Renal disease inpregnancy
Presented by
Ahmed Mukhtar Ali Mohammed
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Abdominal pain is a common complaint in pregnancy that can be caused by conditions directly related to pregnancy or unrelated. It can be difficult to determine the cause without investigations. Causes in the first trimester include abortion, molar pregnancy, and ectopic pregnancy. In the second trimester, potential causes are abortion, incarcerated retroverted uterus, complications of amniocentesis, preterm labor, and fibroid degeneration. The third trimester may involve round ligament pain, placental abruption, preeclampsia, and uterine rupture. A careful history, exam, and potential ultrasound or laparoscopy are needed to diagnose the source of abdominal pain in pregnancy.
Abdominal pain during pregnancy can have many potential causes and can be difficult to diagnose. A thorough history, physical exam, and consideration of both maternal and fetal well-being is important. Common causes of abdominal pain in pregnancy include appendicitis, urinary tract infections, gallstones, round ligament pain, and obstetric emergencies such as preeclampsia, placental abruption, and ectopic pregnancy. A multidisciplinary approach may be needed and the risks of exploratory surgery must be weighed against risks of delayed diagnosis.
Abdominal pain during pregnancy can have many causes, both pregnancy-related and non-pregnancy related. Pregnancy-related causes include round ligament pain, Braxton Hicks contractions, preterm labor, placental problems, and liver issues related to conditions like preeclampsia. Non-pregnancy related causes include issues like appendicitis, kidney infections, and digestive system problems. A thorough physical exam and testing is needed to determine the cause, and treatment depends on the underlying issue and gestational age of the fetus. The well-being of both the mother and fetus must be closely monitored.
Abdominal pain in pregnancy is a very common problem encountered in day to day practice. Although is can be benign at times great care should be exercised to dismiss as nothing significant.
Abdominal pain is a common complaint during early pregnancy. Differential diagnoses include conditions specific to pregnancy like ectopic pregnancy and ovarian cysts, as well as non-pregnancy related conditions. Evaluating abdominal pain in pregnancy can be challenging due to common symptoms of normal pregnancy. Ultrasound is often used to locate potential sources of pain like ectopic pregnancies outside the uterus. Both medical and surgical treatments may be considered depending on the severity and location of the condition causing the abdominal pain.
Abdominal pain in pregnancy can have many potential causes including obstetric, gynecological, surgical, and medical issues. A thorough history and physical exam is important to determine the cause, which may include conditions like preterm labor, placental abruption, appendicitis, or ectopic pregnancy. Based on the findings, appropriate investigations like urine tests, ultrasound, and fetal monitoring can help make the diagnosis. Management is tailored to the specific cause but the priority is always the health and safety of the mother and baby.
This document discusses the evaluation and management of acute abdomen during pregnancy. It outlines common etiologies including appendicitis, bowel obstruction, and pregnancy-related causes. The evaluation involves history, physical exam focusing on signs of peritonitis, and lab tests. Imaging options like ultrasound and MRI are discussed. Laparoscopy is generally safe in pregnancy with precautions. Acute appendicitis is the most common non-obstetric surgical emergency. It can be more severe in pregnancy and risks increase with delayed treatment.
- Pelvic pain can have many causes involving the reproductive, gastrointestinal, genitourinary, and musculoskeletal systems.
- A thorough history and physical exam are essential to determine the underlying cause, which can be acute (less than 3 months), chronic (greater than 3 months), or recurrent.
- Common causes of acute pelvic pain include pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, and endometriosis. Chronic causes include endometriosis, pelvic congestion syndrome, and irritable bowel syndrome.
Abdominal pain is a common complaint in pregnancy that can be caused by conditions directly related to pregnancy or unrelated. It can be difficult to determine the cause without investigations. Causes in the first trimester include abortion, molar pregnancy, and ectopic pregnancy. In the second trimester, potential causes are abortion, incarcerated retroverted uterus, complications of amniocentesis, preterm labor, and fibroid degeneration. The third trimester may involve round ligament pain, placental abruption, preeclampsia, and uterine rupture. A careful history, exam, and potential ultrasound or laparoscopy are needed to diagnose the source of abdominal pain in pregnancy.
Abdominal pain during pregnancy can have many potential causes and can be difficult to diagnose. A thorough history, physical exam, and consideration of both maternal and fetal well-being is important. Common causes of abdominal pain in pregnancy include appendicitis, urinary tract infections, gallstones, round ligament pain, and obstetric emergencies such as preeclampsia, placental abruption, and ectopic pregnancy. A multidisciplinary approach may be needed and the risks of exploratory surgery must be weighed against risks of delayed diagnosis.
Abdominal pain during pregnancy can have many causes, both pregnancy-related and non-pregnancy related. Pregnancy-related causes include round ligament pain, Braxton Hicks contractions, preterm labor, placental problems, and liver issues related to conditions like preeclampsia. Non-pregnancy related causes include issues like appendicitis, kidney infections, and digestive system problems. A thorough physical exam and testing is needed to determine the cause, and treatment depends on the underlying issue and gestational age of the fetus. The well-being of both the mother and fetus must be closely monitored.
Abdominal pain in pregnancy is a very common problem encountered in day to day practice. Although is can be benign at times great care should be exercised to dismiss as nothing significant.
Abdominal pain is a common complaint during early pregnancy. Differential diagnoses include conditions specific to pregnancy like ectopic pregnancy and ovarian cysts, as well as non-pregnancy related conditions. Evaluating abdominal pain in pregnancy can be challenging due to common symptoms of normal pregnancy. Ultrasound is often used to locate potential sources of pain like ectopic pregnancies outside the uterus. Both medical and surgical treatments may be considered depending on the severity and location of the condition causing the abdominal pain.
Abdominal pain in pregnancy can have many potential causes including obstetric, gynecological, surgical, and medical issues. A thorough history and physical exam is important to determine the cause, which may include conditions like preterm labor, placental abruption, appendicitis, or ectopic pregnancy. Based on the findings, appropriate investigations like urine tests, ultrasound, and fetal monitoring can help make the diagnosis. Management is tailored to the specific cause but the priority is always the health and safety of the mother and baby.
This document discusses the evaluation and management of acute abdomen during pregnancy. It outlines common etiologies including appendicitis, bowel obstruction, and pregnancy-related causes. The evaluation involves history, physical exam focusing on signs of peritonitis, and lab tests. Imaging options like ultrasound and MRI are discussed. Laparoscopy is generally safe in pregnancy with precautions. Acute appendicitis is the most common non-obstetric surgical emergency. It can be more severe in pregnancy and risks increase with delayed treatment.
- Pelvic pain can have many causes involving the reproductive, gastrointestinal, genitourinary, and musculoskeletal systems.
- A thorough history and physical exam are essential to determine the underlying cause, which can be acute (less than 3 months), chronic (greater than 3 months), or recurrent.
- Common causes of acute pelvic pain include pelvic inflammatory disease, ectopic pregnancy, ovarian cysts, and endometriosis. Chronic causes include endometriosis, pelvic congestion syndrome, and irritable bowel syndrome.
Abdominal pain during pregnancy can have many causes and requires careful diagnosis. A thorough history and physical exam are important to determine the nature, timing, and location of the pain. Common causes include conditions of the reproductive organs like ectopic pregnancy or ovarian cysts. Other medical issues like appendicitis, pancreatitis, or infections must also be considered. The diagnosis and treatment plan aim to address the mother's needs while minimizing risk to the fetus. Proper evaluation and early intervention are important to prevent life-threatening complications for both mother and baby.
This document presents a case report of a 27-year-old pregnant woman at 16 weeks gestation who presented with abdominal pain. She reported a history of falling one month prior and intermittent abdominal pain since. On examination, she had direct tenderness in the right lower quadrant. Tests showed no abnormalities. She was admitted with a diagnosis of possible acute appendicitis. After observation and scans showed no issues, she was discharged. The document then reviews abdominal pain in pregnancy, challenges in evaluation, relevant tests and imaging, and various obstetric and surgical conditions that could cause acute abdominal pain in pregnancy.
Information about acute abdomen in pregnancy.
Gastrointestinal surgery in pregnancy.
Presentation on acute abdomen in pregnancy, physiology of pregnancy, upper abdominal pain, lower abdomen pain, diffuse abdominal pain, lonizing radiation etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document discusses the menstrual cycle and phases, assessment of gynecological patients, and management of common gynecological emergencies including abdominal pain, vaginal bleeding, trauma, and sexual assault. It describes the proliferative, secretory, ischemic, and menstrual phases of the typical 28-day menstrual cycle and notes important assessment factors like last menstrual period and contraceptive use. Guidance is provided on supporting patients with gynecological complaints and emergencies without performing internal exams in the field.
