O bstetric Emergency

1. Obstetric Emergency Dr. Miada Mahmoud Rady

2. Topics of the lecture : • Renal disease during pregnancy • RH sensitization • Introduction to infection during • Clinical presentation and complication of various infection.

3. Renal diseases • Infection : • In pregnancy there is increased liability to urinary tract infection . • Pathogenesis : • kidney increases in size . • Ureters become longer ,wider and more curved. • leading to urine stasis which increase liability to infection.

4. Renal diseases • Infection may be • Mild . • Sever : which could be complicated by : • Low fetal birth weight and retarded fetal development • Premature labor • Intrauterine fetal death.

5. Renal diseases • Frequency of micturition • caused by pressure of gravid uterus on bladder. • Exacerbation of preexisting renal disease : • Load of pregnancy on diseased kidney may lead to renal failure .

6. Rh sensitization

7. Infections • Viral and parasitic infections can cause problems for both the woman and the fetus. • Early-pregnancy infections : can affect organ system formation. • Later-pregnancy infections : can cause → • Neurologic impairments • Growth disturbances • Heart and respiratory conditions

8. Urinary tract infection • Caused by Streptococcus agalactiae, which lives normally in the genitourinary and GI tracts of healthy people. • The bacteria can proliferate during pregnancy, resulting in: • Urinary tract infection • Uterus infection • Stillbirth

9. Urinary tract infection • If it is passed to the newborn, it can cause: • Respiratory problems • Pneumonia • Septic shock • Meningitis

10. Human immunodeficiency virus (HIV) • Pregnant women may infect their fetus: • During pregnancy • During delivery • From breastfeeding • The woman may be asymptomaticand unaware that she is infected.

11. Human immunodeficiency virus (HIV) • Prevention : • An HIV-positive woman can take medications to control the infection and decrease the chances of transmitting HIV to the infant. • An HIV-infected women should not breastfeed.

12. Cholestasis • Cholestasis means slowing of bile flow . • Pathogenesis of liver disease during pregnancy :

13. Cholestasis • Risk factors • Multiple pregnancies. • Familial history of cholestasis. • Previous liver damage. • History of gall bladder disease.

14. Cholestasis • Clinical presentation : • itching, particularly in the hands and feet (most common). • Fatigue or depression. • Nausea. • Right upper quadrant pain. • Dark urine and clay colored stool.

15. Cholestasis • Course : • Relatively benign and transitory for the woman but can be serious for the fetus. • Complications include preterm birth and stillbirth.

16. Sexually transmitted infections • Bacterial vaginosis : • Normal vaginal bacteria are replaced by overgrowth of other bacteria. • Symptoms include: (a) Itching. (b) Burning. (c) Pain. (d) Foul smelling discharge ( fishy odour )

17. Can lead to: (a) Premature birth. (b) Low birth weight. (c) Pelvic inflammatory disease in the woman. • Treated with the antibiotic and metronidazole .

18. Candidiasis (thrush, or yeast Infection) : • More common in pregnancy because of chemical changes in the vagina (increased glycogen). • Risk factors include: (a) Poorly controlled diabetes and gestational diabetes. (b) Taking antibiotics . (c) Wearing tight-fitting clothing .

19. Treatment : antifungal creams • Complication : can pass to fetus causing oral candidiasis

20. Chlamydia : • Symptoms are usually mild or absent, but may include: (a) Lower abdominal pain (b) Low back pain (c) Nausea (d) Fever. (e) Painful intercourse. (f) Bleeding between menstrual periods.

21. Can spread to the rectum, causing: (a) Rectal pain (b) Discharge (c) Bleeding • If untreated, can progress to pelvic inflammatory disease

22. Gonorrhea • bacterial infection that multiplies rapidly. • Causative organism: gonococci . • Sites of infection: genital tract , mouth, throat, eyes, and anus.

23. Clinical presentation : • Asymptomatic : Women may be infected for months with no symptoms. • Symptomatic : • Dysuria with burning or itching. • Yellowish or bloody vaginal discharge. • Bleeding with vaginal intercourse. • Intermenstural spotting , anal bleeding and discharge.

24. HPV is precancerous Human papilloma virus (HPV) • Viral infection . • Could be asymptomatic or manifest by multiple growth in the genital tract. • Complication • Maternal : Urinary obstruction Obstruction of birth canal Risk factor for vulvar , cervical and anal cancer . • Fetal : laryngeal papillomatosis which is potentially fatal.

25. Syphilis • Bacterial infection . • Transmitted through direct contact with open sores usually mouth lips, nipples ,genitals and anus. • Clinical presentation : • Asymptomatic . • Symptomatic : passes in 3 stages : Primary , secondary and tertiary.

26. Primary stage : • usually begins with a single sore ,painless, small, firm, and round • Disappears after 3 to 6 weeks.

27. Remember FHAM • Secondary stage : Mucocutaneous rash and systemic manifestation of infection which resolve spontaneously. • Fever and fatigue , • Sore throat and lymphadenopathy. • Patchy hair loss and weight loss. • Headache and muscle aches.

28. Tertiary stage : No signs or symptoms present, but the disease attacks the: • Brain • Nerves • Eyes • Heart • Blood vessels • Liver • Bones • Joints Gumma formation

29. Complication of syphilis during pregnancy : • Abortions and still births. • Congenital anomalies. • Congenital blindness. • Short survival after birth.

30. Trichomoniasis • Parasitic Infection. • Clinical presentation : • Asymptomatic . • Symptomatic • Vaginal discharge frothy, yellow with a strong odor. • Irritation and itching. • Dysuria and painful sexual intercourse .

31. Lower abdominal pain. • Complication • Increased susceptibility to HIV infection. • Premature labour. • Low birth weight.

32. Torch syndrome • infections that pass through the placenta from the woman to the fetus . • Neonates show similar symptoms for any of the five infections.

34. Cat disease Toxoplasmosis • Parasitic infection . • Caused from handling or eating contaminated food or from handling cat litter. • If early in the pregnancy, there is a decreased chance of passing it on to the fetus. • Newborns do not show infection signs at birth but may develop learning, visual, and hearing disabilities later.

36. Rubella • Viral infection . • If infection occurs less than 20 weeks gestation, there is a significant chance of developmental problems with the fetuswhich include : • Congenital blindness or deafness. • Significant cardiac and respiratory abnormalities.

37. Cytomegalovirus (CMV) • Viral infection . • Can remain dormant in the body for years , activated during pregnancy due to low immunity. • Cause serious complication during pregnancy : • Lung and liver problems • Blood problems and lymphadenopathy • Rash • Poor weight gain

38. Herpes simplex • Viral infection • Two types of viruses (HSV) : • Type 1 ( oral ) : causes infection of mouth and lips • Type 2 ( genital ) : primary cause of genital herpes , so genital herpes is caused mainly by type 2 HSV less commonly by type 1. • Clinical presentation : FAHM + sores and tingling at site of infection . {Fever , Headache , Anorexia , Malaise , Aches ( bone and muscle )}

39. Summary • Infection encountered during pregnancy represent common health problem which has various adverse outcome for both the baby and mother. • STDs all share common site of infection which are lips , nipples , breast , vagina , vulva and rectum. • STDS include herpes simplex , chlamydia , trichomoniasis , bacterial vaginosis , gonorrhea and syphilis.

40. Common complication of infection associated with pregnancy include : preterm labour , abortion , congenital anomalies , intrauterine growth retardation and post partum poor weight gain of newborn. • Most of genital infection share common presentation which is either asymptomatic orsymptomatic → dysuria , abnormal vaginal discharge , painful sexual intercourse and Intermenstural spotting.