Title Obstetrics Dr Amr Omar- Highlighted for SCA_.pdf ✅

WOMEN HEALTH Obstetrics MARCH 1, 2024 Dr Amr Omar MB ChB, MD, Alexandria University, Egypt MSc, University of Tsukuba, Japan

2 iv. rhesus negative pregnancy o test for D antibodies in all Rh -ve mothers at booking. o Give anti-D to non-sensitised Rh -ve mothers at 28 and 34 weeks or single dose at 28 weeks. o anti-D is prophylaxis - once sensitization has occurred it is irreversible. o if event is in 2nd/3rd trimester give large dose of anti-D and perform Kleihauer test - determines proportion of foetal RBCs present. o Anti-D immunoglobulin should be given as soon as possible (but always within 72 hours) in the following situations: ➢ delivery of a Rh +ve infant, whether live or stillborn ➢ any termination of pregnancy ➢ miscarriage if gestation is > 12 weeks. ➢ ectopic pregnancy (if managed surgically) ➢ external cephalic version ➢ antepartum haemorrhage ➢ amniocentesis, chorionic villus sampling, fetal blood sampling ➢ abdominal trauma o Tests ➢ all babies born to Rh -ve mother should have cord blood taken at delivery for FBC, blood group & direct Coombs test. ➢ Coombs test: direct antiglobulin, will demonstrate antibodies on RBCs of baby. ➢ Kleihauer test: add acid to maternal blood, foetal cells are resistant. o Affected foetus. ➢ oedematous (hydrops fetalis, as liver devoted to RBC production albumin falls) ➢ jaundice, anaemia, hepatosplenomegaly ➢ heart failure ➢ kernicterus ➢ treatment: transfusions, UV phototherapy Antenatal screening Conditions which all pregnant women should be offered screening Conditions for which screening should not be offered Anaemia Bacteriuria Blood group, Rhesus status and anti-red cell antibodies Down's syndrome Fetal anomalies Hepatitis B HIV Neural tube defects Risk factors for pre-eclampsia Syphilis The following should be offered depending on Hx: Placenta praevia Psychiatric illness Sickle cell disease Tay-Sachs disease Thalassaemia Bacterial vaginosis Chlamydia Cytomegalovirus Fragile X Hepatitis C Group B Streptococcus Toxoplasmosis
3 Antenatal Screening – Down’s Syndrome o The combined test is now standard. ➢ these tests should be done between 11 - 13+6 weeks. ➢ nuchal translucency measurement + serum B-HCG + pregnancy-associated plasma protein A (PAPP-A) ➢ Down's syndrome is suggested by ↑ HCG, ↓ PAPP-A, thickened nuchal translucency. ➢ trisomy 18 (Edward syndrome) and 13 (Patau syndrome) give similar results but the hCG tends to lower. o quadruple test (alpha-fetoprotein, unconjugated oestriol, human chorionic gonadotrophin and inhibin A). ➢ if women book later in pregnancy the quadruple test should be offered between 15 - 20 weeks. ➢ Interpreting the results of quadruple tests Alpha-fetoprotein Unconjugated oestriol Human chorionic gonadotrophin Inhibin A Down's syndrome ↓ ↓ ↑ ↑ Edward's syndrome ↓ ↓ ↓ ↔ Neural tube defects ↑ ↔ ↔ ↔ o Results of combined or quadruple tests ➢ Both the combined and quadruple tests return either a 'lower chance' or 'higher chance' result • 'Lower chance': 1 in 150 chance or more e.g. 1 in 300 • 'Higher chance': 1 in 150 chance or less e.g. 1 in 100 o If a woman has a ’higher chance’ result => Offer a second screening Non-invasive prenatal screening test (NIPT) which has high sensitivity and specificity (preferred test) or a diagnostic test (e.g. amniocentesis or chorionic villus sampling (CVS). ➢ analyses small foetal DNA fragments that circulate in the blood of a pregnant woman (cell free foetal DNA, cffDNA). ➢ sensitivity and specificity are very high for trisomy 21 (>99%) and similarly high for other chromosomal abnormalities. ➢ private companies (e.g., Harmony) offer NIPT screening from 10 weeks gestation. o Alpha-fetoprotein (AFP) is a protein produced by the developing foetus Increased AFP Decreased AFP Neural tube defects (meningocele, myelomeningocele and anencephaly) Abdominal wall defects (omphalocele and gastroschisis) Multiple pregnancy Down's syndrome Trisomy 18 Maternal diabetes mellitus Anaemia in pregnancy o Pregnant women are screened for anaemia at: • the booking visit (often done at 8-10 weeks), and at • 28 weeks NICE use the following cut-offs to determine whether a woman should receive oral iron therapy: Gestation Cut-off First trimester < 110 g/L Second/third trimester < 105 g/L Postpartum < 100 g/L o Management => oral ferrous sulphate or ferrous fumarate ➢ treatment should be continued for 3 months after iron deficiency is corrected to allow iron stores to be replenished.