1. Ruptured ectopic pregnancy presents with sudden onset of severe abdominal pain and vaginal bleeding. Diagnosis is confirmed with transvaginal ultrasound and beta-hCG levels. Treatment depends on stability and may include medical or surgical options like salpingectomy.
2. Acute pelvic inflammatory disease is caused by ascending bacterial infection and presents with abdominal pain and abnormal discharge. Diagnosis involves screening for infections and inflammatory markers. Treatment involves intravenous antibiotics.
3. Testicular torsion presents with sudden severe scrotal pain. Diagnosis involves physical exam showing a high-riding painful testicle. Immediate surgical detorsion is required to save the testis.
Uterine prolapse occurs when the uterus descends from its normal position in the pelvis due to weakening of the pelvic muscles and ligaments that support it. It is a common condition seen primarily in post-menopausal women with a history of one or more vaginal deliveries. Symptoms include a feeling of pressure or fullness in the pelvis, back pain, difficulty emptying the bladder or bowels fully, and the visible protrusion of the uterus from the vagina. Management involves pelvic floor exercises, pessary devices, and surgery depending on the severity of the prolapse. Surgery such as vaginal hysterectomy is often used to correct uterine prolapse.
This document discusses several potential causes of acute pelvic pain in women, including ectopic pregnancy, adenexal masses, pelvic inflammatory disease, and fibroids. It notes key differentiating symptoms for each condition such as localized pain from an unruptured ectopic pregnancy versus generalized pain from a ruptured one. Diagnostic tests mentioned include culdocentesis and ultrasonography. Complications of certain conditions like corpus luteum hematoma or a ruptured tubo-ovarian abscess are also outlined.
Pelvic pain has many potential causes and requires a thorough history, examination, and testing to determine the underlying issue. It may originate from reproductive organs, the gastrointestinal or urinary systems, or other nearby structures. A careful differential diagnosis is needed to evaluate for conditions like pelvic inflammatory disease, endometriosis, fibroids, ovarian cysts, and other infections or abnormalities. The history should include details on the nature and timing of pain, along with associated symptoms, to help guide diagnostic testing and identify the cause of a patient's acute or chronic pelvic pain.
This document defines breech presentation and outlines its varieties, etiology, diagnosis, labor mechanism, complications, and management. It discusses the three main varieties of breech presentation: complete, frank, and footling. Risks to the baby include intrapartum death, brain/skull injuries, birth asphyxia, and birth injuries. Prevention includes external cephalic version to turn the baby, elective c-section if version fails, and skilled vaginal delivery with a team approach. Antenatal management involves identifying complicating factors, attempting external version, and planning the delivery method.
This document discusses subinvolution and urinary tract infections during the postpartum period. Subinvolution occurs when the uterus takes longer than normal to return to its non-pregnant size after delivery and can be caused by factors like multiparity, infection, or cesarean section. Common urinary complications include urinary tract infection, retention of urine, incontinence, and acute kidney injury. Urinary tract infections are treated with antibiotics, fluids, and rest while retention requires catheterization. Acute kidney injury involves phases of oliguria, anuria, early and late diuresis, and recovery managed through fluid balance, nutrition, and dialysis if needed.
This document discusses several common surgical diseases that may occur during pregnancy, including their presentation, diagnosis, and treatment considerations. It covers acute appendicitis, cholecystitis, intestinal obstruction, hernias, thyrotoxicosis, breast cancer, jaundice, urinary tract infections, and provides details on:
- How pregnancy can modify the signs and symptoms of these conditions, making diagnosis more difficult.
- The preferred timing and surgical approaches for treating these diseases while minimizing risks to the mother and fetus.
- The importance of prompt treatment for conditions like acute appendicitis to prevent complications.
- Nonsurgical and medical management options when surgery is relatively contraindicated during pregnancy.
This document discusses abnormal uterine action during labor, including definitions, types, causes, diagnosis, and management. The main types discussed are uterine inertia, ineffective contractions, abnormal polarity, incoordinate contractions including spastic lower segment and constriction ring, cervical dystocia, precipitate labor, tonic contractions, and retraction ring. The importance of assessing uterine tone, frequency and strength of contractions is emphasized for diagnosis. Management depends on the specific abnormality but may include oxytocin augmentation, amniotomy, operative vaginal delivery, or cesarean section.
Nausea and vomiting, heartburn, constipation, edema, and urinary frequency are some of the most common minor disorders experienced during pregnancy. Nursing interventions for these conditions include dietary changes like eating small, frequent meals; hydration; exercise; rest; and reassurance that the symptoms are normal and temporary. Proper posture and stress relief techniques can also help alleviate discomfort. Notifying the medical provider is recommended if problems arise like pain, bleeding, or other abnormal symptoms. Overall, minor pregnancy complaints are usually nothing to worry about with simple lifestyle adjustments.
This document discusses various gynecological disorders that can occur during pregnancy, including vaginal discharge, trichomoniasis, candidiasis, cervical polyps, cervical cancer, fibroids, ovarian cysts, retroverted uterus, uterine prolapse, and incarcerated retroverted gravid uterus. For each condition, it describes the prevalence during pregnancy, potential effects on the pregnancy and delivery, signs and symptoms, diagnosis, and recommended treatment approaches. Conservative management is typically recommended where possible to allow the pregnancy to continue.
The document discusses minor discomforts and complications that can occur during the postpartum period known as the pueperium. It defines pueperium as the 6-week period following childbirth where the body reverts to its pre-pregnant state. Common minor discomforts include afterpains, perineal pain, breast engorgement, increased urination, and constipation. Potential complications include postpartum hemorrhage, puerperal pyrexia (fever), puerperal sepsis (infection), urinary tract infections, and subinvolution where the uterus does not return to normal size. The document provides information on causes, signs, symptoms, and management of these minor discomforts
Pelvic pain can be caused by a wide range of conditions affecting the reproductive, urinary, digestive, and musculoskeletal systems. Some common causes of pelvic pain include appendicitis, irritable bowel syndrome, ovarian cysts, uterine fibroids, endometriosis, urinary tract infections, kidney stones, sexually transmitted diseases, and scar tissue formation. Chronic pelvic pain lasting over 6 months may interfere with daily life and requires diagnosis and treatment from a doctor to identify the underlying cause and provide appropriate treatment.
1. Inversion of the uterus is a life-threatening complication where the uterus turns inside out, either partially or completely. It most commonly occurs within 24 hours of delivery.
2. Inversion of the uterus can be classified based on the severity, from first degree where only the fundus is inverted to the internal os, to third degree where the entire uterus, cervix and vagina are inverted.
3. Symptoms include severe abdominal pain, a vaginal mass, and cardiovascular collapse. Diagnosis involves inability to palpate the fundus of the uterus. Treatment aims to manually reposition the uterus or use hydrostatic pressure with saline. Surgery may be required if conservative methods fail.
Uterine inversion occurs when the uterus turns inside out, most commonly during delivery from excessive cord traction or fundal pressure. It can range from the fundus inverting into the cervix to the entire uterus prolapsing outside the body. Prompt diagnosis and management is needed to prevent shock. The uterus must be manually or surgically replaced before detaching the placenta to avoid hemorrhage. Prevention involves controlled cord traction and avoiding fundal pressure until the placenta separates naturally.
1) Abdominal trauma can result from blunt or penetrating injuries and cause injuries to solid organs like the liver or spleen as well as hollow organs like the intestines.
2) Early definitive treatment within an hour of injury ("golden hour") can significantly reduce deaths and complications from abdominal trauma.
3) Diagnosis of abdominal trauma involves the patient history, physical exam looking for signs of internal bleeding, imaging like ultrasound, CT scans, and X-rays to identify injuries.
4) Management depends on the severity of the injuries but may include observation, surgery to repair damage, or an abbreviated "damage control" surgery to stop life-threatening bleeding followed by further treatment once the patient is stabilized.
Breast complications during lactation can include engorgement, cracked or retracted nipples, mastitis, breast abscesses, and lactation failure. Engorgement is caused by a buildup of milk, blood and fluids in the breast tissues due to an imbalance between milk supply and infant demand. It causes swollen, painful breasts. Mastitis is an inflammation of breast tissue that can be infectious or non-infectious. Infectious mastitis requires antibiotic treatment to prevent complications like abscesses. Breast abscesses form when mastitis is left untreated and require drainage procedures. Septic pelvic vein thrombophlebitis refers to infected blood clots in the pelvic veins that can lead to abs
The document discusses the evaluation and management of acute abdomen in pregnancy. It defines acute abdomen and notes the diagnostic approach is similar to non-pregnant patients but physiological changes of pregnancy must be considered. Common causes of abdominal pain in pregnancy include urinary tract infections, appendicitis, round ligament pain, and complications of pregnancy like placental abruption. A thorough history, physical exam, and testing are important to diagnose the source of pain while also monitoring the mother and fetus. Both pregnancy-related and non-pregnancy related conditions can cause abdominal pain and require appropriate treatment.
