1. Women presenting with spotting who are no longer bleeding and where
placenta praevia has been excluded can go home after a reassuring
initial clinical assessment.
(spotting ----> staining, streaking or blood spotting noted on underwear or sanitary protection)
2. All women with APH heavier than spotting and women with on-going
bleeding should remain in hospital at least until the bleeding has
stopped.
3. Following single or recurrent episodes of APH from a cervical ectropion, subsequent antenatal care need not be altered.
4. Following APH from placental abruption or unexplained APH, the
pregnancy should be reclassified as ‘high risk’ and antenatal care
should be consultant-led.
Serial ultrasound for fetal growth should be
performed.
Wednesday, July 17, 2013
Haemorrhage
Definitions :
1. Spotting – staining, streaking or blood spotting noted on underwear or sanitary protection
2. Minor haemorrhage – blood loss less than 50 ml that has settled
3. Major haemorrhage – blood loss of 50–1000 ml, with no signs of clinical shock
4. Massive haemorrhage – blood loss greater than 1000 ml and/or signs of clinical shock.
1. Spotting – staining, streaking or blood spotting noted on underwear or sanitary protection
2. Minor haemorrhage – blood loss less than 50 ml that has settled
3. Major haemorrhage – blood loss of 50–1000 ml, with no signs of clinical shock
4. Massive haemorrhage – blood loss greater than 1000 ml and/or signs of clinical shock.
Grades of placenta previa
Grade I: Placenta implanted in the lower segment, but lower edge does not reach the internal os
Grade II: The lower edge of the low lying placenta reaches but does not cover the internal os
Grade III: The placenta covers the internal os asymmetrically
Grade IV: Placenta covers internal os symmetrically
Grades I & II are minor or marginal placenta previa.
Grades III & IV are major or central placenta previa.
Ectopic pregnancy - Risk factors
RISK FACTORS FOR ECTOPIC PREGNANCY
1. Previous ectopic pregnancy
2. Tubal surgery / reversal of sterilisation
3. Previous PID
4. Use of progesterone-only contraception - affects tubal motility.
(Risk in women taking mini-pill higher than for COCP but lower than for sexually active women not
taking contraception)
5. Use of ovulation-inducing agents (clomiphene, gonadotrophins) / IVF
6. Pregnancy with IUCD in-situ
7. Smoking
1. Previous ectopic pregnancy
2. Tubal surgery / reversal of sterilisation
3. Previous PID
4. Use of progesterone-only contraception - affects tubal motility.
(Risk in women taking mini-pill higher than for COCP but lower than for sexually active women not
taking contraception)
5. Use of ovulation-inducing agents (clomiphene, gonadotrophins) / IVF
6. Pregnancy with IUCD in-situ
7. Smoking
Placenta previa - Risk factors
Risk factors for placenta previa -
1. Previous placenta praevia
2. Previous caesarean sections
3. Previous termination of pregnancy
4. Multiparity
5. Advanced maternal age (>40 years)
6. Multiple pregnancy
7. Smoking
8. Deficient endometrium due to presence or history of -
- uterine scar
- Endometritis
- Manual removal of placenta
- submucous fibroid
- assisted conception
- curettage
(Multiparity, advanced maternal age & assisted conception are high risk factors for placenta previa & abruption both.
Mutiple pregnancy is a risk factor for placenta previa but not abruption.
Non-vertex presentation is a risk factor for abruption but not placenta previa)
1. Previous placenta praevia
2. Previous caesarean sections
3. Previous termination of pregnancy
4. Multiparity
5. Advanced maternal age (>40 years)
6. Multiple pregnancy
7. Smoking
8. Deficient endometrium due to presence or history of -
- uterine scar
- Endometritis
- Manual removal of placenta
- submucous fibroid
- assisted conception
- curettage
(Multiparity, advanced maternal age & assisted conception are high risk factors for placenta previa & abruption both.
