal death • Obstetric hemorrhage • cardiac disease • PIH • amniotic fluid embolism • puerperium infection • liver disease in pregnancy

  5. Heart disease in pregnancy • Although most patients with heart disease 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.

  6. 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 thrombosis,et al

  7. Functional capacity of the myocardium • Grade 1: no dyspnea or limitation of activity • Grade 2: dyspnea, with some limitation of activity • Grade 3: severe dyspnea with limitation of even ordinary activity • Grade 4: dyspnea even at rest, or history of cardiac failure

  8. Signs of early cardiac failure • Chest distress,palpitation,short breath only after slight movement • At rest, HR>110bpm,R>20 • Persistant mild moist rales at the basis pulmonisis,can’t disappear after cough

  9. 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

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

  11. C:puerperium • Dangerous: within 3 days after labor • Prevention: heart failure • infection • Functional capacity>=grade 3 • no breast feeding

  12. Liver disease in pregnancypage171 • Infective hepatitis • viral heptitis • hepatitis A • hepatitis B • hepatitis C • hepatitis D • hepatitis E

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

  14. 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

  15. Carbonhydrate metabolism in pregnancy • Gestational diabetes mellitus • gestation complicated with diabetes mellitus • glucosuria • macrosomia

  16. Sexually transmitted diseases • Syphilis:early stage of syphilis---placenta---fetus • Gonorrhea • Condyloma acuminata:rare intrauterus infection,mainly transvaginal infection • Cytomegalovirus(CMV) • Genital herpes • Chlamydia trachomatis(CT)

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