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O bstetric Emergency. Dr. Miada Mahmoud Rady. Topics of the lecture : Renal disease during pregnancy RH sensitization Introduction to infection during Clinical presentation and complication of various infection. Renal diseases. Infection :

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o bstetric emergency

Obstetric Emergency

Dr. Miada Mahmoud Rady

slide2

Topics of the lecture :

  • Renal disease during pregnancy
  • RH sensitization
  • Introduction to infection during
  • Clinical presentation and complication of various infection.
renal diseases
Renal diseases
  • Infection :
  • In pregnancy there is increased liability to urinary tract infection .
  • Pathogenesis :
  • kidney increases in size .
  • Ureters become longer ,wider and more curved.
  • leading to urine stasis which increase liability to infection.
renal diseases1
Renal diseases
  • Infection may be
  • Mild .
  • Sever : which could be complicated by :
  • Low fetal birth weight and retarded fetal development
  • Premature labor
  • Intrauterine fetal death.
renal diseases2
Renal diseases
  • Frequency of micturition
  • caused by pressure of gravid uterus on bladder.
  • Exacerbation of preexisting renal disease :
  • Load of pregnancy on diseased kidney may lead to renal failure .
infections
Infections
  • Viral and parasitic infections can cause problems for both the woman and the fetus.
  • Early-pregnancy infections : can affect organ system formation.
  • Later-pregnancy infections : can cause →
  • Neurologic impairments
  • Growth disturbances
  • Heart and respiratory conditions
urinary tract infection
Urinary tract infection
  • Caused by Streptococcus agalactiae, which lives normally in the genitourinary and GI tracts of healthy people.
  • The bacteria can proliferate during pregnancy, resulting in:
  • Urinary tract infection
  • Uterus infection
  • Stillbirth
urinary tract infection1
Urinary tract infection
  • If it is passed to the newborn, it can cause:
  • Respiratory problems
  • Pneumonia
  • Septic shock
  • Meningitis
human immunodeficiency virus hiv
Human immunodeficiency virus (HIV)
  • Pregnant women may infect their fetus:
  • During pregnancy
  • During delivery
  • From breastfeeding
  • The woman may be asymptomaticand unaware that she is infected.
human immunodeficiency virus hiv1
Human immunodeficiency virus (HIV)
  • Prevention :
  • An HIV-positive woman can take medications to control the infection and decrease the chances of transmitting HIV to the infant.
  • An HIV-infected women should not breastfeed.
cholestasis
Cholestasis
  • Cholestasis means slowing of bile flow .
  • Pathogenesis of liver disease during pregnancy :
cholestasis1
Cholestasis
  • Risk factors
  • Multiple pregnancies.
  • Familial history of cholestasis.
  • Previous liver damage.
  • History of gall bladder disease.
cholestasis2
Cholestasis
  • Clinical presentation :
  • itching, particularly in the hands and feet (most common).
  • Fatigue or depression.
  • Nausea.
  • Right upper quadrant pain.
  • Dark urine and clay colored stool.
cholestasis3
Cholestasis
  • Course :
  • Relatively benign and transitory for the woman but can be serious for the fetus.
  • Complications include preterm birth and stillbirth.
sexually transmitted infections
Sexually transmitted infections
  • Bacterial vaginosis :
  • Normal vaginal bacteria are replaced by overgrowth of other bacteria.
  • Symptoms include:

(a) Itching.

(b) Burning.

(c) Pain.

(d) Foul smelling discharge ( fishy odour )

slide17

Can lead to:

(a) Premature birth.

(b) Low birth weight.

(c) Pelvic inflammatory disease in the woman.

  • Treated with the antibiotic and metronidazole .
slide18

Candidiasis (thrush, or yeast Infection) :

  • More common in pregnancy because of chemical changes in the vagina (increased glycogen).
  • Risk factors include:

(a) Poorly controlled diabetes and gestational diabetes.

(b) Taking antibiotics .

(c) Wearing tight-fitting clothing .

slide19

Treatment : antifungal creams

  • Complication : can pass to fetus causing oral candidiasis
slide20

Chlamydia :

  • Symptoms are usually mild or absent, but may include:

(a) Lower abdominal pain

(b) Low back pain

(c) Nausea

(d) Fever.

(e) Painful intercourse.