This document discusses various types of ectopic pregnancies. It begins by defining an ectopic pregnancy as implantation outside the uterine cavity, most commonly in the fallopian tubes. It then discusses the signs, symptoms, risk factors, diagnosis and treatment of tubal, abdominal, ovarian, angular, cornual and cervical ectopic pregnancies. Medical treatments include methotrexate, while surgical treatments include laparoscopy or laparotomy to remove the ectopic pregnancy. Complications can include rupture and internal bleeding. The document provides detailed information on the locations, causes and management of different ectopic pregnancy types.
Abdominal pain during pregnancy can have many causes and requires careful diagnosis. A thorough history and physical exam are important to determine the nature, timing, and location of the pain. Common causes include conditions of the reproductive organs like ectopic pregnancy or ovarian cysts. Other medical issues like appendicitis, pancreatitis, or infections must also be considered. The diagnosis and treatment plan aim to address the mother's needs while minimizing risk to the fetus. Proper evaluation and early intervention are important to prevent life-threatening complications for both mother and baby.
This document presents a case report of a 27-year-old pregnant woman at 16 weeks gestation who presented with abdominal pain. She reported a history of falling one month prior and intermittent abdominal pain since. On examination, she had direct tenderness in the right lower quadrant. Tests showed no abnormalities. She was admitted with a diagnosis of possible acute appendicitis. After observation and scans showed no issues, she was discharged. The document then reviews abdominal pain in pregnancy, challenges in evaluation, relevant tests and imaging, and various obstetric and surgical conditions that could cause acute abdominal pain in pregnancy.
Information about acute abdomen in pregnancy.
Gastrointestinal surgery in pregnancy.
Presentation on acute abdomen in pregnancy, physiology of pregnancy, upper abdominal pain, lower abdomen pain, diffuse abdominal pain, lonizing radiation etc.
https://drdhavalmangukiya.com/
http://www.youtube.com/c/DrDhavalMangukiyaGastrosurgeonSurat
https://gastrosurgerysurat.blogspot.com/
This document discusses the menstrual cycle and phases, assessment of gynecological patients, and management of common gynecological emergencies including abdominal pain, vaginal bleeding, trauma, and sexual assault. It describes the proliferative, secretory, ischemic, and menstrual phases of the typical 28-day menstrual cycle and notes important assessment factors like last menstrual period and contraceptive use. Guidance is provided on supporting patients with gynecological complaints and emergencies without performing internal exams in the field.
1. Ruptured ectopic pregnancy presents with sudden onset of severe abdominal pain and vaginal bleeding. Diagnosis is confirmed with transvaginal ultrasound and beta-hCG levels. Treatment depends on stability and may include medical or surgical options like salpingectomy.
2. Acute pelvic inflammatory disease is caused by ascending bacterial infection and presents with abdominal pain and abnormal discharge. Diagnosis involves screening for infections and inflammatory markers. Treatment involves intravenous antibiotics.
3. Testicular torsion presents with sudden severe scrotal pain. Diagnosis involves physical exam showing a high-riding painful testicle. Immediate surgical detorsion is required to save the testis.
Uterine prolapse occurs when the uterus descends from its normal position in the pelvis due to weakening of the pelvic muscles and ligaments that support it. It is a common condition seen primarily in post-menopausal women with a history of one or more vaginal deliveries. Symptoms include a feeling of pressure or fullness in the pelvis, back pain, difficulty emptying the bladder or bowels fully, and the visible protrusion of the uterus from the vagina. Management involves pelvic floor exercises, pessary devices, and surgery depending on the severity of the prolapse. Surgery such as vaginal hysterectomy is often used to correct uterine prolapse.
This document discusses several potential causes of acute pelvic pain in women, including ectopic pregnancy, adenexal masses, pelvic inflammatory disease, and fibroids. It notes key differentiating symptoms for each condition such as localized pain from an unruptured ectopic pregnancy versus generalized pain from a ruptured one. Diagnostic tests mentioned include culdocentesis and ultrasonography. Complications of certain conditions like corpus luteum hematoma or a ruptured tubo-ovarian abscess are also outlined.
Pelvic pain has many potential causes and requires a thorough history, examination, and testing to determine the underlying issue. It may originate from reproductive organs, the gastrointestinal or urinary systems, or other nearby structures. A careful differential diagnosis is needed to evaluate for conditions like pelvic inflammatory disease, endometriosis, fibroids, ovarian cysts, and other infections or abnormalities. The history should include details on the nature and timing of pain, along with associated symptoms, to help guide diagnostic testing and identify the cause of a patient's acute or chronic pelvic pain.
This document defines breech presentation and outlines its varieties, etiology, diagnosis, labor mechanism, complications, and management. It discusses the three main varieties of breech presentation: complete, frank, and footling. Risks to the baby include intrapartum death, brain/skull injuries, birth asphyxia, and birth injuries. Prevention includes external cephalic version to turn the baby, elective c-section if version fails, and skilled vaginal delivery with a team approach. Antenatal management involves identifying complicating factors, attempting external version, and planning the delivery method.
This document discusses subinvolution and urinary tract infections during the postpartum period. Subinvolution occurs when the uterus takes longer than normal to return to its non-pregnant size after delivery and can be caused by factors like multiparity, infection, or cesarean section. Common urinary complications include urinary tract infection, retention of urine, incontinence, and acute kidney injury. Urinary tract infections are treated with antibiotics, fluids, and rest while retention requires catheterization. Acute kidney injury involves phases of oliguria, anuria, early and late diuresis, and recovery managed through fluid balance, nutrition, and dialysis if needed.
This document discusses several common surgical diseases that may occur during pregnancy, including their presentation, diagnosis, and treatment considerations. It covers acute appendicitis, cholecystitis, intestinal obstruction, hernias, thyrotoxicosis, breast cancer, jaundice, urinary tract infections, and provides details on:
- How pregnancy can modify the signs and symptoms of these conditions, making diagnosis more difficult.
- The preferred timing and surgical approaches for treating these diseases while minimizing risks to the mother and fetus.
- The importance of prompt treatment for conditions like acute appendicitis to prevent complications.
- Nonsurgical and medical management options when surgery is relatively contraindicated during pregnancy.
This document discusses abnormal uterine action during labor, including definitions, types, causes, diagnosis, and management. The main types discussed are uterine inertia, ineffective contractions, abnormal polarity, incoordinate contractions including spastic lower segment and constriction ring, cervical dystocia, precipitate labor, tonic contractions, and retraction ring. The importance of assessing uterine tone, frequency and strength of contractions is emphasized for diagnosis. Management depends on the specific abnormality but may include oxytocin augmentation, amniotomy, operative vaginal delivery, or cesarean section.
Nausea and vomiting, heartburn, constipation, edema, and urinary frequency are some of the most common minor disorders experienced during pregnancy. Nursing interventions for these conditions include dietary changes like eating small, frequent meals; hydration; exercise; rest; and reassurance that the symptoms are normal and temporary. Proper posture and stress relief techniques can also help alleviate discomfort. Notifying the medical provider is recommended if problems arise like pain, bleeding, or other abnormal symptoms. Overall, minor pregnancy complaints are usually nothing to worry about with simple lifestyle adjustments.
This document discusses various gynecological disorders that can occur during pregnancy, including vaginal discharge, trichomoniasis, candidiasis, cervical polyps, cervical cancer, fibroids, ovarian cysts, retroverted uterus, uterine prolapse, and incarcerated retroverted gravid uterus. For each condition, it describes the prevalence during pregnancy, potential effects on the pregnancy and delivery, signs and symptoms, diagnosis, and recommended treatment approaches. Conservative management is typically recommended where possible to allow the pregnancy to continue.
The document discusses minor discomforts and complications that can occur during the postpartum period known as the pueperium. It defines pueperium as the 6-week period following childbirth where the body reverts to its pre-pregnant state. Common minor discomforts include afterpains, perineal pain, breast engorgement, increased urination, and constipation. Potential complications include postpartum hemorrhage, puerperal pyrexia (fever), puerperal sepsis (infection), urinary tract infections, and subinvolution where the uterus does not return to normal size. The document provides information on causes, signs, symptoms, and management of these minor discomforts
Pelvic pain can be caused by a wide range of conditions affecting the reproductive, urinary, digestive, and musculoskeletal systems. Some common causes of pelvic pain include appendicitis, irritable bowel syndrome, ovarian cysts, uterine fibroids, endometriosis, urinary tract infections, kidney stones, sexually transmitted diseases, and scar tissue formation. Chronic pelvic pain lasting over 6 months may interfere with daily life and requires diagnosis and treatment from a doctor to identify the underlying cause and provide appropriate treatment.
