DOCSLIB.ORG

My Reference Book in Obstetrics Niels Jørgen

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

MY REFERENCE BOOK IN OBSTETRICS NIELS JØRGEN SECHER PROFESSOR Department of Obstetrics and Gynecology Copenhagen University Hospital in Hvidovre 2650 Hvidovre E-mail: [email protected] Reappraised in May 2008 2 TABLE OF CONTENTS Forword ....................................................................................... 4 Antiphospholipid syndrome(APS) (Acgurred Acquired thrombophilia) ............................................................................ 5 Bleeding antepartum.................................................................. 8 Volume Replacement......................................................... 8 Abruptio Placenta............................................................... 8 Placenta Previa.................................................................. 9 Bleeding post partum............................................................... 11 Cytomegalovirus ...................................................................... 17 Diabetes in pregnancy ............................................................. 20 GBS-Syndrome ......................................................................... 32 Hepatitis .................................................................................... 34 Herpes ....................................................................................... 37 Hydrops fetalis (nonimmune) and fetal ascites ..................... 39 Hyperemesis gravidarum......................................................... 41 Hypertension and preeclampsia in pregnancy ..................... 43 Drugs ............................................................................... 46 Management of server hypertension, preeclampsia and HEELP ............................................................................. 47 Management of severe hypertension (>160/110 mm Hg) 48 Treatment of eclampsia ................................................... 49 Induction of labour ................................................................... 52 Intrauterine growthrestriction (IUGR) ..................................... 56 Lupus erytthematosus (SLE)................................................... 63 Lupus syndrome (NEONATAL) ............................................... 65 Necrotizing infection of the skin and fascia........................... 67 Necrotizing cellulitis ......................................................... 67 Necrotizing fasciitis .......................................................... 67 Recommendations:.......................................................... 68 Neonatal alloimmune thrombocytopenia (NAIT).................... 70 Parvovirus................................................................................. 72 Preterm premature rupture of membranes(PPROM) (< 34 [37] weeks) ....................................................................................... 74 Premature rupture of membranes (PROM) (>34 [37] weeks . 76 Preterm labour with intact membranes .................................. 78 Tocolysis.......................................................................... 79 Red group cell immunization (Rhesus immunization) .......... 82 Rubella....................................................................................... 86 Shoulder dystocia .................................................................... 88 Skin and pregnancy ................................................................. 90 Obstetric cholestasis (Pruritus gravidarum) ..................... 91 Herpes gestationis (or pemphigoid gestationis) ............... 92 Pruritic urticarial papules and plagues of pregnancy (PUPPP) .......................................................................... 92 Striae distensae ............................................................... 92 Streptococcal toxic shock syndrome (STSS) ........................ 93 Staphylococcal toxic shock syndrome (tampon syndrome) 95 3 Thrombocytopenia in pregnancy ............................................ 97 Gestational thrombocytopenia ......................................... 97 ITP - Idiopathic (autoimmune) Thrombocytopenic (purpura)97 Thromboembolism in pregnancy ............................................ 99 Congenital Thrombophilia: ............................................... 99 Antithrombin III deficiency................................................ 99 Acquired Thrombophilia: .................................................. 99 D V T:............................................................................... 99 Pulmonary embolus (PE) ............................................... 100 Drugs: ............................................................................ 100 Treatment: ..................................................................... 