Pregnancy with SLE or any other medical issue should deliver between 37 -38 completed weeks ... Untill and unless there is any strong indication for preterm delivery like eclampsia . Post delivery baby should be evaluated thoroughly for congenital heart block and other congenital anamolies
Before 37 werks ... But always remember..Systemic lupus erythematosus (SLE) is an autoimmune disease, primarily affecting young females. Pregnancy in a woman with SLE remains a high risk situation with higher maternal and fetal mortality and morbidity. ... Mothers are faced with disease flares, pre-eclampsia and other complications.
Before 37 week of gestation....It is strongly recommended that you avoid pregnancy until at least six months after the lupus disease activity, especially kidney disease, has been completely brought under control. Pregnancy places an added burden on your kidneys and active kidney disease can even lead to pregnancy loss
In absence of preeclampsia or any other impending indication for delivery ....are we justified in delivering preterm baby?
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A 38 y/o pregnant female at 27 weeks of gestation, presented a moderate decrease of fetal long bones growth during an ultrasound scan. Femur and humerus lengths were 4 weeks less than amenorrhea. The ratio of femur length (FL)/foot length was 0.86 and ratio of femur/abdominal circumference (AC) was 0.17. Thorax development and the rest of the fetal morphological study were strictly normal. What next should be done?Dr. Leena Das1 Like13 Answers
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CAUSES OF NON-IMMUNE HYDROPS FETALIS (NIHF). NIHF is extracellular accumulation of gluid in soft tissues and serous cavities of the fetus without any identifiable circulating antibody against red blood cell antigen. CAUSES :Classified as maternal,placental and fetal causes. MATERNAL : 1.Anemia. 2.Pre eclampsia. 3.Hypoalbuminemia. 4.Diabetes mellitus. PLACENTAL : 1.Chorioangioma. 2.Compression /torsion of umbilical cord. FETAL : 1.HEMATOLOGICAL CAUSES : *Twin-to-twin transfusion. *Chronic fetomaternal transfusion. *Homozygous alpha thalassemia. 2.CARDIOVASCULAR CAUSES: *Congenital cardiac abnormalities. tetralogy of fallot. ASD ,VSD , Subaortal stenosis. dysrrhythmias. hypoplasio cordis. *Vascular tumours. *Arteriovenous malformations. *Vena cava inferior thrombosis. *Endocardial fibroelastosis calcifications in the pericardial sac. *Myocarditis (coxsackie,CMV,parvovirus B-19) 3.INFECTIOUS CAUSES : *Toxoplasmosis. *Parvovirus B-19. *CMV hepatitis,Myocarditis. *Coxsackie virus. *Syphilis. *HSV. *Leptospirosis. 4.RENAL DISORDERS : *Congenital nephrotic syndrome with hypoproteinemia. *Obstructive uropathy. *Polycystic kidney disease. *Hydrometrocolpos. *Hypoplastic kidneys. *Prune-belly syndrome. 5.GASTROINTESTINAL DISORDERS : *Diaphragmatic hernia. *Midgut volvulus. *Gastrointestinal obstructions. *Meconium peritonitis. *Hepatic disorders like cirrhosis and necrosis. 6.CHROMOSOMAL ABNORMALITIES : *Trisomies 13,18,21. *Mosaicisms. *Unbalanced tranlocations &triploidy. *Turner syndrome. 7.METABOLIC DISORDERS :. *Cerebrosidosis.(Gaucher's disease) *Gangliosidosis GM 1 Type I. *Mucopolysaccharidosis. *Mucoliposis. 8.PULMONARY CAUSES : *Congenital adenomatoid malformations. *Pulmonary lymphangiectasia. *Pulmonary leiomyosarcoma. *Diaphragmatic hernia. *Alveolar cell adenoma of lung.Dr. Suvarchala Pratap15 Likes12 Answers
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Preeclampsia and Eclampsia What Is Preeclampsia? Formerly called toxemia, preeclampsia is a condition that pregnant women develop. It is marked by high blood pressure in women who have previously not experienced high blood pressure before. Preeclamptic women will have a high level of protein in their urine and often also have swelling in the feet, legs, and hands. This condition usually appears late in pregnancy, generally after the 20 week mark, although it can occur earlier. If undiagnosed, preeclampsia can lead to eclampsia, a serious condition that can put you and your baby at risk, and in rare cases, cause death. Women with preeclampsia who have seizures are considered to have eclampsia. There's no way to cure preeclampsia, and that can be a scary prospect for moms-to-be. But you can help protect yourself by learning the symptoms of preeclampsia and by seeing your doctor for regular prenatal care. When