Hot topics in obstetrics
Download
1 / 41

Hot topics in Obstetrics - PowerPoint PPT Presentation


  • 145 Views
  • Updated On :

Hot topics in Obstetrics. Dr Jane Rutherford Consultant in Maternal and Fetal Medicine QMC. NOTTINGHAM PRIMARY CARE TRUSTS. NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST. OBSTETRIC CLINICAL GUIDELINES. Fetal Varicella Syndrome. Exposure in the first 20 weeks of pregnancy

Related searches for Hot topics in Obstetrics

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Hot topics in Obstetrics' - leiko


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
Hot topics in obstetrics l.jpg

Hot topics in Obstetrics

Dr Jane Rutherford

Consultant in Maternal and Fetal Medicine

QMC


Slide4 l.jpg

NOTTINGHAM PRIMARY CARE TRUSTS

NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST

OBSTETRIC CLINICAL GUIDELINES


Fetal varicella syndrome l.jpg
Fetal Varicella Syndrome

  • Exposure in the first 20 weeks of pregnancy

  • 1% before 12 weeks; 2% between 13 and 20 weeks

  • Skin scarring in a dermatomal distribution

  • Limb hypoplasia and/or paresis

  • Low birth weight

  • Less commonly microcephaly, neurological anomalies and eye defects


Varicella in pregnancy l.jpg
Varicella in pregnancy

  • Varicella pneumonia in 5-14% of adults

  • Mortality and morbidity higher in pregnancy

  • More common in smokers


Vzig for varicella contacts l.jpg
VZIG for Varicella Contacts

  • A seronegative pregnant woman with a significant contact should be offered VZIG.

  • The outcome in pregnant women is not adversely affected if the administration of VZIG is delayed up to 10 days.

  • Clinical chickenpox will still develop in a proportion of women given VZIG but may be attenuated.

  • Women who have had contact with chickenpox (regardless of whether or not they have received VZIG) should be asked to notify a health professional if a rash develops.


Aciclovir l.jpg
Aciclovir

  • Oral aciclovir may be given to women who present in the first 24 hours of rash or are more than 20 weeks pregnant.


Down s syndrome screening l.jpg
Down’s syndrome screening

  • Nuchal translucency

  • Serum (triple) screening

    • Oestriol

    • Free βHCG

    • AFP



Down s syndrome screening11 l.jpg
Down’s syndrome screening

  • National screening committee guidelines

  • A detection rate of at least 60% with a false positive rate of 5% or less (by April 2004/5)

  • A detection rate of greater than 75% with a false positive rate of less than 3% (by April 2007)

  • http://www.screening.nhs.uk/downs


Down s screening l.jpg
Down’s screening

  • The quadruple test :Second trimester test based on the measurement of AFP, uE3, free beta-hCG (or total hCG), and inhibin-A together with the woman’s age.

  • The serum integrated test


Slide13 l.jpg

  • The combined test: First trimester test based on combining nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • The integrated test: nuchal translucency measurement and PAPP-A in the first trimester with the quadruple test in the second - better performance than the combined test if good quality NT measurement is available and the woman is prepared to wait until the second trimester for results.


Parvovirus b19 l.jpg
Parvovirus B19 nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Erythema infectiosum

  • Fifth disease

  • Droplet transmission

  • Viraemia 6-8 days after exposure and persists for 7 days

  • Fever, rash (slapped cheek), arthropathy


Parvovirus l.jpg
Parvovirus nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.


Parvovirus17 l.jpg
Parvovirus nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • May be associated with fetal loss or hydrops

  • Risk of fetal loss highest in first 20 weeks – approx 10%

  • After 20 weeks fetal loss risk <1%, risk of hydrops 0.3%


Parvovirus serology l.jpg
Parvovirus serology nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • IgM can be detected 10 days after exposure and lasts for 3 months

  • IgG is a marker of past infection


Exposure to parvovirus l.jpg
Exposure to parvovirus nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Check immunity

  • If IgG/IgM negative repeat in 3 weeks

  • If IgG negative and IgM positive

    • Counsel that risks are low

    • If > 20 weeks refer for hydrops screening

    • If hydrops detected, consider intrauterine transfusion


Slide21 l.jpg

www.rcog.org.uk nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.