Mutiple pregnancy is a risk factor for placenta previa but not abruption.
Non-vertex presentation is a risk factor for abruption but not placenta previa)
Placenta previa
- Incidence of fetal anomalies is almost double than normal population.
- Up to 15 % cases may have placenta accreta.
- Trans-abdominal scanning is associated with high false positive diagnoses.
- Trans-vaginal scanning is safe & superior to trns-abdominal.
- Placenta previa encroaching within 2 cm of the internal os in contra-indication to vaginal delivery.
- Up to 15 % cases may have placenta accreta.
- Trans-abdominal scanning is associated with high false positive diagnoses.
- Trans-vaginal scanning is safe & superior to trns-abdominal.
- Placenta previa encroaching within 2 cm of the internal os in contra-indication to vaginal delivery.
Placental abruption - Risk factors
1. Pre-eclampsia
2. Smoking
3. Previous h/o abruption
one previous abruption - 4-5 %
two previous abruptions - 20-25 %
4. Polyhydramnios
5. Multiple pregnancy
6. Advanced maternal age
7. Multiparity
8. Low BMI
9. Pregnancy following assisted reproduction techniques
10.IUGR (possibly due to chronic processes associated with vascular dysfunction)
11. Intrauterine infection
12. PROM
13. Abdominal trauma
14.h/o first trimester bleeding
15. Cocaine use
16. Non-vertex presentations
2. Smoking
3. Previous h/o abruption
one previous abruption - 4-5 %
two previous abruptions - 20-25 %
4. Polyhydramnios
5. Multiple pregnancy
6. Advanced maternal age
7. Multiparity
8. Low BMI
9. Pregnancy following assisted reproduction techniques
10.IUGR (possibly due to chronic processes associated with vascular dysfunction)
11. Intrauterine infection
12. PROM
13. Abdominal trauma
14.h/o first trimester bleeding
15. Cocaine use
16. Non-vertex presentations
Massive blood transfusion
- Acute administration of more than 1.5 times of patient's blood volume
OR
Replacement of 10 units of blood in 24 hours
OR
replacement of the patient's total blood volume within 24 hours
- What are the complications ?
1.Thrombocytopenia- dilutional
2. Coagulopathy - due to depleted clotting factors
3. Acid-base imbalance
4. Hypocalcemia - due to formation of complexes of citrate in the blood with serum calcium
5. Hyperkalemia - due to release of high potassium in stored blood cells
6. TRALI - transfusion related acute lung injury
- Iron overload does not occur.
OR
Replacement of 10 units of blood in 24 hours
OR
replacement of the patient's total blood volume within 24 hours
- What are the complications ?
1.Thrombocytopenia- dilutional
2. Coagulopathy - due to depleted clotting factors
3. Acid-base imbalance
4. Hypocalcemia - due to formation of complexes of citrate in the blood with serum calcium
5. Hyperkalemia - due to release of high potassium in stored blood cells
6. TRALI - transfusion related acute lung injury
- Iron overload does not occur.
Tuesday, July 16, 2013
Tamoxiphen
Side effects -
1. hot flushes,
2. abnormal vaginal bleeding,
3. GI disturbance,
4. headache,
5. visual disturbance,
6. VTE,
7. altered liver enzymes
1. hot flushes,
2. abnormal vaginal bleeding,
3. GI disturbance,
4. headache,
5. visual disturbance,
6. VTE,
7. altered liver enzymes
PCOS & levels of hormones
TSH - unchanged
LH - Elevated in ~ 40 %
DHEA-S - Elevated in ~ 50 %
(DHEA-S is an adrenal androgen)
LH - Elevated in ~ 40 %
DHEA-S - Elevated in ~ 50 %
(DHEA-S is an adrenal androgen)
Monday, July 15, 2013
Uterine sandwitch method for PPH
Combination of B-Lynch sutures (For upper segment) + Balloon tamponade (For lower segment)
B-Lynch sutures
- Professor Christopher B-Lynch
- B-Lynch sutures only compresses upper uterine segment, & therefore will be ineffective in controlling bleeding from lower segment - Balloon tamponade is effective in such cases.
