1. Intercurrent Disease during Pregnancy
Page 166

2. Contents Heart disease in pregnancy Liver disease in pregnancy
Chronic renal disease during pregnancy
anemia during pregnancy
iron-deficiency anemia
megaloblastic anemia
pulmonary tuberculosis and pregnancy

3. Carbohydrate metabolism in pregnancy renal disease in pregnancy
sexually transmitted diseases in pregnancy
gonorrhoea
syphilis
disorders of the thyroid gland
hyperthyroidism
appendicitis
appendicectomy
continue

4. Orders of the causes leading to the maternal death
Obstetric hemorrhage
cardiac disease
PIH
amniotic fluid embolism
puerperium infection
liver disease in pregnancy

5. Heart disease in pregnancy
Although most patients with heart disease go through pregancy and labour successfully if their management is conducted efficiently, that there is an added risk is shown by the fact that heart disease is the commonest ‘associated disease’ to cause meternal death.

6. Classification Atiology of heart disease in pregnancy
Congenital heart disease
Rheumatic heart disease: mitral stenosis
Cardic disorders due to PIH
Cardiomyopathy of pregnancy
Myocaiditis
cardiac arrhythmias
others:bacterial endocarditis, and coronary thrombosis,et al

7. Functional capacity of the myocardium
Grade 1: no dyspnea or limitation of activity
Grade 2: dyspnea, with some limitation of activity
Grade 3: severe dyspnea with limitation of even ordinary activity
Grade 4: dyspnea even at rest, or history of cardiac failure

8. Signs of early cardiac failure
Chest distress,palpitation,short breath only after slight movement
At rest, HR>110bpm,R>20
Persistant mild moist rales at the basis pulmonisis,can’t disappear after cough

9. Treatment A:During pregnancy Adequate rest
avoidance of respiratory infection
treatment of any dental sepsis
prevention and treatment of anemia
admission to hospital:2or 3 weeks rest in hospital prior to labor is desirable for the more severe cases
heart failure: digitalis ,diuretics

10. B:At labor
Grade 1,2
Vaginal delivery
Grade 3,4 CS

11. C:puerperium Dangerous: within 3 days after labor
Prevention: heart failure
infection
Functional capacity>=grade 3
no breast feeding

12. Liver disease in pregnancypage171
Infective hepatitis
viral heptitis
hepatitis A
hepatitis B
hepatitis C
hepatitis D
hepatitis E

13. Effects of hepatitis B on mothers
Obvious early gestational reaction
PIH
Postpartium haemmorrhage
DIC

14. Differential Diagnosis
Hyperemesis gravidarum
PIH
intrahepatic cholestasis of pregnancy
acute fatty liver of pregnancy
acute hepatic failure during pregnancy
cause is unknown and no effective treatment
toxic hepatitis caused by chemical agents

15. Carbonhydrate metabolism in pregnancy
Gestational diabetes mellitus
gestation complicated with diabetes mellitus
glucosuria
macrosomia

16. Sexually transmitted diseases
Syphilis:early stage of syphilis---placenta---fetus
Gonorrhea
Condyloma acuminata:rare intrauterus infection,mainly transvaginal infection
Cytomegalovirus(CMV)
Genital herpes
Chlamydia trachomatis(CT)