1. Inversion of the uterus is a life-threatening complication where the uterus turns inside out, either partially or completely. It most commonly occurs within 24 hours of delivery.
2. Inversion of the uterus can be classified based on the severity, from first degree where only the fundus is inverted to the internal os, to third degree where the entire uterus, cervix and vagina are inverted.
3. Symptoms include severe abdominal pain, a vaginal mass, and cardiovascular collapse. Diagnosis involves inability to palpate the fundus of the uterus. Treatment aims to manually reposition the uterus or use hydrostatic pressure with saline. Surgery may be required if conservative methods fail.
Uterine inversion occurs when the uterus turns inside out, most commonly during delivery from excessive cord traction or fundal pressure. It can range from the fundus inverting into the cervix to the entire uterus prolapsing outside the body. Prompt diagnosis and management is needed to prevent shock. The uterus must be manually or surgically replaced before detaching the placenta to avoid hemorrhage. Prevention involves controlled cord traction and avoiding fundal pressure until the placenta separates naturally.
1) Abdominal trauma can result from blunt or penetrating injuries and cause injuries to solid organs like the liver or spleen as well as hollow organs like the intestines.
2) Early definitive treatment within an hour of injury ("golden hour") can significantly reduce deaths and complications from abdominal trauma.
3) Diagnosis of abdominal trauma involves the patient history, physical exam looking for signs of internal bleeding, imaging like ultrasound, CT scans, and X-rays to identify injuries.
4) Management depends on the severity of the injuries but may include observation, surgery to repair damage, or an abbreviated "damage control" surgery to stop life-threatening bleeding followed by further treatment once the patient is stabilized.
Breast complications during lactation can include engorgement, cracked or retracted nipples, mastitis, breast abscesses, and lactation failure. Engorgement is caused by a buildup of milk, blood and fluids in the breast tissues due to an imbalance between milk supply and infant demand. It causes swollen, painful breasts. Mastitis is an inflammation of breast tissue that can be infectious or non-infectious. Infectious mastitis requires antibiotic treatment to prevent complications like abscesses. Breast abscesses form when mastitis is left untreated and require drainage procedures. Septic pelvic vein thrombophlebitis refers to infected blood clots in the pelvic veins that can lead to abs
The document discusses the evaluation and management of acute abdomen in pregnancy. It defines acute abdomen and notes the diagnostic approach is similar to non-pregnant patients but physiological changes of pregnancy must be considered. Common causes of abdominal pain in pregnancy include urinary tract infections, appendicitis, round ligament pain, and complications of pregnancy like placental abruption. A thorough history, physical exam, and testing are important to diagnose the source of pain while also monitoring the mother and fetus. Both pregnancy-related and non-pregnancy related conditions can cause abdominal pain and require appropriate treatment.
This document discusses various types of ectopic pregnancies. It begins by defining an ectopic pregnancy as implantation outside the uterine cavity, most commonly in the fallopian tubes. It then discusses the signs, symptoms, risk factors, diagnosis and treatment of tubal, abdominal, ovarian, angular, cornual and cervical ectopic pregnancies. Medical treatments include methotrexate, while surgical treatments include laparoscopy or laparotomy to remove the ectopic pregnancy. Complications can include rupture and internal bleeding. The document provides detailed information on the locations, causes and management of different ectopic pregnancy types.
This document discusses placenta praevia, beginning with definitions and classifications. It then discusses causes, pathology, clinical presentation, investigations and management. Placenta praevia is defined as the placenta being wholly or partly in the lower uterine segment. It is classified depending on the extent of coverage of the cervical os, from Type I where the placenta reaches the margin to Type IV where it completely covers the os. Clinical presentation includes painless vaginal bleeding. Investigations include ultrasound and CTG. Management depends on the type, with Types I and II anterior usually being managed by ARM and oxytocin, while Types II posterior, III and IV usually require caesarean section due to risk of
Palpate for uterine tenderness and contractions. Check cervix for effacement and dilation. Rule out PPROM by checking for amniotic fluid pooling or leaking. Consider infection/bleeding as potential causes based on history and exam findings.
This document discusses the clinical presentation of ectopic pregnancy. Common symptoms include abdominal or pelvic pain, missed periods, and vaginal bleeding with or without clots. Before rupture, vital signs are usually normal but moderate hemorrhaging can cause bradycardia and hypotension while full rupture leads to tachycardia, hypotension, and signs of hypovolemic shock. On examination, tenderness may be present and in some cases a pelvic mass is detectable that feels soft and elastic. Culdocentesis, where fluid is extracted from the cul-de-sac, can help identify hemoperitoneum supporting a diagnosis of ruptured ectopic pregnancy.
Ectopic pregnancy occurs when a fertilized egg implants somewhere other than the uterus, most commonly in one of the fallopian tubes. Tubal pregnancies account for over 90% of ectopic pregnancies and develop when the fertilized egg is unable to travel to the uterus to implant. Ectopic pregnancies can be caused by congenital abnormalities of the fallopian tubes, previous infections, IUD use, or fertility treatments. Clinical features include abdominal pain, vaginal bleeding, and amenorrhea. Diagnosis involves blood tests for human chorionic gonadotropin and ultrasound imaging. Treatment options include medical management with methotrexate or surgical management via laparoscopy.
Ectopic pregnancy occurs when a fertilized egg implants and grows outside of the uterus, most commonly in the fallopian tubes. It is a serious condition that can cause life-threatening bleeding. Symptoms include missed period, abdominal pain, and vaginal bleeding. Diagnosis is confirmed through blood tests of beta-hCG and progesterone levels, ultrasound showing empty uterus, and sometimes laparoscopy. Treatment depends on severity but may include medication, surgery, or in rare cases expectant management.
This document discusses abortion, including its definition, causes, types, diagnosis, and management. It defines abortion as the expulsion of the products of conception from the uterus before 20 weeks of gestation or when the fetus weighs less than 500g. It describes the various causes of abortion including faults in the embryo or maternal environment. It discusses the types of abortion like threatened, incomplete, complete, missed, and recurrent abortion. It covers the diagnosis and management of abortion as well as complications like septic abortion. It also describes methods of induced abortion in the first and second trimester.
1. Surgical illness during pregnancy requires careful consideration of risks to both the mother and fetus.
2. The second trimester is generally safest for elective surgery due to lower risks of teratogenesis, miscarriage, and preterm delivery.
3. Emergency surgery may be required at any time in pregnancy to stabilize the mother, with close monitoring of the fetus thereafter.
Miscarriage is the loss of a pregnancy during the first trimester and occurs in about 25% of pregnancies. Warning signs of miscarriage include cramping, back pain, vaginal bleeding or discharge. There are different types of miscarriage such as threatened, inevitable, complete, and missed. Causes can include placental problems, womb abnormalities, and lifestyle factors like smoking, drinking, or drug use. To help prevent miscarriage, women should avoid these lifestyle factors, eat nutritious foods, maintain a healthy weight, and avoid infections.
Abruptio placenta, or premature separation of the placenta from the uterine wall, can occur anytime after 20 weeks of pregnancy. It poses risks to both the mother and fetus, such as bleeding, shock, and restricted blood flow between the placenta and fetus. Risk factors include advanced maternal age, smoking, and prior abruption. Management may involve bed rest, monitoring of the fetus and mother, and sometimes surgical delivery of the baby via cesarean section.
inversion of uterus- Complication of third stage labor
Introduction
It is an extremely rare but a life threatening complication in third stage in which the uterus is turned inside out partially or completely.
The incidence is about 1 in 20,000 deliveries.
The obstetric inversion is almost always an acute one and usually complete.
Types or degrees
First degree
There is dimpling of the fundus which still remains above the level of internal os.
Second degree
The fundus passes through the cervix but lies inside the vagina.
Third degree (complete)
The endometrium with or without the attached placenta is visible outside the vulva. The cervix and part of the vagina may also be involved in the process
Etiology
First degree
There is dimpling of the fundus which still remains above the level of internal os.
Second degree
The fundus passes through the cervix but lies inside the vagina.
Third degree (complete)
The endometrium with or without the attached placenta is visible outside the vulva. The cervix and part of the vagina may also be involved in the process
Risk factors
Uterine over enlargement
Prolonged labour
Fetal macrosomia
Uterine malformations
Morbid adherent placenta
Short umbilical cord
Pathogenesis
The underlying pathophysiologic mechanism is unknown
It has been attributed to use of
excessive cord traction and
fundal pressure
atonic uterus
fundal implantation of the placenta
Clinical features
Diagnosis
Management
Complications
Rupture of the uterus can occur spontaneously during pregnancy or labor due to factors like previous scarring or being a grand multipara. It can also be caused by trauma during procedures like external version or the use of oxytocics. Diagnosis involves abdominal pain and tenderness along with signs of shock. Treatment involves resuscitation and laparotomy to perform a hysterectomy, repair the rupture, or repair and perform a sterilization. Preventive measures include careful monitoring of at-risk mothers and avoiding unnecessary interventions.