.
Balloon tamponade for PPH
- A good ppt on PPH ( For balloon tamponade- read from slide 55)
- Simple & efficient
~ 90-95 % success rate
- Can be used after vaginal or caesarean deliveries
- Particularly useful when there are contraindications to prostaglandins (asthma, glaucoma)
- latex-free silicone balloon
- Min- 300 cc, max 500 cc saline
- to be removed in 24 hours
Sunday, July 14, 2013
Tuberculosis - postnatal Mx for neonate
Tuberculin test -
The tuberculin skin test is considered valid and safe to use throughout pregnancy.
Wernicke's encephalopathy
Triad of S/S -
1. Ophthalmoplegia, nystagmus
2. Unsteady gait, ataxia
3. Mental status changes
- Rare but serious complication of hyperemesis gravidarum.
- Underlying thiamine (B1) deficiency causes alterations in carbohydrate metabolism -----> lactic acidosis -----> cerebral damage
Thiamine, also called B1, helps to breakdown glucose. Specifically, it acts as an essential coenzyme to the TCA cycle and the pentose phosphate shunt. Thiamine is first metabolised to its more active form, thiamine diphosphate (TDP), before it is used. The body only has 2–3 weeks of thiamine reserves, which are readily exhausted without intake, or if depletion occurs rapidly.
- Rx
I.V. diluted - 3 times a day x 2 days, followed by once a day x 5 days
- A case report
.
1. Ophthalmoplegia, nystagmus
2. Unsteady gait, ataxia
3. Mental status changes
- Rare but serious complication of hyperemesis gravidarum.
- Underlying thiamine (B1) deficiency causes alterations in carbohydrate metabolism -----> lactic acidosis -----> cerebral damage
Thiamine, also called B1, helps to breakdown glucose. Specifically, it acts as an essential coenzyme to the TCA cycle and the pentose phosphate shunt. Thiamine is first metabolised to its more active form, thiamine diphosphate (TDP), before it is used. The body only has 2–3 weeks of thiamine reserves, which are readily exhausted without intake, or if depletion occurs rapidly.
- Rx
I.V. diluted - 3 times a day x 2 days, followed by once a day x 5 days
- A case report
.
G6PD deficiency
- G6PD is an enzyme required for maintaining normal life span of RBCs.
(Rate limiting enzyme in pentose phosphate pathway----> maintaining glutathione levels ----->preventing oxidative damage to RBCs)
- X-linked recessive disorder.
- 400 million people affected worldwide
- Common in africa, southeast asia
- Most are asymptomatic. May cause acute or chronic hemolysis, neonatal hyperbilirubinemia
- Avoid oxidative stress - infection, oxidative drugs, fava beans
- Aspirin up to 1 gm daily dose is usually harmless (e.g. - for prophylaxis of pre-eclampsia)
- Neonatal screening should be done if family history, ethnic origin suggests.
(Rate limiting enzyme in pentose phosphate pathway----> maintaining glutathione levels ----->preventing oxidative damage to RBCs)
- X-linked recessive disorder.
- 400 million people affected worldwide
- Common in africa, southeast asia
- Most are asymptomatic. May cause acute or chronic hemolysis, neonatal hyperbilirubinemia
- Avoid oxidative stress - infection, oxidative drugs, fava beans
- Aspirin up to 1 gm daily dose is usually harmless (e.g. - for prophylaxis of pre-eclampsia)
- Neonatal screening should be done if family history, ethnic origin suggests.
