Transcript Asymptomatic bacteruia

Zareh. F. MD
Asymptomatic bacteriuria
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Colony count more than 10000
No symptom
incidence 6%
25-40% Progress to pyelonephritis .
Treatment reduces this 10-fold
Ampicillin or nitrofurantoin 10-14 days
U/c one week following therapy
30% of infection recure
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cystitis
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Symptomatic bacteriuria without flank
pain or fever
Diagnosis and treatment as ASB
With sterile urine chlamydia trachomatis
suspected
pyelonephritis
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1-3% of pregnant women
Febrile patient
,chills,urgency,dysuria,nausea,vomiting
Right sided,bilateral
Bacterial endotoxins
Macrophage cytokines
Preterm labor
Recurrent pyelonephritis
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10-18% of patient
Nitrofurantoin 100/night
u/c every month
Treatment: 10-day course of antibiotics
Ivp 3 months postpartum
Urinary calculi
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1/1000 pregnancies
Increase uti to 20-45%
Suppressive nitrofurantoin therapy
u/c monthly
Infection treated aggressively
Sonography 60%
Single view Ivp 96%(50 mrad)
with persisted obstruction ureteral stent or
percutaneous nephrostomy is required .
Chronic renal failure
Mild
cr
1.4
Disease Decline renal
course function.
Increased
proteinuria,
Hypertention.
Returns
postpartum.
Moderate
1.5-2.4
Accelerated
deterioration in
renal function
in 10%
Perinat
al
Mortality 15%
Preeclampsia 50%
preterm delivery 30-80%
Growth restriction 57%
Severe
2.5
30-40% with
Decline in renal
function to end
stage dis in 12yr postpartum
Dialysis
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The goal of dialysis is BUN at 5060mg/dl
Risk of fetal demise is BUN above
80mg/dl
Peritoneal dialysis is superior
for minimize fluid shift and does
not required anticoagulation
Mg-so4 can be added(serum level
5meq/l).
Renal transplantation
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Avoid of pregnancy for 2 years
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Complications :
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With dose of prednisone 15 mg/day , azathioprine
2mg/kg/day
Preeclampsia
Infection (cmv,herpes,hepatitis,uti)
Parathyroid dysfunction, preterm birth
Prematurity 45-60% and 20% of this babies are IUGR
PROM
Pregnancy outcome successful 80-90%
Neurologic disorders
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Tension headache
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Migaine
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Epilepsy
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Subarachnoid hemorrhage
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Pseudotumor cerebri
Migrain headache
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Common, 15% first in pregnancy
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R/O B.tumor,stroke,epilepsy
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Menstrual migrain, 64% improvement in
pregnancy
Cerebral artery vasoconstraction
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3-6 fold ischemic stroke
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treatment
Aspirin , acetaminophen with or without
caffeine
 narcotics,
 Phenothiazine
 Sumatriptan succinate (Imitrex)
 Ergotamin(vasoconstrictor)
 NSAIDs should be avoided in 3th
trimester.
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Epilepsy in pregnancy
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No change 46%
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Reduction 20%
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Increase
34%
Factors that increase the
frequency of seizure
Discontinuation of medication
For belief that it harms the fetus
 Inability to ingest medication
For nausea and vomiting
 Sub therapeutic drug level
Expanding maternal vascular volume
 Lowering of the seizure threshold
By sleep deprivation and stress
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druges
For many anticonvulsant drugs,the
benefit of preventing seizures
outweighs any potential risks to the
fetus
The Druges should be avoided
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fetal factors play a role for fetal
hydantoin syn
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Valproic acid befor 8w
Trimetadione
Epoxide hydrolase deficiency
Birth defects increases 3% to 7%
management
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Lowest medication
Minimized stressors
Multivitamin ,folate
Vit K
Sonography
During labor antiseizure medication
Pain relief
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Pain
hvt
resp.alkalosis
sz.threshold
diagnosis
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CT scan
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CSF exam
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angiography
M.S
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Multifocal demyelinating dis of CNS
white matter
Characterized by :chronic inflammation,
selective demyelination, scarring
Etiology: unknown, virus-triggered
autoimmune phenomen
pregnancy
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UTI
Constipation
Fatigue
Morbidity problem
With paraplegia or quadriplegia at risk for
precipitous delivery
Lesion at or above T6 are at risk for
autonomic dysreflexia
Flares are common during the first 3
postpartum months
Spinal cord injury
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Generally tolerate pregnancy well
Bowel dysfunction
Pressure necrosis
UTI
Lesion location
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Below T10-11
feel ut. Cont normally