Rupture of the uterus can occur spontaneously during pregnancy or labor due to factors like previous scarring or being a grand multipara. It can also be caused by procedures like cesarean delivery, myomectomy, or induction of labor. Ruptures are described as complete or incomplete depending on whether the peritoneum is involved. Diagnosis involves abdominal pain and tenderness along with signs of internal bleeding. Treatment requires resuscitation followed by laparotomy where a hysterectomy, repair, or repair with sterilization may be performed.
This document summarizes common minor disorders that can occur during pregnancy, organized by body system. It describes nausea and vomiting, heartburn, excessive salivation, pica, constipation, backache, cramps, ligament pain, fatigue, increased urination, leukorrhea, fainting, varicosities, skin itching, and edema. For each disorder, it explains causes and provides management recommendations such as dietary changes, exercises, positions, and when to refer to a medical practitioner. The goal is to help midwives advise women on coping strategies and recognizing signs that warrant medical attention.
This document provides an overview of obstetrical emergencies including uterine rupture and shoulder dystocia. For uterine rupture, it defines the condition, describes the causes, clinical features, and management approach. Management involves supportive care like IV fluids and antibiotics followed by definitive surgery like repair or hysterectomy. For future pregnancies, cesarean delivery is recommended. For shoulder dystocia, it defines the condition, discusses prediction and clinical presentation. Management involves initial maneuvers applied sequentially like McRoberts, Woods screw, and extraction of the posterior arm. More invasive options like clavicular fracture or Zavanelli maneuver may be considered if initial attempts fail. Complications for both mother and baby are described.
1) Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. It can be life-threatening if ruptured. Treatment involves surgery or methotrexate depending on severity.
2) Miscarriage is the spontaneous loss of pregnancy before 20 weeks. Causes include chromosomal abnormalities and infections. Treatment depends on type and severity of symptoms.
3) Hyperemesis gravidarum causes severe nausea and vomiting in pregnancy. It requires hospitalization and IV fluids and antiemetics.
The document discusses displacement and inversion of the uterus. It defines retroversion as the axis of the cervix being behind the vertical axis of the female body. Uterine inversion can occur immediately after childbirth where the uterus turns inside out, described in degrees from the wall extending through the cervix to the entire uterus protruding outside the vagina. Treatment involves manual replacement, tocolytics to relax the uterus, and potentially surgery through the abdomen or vagina. Post-procedure care includes uterotonics, antibiotics, and close monitoring.
1. Abortion is defined as delivery occurring before 28 weeks of gestation and can be spontaneous or induced. Common causes include genetic abnormalities, infection, endocrine or immunological factors.
2. Ectopic pregnancies occur when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. Rupture of an ectopic pregnancy can be life-threatening due to hemorrhage. Diagnosis is made through symptoms, ultrasound identification of an adnexal mass, and positive beta-hCG tests.
3. Hyperemesis gravidarum is a condition of prolonged, severe nausea and vomiting during pregnancy that can cause dehydration, weight loss, and electrolyte
Acutepelvicinflammatorydisease Ahmed Mukhtar Ali ahmed afify
This document provides an overview of acute pelvic inflammatory disease (PID). It discusses what PID is, its epidemiology and risk factors. The main causes are sexually transmitted organisms like Neisseria gonorrhoeae and Chlamydia trachomatis. Diagnosis is based on symptoms and physical exam findings. Treatment involves antibiotics, sometimes hospitalization, to eliminate the infection. Prevention strategies target screening and treatment of sexually transmitted infections.
This document discusses several benign diseases of the vulva, vagina, and cervix. It describes conditions such as Bartholin's cyst, atrophic lichen (lichen sclerosus et atrophicus), and squamous cell hyperplasia. For each condition, it provides details on presentation, etiology, pathology findings, and treatment options. The document aims to comprehensively cover inflammatory diseases, blistering diseases, pigmentary changes, benign tumors, hamartomas and cysts, and congenital malformations that can affect the vulva, vagina, and cervix.
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
This document provides an overview of obstetric anatomy, including the fetal skull, pelvis, and soft tissues involved in childbirth. It describes the diameters and molding of the fetal skull, as well as caput succedaneum and cephalhematoma. It outlines the bones, joints, planes and diameters of the female pelvis and classifies the four pelvic types. It also discusses the formation of the lower uterine segment and birth canal during labor, the muscles of the pelvic floor, and episiotomy. In summary, it provides a detailed anatomical reference for the structures involved in fetal descent and passage through the birth canal.
Presented by:
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
Presented by:
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
Presented by:
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
The document discusses thyroid disease in pregnancy. It describes the physiological changes in thyroid function during pregnancy, including increases in thyroid binding globulin and thyroid hormone levels. It covers the signs, symptoms, risks and treatment of both hyperthyroidism and hypothyroidism in pregnancy. For hyperthyroidism, the most common cause is Graves' disease. Risks include early pregnancy loss, fetal growth issues, and neonatal hyperthyroidism. Treatment involves antithyroid medications. For hypothyroidism, the most common causes are Hashimoto's thyroiditis and iodine deficiency. Risks include infertility, miscarriage, and impaired neurodevelopment. Treatment is levothyroxine supplementation.
Presented by
Ahmed Mukhtar
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
PPH.Presented by
Ahmed Mukhtar Ali Mohammed
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
Spontaneous Bacterial Peritonitis - Pathogenesis , Clinical Features & Manage...Jim Jacob Roy
In this presentation , SBP ( spontaneous bacterial peritonitis ) , which is a common complication in patients with cirrhosis and ascites is described in detail.
The reference for this presentation is Sleisenger and Fordtran's Gastrointestinal and Liver Disease Textbook ( 11th edition ).
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Medical Quiz ( Online Quiz for API Meet 2024 ).pdf
Renal failure-in-pregnancy1
1. Abdominal Pain During PregnancyAbdominal Pain During Pregnancy
Dr. Ahmad mukhtarDr. Ahmad mukhtar
M.B.B.Ch., M.Sc Obstetrics and GynecologyM.B.B.Ch., M.Sc Obstetrics and Gynecology
Assistante lecturer of Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig UniversityFaculty of Medicine, Zagazig University
2. Introduction
Abdominal pain in pregnancy is a common
complaint. It’s management represents
a challenge
to the clinician because the causes may
be due to pregnancy or may be related
to pregnancy but not directly due to it
or may be unrelated to pregnancy at all.
5. The incidence of the different causes
of abdominal pain in pregnancy is
difficult to estimate . The is because
classifying this symptom into
pregnancy & non-pregnancy symptom
related is often not possible until
after delivery.
6. Pain directly related to pregnancy;-
First trimesterFirst trimester
Abortion
Hydatidiform mole
Ectopic pregnancy
The pain is colicky in nature felt in the lower abdomen
or pelvis commonly associated with commonly
associated with amenorrhoea and vaginal bleeding
In threatened & missed abortions there may be mild
or no pain Diagnosis by BHCG,exam & USS
7. .Molar pregnancy Incidence is 1 in
1200 pregnancies Pain when present
is due to the uterus trying to expel
the molar tissue (colicky) When
severe may suggest intra-peritoneal
bleeding Uterus large for date
,watery blood stained discharge
USS shows snow – storm appearance .
8. . Ectopic pregnancy Incidence is 1 in
100 pregnancies in UK Presents with
pain & amenorrhoea The pain is
commonly in one of the iliac fossa and
may be referred to the tip of the shoulder
Most of cases are diagnosed by
BHCG,TVS and/or laparoscopy.
9. . Second trimester * Abortion* * Acute
urinary retention in association with
incarcerated* retroverted gravid uterus
typically at 12-14 weeks *
Chorioamnionitis following PROM* *
Retroplacental haemorrhage following
amniocentesis* * Round ligament pain due
to stretch classically at 18-22 wks * Red
degeneration of the fibroid
10. Incarcerated retroverted graved uterus
Commonly occurs between 12-14wks
Causes urethral obstruction with acute
urinary retention & pain Indwelling urine
cathter helps allow the uterus to become
abdominal
11. . Retroplacental haemorrhage following
amniocentesis Can complicate both
diagnostic & therapeutic amniocentesis
especially when the needle inserted
transplacentally Pain is felt a few hours
after after the procedure Constant &
localised to the puncture site
12. Round ligament pain Occurs secondary
to stretching of the ligament as the uterus
enlarges into the abdomen (10-30% of
pregnancy) Commonly occurs in the
late 1stst and early 2and trimester Felt
as dragging, stabbing or cramp-like pain in
the outer lower abdomen radiating to
groin Diagnosis is made by excluding
other other causes .