G6PD deficiency inheritance
- X-linked recessive
A) If the father is unaffected (healthy) and the mother is a carrier (no clinical symptoms):
A) If the father is unaffected (healthy) and the mother is a carrier (no clinical symptoms):
- One daughter out of two will be a carrier
- One son out of two will be G6PD deficient
- All daughters will be carriers
- All sons will be unaffected
- One daughter out of two will be G6PD deficient
- One daughter out of two will be a carrier
- One son out of two will be G6PD deficient
- One son out of two will be unaffected
- All daughters will be carriers
- All sons will be G6PD deficient
- All daughters will be G6PD deficient
- All sons will be G6PD deficient
Endometriosis & infertility
Endometriosis & infertility-
- 15-60 % of women presenting with subfertility have e/o endometriosis at laparoscopy.
- may be asymptomatic
Rx options -
1. Conservative 2. Medical 3. Surgical 4. Assisted reproduction
1. Conservative -
- Minimal to mild endometriosis is of equivalent degree to unexplained infertility.
- The chances of spontaneous conception in the next 9 months are ~ 30-40 %
2. Medical -
- There is no role of medical Mx in subfertility associated with endometriosis
- Medical Mx will suppress the ovarian function & delay the pregnancy
- No benefits over no Rx.
3. Surgical -
a. Mild to moderate disease - Laparoscopic ablation of endometriotic deposits with adhesiolysis improves fertility.
b. Moderate to severe disease - Role of surgery is uncertain.
c. Advanced disease with dense pelvic adhesions - Laparotomy / laparoscopic Rx improves fertility
d. Endometrioma - Cystectomy (rather than drainage & coagulation) improves fertility.
- Risk of reduced or loss of ovarian function after surgery should be kept in mind.
e. Tubal flushing with oil soluble media - improves fertility.
4. Assisted reproduction techniques -
- effective at all stages of endometriosis
- Success rates ~ 25-40 %
- pregnancy rates not affected by disease
- IUI for 6 cycles - for mild disease with patent tubes
- Ovarian stimulation before IUI improves success, but risk of complications like OHSS & mutiple pregnancy
- IVF - in severe disease, blocked tubes or failure with IUI
- Treatment with GNRH agonists before IVF improves success.
- 15-60 % of women presenting with subfertility have e/o endometriosis at laparoscopy.
- may be asymptomatic
Rx options -
1. Conservative 2. Medical 3. Surgical 4. Assisted reproduction
1. Conservative -
- Minimal to mild endometriosis is of equivalent degree to unexplained infertility.
- The chances of spontaneous conception in the next 9 months are ~ 30-40 %
2. Medical -
- There is no role of medical Mx in subfertility associated with endometriosis
- Medical Mx will suppress the ovarian function & delay the pregnancy
- No benefits over no Rx.
3. Surgical -
a. Mild to moderate disease - Laparoscopic ablation of endometriotic deposits with adhesiolysis improves fertility.
b. Moderate to severe disease - Role of surgery is uncertain.
c. Advanced disease with dense pelvic adhesions - Laparotomy / laparoscopic Rx improves fertility
d. Endometrioma - Cystectomy (rather than drainage & coagulation) improves fertility.
- Risk of reduced or loss of ovarian function after surgery should be kept in mind.
e. Tubal flushing with oil soluble media - improves fertility.
4. Assisted reproduction techniques -
- effective at all stages of endometriosis
- Success rates ~ 25-40 %
- pregnancy rates not affected by disease
- IUI for 6 cycles - for mild disease with patent tubes
- Ovarian stimulation before IUI improves success, but risk of complications like OHSS & mutiple pregnancy
- IVF - in severe disease, blocked tubes or failure with IUI
- Treatment with GNRH agonists before IVF improves success.
Saturday, July 13, 2013
Pheochromocytoma
What is it ?
- A tumour of adrenal medulla
What does it secrete?
-Catecholamines (adrenaline & noradrenaline)
What is the incidence?
- very rare - 1 in 50,000
Why does impaired glucose tolerance occur?
- Increased catecholamines ----> stimulation of lipolysis ---->High levels of free fatty acids----->Inhibition of glucose uptake by muscle cells
In pregnancy, it may be confused with severe pre-eclampsia.