101 Propfylactic regime in prevention thromboembolic disease:103 Prevention of Osteoporosis................................................... 104 Labour, epidural and Cesarean sectio:................................. 104 Thrombophilia in pregnancy (Inherited)............................... 107 Thyroid disease in pregnancy ............................................... 111 Fetal and neonatal Grave´s disease .............................. 113 Toxoplasmosis ....................................................................... 118 Travel and vaccination........................................................... 121 Ultrasound screening............................................................. 124 Risk if parent or previous child has chromosome abnormality .................................................................... 127 Soft ultrasound markers in trisomy................................. 127 Soft ultrasound markers in trisomy................................. 127 Vacuum, extraction / Forceps................................................ 133 Varicella / Chicken pox .......................................................... 137 4 FOREWORD This manual is a combination of Guidelines and Protocols of patient management in Obstetrics. I hope it will be a concise reference, readily accessible in a clinical setting, decreasing the need to access a detailed textbook, which may not always be available. I compiled this manual in order to refresh my memory regarding the complex medical cases we see, and in an attempt not to omit any important steps in the management or treatment of these cases. These guidelines are not the official protocols of Copenhagen University Hospital at Hvidovre, but they express my personal opinions and are as 'evidence based' as possible. I wish to thank my colleagues at King Faisal Specialist Hospital, Kingdom of Saudi Arabia, who helped me with the first edition, when I worked there as the Chairman, and my colleagues in Denmark (the Sandbjerg Guidelines and Guidelines at Hvidovre Hospital) as well as my secretaries Ms. Zenaida C. Viktoria, Mette Krøll and Karen Eckhoff, who painstakingly dedicated their time and effort in completing this reference. Thanks to my young colleagues Birger Breum, B. Baldur-Felskov, Suher Hassan, Bo Rud and R. Svetlana for their input. I also want to thank Lars Krag Moeller, MD for his comments and making it possible to see the book on the Internet at: http://www.gyncph.dk/secher/index.htm Niels J. Secher, MD Professor Department of Obstetrics and Gynecology Copenhagen University Hospital in Hvidovre Denmark E-mail: [email protected] May 2008 5 Antiphospholipid syndrome(APS) (Acgurred Acquired thrombophilia) Definition: Criteria for the classification of the APS: At least one of the following clinical criteria and one of the following paraclinical/laboratorial criteria should be met: Clinical Criteria: 1. Vascular thrombosis and/or 2. Pregnancy morbidity (Poor Obstetric History) a) Unexplained death of a morphologically normal fetus at or beyond 10 weeks. b) One or more premature deliveries before 34 week of gestation because of severe preeclampsia/eclampsia or severe IUGR. c) Three or more unexplained consecutive abortions before 10 weeks of gestation (controversial, if no fetal heart has been seen, as some believe that very early abortion is not caused by APS) Paraclinical/laboratory Criteria: The presence of Antiphospholipid antibody (aPL) on two or more occations at least 12 weeks apart Antiphospholipid (aPL) antibodies: - Lupus anticoagulant (LA) directed against phospholipidbinding plasm proteins prolonged activated partial thromboplastin time. - Beta 2- glycoprotein-1 antibodies, β2-GP >99th percentile - Anticardiolipin (aCL) antibody Medium titer: 20 - 50 anticardiolipin IgG and 20 -80 anticardiolipin IgM. Secondary Antiphospholipid Syndrome: When antibodies is found in association with systemic lupus (SLE) (see also page 63 ), other rheumatic disease, autoimmune disorders, infections and medicine. Prevalence: 2 - 5% of all pregnant women have cardiolipin antibodies or lupus anticoagulant but very few have antiphospholipid syndrome. 30% of women with severe early onset preeclampsia may have antiphospholipid antibodies. Background: Anticardiolipin antibodies react with proteins bound to phospholipids in the cell membrane such as cardiolipin. Different isotypes and subclasses are associated with aCL including IgA, IgM, and IgG subclasses 1 to 4. Elevated levels of IgG anticardiolipin antibodies (particularly IgG2) incur a greater risk. Risks: Maternal thromboembolism is highly variable and exacerbated by co- existent hereditary coagulopathies. In one study thrombosis during pregnancy was 5% among women with known antiphospholipid syndrome. 6
Recommended publications
  • L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion

    L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion

    L&D – Amnioinfusion Guideline and Procedure for Amnioinfusion. Purpose: Replacing the amniotic fluid with normal saline has been found to be a safe, simple, and very effective way to reduce the occurrence of repetitive variable decelerations. Procedure: Initiation of Amnioinfusion will be ordered and performed by a Certified Nurse Midwife (CNM) or physician (MD). 1. Prepare NS or LR 1000ml with IV tubing in the same fashion as for intravenous infusion. Flush the tubing to clear air. 2. An intrauterine pressure catheter (IUPC) will be placed by the MD/CNM. 3. Elevate the IV bag 3-4 feet above the IUPC tip for rapid infusion. Infuse 250-500ml of solution over a 20-30 minute time frame followed by a 60-180ml/hour maintenance infusion. The total volume infused should not exceed 1000ml unless one has access to ultrasound and can titrate to an amniotic fluid index (AFI) of 8-12 cm to prevent polyhydramnios and hypertonus. 4. If variable decelerations recur or other new non-reassuring FHR patterns develop, notify the MD/CNM. The procedure may be repeated as ordered. 5. Resting tone of the uterus will be increased during infusion but should not increase > 15mmHg from previous baseline. If this occurs, infusion should stop until there is a return to the previous baseline then it can be restarted. An elevated baseline prior to infusion is a contraindication. 6. Monitor for an outflow of infusion. If there is a sudden cessation of outflow fetal head engagement may have occurred increasing the risk of polyhydramnios. Complications are rare but can include iatrogenic polyhydramnios, uterine hypertonus, chorioamnionitis, uterine rupture, placental abruption, and maternal pulmonary embolus.
  • Fetal Compromise (Acute): Management If Suspected This Document Should Be Read in Conjunction with the Disclaimer

    Fetal Compromise (Acute): Management If Suspected This Document Should Be Read in Conjunction with the Disclaimer

    King Edward Memorial Hospital King Edward Memorial Hospital Obstetrics & Gynaecology Obstetrics & Gynaecology CLINICAL PRACTICE GUIDELINE Fetal compromise (acute): Management if suspected This document should be read in conjunction with the Disclaimer Aim To identify suspected or actual fetal compromise and initiate early intervention to promote placental and umbilical blood flow to decrease risk of hypoxia and acidosis. Key points1 1. Fetal compromise in labour may be due to a variety of pathologies including placental insufficiency, uterine hyperstimulation, maternal hypotension, cord compression and placental abruption. Identification and management of reversible abnormalities may prevent unnecessary intervention. 2. Continuous electronic cardiotocograph (CTG) monitoring should be commenced when fetal compromise is detected at the onset of labour or develops during labour. 3. A normal CTG is associated with a low probability of fetal compromise and has the following features: Baseline rate 110-160 bpm Baseline variability 6-25 bpm Accelerations of 15 bpm for 15 seconds No decelerations. 4. The following features are unlikely to be associated with fetal compromise when occurring in isolation: Baseline rate 100-109 bpm Absence of accelerations Early decelerations Variable decelerations without complicating features. 5. The following features may be associated with significant fetal compromise and require further action (see management section on next page): Baseline fetal tachycardia >160 bpm Reduced or reducing baseline variability
  • Amniotic Fluid Volume: When and How to Take Action