13. . Red degeneration of fibroid Occurs due to
infarction of the centre of the fibroid during mid –
pregnancy The fibroid suddenly enlarges & is
painful and tender The pain is ischaemic
,constant, and localised to one side of the uterus
but sometimes diffuse. Mild pyrexia leucocytosis.
USS may be helpful Treatment is
conservative
Third Trimester
14. 17. Fetal movements & Braxton-Hicks
contractions These are spontaneous
uterine contractions becoming more
frequent as pregnanc. advances.
15. Initially painless but then perceived as
vague backache which is minimally
uncomfortable but does not need
analgesia, however can be sever requiring
hospital admission commonly in
primigravida.
16. Placental abruption Presents with
abdominal pain or vaginal bleeding or
without vaginal bleeding Complicates up
to 1% of pregnancies Abdominal pain
could be mild constant or intermittent (like
labour pains)
When no vaginal bleeding, can be
confused with other causes of abdominal
pain.
17. Sever Pre-eclampsia & eclampsia
Incidence about 6% among primigravida
about 6% among primigravidae Pain is mainly
at the epigastrium & Rt upper quadrantquadrant
It’s due to stretching of the liver capsuleIt’s
secondary to subcapsular haemorrhage Other
symptoms & signs are often present
Treatment involves control & delivery.
18. 20. Uterine rupture Unlikely to occur silently
during pregnancy but it can occur in women
with previous classical C/S usually from early
3rdrd trimester. Others occur in labour in women
who had Others c/s or perforated uterus during
D/C The abdominal pain typically acute,
, associated with shock & shoulder tip pain
Laparotomy is required after resuscitblock.
19. Pain not directly related to pregnancy
22. Gastrointestinal TractGastrointestinal Tract
23. Gastro-esophagealGastro-esophageal refluxreflux
A common cause of upper abdominalA common cause
of upper abdominal pain in pregnancy. Incidence 60-
70%pain in pregnancy. Incidence 60-70% More
common in late pregnancyMore common in late
pregnancy multiple pregnancy & polyhydramniosmultiple
pregnancy & polyhydramnios Felt as burning
sensation inFelt as burning sensation in epigastrium &
behind the sternumepigastrium & behind the sternum
Caused by relaxation of gastro-Caused by relaxation of
gastro- esophageal sphincteresophageal sphincter
20. Peptic ulcerPeptic ulcer Uncommon during
pregnancyUncommon during pregnancy Usually there
is a pre-existing historyUsually there is a pre-existing
history Pain typically in the epigasric & RtPain typically
in the epigasric & Rt hypochodrium worse with hunger &
spicyhypochodrium worse with hunger & spicy foodfood
Perforation is rare but may occur especiallyPerforation
is rare but may occur especially after delivery. Presents
with acute painafter delivery. Presents with acute pain
,collapse & peritonitis,collapse & peritonitis Gas under
diaphragm on erect x-ray abdomGas under diaphragm
on erect x-ray abdom
21. . Hiatus herniaHiatus hernia Incidence 7-22% of all
pregnanciesIncidence 7-22% of all pregnancies Present in 62% of
cases of severPresent in 62% of cases of sever heartburn in the
3heartburn in the 3rdrd trimestertrimester Very severe cases
present with severVery severe cases present with sever vomiting &
haematemesisvomiting & haematemesis Treatment as for reflux
esophagitisTreatment as for reflux esophagitis
26. constipationconstipation May present as sever or chronicMay
present as sever or chronic abdominal painabdominal pain
Caused by slow peristalsisCaused by slow peristalsis (progeterone
effect)(progeterone effect) Felt as dull, constant & sometimesFelt
as dull, constant & sometimes colicky pain in the iliac fossae
(Ltcolicky pain in the iliac fossae (Lt Treatment with high fibre diet
&Treatment with high fibre diet & laxativeslaxatives
22. 27. Acute appendicitisAcute appendicitis
Complicates 1 in 1500-2500Complicates 1 in
1500-2500 pregnancies (as in non-
pregnants)pregnancies (as in non-pregnants)
Symptoms & signs may be atypical.Symptoms &
signs may be atypical. Pain may be in the Rt
lumber region inPain may be in the Rt lumber
region in early gestation or in the Rtearly
gestation or in the Rt hypochondrium in late
pregnancy duehypochondrium in late pregnancy
due to displacement of caecum & appedixto
displacement of caecum & appedix by the gravid
uterusby the gravid uterus
23. The pain in early pregnancy startsThe pain in early pregnancy starts around the umbilicus then
settles inaround the umbilicus then settles in the RIFthe RIF Accompanied by nausea,
vomitingAccompanied by nausea, vomiting anorexia & fever however, theseanorexia & fever
however, these symptoms may be absent in latesymptoms may be absent in late
pregnancypregnancy
29. Leucocytosis is an important sign butLeucocytosis is an important sign but due to
physiological leucocytosis indue to physiological leucocytosis in pregnancy, serial count is more
usefulpregnancy, serial count is more useful Pyrexia, tenderness & guarding overPyrexia,
tenderness & guarding over the Rt abdomen may be the only signsthe Rt abdomen may be the
only signs presentpresent The inflammed appendix may induceThe inflammed appendix may
induce preterm labourpreterm labour
30. Treatment of acute appendicitisTreatment of acute appendicitis In early pregnancy
laparoscopicIn early pregnancy laparoscopic appendectomy can be done or
throughappendectomy can be done or through the classical McBurney incisionthe classical
McBurney incision If laparotomy is necessary, a para-If laparotomy is necessary, a para-
median incision over the area of maxmedian incision over the area of max tenderness allows the
best access iftenderness allows the best access if extension is neededextension is needed
31. Complications of appendicitis inComplications of appendicitis in pregnancypregnancy
RuptureRupture Peritonitis: organ displacementPeritonitis: organ displacement prevents
walling- off of the inflammedprevents walling- off of the inflammed appendixappendix PROM &
preterm labourPROM & preterm labour
24. . Bowel obstructionBowel obstruction Is a rare cause of acute abdominalIs
a rare cause of acute abdominal pain in pregnancy (1 in 2500-3500 )pain in
pregnancy (1 in 2500-3500 ) Incidence appears to be increasingIncidence
appears to be increasing due to increased abdomino –pelvicdue to
increased abdomino –pelvic surgery causing adhesion bandssurgery
causing adhesion bands Rarely caused by strangulated femoralRarely
caused by strangulated femoral or inguinal herniae & volvulus.or inguinal
herniae & volvulus.