preeclampsia is caught early, it's easier to manage. What Causes Preeclampsia? The exact causes of preeclampsia and eclampsia -- a result of a placenta that doesn't function properly -- are not known, although some researchers suspect poor nutrition or high body fat are possible causes. Insufficient blood flow to the uterus could be associated. Genetics plays a role, as well. Who Is at Risk for Preeclampsia? Preeclampsia is most often seen in first-time pregnancies, in pregnant teens, and in women over 40. While it is defined as occurring in women have never had high blood pressure before, other risk factors include: A history of high blood pressure prior to pregnancyA history of preeclampsiaHaving a mother or sister who had preeclampsiaA history of obesityCarrying more than one babyHistory of diabetes, kidney disease, lupus, or rheumatoid arthritis What Are the Signs and Symptoms of Preeclampsia? In addition to swelling, protein in the urine, and high blood pressure, preeclampsia symptomscan include: Rapid weight gain caused by a significant increase in bodily fluidAbdominal painSevere headachesChange in reflexesReduced urine or no urine outputDizzinessExcessive vomiting and nauseaVision changes You should seek care right away if you have: Sudden and new swelling in your face, hands, and eyes (some feet and ankleswelling is normal during pregnancy.)Blood pressure greater than 140/90.Sudden weight gain over 1 or 2 daysAbdominal pain, especially in the upper right sideSevere headachesA decrease in urineBlurry vision, flashing lights, and floaters You can also have preeclampsia and not have any symptoms. That's why it's so important to see your doctor for regular blood pressure checks and urine tests. How Can Preeclampsia Affect My Baby and Me? Preeclampsia can prevent the placenta from receiving enough blood, which can cause your baby to be born very small. It is also one of the leading causes of premature births, and the complications that can follow, including learning disabilities, epilepsy, cerebral palsy, hearing and vision problems. In moms-to-be, preeclampsia can cause rare but serious complications that include: *Stroke *Seizure *Water in the lungs *Heart failure *Reversible blindness *Bleeding from the liver *Bleeding after you've given birth Preeclampsia can also cause the placenta to suddenly separate from the uterus, which is called placental abruption. This can cause stillbirth. The only cure for preeclampsia and eclampsia is to deliver your baby. Your doctor will talk with you about when to deliver based on how far along your baby is, how well your baby is doing in your womb, and the severity of your preeclampsia. If your baby has developed enough, usually by 37 weeks or later, your doctor may want to induce labor or perform a cesarean section. This is will keep preeclampsia from getting worse. If your baby is not close to term, you and your doctor may be able to treat preeclampsia until your baby has developed enough to be safely delivered. The closer the birth is to your due date, the better for your baby. If you have mild preeclampsia - also known as preclampsia with and without severe features, your doctor may prescribe: Bed rest either at home or in the hospital; you'll be asked to rest mostly on your left side.Careful observation with a fetal heart ratemonitor and frequent ultrasoundsMedicines to lower your blood pressureBlood and urine tests Your doctor also may recommend that you stay in the hospital for closer monitoring. In the hospital you may be given: Medicine to help prevent seizures, lower your blood pressure, and prevent other problemsSteroid injections to help your baby's lungs develop more quickly Other treatments include: Magnesium can be injected into the veins to prevent eclampsia-related seizuresHydralazine or another antihypertensive drug to manage severe blood pressure elevations Monitoring fluid intake and urine outputDr. Vasundhara Nanavaty9 Likes7 Answers