    Amniotic Fluid Volume: When and How to Take Action

    Amniotic fluid volume: When and how to take action http://contemporaryobgyn.modernmedicine.com/pr... Published on Contemporary OB/GYN (http://contemporaryobgyn.modernmedicine.com) Amniotic fluid volume: When and how to take action Alessandro Ghidini, MD and Marta Schilirò, MD and Anna Locatelli, MD Publish Date: JUN 01,2014 Dr. Ghidini is Professor, Georgetown University, Washington, DC, and Director, Perinatal Diagnostic Center, Inova Alexandria Hospital, Alexandria, Virginia. Dr. Schilirò is Medical Doctor, Obstetrics and Gynecology, University of Milano-Bicocca, Monza, Italy. Dr. Locatelli is Associate Professor, University of Milano-Bicocca, Monza, Italy, and Director, Department of Obstetrics and Gynecology, Carate- Giussano Hospital, AO Vimercate-Desio, Italy. None of the authors has a conflict of interest to report with respect to the content of this article. Assessment of amniotic fluid volume (AFV) is an integral part of antenatal ultrasound evaluation during screening exams, targeted anatomy examinations, and in tests assessing fetal well-being. 1 di 17 18/06/2014 11:10 Amniotic fluid volume: When and how to take action http://contemporaryobgyn.modernmedicine.com/pr... Abnormal AFV has been associated with an increased risk of perinatal mortality and several adverse perinatal outcomes, including premature rupture of membranes (PROM), fetal abnormalities, abnormal birth weight, and increased risk of obstetric interventions.1 A recent systematic review demonstrated associations between oligohydramnios, birthweight <10th percentile, and perinatal mortality, as well as between polyhydramnios, birthweight >90th percentile, and perinatal mortality. The predictive ability of AFV alone, however, was generally poor.2 How to assess AFV Ultrasound (U/S) examination is the only practical method of assessing AFV.
  • Fetal Assement Methods

    Fetal Assement Methods

    12/3/2020 Fetal Assement Methods 1 up to 9% of exam 5 to 9 questions 13.00 Adjunct Fetal Surveillance Methods 10%) 13.01 Auscultation (Intermittent Auscultation- IA) 13.02 Fetal movement counting 13.03 Nonstress testing 13.04 Fetal acid base interpretation – will be covered in a separate section 13.05 Biophysical profile 13.06 Fetal Acoustic Stimulation 2 1 12/3/2020 HERE IS ONE FOR YOU!! AWW… Skin to Skin in the OR ☺ 3 Auscultation 4 2 12/3/2020 Benefits of Auscultation • Based on Random Control Trials, neonatal outcomes are comparable to those monitored with EFM • Lower CS rates • Technique is non-invasive • Widespread application is possible • Freedom of movement • Lower cost • Hands on Time and one to one support are facilitated 5 Limitation of Auscultation • Use of the Fetoscope may limit the ability to hear FHR ( obesity, amniotic fluid, pt. movement and uterine contractions) • Certain FHR patterns cannot be detected – variability and some decelerations • Some women may think IA is intrusive • Documentation is not automatic • Potential to increase staff for 1:1 monitoring • Education, practice and skill assessment of staff 6 3 12/3/2020 Auscultation • Non-electronic devices such as a Fetoscope or Stethoscope • No longer common practice in the United States though may be increasing due to patient demand • Allows listening to sounds associated with the opening and closing of ventricular valves via bone conduction • Can hear actual heart sounds 7 Auscultation Fetoscope • A Fetoscope can detect: • FHR baseline • FHR Rhythm • Detect accelerations and decelerations from the baseline • Verify an FHR irregular rhythm • Can clarify double or half counting of EFM • AWHONN, (2015), pp.
  • Cutoff Point Amniotic Fluid Index and Pregnancy Prognosis in the Third Trimester of Pregnancy in Shariati Hospital of Bandar Abbas in 2013-14

    Cutoff Point Amniotic Fluid Index and Pregnancy Prognosis in the Third Trimester of Pregnancy in Shariati Hospital of Bandar Abbas in 2013-14