33. Bowel obstruction ..contBowel obstruction ..cont The pain is colicky
with exaggerated bowelThe pain is colicky with exaggerated bowel sounds
& constipation. Abdominalsounds & constipation. Abdominal distension may
be difficult to detect indistension may be difficult to detect in advanced
pregnancyadvanced pregnancy Treatment is conservative with N/S
tubing,Treatment is conservative with N/S tubing, fluid & electrolyte
replacementfluid & electrolyte replacement it usually settle within few hours
otherwiseit usually settle within few hours otherwise laparotomy is required
to divide adhesionslaparotomy is required to divide adhesions
25. . Gallstones &Gallstones & cholecystitischolecystitis Pregnancy predisposes to gallstonesPregnancy predisposes to gallstones due to
biliary stasis and raiseddue to biliary stasis and raised cholesterol in pregnancycholesterol in pregnancy Incidence about 3.5%Incidence
about 3.5% Most women are asymptomaticMost women are asymptomatic Symptomatic Pt’s present with suddenSymptomatic Pt’s
present with sudden onset of colicky abdominal painonset of colicky abdominal pain radiating to the back in Rt hypochodriuradiating to the
back in Rt hypochodriu
35. Gallbladder ..contGallbladder ..cont Nausea, vomiting & vasovagal attacksNausea, vomiting & vasovagal attacks Tenderness &
positive murphy’s signTenderness & positive murphy’s sign may be the only positive clinical signsmay be the only positive clinical signs
Diagnosis can be made by ultrasoundDiagnosis can be made by ultrasound Treatment is coservativeTreatment is coservative
Surgery can be performed in earlySurgery can be performed in early pregnancy laparoscopicallypregnancy laparoscopically
36. Gallbladder..contGallbladder..cont Open surgery can be done inOpen surgery can be done in advanced pregnancy but risks
areadvanced pregnancy but risks are ascending cholangitis which may leadascending cholangitis which may lead to septicaemia &
preterm labourto septicaemia & preterm labour
37. Gallbladder..contGallbladder..cont Acute cholecystitis is uncommon inAcute cholecystitis is uncommon in pregnancypregnancy
Presents with acute Rt hypochonderialPresents with acute Rt hypochonderial pain, nausea, vomiting & pyrexiapain, nausea, vomiting &
pyrexia Pyrexia differentiating it from gallstonePyrexia differentiating it from gallstone Incidence 1 in 1000 pregnanciesIncidence 1 in
1000 pregnancies Treatment with antibiotics & analgesiaTreatment with antibiotics & analgesia
38. pancreatitispancreatitis Uncommon in pregnancy (1 in 5000)Uncommon in pregnancy (1 in 5000) More common in pregnants
than nonMore common in pregnants than non High mortality rate (>10%)High mortality rate (>10%) Presents with central or
upperPresents with central or upper abdominal pain radiating to the backabdominal pain radiating to the back There may be nausea,
vomiting &There may be nausea, vomiting & shock. Few with juandice when thereshock. Few with juandice when there is obstructed
biliary systemis obstructed biliary system
39. Pancreatitis.. contPancreatitis.. cont Diagnosis confirmed by raised serumDiagnosis confirmed by raised serum amylaseamylase
Ultrasound shows gallstones in 50% ofUltrasound shows gallstones in 50% of casescases Treatment is conservative with iv
fluidTreatment is conservative with iv fluid & electrolyte replacement, pethidine,& electrolyte replacement, pethidine, steroids, antibiotics
cimitidine &steroids, antibiotics cimitidine & glucgoneglucgone
40. Renal tractRenal tract
41. Acute pyelonephritisAcute pyelonephritis Is the most common renal cause ofIs the most common renal cause of abdominal pain in
pregnancy (1-2%)abdominal pain in pregnancy (1-2%) Most cases present in the 2Most cases present in the 2ndnd & 3& 3rdrd
trimesters with sever abdominal paintrimesters with sever abdominal pain in the lumbar region radiating to thein the lumbar region
radiating to the iliac fossa or vulvailiac fossa or vulva Nausea, vomiting, pyrexia, rigors &Nausea, vomiting, pyrexia, rigors & tachycardia
with loin tendernesstachycardia with loin tenderness
26. . Pyelonephritis..contPyelonephritis..cont Associated with increased risk ofAssociated with increased risk of preterm labourpreterm labour Diagnosis by MSU for R/E
& C/SDiagnosis by MSU for R/E & C/S E. Coli is the most common causeE. Coli is the most common cause If recurrent exclude renal anomaliesIf recurrent exclude
renal anomalies USS during preg. Or IVP 3-4 monthsUSS during preg. Or IVP 3-4 months after delivery.after delivery.
43. Renal stonesRenal stones Affects 0.03-0.05% of pregnant women (asAffects 0.03-0.05% of pregnant women (as in non-pregnants)in non-pregnants) Pregnancy
does not predispose to stonePregnancy does not predispose to stone formation . In fact small stones may passedformation . In fact small stones may passed unnoticed
due to ureteric dilatationunnoticed due to ureteric dilatation Presents with loin pain radiating to thePresents with loin pain radiating to the suprapubic region the pain may
besuprapubic region the pain may be excruciating & associated with shockexcruciating & associated with shock
44. Renal stones...contRenal stones...cont Renal tenderness may be the only clinicalRenal tenderness may be the only clinical sign USS may show dilated renal tract or
asign USS may show dilated renal tract or a stonestone Treatment mostly conservative with potentTreatment mostly conservative with potent analgesic & liberal fluid
intakeanalgesic & liberal fluid intake If obstruction persist surgery is indicatedIf obstruction persist surgery is indicated There is a risk of precipitating pretermThere is
a risk of precipitating preterm labourlabour
45. Acute retention of urineAcute retention of urine More likely to occur in the 1More likely to occur in the 1stst trimestertrimester and in the puerperium.and in the
puerperium. Causes include:Causes include: - incarcerated R/v gravid uterus- incarcerated R/v gravid uterus - pelvic mass (ovarian or fibroid)- pelvic mass (ovarian or
fibroid) - acute herpes infection- acute herpes infection - vulval haematoma- vulval haematoma
46. Urine retention..contUrine retention..cont Presents with sudden onset of severPresents with sudden onset of sever pain with distended bladder on exampain with
distended bladder on exam Catherterization for 24-48hrs &Catherterization for 24-48hrs & analgesia are very helpful and allowanalgesia are very helpful and allow the
gravid uterus to becomethe gravid uterus to become abdominalabdominal
47. Adenxal accidentsAdenxal accidents Corpus luteum cyst in early pregnancy mayCorpus luteum cyst in early pregnancy may bleed causing pain or rupture causing
shockbleed causing pain or rupture causing shock Mostly diagnosed by USS or bimanually ifMostly diagnosed by USS or bimanually if they are largethey are large
Managed mostly conservatively but if theyManaged mostly conservatively but if they are large or showing abnormal pathologyare large or showing abnormal pathology
they should be removed after 14 wksthey should be removed after 14 wks
48. Adenxal accidents..contAdenxal accidents..cont Torsion of a pre-existing ovarian cystTorsion of a pre-existing ovarian cyst (benign or malignant) presents
with(benign or malignant) presents with intermittent abdominal pain which laterintermittent abdominal pain which later becomes constant (indicatingbecomes constant
(indicating ischaemia). There may be nausea,ischaemia). There may be nausea, vomiting, low grade fever andvomiting, low grade fever and leucocytosis .If ignored the
ovary mayleucocytosis .If ignored the ovary may become gangrenousbecome gangrenous
49. Adnexal accidents..contAdnexal accidents..cont Laparotomy with oophorectomy orLaparotomy with oophorectomy or fixing the ovary if viablefixing the ovary if viable
Torsion of a pedunculated fibroid mayTorsion of a pedunculated fibroid may present in a similar way to tortedpresent in a similar way to torted ovarian cyst. They need to
beovarian cyst. They need to be removed at laparotomy. Don’t try toremoved at laparotomy. Don’t try to remove subserous, intramural fibroidremove subserous, intramural
fibroid as it may end by hysterectomyas it may end by hysterectomy
50. Miscellaneous causeMiscellaneous cause Musculoskeletal :Musculoskeletal : - exaggerated lumbar lordosis- exaggerated lumbar lordosis - sumphyseal diasthesis-
sumphyseal diasthesis * sickle cell crisis* sickle cell crisis * rectus sheath haematoma* rectus sheath haematoma * porphyria* porphyria * Aortic aneurysm* Aortic
aneurysm
Recommended
Strategic Planning Fundamentals
Time Management Fundamentals
27. Renal DisordersRenal Disorders
Pathogenesis:-
75-90% due to E coli, probably
derived from large bowel Colonization
of urinary tract results from
ascending infection from the perineum
and is related to sexual intercourse.
28. DiagnosisDiagnosis
Most women with asymptomatic
bacteriuria are found to be infected
during early pregnancy and very few
subsequently acquire asymptomatic
bacteriuria
Bacteriuria is only considered
significant if the colony count exceeds
100,000/ml on a MSU
29. ManagementManagement
The choice of antibiotic depends on
culture/sensitivity Ampicillin,
amoxicillin, Augmentin and the
cephalosporin are safe and
appropriate antibiotics in pregnancy.
Treatment should be continued for 2
weeks in the first instance and
regular urinary culture required.
31. Acute CystitisAcute Cystitis
Acute cystitis:-inflammation of the
bladder {bacterial or nonbacterial
causes (eg, radiation or viral
infection)}.
Cystitis complicates 1% of pregnancies
Clinical features:- Urinary frequency,
dysuria, haemeturia and suprapubic
pain
Diagnosis Significant bacteriuria on
MSU
32. Acute CystitisAcute Cystitis
Management:-
Same as asymptomatic bacteriuria
Several non-pharmacological
maneuvers may help to prevent
recurrent infection in women with
recurrent urinary-tract infections in
pregnancy. These include: Increase
fluid intake Emptying the bladder
following sexual intercourse
34. Epidemiology:-
UTIs in women: 14 times more frequent
than in men.
1. The urethra is shorter
2. lower 1/3 of the urethra is continually
contaminated with pathogens from the
vagina and the rectum
3. Women tend not to empty their bladders
as completely as men do
4. Urogenital system is exposed to bacteria
during intercourse .
35. Hormonal and mechanical changes:-
urinary stasis and vesicoureteral reflux urinary
stasis {progesterone-induced ureteral smooth
muscle relaxation}.
urinary retention {weight of the enlarging uterus}
Loss of ureteral tone combined with increased
urinary tract volume.
urinary stasis: dilatation of the ureters, renal
pelvis, and calyces. more common on right side
(86% of cases)
Glycosuria and aminoaciduria.