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Proteinuria Proteinuria is a condition characterized by the presence of greater than normal amounts of protein in the urine. It is usually associated with some kind of disease or abnormality but may occasionally be seen in healthy individuals. Plasma, the liquid portion of blood, contains many different proteins. One of the many functions of the kidneys is to conserve plasma protein so that it is not eliminated along with waste products. Types of proteinuria Proteinuria can be divided into three categories: transient (intermittent), orthostatic (related to sitting/standing or lying down), and persistent (always present). Transient proteinuria – Transient (intermittent) proteinuria is by far the most common form of proteinuria. Transient proteinuria usually resolves without treatment. Stresses such as fever and heavy exercise may cause transient proteinuria. Orthostatic proteinuria – Orthostatic proteinuria occurs when one loses protein in the urine while in an upright position but not when lying down. It occurs in 2 to 5 percent of adolescents but is unusual in people over the age of 30 years. The cause of orthostatic proteinuria is not known. Orthostatic proteinuria is not harmful, does not require treatment, and typically disappears with age. Persistent proteinuria – In contrast to transient and orthostatic proteinuria, persistent proteinuria occurs in people with underlying kidney disease or other medical problems. Examples include: Kidney diseases Diseases that affect the kidney, such as diabetes mellitus or high blood pressure Diseases that cause the body to overproduce certain types of protein Pathophysiology Proteinuria is the consequence of two mechanisms: the abnormal transglomerular passage of proteins due to increased permeability of the glomerular capillary wall and their subsequent impaired reabsorption by the epithelial cells of the proximal tubule. In the various glomerular diseases, the severity of disruption of the structural integrity of the glomerular capillary wall correlates with the area of the glomerular barrier being permeated by “large” pores, permitting the passage in the tubular lumen of high-molecular-weight (HMW) proteins, to which the barrier is normally impermeable. The increased load of such proteins in the tubular lumen leads to the saturation of the reabsorptive mechanism by the tubular cells, and, in the most severe or chronic conditions, to their toxic damage, that favors the increased urinary excretion of all proteins, including low-molecular-weight (LMW) proteins, which are completely reabsorbed in physiologic conditions. Causes Diseases of the glomeruli (the kidney’s filtering units), for example, glomerulonephritis or diabetes Urine infection can cause proteinuria, but usually, there are other signs of this – see cystitis/urinary tract infections Proteinuria can also be a symptom of some other conditions and diseases: for example congestive heart failure, the first warning of eclampsia in pregnancy Temporary proteinuria may occur after vigorous exercise or if you have a high fever Risk factors The two most common risk factors for proteinuria are: Diabetes High blood pressure (hypertension) Other types of kidney disease unrelated to diabetes or high blood pressure can also cause protein to leak into the urine. Examples of other causes include: Medications Trauma Toxins Infections Immune system disorders Other risk factors include: Obesity Age over 65 The family history of kidney disease Preeclampsia (high blood pressure and proteinuria in pregnancy) Race and ethnicity: African-Americans, Native Americans, Hispanics, and Pacific Islanders are more likely than whites to have high blood pressure and develop kidney disease and proteinuria. Symptoms Usually, there are no symptoms. When your kidney damage gets worse and large amounts of protein escape through your urine, you may notice the following symptoms: Foamy, frothy or bubbly-looking urine when you use the toilet Swelling in your hands, feet, abdomen or face Other symptoms of Proteinuria can include: Weight gain caused by fluid retention Diminished appetite Hypertension Complications Proteinuria complications depend on the underlying cause of the condition. Generally, protein in urine is associated with kidney disease, so kidney function may begin to decline over time. You may also experience high blood pressure and high cholesterol, which can further be damaged the kidneys if not managed properly. Proteinuria may progress to renal impairment or chronic kidney disease. Patients with proteinuria are also at risk of cardiovascular disease. Diagnosis and Test Physical examination is of limited use, but vital signs should be reviewed for increased BP, suggesting glomerulonephritis. The examination should seek signs of peripheral edema and ascites, reflective of fluid overload or low