Thromboprophylaxis can be started at 28 weeks if there are at least three risk factors. It can also be started as soon as the first trimester if there are 4 or more risk factors. Women with increased risk of VTE receive prophylaxis with low molecular weight heparin (LMWH)…
The total iron requirement in pregnancy is 1200 mg. Iron is needed for expansion of the maternal red cell mass, foetal growth, placental growth, and blood loss at delivery. Daily iron requirement Trimester Requirement 1st ~0.8 mg/day 2nd 4–5 mg/day 3rd…
Cephalopelvic disproportion occurs when the fetal head is too large to pass through the maternal pelvis, due to a mismatch between the fetal head and pelvic dimensions. It can lead to obstructed labour. Cephalopelvic disproportion occurs either at the pelvic inlet or at the mid-cavity. The…
Twin-twin transfusion syndrome (TTTS) is a serious complication that occurs in monochorionic diamniotic (MCDA) twins. It is caused by unequal blood flow due to abnormal vascular connections in the shared placenta. The donor twin experiences hypovolemia, growth restriction and oligohydramnios while the recipient twin experiences hypervolemia, polyhydramnios and the…
Peripartum cardiomyopathy is a dilated cardiomyopathy which occurs in the last month of pregnancy and may last up to 5 months post-partum. It is characterised by left ventricular systolic dysfunction – LVEF < 45% – in the absence of any other possible…
The ZAHARA score or CARPREG score can be used to assess the risk of adverse cardiac events during pregnancy in women with congenital heart disease. Pregnancy is contraindicated with Class IV congenital heart disease. Modified WHO classification of CHD in pregnancy…
Rheumatic heart disease is a common cause of acquired heart disease in pregnancy. Causes of acquired heart disease in pregnancy Cause Comment Mitral stenosis This is the most common structural heart defect Aortic stenosis This commonly occurs due to a bicuspid…
Pregestational diabetes is type 1 diabetes or type 2 diabetes that exists before pregnancy. The most common form is type 2 diabetes. Classification of pregestational (overt) diabetes Class Key Feature B Diabetes begins after age 20 and has been present < 10 years. No…
Gestational diabetes mellitus is glucose intolerance that is first recognised during pregnancy. Screening for gestational diabetes is performed at 24 – 28 weeks. Classification of gestational diabetes Class Description A1 Controlled with diet and lifestyle measures A2 Requires pharmacologic treatment Positive…
A 40-year-old male presents after being struck on the back of his wrist by a heavy metal object at work. He has localised pain on the radial side of his wrist, limited wrist movement and swelling.