    Available online at www.ijmrhs.com International Journal of Medical Research & ISSN No: 2319-5886 Health Sciences, 2016, 5, 12:212-216 Cutoff point amniotic fluid index and pregnancy prognosis in the third trimester of pregnancy in Shariati Hospital of Bandar Abbas in 2013-14 AzinAlavi 1, Najmesadat Mosallanezhad 1,Hosein Hamadiyan 2, Mohammad Amin Sepehri Oskooe 2 and Keivan Dolati 2* 1Fertility and Infertility Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran 2Student Research Committee, Hormozgan University of Medical Sciences, Bandar Abbas, Iran *CorrespondingEmail:[email protected] _____________________________________________________________________________________________ ABSTRACT Background and purpose of study: Amniotic fluid volume varies according to different stages of fetal growth and its different requirements. Disrupted amniotic fluid volume is associated with an increased risk for the fetus. The present research aims to investigate the effect of cutoff point amniotic fluid index on pregnancy prognosis at the third trimester of pregnancy in Shariati hospital of Bandar Abbas. Materials and methods: In the present analytical, cross-sectional research, AFI ≤ 5 cm was considered as oligohydramnios; AFI 5.1-8 was taken as the cut-off point; AFI ˃ 8.1-24 was regarded as normal; AFI ˃ 24 was considered as polyhydramnios. The data were analyzed via SPSS version 16.0 using Chi-squared test, Fisher’s test, Mann-Whitney U-test and Spearman’s correlation coefficient. P-value was set at ≤ .05 for the significance of data. Findings: Subjects with cut-off point AFI (5.1-8) were 38 (40.4%); those with normal AFI (8.1-24) were 56 (59.6%). The mean score of AFI was 8.85±9.54cm.
  • Amnioinfusion

    Amnioinfusion

    Review Article Indian Journal of Obstetrics and Gynecology Volume 7 Number 4 (Part - II), October – December 2019 DOI: http://dx.doi.org/10.21088/ijog.2321.1636.7419.12 Amnioinfusion Alka Patil1, Sayli Thavare2, Bhagyashree Badade3 How to cite this article: Alka Patil, Sayli Thavare, Bhagyashree Badade. Amnioinfusion. Indian J Obstet Gynecol. 2019;7(4)(Part-II):641–644. 1Professor and Head, 2,3Junior Resident, Department of Obstetrics and Gynaecology, ACPM Medical College, Dhule, Maharashtra 424002, India. Corresponding Author: Alka Patil, Professor and Head, Department of Obstetrics and Gynaecology, ACPM Medical College, Dhule, Maharashtra 424002, India. E-mail: [email protected] Received on 20.11.2019; Accepted on 16.12.2019 Abstract potentially at risk. Oligohydramnios is one of the high-risk pregnancy, posing diagnostic challenge Amniotic fluid is a dynamic medium that plays and dilemma in management. These high-risk a significant role in fetal well-being. It is essential pregnancies should be monitored, managed during pregnancy for normal fetal growth and organ and delivered at a tertiary care center for good development. About 4% of pregnancies are complicated pregnancy outcome. by oligohydramnios. It is associated with an increased incidence of perinatal morbidity and mortality due to its Amniotic fl uid is essential for the continued well antepartum and intrapartum complications. Gerbruch being of the fetus and has following functions: and Hansman described a technique of Amnioinfusion • Shock absorber preventing hazardous to overcome these difficulties to prevent the occurrence pressure on the fetal parts of fetal lung hypoplasia in pregnancies complicated by oligohydramnios. Amnioinfusion reduces both • Prevents adhesion formation between fetal the frequency and depth of FHR deceleration.
  • INTRODUCTION Effect of Different Dosages of Intravaginal Misoprostol

    INTRODUCTION Effect of Different Dosages of Intravaginal Misoprostol

    Original Article Gynecology and Obstetrics Medical Journal of Islamic World Academy of Sciences Effect of Different Dosages of Intravaginal Misoprostol for Second Trimester Pregnancy Termination Maysoon Sharief1, Enaas S. Al-Khayat1 1Department of Gynecology and Obstetrics, College of Medicine, University of Basrah, Basrah, Iraq. ABSTRACT Miscarriage is a common complication of early pregnancy; however; curettage and dilation are considered standard methods taking care of early pregnancy failure. Misoprostol has been used as an alternative agent for termination of early pregnancy. Therefore, this study was aimed to compare the efficacy and side effects of two different intravaginal misoprostol trials for the second trimester pregnancy termination of missed miscarriage between 14 and 23 weeks. A clinical trial was carried out in Basrah Maternity & Children Hospital during the period from October 2011 to November 2012. A total of 100 women experienced missed miscarriages at 14-23 weeks of gestation were admitted for medical termination of pregnancy. Patients were divided into the following two groups: Group 1: 50 patients received 400 µg of intravaginal misoprostol/8 hours. Group 2: 50 patients received 800 µg of intravaginal misoprostol/8 hours. The patients were followed up for 24 hours. The primary outcome measure was induction-miscarriage interval; the secondary outcomes were the rate of successful miscarriage and complete miscarriage; the incidence of side effects was compared in both groups. The rates of successful termination of pregnancy in both groups 1 and 2 were 86% and 90%, respectively. The success rates of the drug in group 1 were 0%, 12%, 36%, 34%, 10%, and 4% after first, second, third, fourth, fifth, and sixth doses, respectively; whereas, the success rates in group 2 were 24%, 34%, 24%, 12%, 4%, and 0% after first, second, third, fourth, fifth, and sixth doses, respectively.
  • Amnioinfusion in the Etiological Diagnosis and Therapeutics Of