36. Etiology :-
E coli : most common cause of UTI, 80-
90% originates from fecal flora colonizing
the periurethral area: ascending infection.
Other pathogens: Klebsiella pneumoniae
(5%) Proteus mirabilis (5%) Enterobacter
species (3%) Staphylococcus saprophyticus
(2%) Group B beta-hemolytic Streptococcus
(GBS; 1%) Proteus species (2%)
37. Acute PyelonephritisAcute Pyelonephritis
Clinical Features :- Fever, Loin and
abdominal pain, Vomiting, Rigors
Proteinuria, Haematuria.
Risk increases in women:-
On steroid therapy
With polycystic kidneys
Congenital abnormalities of renal
tract
Urinary-tract calculi
Diabetes
42. Chronic Renal DiseaseChronic Renal Disease
Pregnancy with Chronic Renal Disease
Effects of Pregnancy The risks include:
Accelerated decline in renal function
Rising hypertension
Worsening proteinuria
Effects of chronic renal disease on
pregnancy The risks includes:
Miscarriage
Pre-eclampsia
Intrauterine growth retardation
Preterm delivery Fetal death
43. Chronic Renal DiseaseChronic Renal Disease
Factors Influencing Outcome
The presence and degree of renal
impairment
The presence and severity of
proteinuria
The underlying type of chronic renal
disease
45. Chronic Renal DiseaseChronic Renal Disease
In general, women without
hypertension or renal impairment prior
to conception have successful
pregnancies, and pregnancy does not
adversely influence the progression of
the renal disease.
46. Specific Types of RenalSpecific Types of Renal
DiseaseDisease
Glomerulonephritis
Reflux nephropathy
Diabetic nephropathy
SLE nephritis
Polycystic kidney
disease (PKD)
47. Chronic Renal DiseaseChronic Renal Disease
Women with chronic renal disease should be
managed jointly by obstetricians and
physicians Preconceptual assessment of
renal functions and blood pressure should
be made. In view of the increased risk of
pre-eclampsia, treatment with low dose
aspirin should be considered especially in
those with hypertension, renal impairment
or a previous poor obstetric history.
Careful monitoring and control of blood
pressure both prepregnancy and antenatally
is important.
48. Specific Types of Renal DiseaseSpecific Types of Renal Disease
The fetus should be monitored
with regular ultrasound
assessment of growth and Doppler
assessment of uterine and
umbilical circulation. Admission
should be considered if the woman
develops worsening hypertension,
deteriorating renal function or
proteinuria, or superimposed
eclampsia.
51. Idiopathic postpartum renalIdiopathic postpartum renal
failurefailure
Associated primarily withAssociated primarily with
microangiopathic processesmicroangiopathic processes
Postpartum hemolytic-uremic syndrome.Postpartum hemolytic-uremic syndrome.
These were often irreversible and wereThese were often irreversible and were
associated with substantial mortality.associated with substantial mortality.
Now improved outcome with plasmaNow improved outcome with plasma
exchange,dialysis,prostacyclin infusion,exchange,dialysis,prostacyclin infusion,
correcting coagulopathycorrecting coagulopathy
5151Dr Mona ShroffDr Mona Shroff
52. DialysisDialysis
pregnancy on dialysis is unusual: end-stagepregnancy on dialysis is unusual: end-stage
renal failure reduces fertility.renal failure reduces fertility.
Patients on dialysis should be advised not toPatients on dialysis should be advised not to
get pregnant.get pregnant.
Common risks: anaemia and haemorrhage.Common risks: anaemia and haemorrhage.
Increased risks of:Increased risks of:
miscarriage, fetal death, pre-eclampsia, pre-miscarriage, fetal death, pre-eclampsia, pre-
term labour, PROM, polyhydramnios andterm labour, PROM, polyhydramnios and
placental abruption.placental abruption.
Pregnant women require increasing dialysis toPregnant women require increasing dialysis to
maintain the pre-dialysis urea < 15-20 mmol/l.maintain the pre-dialysis urea < 15-20 mmol/l.
Poor obstetric outcome is similar with bothPoor obstetric outcome is similar with both
haemodialysis and peritoneal dialysis.haemodialysis and peritoneal dialysis.
53. Indications for KidneyIndications for Kidney
Replacement TherapyReplacement Therapy
Acidosis unresponsive to medical therapyAcidosis unresponsive to medical therapy
Acute, severe, refractory electrolyteAcute, severe, refractory electrolyte
changes (e.g., hyperkalemia)changes (e.g., hyperkalemia)
EncephalopathyEncephalopathy
Significant azotemia (blood urea nitrogenSignificant azotemia (blood urea nitrogen
level >100 mg per dL [36 mmol per L])level >100 mg per dL [36 mmol per L])
Significant bleedingSignificant bleeding
Uremic pericarditisUremic pericarditis
Volume overloadVolume overload
5353Dr Mona ShroffDr Mona Shroff
54. Hemodialysis Vs PeritonealHemodialysis Vs Peritoneal
dialysisdialysis
Limited usefulnessLimited usefulness
if hypotensionif hypotension
C/I in activelyC/I in actively
bleeding pt.bleeding pt.
ControlledControlled
anticoagulation reqdanticoagulation reqd
Volume shifts-Volume shifts-
carefulcareful
Faster correctionFaster correction
Can be used inCan be used in
preg/PP pt.preg/PP pt.
Easily availableEasily available
Simple,inexpensiveSimple,inexpensive
Lower Cx rateLower Cx rate
Minimises rapidMinimises rapid
metabolicmetabolic
pertubations & fluidpertubations & fluid
shiftsshifts
Insert cath highInsert cath high
direct visiondirect vision
5454Dr Mona ShroffDr Mona Shroff
55. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
Women receiving renal
transplants should be warned that
as renal function returns to
normal, ovulation, menstruation
and fertility also resume.
Women desiring pregnancy are
usually advised to wait about 1-2
years after transplantation.
56. Guidelines for pregnancy in kidney:-
transplant recipient
Two years post-transplant, with good
general health and serum creatinine less
than 2.0 mg/dL (preferably <1.5 mg/dL(.
No recent or ongoing rejection .
Normotension, or minimal
antihypertensives
Absent or minimal proteinuria.
No evidence of pelvicalyceal dilation on
renal ultrasonogram
57. Immunosuppression
Prednisone - Less than 15 mg per day
Azathioprine - Less than or equal to 2
mg/kg/d
Calcineurin inhibitor–based therapy -
Therapeutic levels
Mycophenolate mofetil and sirolimus -
Discontinue 6 weeks prior to conception
58. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
Complication Risks Immunosuppressive agents
increase the risk of hypertension during pregnancy.
Preeclampsia occurs in approximately one-third of
transplant recipients.
Almost 50% of pregnancies in these women end in
preterm delivery due to hypertension
Blood levels of calcineurin inhibitors need to be
frequently monitored due to changes in volumes of
distribution of extracellular volume.
There is an increased risk of infection included
cytomegalovirus, toxoplasmosis, and herpes
infections, and bacterial infection which arouse
concern for the fetus.
59. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
Effects of pregnancy on renal transplants:-
Pregnancy probably has no adverse long-
term effect Renal allograft adapt to
pregnancy About 15% of women develop
significant impairment About 40% develop
proteinuria towards term.
Effect of renal transplants on pregnancy:-
The chance of successful outcome is
>90%, but this is reduced to 70% if
complications occur before 28 weeks’
gestation. The complication rate is higher
for diabetics.
60. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
Recommended :-
Antenatal Management;-Women should
be managed jointly by nephrologists
and obstetricians with expertise in
the care of pregnant renal transplant
recipients.
Careful monitoring and control of
blood pressure is important.
Regular assessment of RFTs by
creatinine clearance and 24 hour
protein excretion,
61. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
as well as serum creatinine and urea
is essential.
a full blood count, LFTs should also
be checked regularly.
Anemia is common and haematinics
should be prescribed.
The fetus should be monitored with
regular ultrasound assessment of
growth and Doppler assessment of
uterine Sand umbilical circulation.
62. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
Immunosuppressive Therapy:-
The doses of immunosuppressive
drugs are maintained at prepregnancy
Levels which should preferably be:
Prednisolone, <15 mg/day plus either
Azathioprine, <2 mg/kg/day
Cyclosporin A, 2-4 mg/kg/day
63. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
Delivery :-
Caesarean section is only required for
obstetric indications. Prophylactic
antibiotics should be given to cover any
surgical procedure including episiotomy.
Parental steroids are necessary to cover
labour, as with any woman on
maintenance steroids.
64. Pregnancy in Renal TransplantPregnancy in Renal Transplant
RecipientsRecipients
Neonatal Problems These are largely
related to prematurely but also
include the following:
Thymic atrophy
Transient leukopenia or
thrombocytopenia
Depressed haemopoiesis