A good article - Pheochromocytoma in pregnancy
- A tumour of adrenal medulla
What does it secrete?
-Catecholamines (adrenaline & noradrenaline)
What is the incidence?
- very rare - 1 in 50,000
Why does impaired glucose tolerance occur?
- Increased catecholamines ----> stimulation of lipolysis ---->High levels of free fatty acids----->Inhibition of glucose uptake by muscle cells
In pregnancy, it may be confused with severe pre-eclampsia.
A good article - Pheochromocytoma in pregnancy
Cytomegalovirus infection in pregnancy
A good article :
CMV infection in pregnancy
It is the most common congenitally acquired infection in infants.
CMV infection in pregnancy
It is the most common congenitally acquired infection in infants.
- Microcephaly
- Ascites
- Hydrops fetalis
- Oligo or polyhydramnios
- Hepatomegaly
- Pseudomeconium ileus
- Hydrocephalus (ventricular dilation)
- Intrauterine growth restriction (IUGR)
- Pleural or pericardial effusions
- Intracranial calcification
- Abdominal calcification
Keilland's forceps
Keilland's forceps
- Rotational forceps
- Allow correction of acynclitism
Kielland's forceps should only be performed in theatre with tested, effective, regional anaesthesia.
Wikipedia article on forceps
- Rotational forceps
- Allow correction of acynclitism
Kielland's forceps should only be performed in theatre with tested, effective, regional anaesthesia.
Wikipedia article on forceps
Oxytocin
Oxytocin
Why neonatal jaundice may occur after oxytocin therapy ?
- The vasopressin-like action of oxytocin causes osmotic swelling of erythrocytes leading to decreased deformability and hence more rapid destruction with resultant hyperbilirubinaemia in the neonate.
This can be minimised by administering oxytocin in sodium-free iv fluids.
Why neonatal jaundice may occur after oxytocin therapy ?
- The vasopressin-like action of oxytocin causes osmotic swelling of erythrocytes leading to decreased deformability and hence more rapid destruction with resultant hyperbilirubinaemia in the neonate.
This can be minimised by administering oxytocin in sodium-free iv fluids.
Risks due to amniocentesis
Serious risks -
1. Failure to obtain a a sample (success rate - 94 % at first attempt)
2. Blood stained sample (0.8 %)
3. Miscarriage - 1 % over normal
4. Fetal injury -Rare
5. Maternal bowel injury - Rare
6. Chorioamnionitis - less than 1 in 1000
7. failure of cell culture in the laboratory
? increased risk of orthopedic deformities if performed early
Frequent risks-
1. Discomfort at the needle insertion site
Read :
RCOG consent advice about amniocentesis
Amniocentesis
1. Failure to obtain a a sample (success rate - 94 % at first attempt)
2. Blood stained sample (0.8 %)
3. Miscarriage - 1 % over normal
4. Fetal injury -Rare
5. Maternal bowel injury - Rare
6. Chorioamnionitis - less than 1 in 1000
7. failure of cell culture in the laboratory
? increased risk of orthopedic deformities if performed early
Frequent risks-
1. Discomfort at the needle insertion site
Read :
RCOG consent advice about amniocentesis
Amniocentesis
Propylthiouracil
Propylthiouracil-
Used for - Rx of hyperthyroidism
Pregnancy category - D
Crosses placenta - Yes
S/E - Can cause fetal goitre & cretinism in developing fetus
- Can cause liver damage in mother & fetus
Alternative drug - Methimazole
Since methimazole may be associated with the rare development of fetal abnormalities such as aplasia cutis and choanal atresia, propylthiouracil may be the preferred agent during organogenesis, in the first trimester of pregnancy.
Given the potential maternal adverse effects of propylthiouracil (e.g., hepatotoxicity), it may be preferable to switch from propylthiouracil to methimazole for the second and third trimesters.