    Amnioinfusion in the Etiological Diagnosis and Therapeutics Of

    14th World Congress in Fetal Medicine Amnioinfusion in the etiological diagnosis and therapeutics of oligohydramnios: 17 years of experience Borges-Costa S, Bernardo A, Santos A Prenatal Diagnosis Center, Hospital Garcia de Orta, Almada, Portugal Objective To review the maternal and fetal outcomes of all amnioinfusions performed for the diagnosis and treatment of oligohydramnios during pregnancy (excluding labor). Methods This is a retrospective study of 31 singleton pregnancies with oligohydramnios in the second and third trimesters which underwent transabdominal amnioinfusion between December/1997 and December/2014 in the Prenatal Diagnosis Center at the Hospital Garcia de Orta. The gestational age ranged from 15 weeks and 5 days to 32 weeks and 2 days (average 22 weeks). The initial amniotic fluid index ranged from 0 to 6, 5 cm. The procedure was done only by trained professionals. Under ultrasound guidance, isotonic fluid, such as normal saline or Ringer's lactate, is infused into the amniotic cavity via a 20 G needle inserted through the uterine wall. The volume infused ranged from 100 to 800cc (average 380cc). A genetic study was conducted in 29 cases (93, 5%), performed after amniocentesis (26 cases) or cordocentesis (3 cases). In all cases, there was an exhaustive study of the fetal anatomy after the amnioinfusion. In this study the following parameters were evaluated: maternal characteristics (age, personal and obstetrical history), evolution of pregnancy, perinatal mortality and maternal complications. Histopathological examinations
  • PPH 2Nd Edn #23.Vp

    PPH 2Nd Edn #23.Vp

    43 Standard Medical Therapy for Postpartum Hemorrhage J. Unterscheider, F. Breathnach and M. Geary INTRODUCTION firm contraction of the organ. If severe haemorrhage has already set in, it is highly recommended that the drug should Failure of the uterus to contract and retract following be given by the intravenous route. For this purpose one-third childbirth has for centuries been recognized as the of the standard size ampoule may be injected or, for those most striking cause of postpartum hemorrhage (PPH) who wish accurate dosage, a special ampoule containing and complicates up to 10% of pregnancies globally. In 0.125 mg is manufactured. An effect may be looked for in less the developing world, PPH is responsible for one than one minute.’ maternal death every 7 minutes1. Another uterotonic agent, oxytocin, the hypothalamic In the 19th century, uterine atony was treated by polypeptide hormone released by the posterior pitu- intrauterine placement of various agents with the aim itary, was discovered in 1909 by Sir Henry Dale8 and of achieving a tamponade effect. ‘A lemon imperfectly synthesized in 1954 by du Vigneaud9. The develop- quartered’ or ‘a large bull’s bladder distended with ment of oxytocin constituted the first synthesis of water’ were employed for this purpose, with apparent a polypeptide hormone and gained du Vigneaud a success. Douching with vinegar or iron perchloride Nobel Prize for his work. was also reported2,3. Historically, the first uterotonic The third group of uterotonics comprises the ever- drugs were ergot alkaloids,
  • OBGYN-Study-Guide-1.Pdf

