HIGH RISK PREGNANCY final 30.06.22.pptx

healthcare

1. HIGH RISK PREGNANCY DR. MONICA AGRAWAL ASSOCIATE PROFESSOR DEPT OF OBS &GYNAE KGMU, LUCKNOW

2. High Risk Pregnancy

3. High Risk Pregnancy

4. Leading Causes Of Maternal Mortality

5. Incidence

6. High Risk Pregnancy

7. Preconception care

8. Preconception Counselling Identifying medical and surgical high risk Identify how each risk factor would alter pregnancy outcome Identify how pregnancy would alter the course of each medical/surgical disorder Preconceptional counselling is important to diagnose high risk factors from history , investigate before pregnancy so that they conceive when their medical conditions are under control.

9. Low Risk Category

10. High Risk Category

11. Current approach for Antenatal care Antenatal care

12. The high concentration of visits in the third trimester implies - That most complications occur at late stage of pregnancy That most adverse outcomes are unpredictable during the first or even second trimester.

13. Inverted Pyramid

14. Inverted Pyramid

15. Antenatal Visits In High Risk Patients High risk patients are issued HIGH RISK or PINK CARD They should be seen every 2 weeks after first trimester and weekly in last trimester They should be admitted in a well equipped tertiary Cre hospital 2 weeks prior to EDD

16. Screening Of Pregnancies For High Risk HISTORY TAKING

17. EXAMINATION

18. EXAMINATION

19. First Trimester 1. Ectopic pregnancy 2. Abortion 3. Molar Pregnancy 4. Uterine rupture Second Trimester 1. Abortion 2. Cervical Incompetence Third Trimester Placenta Praevia Placenta Accreta PPH Uterine rupture Inversion Hypertension High Risk Pregnancy

20. Identifying High Risk Factors

21. Obstetrics High Risk Factors

22. High Risk Pregnancy Conditions

23. High Risk Labour

24. ANEMIA -Global Burden of disease

25. ICMR- Severity Classification Haemoglobin (g/dl) Mild 10.0-10.9 Moderate 7-9.9 Severe <7 Very Severe <4

26. Consequences of IDA in pregnancy

27. Interventions to prevent and correct iron deficiency and IDA

28. Iron supplementation GI side effects include diarrhea , constipation, abdominal pain, flatulence, nausea, black or tarry stools and heartburn. Prophylaxis Treatment WHO 60 mg Iron + 400ug FA till term 120 mg Iron+400 ug FA MoHFW 100 mg Iron + 500 ug FA for 100 days (starting from 14-16 week) Mild anemia-200 mg Iron +500 ug FA for 100 days. Mod anemia - IM Iron + oral folic acid Severe Anemia IV iron Iron Supplementation

29. Intravenous Iron Immediate replineshment Rapid intake by bone marrow & RE system Given in divided dose m/c used iron sucrose, 200 mg in 100 ml normal saline in 15 -20 minutes (for first 5 minutes slowly) Not require test dose More efficacy and safety than im iron Ferric carboxymaltose superior to all parenteral iron ( dextran free, fewer side effects, dose 1000 mg in 15 min)

30. Pre-eclampsia/Eclampsia

31. Mgso4 In Pre-eclampsia/Eclampsia

32. Diabetes In Pregnancy

33. Screening Of GDM 1) Single step method- 75gm glucose is given and 2 hours post prandial blood sugar is checked. Value of more than 140 mg/dl is positive. 2)Two step method- a) Glucose Challenge Test- 50 g glucose b) Glucose Tolerance Test- 100 g glucose

34. Antepartum Hemorrhage Bleeding from the genital tract in the second half of pregnancy. Causes- Placenta previa Placental abruption Placenta accreta Other causes- APH of indeterminate origin -vasa previa -bleeding from lower genital tract -blood stained cervical mucus (show)

35. Cardiac Disease In Pregnancy Cardiac disease complicates 0.2-4% of all pregnancies. Women with cardiac conditions who desire or anticipate pregnancy should be offered preconceptional counselling.

36. Take Home Message