Category: Medicoapps Masterclass

1 step approach-WHO & IAD PSG


1 step approach-WHO & IAD PSG


→ It is done only in females with any risk factor @ 24-28 weeks of pregnancy.

→ It is used both for screening and diagnostic purpose.

→ Patient is advised unrestricted diet for 72 hours followed by overnight fasting and then 75 gm of glucose is given.

→ Total 3 samples are taken:

→ 1st sample – fasting sample

→ 2nd sample = After 1 hour of 75 gm of glucose

→ 3rd sample = After 2 hours of 75 gm glucose

→ Reference Readings of one step approach

Time 75 g OGTT
Fasting 90 mg/dl
1 hour 180 mg/dl
2 hours 153 mg/dl

→ Out of these 3 values if any I value is abnormal; patient is considered as having gestational diabetes\

Anesthesia used in caesarean


Anesthesia used in caesarean


→ Anesthesia given during LSCS in heart disease: Epidural anesthesia.

→ Conditions where general anesthesia is given in cesarean (to prevent hypotension)

  1. Intracardiac shunts

  2. Severe aortic stenosis

  3. Pulmonary arterial hypertension

4.Severe Aortic Regurgitation

5.HOCM-Hypertrophic obstructive cardiomyopathy

Indicators of heart disease during pregnancy


Indicators of heart disease during pregnancy


Indicators of heart disease during pregnancy include the following:

  1. Clubbing
  2. Cyanosis
  3. Paroxysmal nocturnal Dyspnea
  4. Orthopnea
  5. Pulmonary Edema
  6. ↑ JVP
  7. S2 Loud prominent Split
  8. Getting S4 is abnormal
  9. Ejection Systolic Murmur >3/6
  10. Diastolic Murmur
  11. Marked Cardiomegaly
  12. Any Arrhythmia

Risk for Gestational Diabetes


Risk for Gestational Diabetes


Low risk:

  • Age<25years
  • BMI= Normal before pregnancy
  • Normal weight at birth
  • No family history of diabetes
  • No H/O poor obstetrical outcome
  • No H/O poor abnormal glucose tolerance Average risk:

Age>25years

  • Overweight before pregnancy
  • Blood sugar levels are ↑ after 24-28 weeks
  • ↑weight at birth-previous baby

High risk:

  • Age>30 years
  • Marked obesity
  • Previous H/O GDM
  • Strong family H/O type 2 DM
  • H/O Congenital malformation in previous pregnancies
  • >3 spontaneous abortions
  • Stillbirth / IUD
  • Polyhydramnios & Macrosomia

Vaccinations in pregnancy


Vaccinations in pregnancy


Safe:

Mnemonic -HIT Rabies

H-Hepatitis A/B

l-lnfluenza

T-Tetanus

Rabies

Only in epidemics:

Mnemonic -Tab PCM

Tab-Typhoid

P-Pneumococcus

C-Cholera

M-Meningococcus

To be given in case of travel to highly endemic area or exposed to contacts

  • Yellow fever
  • Japanese encephalitis
  • Polio (IPV)

Contraindicated

  • Rubella
  • Measles
  • Mumps
  • BCG
  • Smallpox
  • Chickenpox

Types of diabetes in pregnancy


Types of diabetes in pregnancy


There are 2 types of diabetes:

Overt Diabetes:

  • Diabetic Female has conceived
  • Blood sugar levels are ↑ from day 1 of pregnancy
  • Free radicals are formed from Day 1
  • ↑ chances of congenital malformations in baby

Gestational Diabetes:

  • Female was normoglycemic before
  • Blood sugar levels are ↑ after 24-28 weeks
  • Free radicals are formed after 24-28 weeks
  • Organogenesis is complete
  • No. congenital defects

Supine Hypotension syndrome


Supine Hypotension syndrome


In late 3rd trimester- if patient lie in supine position

Gravid Uterus presses on Inferior Vena Cava

↓ Venous Return

↓ Cardiac output

This decreased cardiac output results in hypotension in mother & decreased fetal blood flow resulting in fetal distress

Singers Alkali denaturation test


Singers Alkali denaturation test


→ Fetal blood contains HbF & is resistant to acid & alkali whereas maternal blood contains HbA which is sensitive to acid & alkali.

→Procedure: Blood is collected in a tube & reagent (KOH or NaOH) is added to the tube

→ If the color is same then its Vasa Previa but if the color changes to brown than it is Placenta previa.

  • Vasa previa will lead to increased fetal blood loss therefore can lead to fetal mortality.
  • Vasa previa means it is fetal blood which is lost.
  • Placenta previa means maternal blood is lost.
  • Investigation in such cases should be done in antenatal period using doppler Usg.
  • Management of such cases is cesarean section.

Sickle cell crisis


Sickle cell crisis


→ It is characterized by intense bone pain due to intense sequestration of sickled erythrocytes & infarction in various organs.

→ Pregnancy can precipitate sickle cell crisis in both women with sickle cell trait and sickle cell disease.

Management:

→ IV fluids, O2

→ Epidural analgesia

→ Antibiotics

→ Thromboprophylaxis

Note: Red cell transfusion after the onset of pain do not have much benefit but prophylactic transfusions before the crisis, helps in decreasing the pain and shortening the duration of crisis.

Sickle cell anemia


Sickle cell anemia


→ Sickle cell disease is the most common hemoglobinopathy encountered during pregnancy.

→ Sickle cell hemoglobinopathies are hereditary disorders.

→ It is caused by a point mutation in the β globin gene on chromosome II. this results in substitution of valine for glutamic acid at position 6 of the β chain of normal hemoglobin.

  • When Gene mutation is homozygous, the individual has sickle cell anemia (Hb-SS).
  • She has a small quantity of fetal hemoglobin (HbF) but no HbA.
  • Heterozygous individual for sickle cell hemoglobin has sickle cell trait (HbAS).
  • Such an individual has about 55-60% of HbA and35-40% of HbS.
  • Sickle cells have a life span of 5-10 days compared to normal RBCs of 120 days
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