serum albumin. Lab tests Screening for protein in the urine may be performed as part of a general health exam or as part of a check-up for an individual who is known to have a condition that may cause proteinuria. Some screening tests include: Urine protein – detects the presence of any type of protein that may be in the urine. It can be performed alone on a random urine sample or as part of a urinalysis. Urinalysis – an evaluation of a urine sample for several different substances that may be in the urine, including protein. This test may be used as part of a general health exam. Urine albumin (microalbumin) – a sensitive test that is used to monitor people with diabetes for small amounts of albumin, the main blood protein, in the urine. In addition to testing urine, there are several other tests that may be used to evaluate kidney function and/or assess the nature of the protein present in the urine. BUN (Blood Urea Nitrogen) and Creatinine – blood tests used to evaluate kidney function; urea and creatinine are nitrogen-containing waste products that healthy kidneys move from the blood to the urine. eGFR (estimated Glomerular Filtration Rate) – uses a blood creatinine level along with age and values assigned for sex and race to calculate the estimated rate of urine filtration; the eGFR rate decreases with progressive kidney damage. Creatinine clearance – measures creatinine in a 24-hour urine sample and a blood sample to calculate the amount of creatinine that has been cleared from the blood and passed into the urine; this calculation allows for a general evaluation of kidney function based on the rate of creatinine excretion from the body. Total Protein (TP) – a blood test that measures all of the protein in the serum Albumin – a blood test that measures the concentration of albumin (the most prevalent protein in blood serum) Serum protein electrophoresis – determines the types and relative amounts of protein in blood serum and is compared to the urine electrophoresis pattern to determine if blood is the source of the protein seen in the urine Serum Free Light Chains (SFLC) – a blood test used to help diagnose and monitor conditions associated with an increased production of free light chains such as multiple myeloma The recommended baseline measures of albumin/creatinine or protein/creatinine ratio (ACR or PCR) are given in the following table. ACR (mg/mmol) PCR (mg/mmol) Implications ACR >3 >15 Abnormal and adequate to define CKD G1 or G2. 30 50 Favour ACE inhibitor/ ARB if hypertensive Suffix A3 if ACR > 30 mg/mmol on CKD stage 70 100 Stricter BP limits apply Referral threshold in non-diabetics >250 >300 Sometimes referred to as “nephrotic range” proteinuria In the presence of edema and hypoalbuminemia, sufficient to define the “nephrotic syndrome” Treatment and Medications Medical management of proteinuria has the following two components: Nonspecific treatment: Treatment that is applicable irrespective of the underlying cause, assuming the patient has no contraindications to the therapy Specific treatment: Treatment that depends on the underlying renal or non-renal cause and, in particular, whether or not the injury is immune-mediated Medications Angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs) reduce intra-glomerular pressure by inhibiting angiotensin II-mediated efferent arteriolar vasoconstriction. These drugs also have a proteinuria-reducing effect that is independent of their antihypertensive effect. Natural remedies Ѕhоrtаgеs of these nutrіеnts mау саusе mаnу соmрlісаtіоns, whісh саn аfflісt раtіеnts а lоt. Тhе fооds below саn help them to іmрrоvе this соndіtіоn. Раtіеnts should еаt more fооds rісh in mаgnеsіum, like millet, whеаt, and bаrlеу. You саn find zinc in millet, whеаt, соrn and саrrоt. Ѕtrаwbеrrу, саrrоts, оrаngе are rісh in vіtаmіn С. Prevention and Cure Get regular blood and urine tests if you feel that you are at risk for proteinuria. Balance your diet follow your doctors recommend. Eat lots of fiber, up to 55g each day in the form of whole grains, fresh vegetables, and even supplements if necessary. Keep your condition controlled if you happen to have hypertension, diabetes or both. While these conditions put you at risk for proteinuria, you can prevent a problem by using your medication, a healthy diet and exercise to keep your symptoms under control. If you are struggling with your symptoms, speak to your doctor as soon as possible for ways to further manage your condition.Dr. Shailendra Kawtikwar3 Likes3 Answers
