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Antepartum Haemorrhage
Published in Sanjeewa Padumadasa, Malik Goonewardene, Obstetric Emergencies, 2021
Although placental abruption is generally a clinical diagnosis, there is considerable overlap between the clinical features of placental abruption and those of placenta praevia, especially in regard to the presence or absence of abdominal pain, a malpresentation or high presenting part of the fetus, as well as the amount of bleeding. The placental location should be checked by going through previous antenatal ultrasound reports. However, it is possible that an anomaly scan may not have been performed, and only a first-trimester dating scan may be available. As transvaginal scanning is not part of routine antenatal care, a low-lying placenta could have been missed. Therefore, an abdominal ultrasound scan for placental location is mandatory in all cases of APH. A transvaginal scan should be performed if a low-lying placenta is detected or suspected on abdominal scanning. A digital vaginal examination should not be done until placenta praevia or low lying placenta is excluded by an urgent abdominal ultrasound scan. A speculum examination is required to assess the bleeding and to exclude cervical and vaginal causes which could have given rise to the mentioned bleeding.
Practice exam 2: Answers
Published in Euan Kevelighan, Jeremy Gasson, Makiya Ashraf, Get Through MRCOG Part 2: Short Answer Questions, 2020
Euan Kevelighan, Jeremy Gasson, Makiya Ashraf
Multidisciplinary team management. Routine screening tests and anomaly scan.Antiretroviral treatment. If prenatal diagnosis, refer fetal medicine unit.Monitoring of plasma viral load and CD4 T-lymphocyte count.Prophylaxis for PCP.Single agent or combination therapy.Monitoring for maternal drug toxicity.Checking for other genital infeaions.
Cardiac conditions
Published in Judy Bothamley, Maureen Boyle, Medical Conditions Affecting Pregnancy and Childbirth, 2020
A 22–24 week uterine artery Doppler (via transvaginal ultrasound) to screen for potential uteroplacental insufficiency20 may be used. Umbilical artery Doppler velocimetry is known to reflect placental function21, and this may be undertaken regularly throughout pregnancy to assess fetal well-being and underpin the timing of delivery20. Fetal echocardiography (transvaginal or transabdominal imaging studies from late in the first trimester to beyond the second trimester) by a fetal cardiologist is the normal diagnostic tool used. This may provide information for the mother (who may consider termination) or enable management plans to be made for the delivery to be at the best time and place and with relevant professionals available for a compromised baby. An early fetal echocardiography (14–16 weeks) is recommended, but many conditions may be missed at this early stage, and it is more commonly done – or repeated – at 18–22 weeks18. A detailed anomaly scan by a fetal medicine specialist should also be carried out, as there is a high frequency of extracardiac abnormalities, as well as karyotype abnormalities associated with congenital heart disease. Ongoing assessment may be necessary as some cardiac anomalies progress during pregnancy18.
Evaluation of pre-test counselling offered for non-invasive prenatal testing (NIPT) as a primary screening tool
Published in Journal of Obstetrics and Gynaecology, 2023
Ho Yin Diana Lee, Lin Wai Chan
About two-third of our participants were not aware of the recommendation to have NT measurement prior to NIPT. Increased NT is known to be associated with chromosomal abnormalities and structural malformations. About one-third of foetal congenital abnormalities would have been missed if only NIPT was performed as screening test (Bardi et al.2020). There is a consensus that NIPT should be offered in combination with ultrasound to detect markedly increased NT and structural foetal anomalies to avoid missed diagnosis or delaying diagnosis to the second trimester (Kozlowski et al.2019, Bedei et al.2021). Although markedly increased NT and foetal abnormalities are considered exclusion criteria for NIPT, some women might have NIPT at the earliest opportunity of 10 weeks, when nuchal translucency could only be performed after 11 weeks. This is the reason why some would suggest postponing NIPT until 13–14 weeks when an early anomaly scan can be performed (Zalel 2015).
Short-rib polydactyly syndrome presenting with recurrent severe first-trimester phenotypes: the utility of exome sequencing in deciphering variants of DYNC2H1 gene
Published in Journal of Obstetrics and Gynaecology, 2020
Yi He, Yu-Juan Li, Li-Li Xu, Dong-Zhi Li
Prenatal diagnosis of SRPS can be accomplished by finding the characteristic triad which includes micromelic dwarfism, a narrow thorax and polydactyly. These typical features are usually detected during second-trimester anomaly scan. First-trimester identification may be challenging. However, SRPS can be associated with increased NT (Eleftheriades et al. 2013). In this family, increased NT repeatedly occurred in two affected foetuses. Indeed, among euploid foetuses with increased NT, about one-third have structural defects (Le Lous et al. 2016). An early scan performed at 12–13 weeks by a competent sonographer can detect about half of the prenatally detectable structural anomalies and 100% of those expected to be detected at this stage (Kenkhuis et al. 2018). Since a detailed first-trimester ultrasound scan requires additional examination time and specialised personnel, usually it is not offered routinely to the general population; instead, it is performed in selective cases, such as those with increased NT or unexpected findings. As evidenced by this family, the increased NT alerted the authors to the opportunity to examine foetal anatomy and diagnose rare skeletal abnormalities early in pregnancy.
Chronic myeloid leukaemia in pregnancy: call for guidelines
Published in Journal of Obstetrics and Gynaecology, 2019
Pallavee P., Rupal Samal, Seetesh Ghose
We share our experience of two cases of pregnancy in CML patients treated with Imatinib and had two different outcomes. Both were in the chronic phase, of which, the first was a 25-year old primigravida diagnosed with CML 3 years prior, on Imatinib 600 mg OD. Though she had planned her pregnancy, she did report for preconceptional counselling and had continued Imatinib at the same dosage until 10 weeks of gestation. Later, she stopped Imatinib on her own due to hyperemesis gravidarum and restarted it at a reduced dose of 200 mg at around 16 weeks of gestation. Her first antenatal check up with us was at 24 weeks, when she was asymptomatic, with normal examination findings and a blood picture which showed Hb of 12.5% per gram, leukocytosis of 31,000 cells/cm and a platelet count of 3.5 lakhs/cm. Her anomaly scan was normal. Later, she presented with eclampsia at 26 weeks of gestation, for which termination of pregnancy was done. The foetus had no gross anomalies on inspection and a histopathology of the placenta revealed chorangiosis. The second case was a 29-year old G4A3 diagnosed with CML 6 years prior, who had two induced abortions while on Imatinib, following which she had a spontaneous abortion, all of these in the first trimester. The fourth was a planned pregnancy, and she discontinued Imatinib prior to her pregnancy and delivered a healthy neonate at 38 weeks of gestation.