Obstetric cholestasis l.jpg
Obstetric Cholestasis nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • In UK 0.7% of pregnancies in multi-ethnic populations

  • 1.2–1.5% of women of Indian-Asian or Pakistani-Asian origin.

  • Prevalence is influenced by genetic and environmental aspects and varies between populations.

  • In Chile 2.4% of all pregnancies are affected with 5% prevalence in women of Araucanian-Indian origin.


Obstetric cholestasis23 l.jpg
Obstetric Cholestasis nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Multifactorial condition

  • Intense pruritus in the absence of a skin rash

  • Abnormal liver function tests (LFTs)

  • Remits following delivery.

  • Need to exclude other causes of pruritus and of abnormal LFTs.


Obstetric cholestasis24 l.jpg
Obstetric Cholestasis nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Fetal risks

    • spontaneous prematurity,

    • iatrogenic prematurity

    • intrauterine death

    • Increased meconium stained liquor


Risk of stillbirth with oc l.jpg
Risk of Stillbirth with OC nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Early studies suggest increased rate

  • Most recent studies show no difference in stillbirth compared to normal population but no studies looking at untreated OC

  • Risk of stillbirth in untreated OC is unclear


Management l.jpg
Management nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Ultrasound is not useful in preventing stillbirth

  • Intrauterine death may be a direct cardiac effect of bile acids

  • CTG may be useful but limited

  • Early delivery (?)


Management of oc l.jpg
Management of OC nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Emollients: aqueous cream with menthol

  • Antihistamines

  • Ursodeoxycholic acid

  • Vitamin K

    Follow up

    50% recurrence risk


Slide28 l.jpg

www.apec.org.uk nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.


Slide30 l.jpg

  • Risk Assessment early in Pregnancy nuchal translucency measurement with free beta-hCG, pregnancy-associated plasma protein A (PAPP-A) and the woman’s age.

  • Before developing an antenatal care plan you must identify the presence of any of the following factors that predispose women in a given pregnancy to pre-eclampsia (grade B/C)

    • First pregnancy (almost triples risk)

    • Previous pre-eclampsia (7 times risk in a second pregnancy)

    • ≥ 10 years since last baby (almost triples risk)

    • Age≥40 years (almost twice the risk)

    • Body mass index ≥ 35 (Doubles risk)

    • Family history of pre-eclampsia (mother or sister) (almost triples risk)

    • Booking diastolic blood pressure ≥ 80mmHg

    • Proteinuria at booking (≥ on more than one occasion or ≥300mg/24h)

    • Multiple pregnancy (almost triples risk)

    • Underlying medical conditions:

  • Pre-existing hypertension

  • Pre-existing renal disease

  • Pre-existing diabetes

  • Presence of antiphospholipid antibodies (significantly increases risk)


Slide31 l.jpg

Offer women referral for specialist input to their antenatal care plan if they have one of the following (grade D/good practice point)

·Previous pre-eclampsia

·Multiple pregnancy

·Underlying medical conditions

·Pre-existing hypertension or booking diastolic blood pressure ≥ 90mm Hg

·Pre-existing renal disease or booking proteinuria (≥ + on more then one occasion or ≥ 300mg/24h)

·Pre-existing diabetes

·Presence of antiphospholipid antibodies

·Any two other risk factors


Group b strep l.jpg
Group B Strep care plan if they have one of the following (grade D/good practice point)

www.gbss.org.uk


Slide38 l.jpg
GBS care plan if they have one of the following (grade D/good practice point)

  • Vaginal commensal in 25 – 30% of women

  • Does not need to be treated when found on HVS

  • Does require treatment when found in urine


Screening for gbs l.jpg
Screening for GBS care plan if they have one of the following (grade D/good practice point)

  • Standard HVS – 50% false negative rate

  • Enriched culture medium (ECM)– LVS and rectal swab: considered the “gold standard”. More reliable than HVS

  • ECM only available privately c. £40


Slide40 l.jpg
GBS care plan if they have one of the following (grade D/good practice point)

  • Women who have GBS on a swab at any time require IV antibiotics in labour (penicillin)

  • 2 hours prior to delivery

  • If mother does not receive antibiotics and neonate has no signs of infection then observations for 24 hours

  • If mother does not have antibiotics and there are signs of sepsis then neonate will receive antibiotics.


ad