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medical diseases
Department of
gynaecology and
obstetrics
Digestive system disease
Endocrine system disease
Respiratory system diseases
Blood system disease
Urinary system disease
Immunological diseases
Digestive system diseases
Peptic ulcer disease
Viral hepatiitis
Peptic system disease
General consideration
1. Pregnancy usually ameliorates
extension of ulceration
2.an initial attack rarely occurs during
pregnancy
3.the salutary effect of pregnancy may
be related to progesterone ‘s ability to
inhibit motility, because acis secretion
remains unchanged
4. if activation of previously dormant
ulcer disease does occur,it is usually in
the puerperium.
CLINICAL FINDINGS
1. The classic signs of gastric or
duodenal ulcer are related to a
burning epigastric pain that is
relieved by meals or antacids.
2.patients with a gastric or duodenal
ulcer most often report discomfort
rather than pain and describe this
feeling as “acid”or burning or
indigestion.
3.peptic ulcer disease must be
differentiated from reflex esophagitis
or simple heartburn,which commonly
occurs during pregnancy
DIAGNOSIS
1. The above symptoms of peptic ulcer
disease are relieved by food and return
approximately 1-2h later,paralleling
gastric acidity .
2likewise, antacids may relieve the pain
and help confirm the diagnosis.
3.most commonly , the diagnosisis
confirmed by endoscopic visualization
of the ulcer crater in the stomach or
duodenum.
4 although gastric carcinoma is
rare,many physicians recommend
biopsy during the endoscopic
procedure.
5.Upper gastrointestinal X-ray with barium
studies are usually avoided because of
radiation exposure and because endoscopy
is a more direct diagnostic method .
6. helicobacter pylori is an organism
associated with gastritis,ulcers,and possibly
gastric adenocarcinoma and
lymphoma.diagnosis is based on
biopsy,cultre,or urease test.Noninvasive
testing includes the C-urea breath test
,stool antigen,or serology.
Treatment
1. Documented peptic ulcer disorders
are treated symptomatically during
pregnancy
by avoidance of symptom provoking
foods and use of antacids and
sucralfate.
2. supportive advice may be given
regarding cessation of smoking ,bed
rest,avoidance of stress,and so on .
3. for persisitent symptoms,an H2 antagonist
such as cimetidine or ranitidine can be given
.As a last resort,a proton pump inhibitor such
as lansoprazole can be added to the drug
regimen.
breastfeeding is nor
contraindicated with hepatitis B as
long as the infant has been
immunized
Complications and
prognosis
The acute illness usually resolves
rapidlly in 2-3weeks,with complete
recovery usually occuring within
8weeks,in10% of cases of type B and C
hepatitis,chronic perisitent or chromic
active hepatitis develop acute fulminant
hepatitis.
.the maternal courses of viral hepatitis
is unaltered by pregnancy,but
prematurity may be increased.
all pregnant women should routinely
be tested for hdsag during an early
prenatal visit in each pregnancy
perinatal loss rates are usually high
with a poor maternal
prognosis,particulary with poor liver
function or esopageal varices.
Intrahepatic cholestasis of
pregnancy(icp)
Intrahepatic cholestasis is a condition
characterized by accumulation of bile
acids in the liver,with subsequent
accumulation in the plasma,causing
pruritus and jaundice
estrogen and progestone are therefore
considered to play a role in its etiology
ultrasound examination of the gallbladder
helps rule out cholelithiasis
.if hepatitis associated with
pregnancy..laboratory values show an
increased alkaline phosphatese.,bilirubin,and
serum bile acids Ast,and Alt may be mildly
elevated as well.
Symptomatic treament of pruritus with
diphenhydramine is useful
a slight increase in preterm births and
stillbirth .the etiology is unclear,but
some refer to the fetal toxicity of bile
acids as a causative factor
antenatal testing with a modified
biophysical profile two time per week
starting at the time of diagnosis is
suggested.
there is no agreement as to whether
the pregnancy should be induced at
37-38weeks or whether to await
spontaneous labor
Acute fatty livery of
pregnancy
1.Acute fatty liver of pregnancy is a
rare complication (1in 13.000)of the
third trimester.
2. early recognition and termination of
the pregnancy(delivery)and extensive
supportive therapy have reduced the
mortality rate to approximately 20%.
Symptoms and signs include nausea
and vomiting ,malaise ,epigastric pain
,and jaundice,
an elevated LDH.ast alt ,bilirubin,and
prolonged prothrombin time
.glucose,platelets,cholesterol,triglyceri
des,and fibrinogen are notably
decreased
liver biopsy reveals microvesicular
hepatic steatosis and mitochondrail
disruption on electron microscopy.
complications such as acute renal
failue ,DIC,encephalopathy ,and sepsis
can be severe.
Gestational diabetes
mellitus
General consideration
Diabetes mellitus is the most
common medical complication of
pregnancy
a clinical syndrome characerizes
by deficiency of or insensitiviy to
insulin and exposure of organs to
chronic hyperglycemia
Hyperglycemia around the time of
conception and early organogenesis
results in the developing embryo
having a 6-fold increase in midline
birth defects.
.ketoacidosis is an immediate threat to
life and is the leading cause of
perinatal morbidity in diabetic
pregnancies today ,accounting for 40%
of perinatal mortality
complications of Gdm include fetal
macrosomia,which is associated with
inceased rates of secondary complications
such as operative delivery shoulder
dystocia,and birth trauma.in addition
,neonatal complications attributed to
gestational dabetes include respiratory
distress
syndrome(rds),hypocalcemia,hyperbilirubin
emia,and hypoglycemia
with therapy beginning prior to
conception and continuing throughout
pregnancy, including nutrition
therapy,insulin when necessary ,and
eventual antepartum fetal
surveillancy,there is a marked decline
in overall morbidity and mortality
Diagnosis criteria for diabetes
mellitus prior to pregnancy