Used for - Rx of hyperthyroidism
Pregnancy category - D
Crosses placenta - Yes
S/E - Can cause fetal goitre & cretinism in developing fetus
- Can cause liver damage in mother & fetus
Alternative drug - Methimazole
Since methimazole may be associated with the rare development of fetal abnormalities such as aplasia cutis and choanal atresia, propylthiouracil may be the preferred agent during organogenesis, in the first trimester of pregnancy.
Given the potential maternal adverse effects of propylthiouracil (e.g., hepatotoxicity), it may be preferable to switch from propylthiouracil to methimazole for the second and third trimesters.
Podophyllotoxin
Podophyllotoxin -
Used for - Rx of HPV warts
Pregnancy category - C
Crosses placenta - Yes
S/E - Teratogenic
Used for - Rx of HPV warts
Pregnancy category - C
Crosses placenta - Yes
S/E - Teratogenic
Cholestyramine
Chlestyramine -
Used for - Reduction of LDL cholesterol
Pregnancy category - C
Crosses placenta - No
Since the drug is not absorbed into the systemic circulation, it is not expected to be harmful to the fetus if administered during pregnancy. However, because it may lead to deficiencies in fat-soluble vitamins, cholestyramine should be used with caution in pregnant women.
Used for - Reduction of LDL cholesterol
Pregnancy category - C
Crosses placenta - No
Since the drug is not absorbed into the systemic circulation, it is not expected to be harmful to the fetus if administered during pregnancy. However, because it may lead to deficiencies in fat-soluble vitamins, cholestyramine should be used with caution in pregnant women.
Lithium
Lithium -
Used for - Rx of manic episodes in manic depression
Pregnancy category - D
S/E - Use of lithium in the first trimester has been associated with congenital defects, particularly cardiac defects such as Ebstein's anomaly.
Used for - Rx of manic episodes in manic depression
Pregnancy category - D
S/E - Use of lithium in the first trimester has been associated with congenital defects, particularly cardiac defects such as Ebstein's anomaly.
Indomethacin
Pregnancy category - C
Used in - To arrest premature labour
Crosses placenta
S/E -
fetal hemodynamic changes, premature closure of the ductus arteriosus
resulting in neonatal primary pulmonary hypertension, and neonatal
oliguric renal failure, oligohydramnios, hemorrhage, and intestinal
perforation
Used in - To arrest premature labour
Crosses placenta
S/E -
Subpubic angle
Subpubic angle is narrow in males - average 50-82 degrees, while in females - 90 degrees.
Female
Male
Female
MaleTypes of pelvis
What is Caldwell-Moloy classification of types of pelvis?
Types of Pelvis -
Gynaecoid pelvis - 50 %
· Most suitable for childbirth
· Wider brim
· Ischial spines are blunt
· Sub pubic angle is 90º
Android pelvis - 20 %
· Heart shaped brim
· Anterior posterior diameter is shorter
· Transverse diameter is wider
· Childbirth is difficult
Anthropoid pelvis - 25 %
· Oval in shape
· Transverse diameter is shorter, A-P diameter is greater - more common in black women
· Seen in tall women with narrow shoulders
· Sub pubic angle more than 90º
Platypelloid pelvis - 5 %
· Kidney shaped (Flattened gynaecoid pelvis)
· Anterior posterior diameter is smaller
· Transverse diameter is wider
See this for simple explanation .
Types of Pelvis -
Gynaecoid pelvis - 50 %
· Most suitable for childbirth
· Wider brim
· Ischial spines are blunt
· Sub pubic angle is 90º
Android pelvis - 20 %
· Heart shaped brim
· Anterior posterior diameter is shorter
· Transverse diameter is wider
· Childbirth is difficult
Anthropoid pelvis - 25 %
· Oval in shape
· Transverse diameter is shorter, A-P diameter is greater - more common in black women
· Seen in tall women with narrow shoulders
· Sub pubic angle more than 90º
Platypelloid pelvis - 5 %
· Kidney shaped (Flattened gynaecoid pelvis)
· Anterior posterior diameter is smaller
· Transverse diameter is wider
See this for simple explanation .