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Preeclampsia is defined as the presence of a systolic blood pressure (SBP) greater than or equal to 140 mm Hg or a diastolic blood pressure (DBP) greater than or equal to 90 mm Hg or higher, on two occasions at least 4 hours apart in a previously normotensive patient. If the preeclampsia remains untreated, it can develop into eclampsia, in which the mother can experience convulsions, coma, and can even die. However, complications from preeclampsia are extremely rare if the mother attends her prenatal appointments. Pathophysiology The pathophysiology of preeclampsia likely involves both maternal and fetal/placental factors. Abnormalities in the development of placental vasculature early in pregnancy may result in relative placental underperfusion/hypoxia/ischemia, which then leads to release of antiangiogenic factors into the maternal circulation that alter maternal systemic endothelial function and cause hypertension and other manifestations of the disease (hematologic, neurologic, cardiac, pulmonary, renal, and hepatic dysfunction). However, the trigger for abnormal placental development and the subsequent cascade of events remains unknown. Causes pertaining to Preeclampsia Potential causes are being explored. These include: Genetic factors History of diabetes, kidney disease, lupus, or rheumatoid arthritis Blood vessel problems Insufficient blood flow to the uterus Genetics plays a role, as well Autoimmune disorders Risk factors for Preeclampsia There are also risk factors that can increase your chances of developing preeclampsia. These include: Being pregnant with multiple fetuses Being over the age of 35 Being in your early teens Being pregnant for the first time Being obese Nulliparity Multifetal pregnancy Thrombotic disorders (eg, antiphospholipid antibody syndrome) Having a history of high blood pressure Having a history of diabetes Having a history of a kidney disorder History of lupus, or rheumatoid arthritis Clinical manifestations of Preeclampsia Signs and symptoms of preeclampsia include: Changes in vision, like blurriness, flashing lights, seeing spots or being sensitive to light A headache that doesn’t go away Nausea (feeling sick to your stomach), vomiting or dizziness Pain in the upper right belly area or in the shoulder Sudden weight gain (2 to 5 pounds in a week) Swelling in the legs, hands or face Trouble breathing Decreased urine output Decreased levels of platelets in your blood (thrombocytopenia) Excess protein in your urine (proteinuria) Impaired liver function Many of these signs and symptoms are common discomforts of pregnancy. Complications associated with Preeclampsia Fetal growth restriction or fetal death may result. Diffuse or multifocal vasospasm can result in maternal ischemia, eventually damaging multiple organs, particularly the brain, kidneys, and liver. Factors that may contribute to vasospasm include decreased prostacyclin (an endothelium-derived vasodilator), increased endothelin (an endothelium-derived vasoconstrictor), and increased soluble Flt-1 (a circulating receptor for vascular endothelial growth factor). Women who have preeclampsia are at risk of abruptio placentae in the current and in future pregnancies, possibly because both disorders are related to uteroplacental insufficiency. The coagulation system is activated, possibly secondary to endothelial cell dysfunction, leading to platelet activation. The HELLP syndrome (hemolysis, elevated liver function tests, and low platelet count) develops in 10 to 20% of women with severe preeclampsia Diagnosis and Test All women who present with new-onset hypertension should have the following tests: CBC Serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) levels Serum creatinine Uric acid 24-hour urine collection for protein and creatinine (criterion standard) or urine dipstick analysis Additional studies to perform if HELLP syndrome is suspected are as follows: Peripheral blood smear Serum lactate dehydrogenase (LDH) level Indirect bilirubin Imaging Techniques Ultrasonography: Transabdominal, to assess the status of the fetus and evaluate for growth restriction; umbilical artery Doppler ultrasonography, to assess blood flow Cardiotocography: The standard fetal nonstress test and the mainstay of fetal monitoring Head CT scanning