(f) Bleeding between menstrual periods.

slide21

Can spread to the rectum, causing:

(a) Rectal pain

(b) Discharge

(c) Bleeding

  • If untreated, can progress to pelvic inflammatory disease
gonorrhea
Gonorrhea
  • bacterial infection that multiplies rapidly.
  • Causative organism: gonococci .
  • Sites of infection: genital tract , mouth, throat, eyes, and anus.
slide23

Clinical presentation :

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

HPV

is

precancerous

Human papilloma virus (HPV)
  • Viral infection .
  • Could be asymptomatic or manifest by multiple growth in the genital tract.
  • Complication
  • Maternal : Urinary obstruction

Obstruction of birth canal

Risk factor for vulvar , cervical and anal cancer .

  • Fetal : laryngeal papillomatosis which is potentially fatal.
syphilis
Syphilis
  • Bacterial infection .
  • Transmitted through direct contact with open sores usually mouth lips, nipples ,genitals and anus.
  • Clinical presentation :
  • Asymptomatic .
  • Symptomatic : passes in 3 stages :

Primary , secondary and tertiary.

slide26

Primary stage :

  • usually begins with a single sore ,painless, small, firm, and round
  • Disappears after 3 to 6 weeks.
slide27

Remember FHAM

  • Secondary stage :

Mucocutaneous rash and systemic manifestation of infection which resolve spontaneously.

  • Fever and fatigue ,
  • Sore throat and lymphadenopathy.
  • Patchy hair loss and weight loss.
  • Headache and muscle aches.
slide28

Tertiary stage :

No signs or symptoms present, but the disease attacks the:

  • Brain
  • Nerves
  • Eyes
  • Heart
  • Blood vessels
  • Liver
  • Bones
  • Joints

Gumma formation

slide29

Complication of syphilis during pregnancy :

  • Abortions and still births.
  • Congenital anomalies.
  • Congenital blindness.
  • Short survival after birth.
trichomoniasis
Trichomoniasis
  • Parasitic Infection.
  • Clinical presentation :
  • Asymptomatic .
  • Symptomatic
  • Vaginal discharge frothy, yellow with a strong odor.
  • Irritation and itching.
  • Dysuria and painful sexual intercourse .
slide31

Lower abdominal pain.

  • Complication
  • Increased susceptibility to HIV infection.
  • Premature labour.
  • Low birth weight.
slide32

Torch syndrome

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

Cat disease

Toxoplasmosis
  • Parasitic infection .
  • Caused from handling or eating contaminated food or from handling cat litter.
  • If early in the pregnancy, there is a decreased chance of passing it on to the fetus.
  • Newborns do not show infection signs at birth but may develop learning, visual, and hearing disabilities later.
rubella
Rubella
  • Viral infection .
  • If infection occurs less than 20 weeks gestation, there is a significant chance of developmental problems with the fetuswhich include :
  • Congenital blindness or deafness.
  • Significant cardiac and respiratory abnormalities.
cytomegalovirus cmv
Cytomegalovirus (CMV)
  • Viral infection .
  • Can remain dormant in the body for years , activated during pregnancy due to low immunity.
  • Cause serious complication during pregnancy :
  • Lung and liver problems
  • Blood problems and lymphadenopathy
  • Rash
  • Poor weight gain
herpes simplex
Herpes simplex
  • Viral infection
  • Two types of viruses (HSV) :
  • Type 1 ( oral ) : causes infection of mouth and lips
  • Type 2 ( genital ) : primary cause of genital herpes , so genital herpes is caused mainly by type 2 HSV less commonly by type 1.
  • Clinical presentation :

FAHM + sores and tingling at site of infection .

{Fever , Headache , Anorexia , Malaise , Aches ( bone and muscle )}

summary
Summary
  • Infection encountered during pregnancy represent common health problem which has various adverse outcome for both the baby and mother.
  • STDs all share common site of infection which are lips , nipples , breast , vagina , vulva and rectum.
  • STDS include herpes simplex , chlamydia , trichomoniasis , bacterial vaginosis , gonorrhea and syphilis.
slide40

Common complication of infection associated with pregnancy include : preterm labour , abortion , congenital anomalies , intrauterine growth retardation and post partum poor weight gain of newborn.

  • Most of genital infection share common presentation which is either asymptomatic orsymptomatic → dysuria , abnormal vaginal discharge , painful sexual intercourse and Intermenstural spotting.