Angle of inclination
What is angle of inclination ?
In the erect posture, the pelvis is tilted forward. The plane of the inlet makes an angle of about 55° with the horizontal & is called 'angle of incination'.
When the angle of inclination is increased due to sacralisation of 5 th lumbar vertebra, it is called as High inclination.
Obstetric significance of high inclination -
1. It may cause delay in engagement because the uterine axis fails to coincide with that of the inlet.
2. It favours occipitoposterior position
3. There may be difficulty in descent of the head due to long birth canal & flat sacrum interfering with internal rotation.
(Low inclinaton due to lumbarisation of first sacral vertebra facilitates early engagement)
Read :
Anatomy of pelvis with diagrams
Anatomy of pelvis - summary
African women have greater angle of inclination than caucasians, possibly causing higher rates of CPD.
(Why racial difference? - Related to malnutrition & possible genetic factors. see this pdf
In the erect posture, the pelvis is tilted forward. The plane of the inlet makes an angle of about 55° with the horizontal & is called 'angle of incination'.
When the angle of inclination is increased due to sacralisation of 5 th lumbar vertebra, it is called as High inclination.
Obstetric significance of high inclination -
1. It may cause delay in engagement because the uterine axis fails to coincide with that of the inlet.
2. It favours occipitoposterior position
3. There may be difficulty in descent of the head due to long birth canal & flat sacrum interfering with internal rotation.
(Low inclinaton due to lumbarisation of first sacral vertebra facilitates early engagement)
Read :
Anatomy of pelvis with diagrams
Anatomy of pelvis - summary
African women have greater angle of inclination than caucasians, possibly causing higher rates of CPD.
(Why racial difference? - Related to malnutrition & possible genetic factors. see this pdf
Premature labour
Can vaginal group B streptococcal infection cause premature labour ?
Yes. Relationship bet. GBS & premature labour
Some other causes - Polyamnios, UTI
Yes. Relationship bet. GBS & premature labour
Some other causes - Polyamnios, UTI
Friday, July 12, 2013
Transverse lie
Transverse lie --
1. What are the associations of transverse lie at term gestation?
A transverse lie may occur in association with the following conditions:
2. What are the main dangers in trans. lie ?
- 1. PROM
- 2. Cord prolapse
3. What is the incidence in UK?
1:320
4. What is the management ?
Management
1. What are the associations of transverse lie at term gestation?
A transverse lie may occur in association with the following conditions:
- grand multiparity
- polyhydramnios
- prematurity
- subseptate uterus, bicornuate uterus
- pelvic tumours such as fibroids, ovarian cysts
- placenta praevia
- multiple pregnancy
- foetal abnormality
2. What are the main dangers in trans. lie ?
- 1. PROM
- 2. Cord prolapse
3. What is the incidence in UK?
1:320
4. What is the management ?
Management
Polyhydramnios
Associations of polyhydramnios -
Can imperforate anus cause it ? -- No (unless there are associated upper GI abnormalities - like oesophageal atresia )
See this - Imperforate anus
Can fetal polycystic kidneys cause it ? -- No. It will cause oligohydramnios.
(Learn - What is Potter's syndrome?)
* Learn about causes of polyhydramnios & Oligohydramnios
Can imperforate anus cause it ? -- No (unless there are associated upper GI abnormalities - like oesophageal atresia )
See this - Imperforate anus
Can fetal polycystic kidneys cause it ? -- No. It will cause oligohydramnios.
(Learn - What is Potter's syndrome?)
* Learn about causes of polyhydramnios & Oligohydramnios
Thursday, July 11, 2013
Let's begin
So....Dear, let's start study in our own way.
Random topics, useful links, unsolved (To be solved) queries...
Random topics, useful links, unsolved (To be solved) queries...
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