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Above
not feel “
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Above T6
hyperreflexia
risk of autonomic
hyperreflexia
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Stimuli: labor, urethral catheterization , cervical or
rectal exam
nerve impulses
enter the cord
initiate focal segmental reflexes that not inhibited by
higher center
stimulation of the sympathetic
nervous system
Symptoms: pilomotor erection , excessive sweating ,
facial flushing , dilated pupils , severe headache ,
paroxysmal hypertension , bradycardia
Prevention: epidural anesthesia
Endocrine disorders
Thyroid disease
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Thyroid in pregnancy:
modest thyroid enlargement
TSH , TRH
TBG
( total T3,T4 )
free T4,T3
in early pregnancy HCG
freeT4
Maternal hypothyroidism
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freeT4 ,TSH
Excessive fatigue
Dry skin
Cold intolerance
Constipation
Bradycardia
irritability
Myxedema (rare)
complications
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Infertility
Miscarriage
Abruptio
Preeclampsia
IUGR
Fetal demise
Post partum hemorrhage
Heart failure
Subclinical Hypothyroism
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T4
,TSH (>10mu/ml)
Asymptomatic
5% of women in reproductive age
Complication:
pregnancy induced hypertension
preterm delivery
low IQ in children
Maternal hyperthyroidism
1/500 pregnancy
causes
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Graves disease (most common)
T.S.Is binds to thyroid follicle cell TSH
receptor
Acute and subacute thyroiditis
Toxic nodular goiter
Toxic adenoma
GTD
diagnosis
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Symptoms:
Shortness of breath
Palpitation
Heat intolerance
Weight loss
Poor weight gain
Increase bowel frequency
diagnosis
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Laboratory
Free T4
freeT3 3-5%
TSH
Auto antibodies confirm the
autoimmune nature and fetal
implication
treatment
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Medical
PTU 300-450mg folowed 50-300mg daily
Methimazole
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Sugary
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Radioactive sodium iodine
Drug adverse reaction
PTU
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Skin rash (2-8%)
Bronchospasm
Drug fever
Hepatitis
Oral ulcer
Agranulocyopenia
Metimazole
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Aplasia cutis
Breast feeding
PTU is preferable because more
strongly bounds to plasma
protein
B blockers
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Propranolol 20-40 mg 3times/day
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Reduces sympathetic like syndrome
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Inhibitory effect of T4
T3
Surgery
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If PTU necessary >300 mg/day
radiation
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Contrindicated in pregnancy
Hyperthyroid complication on
pregnancy
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Preeclampsia
Preterm delivery
Fetal demise
Growth restriction
Fetal or neonate thyroid dysfunction
Fetal thyroid function
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Hormon activity by the end of 1th trimester
and gradually increases
T3-T4 CROSS THE PLACENTA MINIMALLY
TSIs cross the placenta easily
Thyroid H deficiency during fetal
development and 2y after birth
irreversible brain damage
Dermatologic
diseases
Physiologic changes
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Hyperpigmentation
Vascular change: spider angioma , palmar
erythema , venous varicosities ,
Hair: growing/resting
Telogen efflovium 1-4 month postpartum
Intrahepatic cholestasis of
pregnancy
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2th most common cause of jaundice in pregnant
Increases :
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bile salt
alk.ph
SGOT
SGPT
Bill
recurrence 50%
Fetal outcome
Herpes gestation
Pemphigoid gestationis
 Onset: mid to late pregnancy
, postpartum
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Severe pruritus , urticarial
papules , plaques , erythema
, vesicles bullae
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Abdomen , extremities , or
generalized
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Exacerbation , remission
common
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IgG depositionat the BM
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5% Dermatologic manif
newborn(resolve sev w)
 Adverse Fetal out come
Recurrence is more severe
and earlier
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Pruritic urticarial papules and
plaques of pregnancy(PUPPP(
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Most common dermatosis of pregnancy 1%
Late preg
Not recur
Generalize , patchy
Abd , buttocks , thigh , arm
Absence of Ab or complement deposition
Perinatal morbidity no increase
PUPPP
PUPPP
treatment
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Antipruritics and topical steroids
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Oral steroid may in severe case
Impetigo herpetiform
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Pustural psoriasis
Late preg
Intertrigiginous surface ( extend to involves
entire skin and mucosa membrane)
Erythematous patches surounded by sterile
pustule
Fever , malaise , GI distress , hypocalcemia
Maternal sepsis is not uncommon
Perinatal morbidity , mortality
treatment
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Treatment is supportive
Maintenance of fluid and electrolyte
balance
Correction of hypocalcemia
Antibiotic therapy
Steroid?
Delivery is not necessarily accompanied
by resolution