    OBGYN-Study-Guide-1.Pdf

    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
  • Prostaglandin E2 Induction of Labor and Cervical Ripening for Term Isolated Oligohydramnios in Pregnant Women with Bishop Score � 5

    Prostaglandin E2 Induction of Labor and Cervical Ripening for Term Isolated Oligohydramnios in Pregnant Women with Bishop Score 5

    + MODEL Available online at www.sciencedirect.com ScienceDirect Journal of the Chinese Medical Association xx (2016) 1e4 www.jcma-online.com Original Article Prostaglandin E2 induction of labor and cervical ripening for term isolated oligohydramnios in pregnant women with Bishop score 5 Hatice Kansu-Celik*, Ozlem Gun-Eryılmaz, Nasuh Utku Dogan, Seval Haktankaçmaz, Mehmet Cinar, Saynur Sarici Yilmaz, Cavidan Gu¨lerman Zekai Tahir Burak Woman's Health, Research and Education Hospital, Department of Obstetrics and Gynecology, Ankara, Turkey Received April 26, 2016; accepted July 15, 2016 Abstract Background: We aimed to evaluate the efficacy and safety of dinoprostone for cervical ripening and labor induction in patients with term oligohydramnios and Bishop score 5. Methods: This was a prospective caseecontrol study, which included 104 consecutive women with a Bishop score 5. Participants were divided into two groups. Women with term isolated oligohydramnios and Bishop score 5 underwent induction of labor with a vaginal insert containing 10-mg timed-release dinoprostone (prostaglandin E2; Group A, n ¼ 40). The control group, Group B, consisted of 64 cases of pregnancy with normal amniotic fluid volume (amniotic fluid index 5 cm) and Bishop score 5, and was matched for patient's age and parity. The primary outcome was time from induction to delivery; the secondary outcomes were the caesarean section (CS) rate, uterine hyperstimulation, rate of failed induction, and neonatal complications. Results: The mean time interval from induction to delivery was not different between the two groups ( p ¼ 0.849), but there was a statistically significant difference between the groups in terms of the CS rate ( p ¼ 0.005).
  • Therapeutic Amnioinfusion in Oligohydramnios During Pregnancy (Excluding Labor)

    Therapeutic Amnioinfusion in Oligohydramnios During Pregnancy (Excluding Labor)

    International Journal of Reproduction, Contraception, Obstetrics and Gynecology Qazi M et al. Int J Reprod Contracept Obstet Gynecol. 2017 Oct;6(10):4577-4582 www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789 DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174445 Original Research Article Therapeutic amnioinfusion in oligohydramnios during pregnancy (excluding labor) Mahvish Qazi1, Najmus Saqib2*, Abida Ahmed1, Imran Wagay3 1Department of Obstetrics and Gynecology, SKIMS Soura Srinagar Kashmir, India 2Department of Paediatrics and Neonatology, Government Medical College Jammu, Jammu and Kashmir, India 3Department of Radiodiagnosis, Govt. Medical College Srinagar, Jammu and Kashmir, India Received: 05 August 2017 Accepted: 04 September 2017 *Correspondence: Dr. Najmus Saqib, E-mail: [email protected] Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Oligohydramnios is a serious complication of pregnancy that is associated with a poor perinatal outcome and complicates 1-5% of pregnancies. The purpose of this study was to evaluate the role of antepartum transabdominal amnioinfusion on amniotic fluid volume/latency period in pregnancies with oligohydramnios. Methods: This study was conducted in the Department of Obstetrics and Gynaecology at Sher-i-Kashmir Institute of Medical Sciences Soura Srinagar. In this study, a total of 54 pregnant women with ultrasonographically diagnosed oligohydramnios i.e. AFI < 5 cm and gestational age of >24 weeks were taken for therapeutic amnioinfusion and its effects on amniotic fluid volume were studied.