is used to detect intracranial hemorrhage in selected patients with any of the following: Sudden severe headaches Focal neurologic deficits Seizures with a prolonged postictal state Atypical presentation for eclampsia Treatment and Medications Preeclampsia has no cure except for delivery of the baby. However, delivery may not always be the best option at the time preeclampsia is diagnosed. The treatment that the patient receives depends on the severity (mild versus severe) of the associated symptoms and the stage of the pregnancy. Close monitoring of the woman and her fetus will be needed. Tests for the mother might include blood and urine tests to see if the preeclampsia is progressing, such as tests to assess platelet counts, liver enzymes, kidney function, and urinary protein levels. Tests for the fetus might include ultrasound, heart rate monitoring, assessment of fetal growth, and amniotic fluid assessment. Anticonvulsive medication, such as magnesium sulfate, might be used to prevent a seizure. Some of the medications used for stroke include labetalol, nifedipine or methyldopa. Natural or Home Remedies Lemon If you are used to its juice, you have already found a wonderful way to hydrate your body, in addition to water. Get fresh lemon juice and combine it with warm water. Drink the mixture 2-3 times on a daily basis. Ginger One surprising fact about ginger root is that it prevents inflammation and swelling very effectively. Ginger has stimulating effects on blood circulation, which means that your baby will get more blood and oxygen as well. Prepare several fresh ginger slices. Mix them into warm water and boil them in several minutes. Continue to steep them in the next 15 minutes. Get it strained. The warm tea can be consumed 2-3 times daily. Garlic Garlic is one of some natural foods with the greatest effects on high blood pressure. Our body has the higher level of hydrogen sulfide and nitric oxide. These substances possess relaxing effects on our blood vessels, which means that preeclampsia pain is under control. Get several fresh garlic cloves grinded. Then, combine garlic powder (about 3 teaspoons) with a cup of water. Boil them for a few minutes before steeping in the next 20 minutes. Strain the mixture Beet Being an excellent source of calcium, beet plays an important role in maintaining the balance of potassium and sodium in our blood. You should consume fresh beet juice by blending it every day to benefit the most from this natural ingredient. Vitamin C Vitamin C plays an essential role in human health, not to mention pregnant women. It is the key to a strong immunity, which ensures a lower risk of different infections. You can go for tomatoes, cabbage, potatoes, strawberries, bananas or citrus fruits. Potassium Among various nutrients, potassium is one of many irreplaceable. The appearance of potassium-rich foods in meals is a great suggestion for those who want to prevent preeclampsia. Some outstanding examples of these foods are bananas, avocados, chicken or beans. Vitamin E Another type of vitamin that is required in the treatment and prevention for preeclampsia is vitamin E. It is effective to improve blood circulation and reduce the risk of swelling. According to the National Institute of Health, pregnant women should take in about 15 mg on a daily basis. Vitamins E can be found in a variety of foods, for example, almonds, corn or fish. Acupuncture Acupuncture has great influence on the blood circulation inside our body, which reduces the risks of high blood pressure significantly. Of course, it should be applied only with the help of professionals. And you had better not abuse this method to cope with preeclampsia pain. Every time you intend to do this, please talk to your doctor for the best advice. Prevention and Cure Maintain a Healthy Weight Get Regular Exercise: The benefits of exercise during pregnancy include reduced inflammation, help to reach and to maintain a healthy weight, and even defense against the effects of stress Eat a Healing Diet to Reduce Blood Pressure Levels Prevent Dehydration and Fatigue Sleep is good for oh-so-many reasons, but it’s especially important for mama to get some rest. Get some sunshine! Low vitamin D is associated with preeclamptic women in a study in Ireland. (You can also eat vitamin D-rich foods such as sardines, egg yolks, grass-fed butter, or cod liver oil.Dr. Nitin Kanholkar3 Likes2 Answers