Category: Medicoapps masterclasses

Complications of Intrauterine growth restriction


Complications of Intrauterine growth restriction


1. Oligohydramnios

• Less space for fetus leading to cord compression

• Umbilical artery & vein gets compressed

• Fetal distress & fetus will pass meconium

• Fetal swallows meconium with amniotic fluid

2. Meconium Aspiration Syndrome

3. Low birth weight

4. Fetal distress/ hypoxia

5. Still birth

→In Neonates

1. Loose Skin

2. ↓ Tone

3. ↑ HMD/RDS

4. ↑ IVH

5. Neonatal Death

→Fetal Surveillance in IUGR is done by NST (Non-Stress Test) Biweekly

Classification of hormones-Based on chemical structure


Classification of hormones-Based on chemical structure


The hormones are classified into the following based on chemical structure

1. Amino Acid Derivative

• SINGLE amino acid

• TYROSINE = (T3, T4) & Catecholamines (Epinephrine, Norepinephrine, Dopamine)

• TRYPTOPHAN -5-HT (Serotonin) & Melatonin

• ARGININE (Nitric Oxide)

2. Protein / Peptide

 MULTIPLE amino acid

 Acts on “EXTRACELLULAR RECEPTORS

 INSULIN (51 amino acids), PARATHORMONE (84 amino acids)

3. Cholesterol derivatives

• Crosses cell Membrane

• Acts on “INTRACELLULAR RECEPTORS”

• STEROID HORMONES (Aldosterone, Cortisol, Estrogen, Progesterone, Testosterone)

4. Vitamins

 VITAMIN A & D

 Acts on “INTRACELLULAR RECEPTORS

Chronic hypertension in pregnancy v/s pregnancy induced hypertension


Chronic hypertension in pregnancy v/s pregnancy induced hypertension


Chronic Hypertension in Pregnancy Pregnancy Induced Hypertension
  • Means a hypertensive female has conceived
  • Normotensive patient conceived & due to placental pathology @20 weeks, her BP ↑
  • Past H/O hypertension present
  • No past H/O hypertension
  • ↑ in B/P will be seen before 20 weeks
  • ↑ in BP is seen after 20 weeks of pregnancy
  • BP- does not come back to normal within 12 weeks of delivery.
  • BP-normal within 12 weeks of delivery.

 

 

Contraindications for cerclage


Contraindications for cerclage


→ Cervical dilatation ≥ 4 cm

→ Ruptured membranes

→ Presence of gross anomaly of fetus

→ Vaginal bleeding Present

→ Pelvic infection +nt.

→ Placenta Previa- relative contraindication

Cardiac Muscle-Unique features


Cardiac Muscle-Unique features


1. Gap junctions

SINGLE NUCLEUS CENTRALLY placed – Seen in Intercalated disc region.

→ Protein subunit – CONNEXONS – 6 subunits of “Connexin”

functions:

→ Gap junctions causes “SYNCHRONIZED CONTRACTION” / “SYNCYTIAL CONTRACTION”.

→ Entire cardiac muscle unit contracts as single unit – FUCNTIONAL SYNCYTIUM.

2. Elasticity

→ Cardiac muscle ELASTICITY – Due to TITIN (Spring type protein)  “Stretch  Recoil”.

→ Titin mutation – Non-elastic cardiac muscle.

→ On stretching  ↑ Stretch (Non-elastic nature)  Dilated Cardiomyopathy (DCM).

3.CICR

Calcium Induced Calcium Release

EXTRACELLULAR calcium induces  INTRACELLULAR calcium release (Stored in sarcoplasmic reticulum).

4.Sarcoplasmic reticulum

Presence of WELL-DEVELOPED sarcoplasmic reticulum (SR) & SERCA pump.

SERCA pump & SR – Aids calcium storage.

5.PHOSPHOLAMBAN

INHIBITS SERCA pump & interferes with calcium storage.

Blood brain barrier


Blood brain barrier


BBB Locations:

→ Formed by TIGHT JUNCTIONS & FOOT PROCESSES OF ASTROCYTES.

→ ABSENT BBB = CIRCUMVENTRICULAR ORGANS (mnemonic – SOAP)

S= Subfornical organ; O – Organum Vasculosum of Lamina Terminalis; A – Area Postrema; P – Posterior Pituitary

BBB Permeability:

PERMEABLE Substance:

Glucose (GLUT-1),

Water (Aquaporin-4),

Gases (CO2, O2, N2),

Lipid soluble hormones (Steroids)

NON-PERMEABLE Substance:

Protein Hormones,

• Dopamine (L-dopa in Parkinsonism),

H+ ions

Heading-Auditory pathway


Heading-Auditory pathway


Mnemonic – E C O L I M A
E – EIGHTH Cranial Nerve

C- COCHLEAR Nerve

O – Superior OLIVARY Nucleus

L – Lateral LEMNISCUS

I – INFERIOR Colliculi

M – MEDIAL Geniculate Body

A-Auditory Cortex (Brodmann Area – 41)

Antiphospholipid antibody syndrome


Antiphospholipid antibody syndrome


• APLA syndrome can lead to thrombosis in vessels. Depending upon which vessels get thrombosed we will get the manifestation like if cerebral vessel get thrombosed manifestation of stroke can be seen. It can even lead to thrombosis in placental blood vessels.

  •  Based on this size of placenta will decrease and there will be placental insufficiency.
  • Abortion can happen in first trimester due to APLA but it generally causes abortion in second trimester (M/C).
  •  Even if there is 1 abortion due to APLA but for first trimester we need 3 abortion to say it is caused due to APLA.

Antihypertensives for chronic hypertension in pregnancy


Antihypertensives for chronic hypertension in pregnancy


For PIH/PE-1st choice- Labetalol

Chronic HT in Pregnancy-Labetalol or α-Methyl Dopa

HT Crisis-I/V Labetalol, I/V Hydralazine

Safe Antihypertensive:

  • Labetalol
  • Alpha-methyldopa (safest)
  • Nitroglycerine
  • Calcium channel blockers – nifedipine
  • Hydralazine
  • Sodium nitroprusside (last resort)
  • Beta Blockers

Contraindicated during pregnancy:

  • ACE inhibitors – like enalapril, captopril
  • Angiotensin receptor blockers-Losartan
  • Diuretics
  • Atenolol
  • Diazoxide

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Polyhydramnios-Grades


  1. Mild- pockets measuring 8-11 cm in the vertical dimension (seen in 80% cases).

  2. Moderate- as pocket measuring 12-15 cm in the vertical dimension (seen in 15% cases).

  3. Severe- free-floating fetus found in pockets of fluid of 16 cm or more (seen in 5% cases).

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