Blood disorders specific to pregnancy

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1 Oxford Medicine Online You are looking at 1-10 of 12 items for: haematology CAR0044 MED00630 Blood disorders specific to pregnancy David J. Perry and Katharine Lowndes Print Publication Year: 2010 Published Online: May 2010 ISBN: eisbn: DOI: /med/ Plasma volume increases by more during pregnancy than does red cell mass, leading to haemodilution and a fall in the haematocrit from about 40% to 33%, with the nadir usually reached at 24 to 32 weeks gestation. Anaemia during pregnancy is defined as a haemoglobin concentration of <10.5 g/dl during the second and third trimesters. Anaemias and haemoglobinopathies The commonest haematological problem encountered in pregnancy is iron deficiency anaemia. Routine iron supplementation in all pregnant women is probably not justified in developed countries, but if iron deficiency is detected it is advisable to treat as early as possible. Folic acid the requirement for folic acid doubles in pregnancy and dietary folate deficiency is the most frequent cause of gestational megaloblastic anaemia. This can be prevented by supplementation with 300 µ#g folic acid daily, although higher doses of folate (up to 5 mg daily) are recommended to prevent neural tube defects. Haemoglobinopathies the diagnosis of variant haemoglobins and the thalassaemia syndromes before pregnancy or early in gestation is important. Screening is usually performed on a blood sample taken at booking. If a haemoglobin variant or thalassaemic indices are detected, then the partner should be tested to determine the risk of having an affected fetus and allowing informed prenatal counselling. Haemostatic disorders Normal pregnancy is associated with marked changes in all aspects of haemostasis, the overall effect of which is to generate a state of hypercoagulability. These changes in haemostasis, whilst reducing the risks of excessive blood loss at delivery, significantly increase the risk of venous thromboembolic disease in pregnancy (see Chapter 14.7). Gestational thrombocytopenia seen in about 8% of all pregnancies and accounts for more than 70% of cases of thrombocytopenia in pregnancy: its main differential diagnosis is immune thrombocytopenic purpura. Disseminated intravascular coagulation can be caused by intrauterine death with a retained fetus, severe pre-eclampsia, premature separation of the placenta (placental abruption), retained placenta, amniotic fluid embolism, haemorrhagic shock and transfusion reaction. Inherited haemostatic disorders, e.g. haemophilia, von Willebrands disease women with these conditions require specialist management during pregnancy. Page 1 of 5

2 Maternal haematological and vascular conditions DOI: /med/ This chapter describes the practical multidisciplinary management of a wide range of haematological and vascular conditions in pregnancy. It provides individual fact files, care pathways, and patient information for each condition, based on up-to-date guidelines and best practice evidence, in a format suitable for use in busy clinical settings. Effective management of relatively common conditions including refractory anaemia, thrombophilias, autoimmune conditions, platelet abnormalities, thromboembolism, haemoglobinopathies and red cell antibodies, as well as rarer conditions such as hereditary spherocytosis, haemorrhagic telangiectasia, and thrombotic thrombocytopenic purpura are described. Fact files summarize epidemiology, genetics, pathophysiology and the impact of pregnancy on the condition and vice versa. Care pathways incorporate specific investigations and assessments in each condition from pre-pregnancy through various stages of pregnancy, appropriate referrals to regional/tertiary centres, recommendations regarding essential documentation, communication of key information for intrapartum/ postnatal care and avoidance of unnecessary interventions. Specific patient information is provided for each condition. Maternal medicine and infections Sabaratnam Arulkumaran, David I. M. Farquharson, Ash Monga, Aris T. Papageorghiou, and Lesley Regan (eds) Print Publication Year: 2011 Published Online: Oct 2011 ISBN: eisbn: DOI: /med/ Adrenal disorders in pregnancy - Anaemia in pregnancy - Autoimmune disease - Bacterial vaginosis - Chicken pox/herpes zoster - Chlamydia - Coagulation disorders - Connective tissue disorder - Cytomegalovirus - Dermatology - Diabetes in pregnancy - Drugs in pregnancy - Epilepsy and other neurological conditions - Gonorrhoea - Perinatal group B streptococcus - Haemoglobinopathies - Heart disease - Hepatitis B - Herpes simplex infection - HIV infection - Human papillomavirus - Hypertension - Immunization - Inflammatory bowel disease - Jaundice - Listeriosis - Liver disease - Measles: rubeola - Parvovirus - Pituitary disorders in pregnancy - Psychiatric disorders in pregnancy - Renal disease - Respiratory disease - Rubella - Substance abuse in pregnancy - Syphilis - Thromboembolic disease - Thyroid and parathyroid disease - Toxoplasmosis in pregnancy - Vulvovaginal candidiasis Page 2 of 5

3 General issues in obstetrics and gynaecology Stergios K. Doumouchtsis, and S. Arulkumaran Print Publication Year: 2016 Published Online: Oct 2016 ISBN: eisbn: DOI: /med/ This chapter outlines general issues in obstetrics and gynaecology. It describes haematological aspects of emergencies in obstetrics and gynaecology (thrombocytopenia, venous thromboembolism, pregnancy-induced exacerbations of pre-existing haematological conditions, and haemorrhage), the identification of very sick patients and options for monitoring, communication and handover between healthcare professionals, and preoperative assessment (risks, benefits, what to expect, and consent). Care of the fetus Sabaratnam Arulkumaran, David I. M. Farquharson, Ash Monga, Aris T. Papageorghiou, and Lesley Regan (eds) Print Publication Year: 2011 Published Online: Oct 2011 ISBN: eisbn: DOI: /med/ Biophysical profile - Cardiotocography - Doppler ultrasound - Fetal abnormalities: cardiovascular - Fetal abnormalities: central nervous system - Fetal abnormalities: chromosomal anomalies - Fetal abnormalities: genetic disorders - Fetal abnormalities: face - Fetal abnormalities: gastrointestinal system - Fetal abnormalities: limbs - Fetal abnormalities: head and neck - Fetal abnormalities: skeletal abnormalities/dysplasias - Fetal abnormalities: thorax - Fetal abnormalities: urinary system - Fetal movement charts - Fetal nuchal translucency - Fetal abnormalities: hydrops - Invasive procedures - IUGR (intrauterine growth restriction) - Multiple pregnancy - Oligohydramnios - Placental abnormalities - Polyhydramnios - Red blood cell isoimmunization - Screening for fetal aneuploidy - Symphyseal fundal height Placental conditions DOI: /med/ This chapter deals with placental conditions including abruption, placenta praevia, morbid adherence (accreta, percreta) and vasa praevia. The aetiology, epidemiology, risk factors, antenatal diagnosis, multidisciplinary management and planning for delivery, recurrence risk in future pregnancy/ies are addressed for each condition. With rising Caesarean section rates, placental pathologies associated with potential maternal mortality/morbidity are increasingly encountered. Abruptio placenta carries a risk of maternal and fetal morbidity/ mortality as well as a risk of recurrence. Vasa praevia is increasingly recognized during Page 3 of 5

4 pregnancy due to better imaging technologies. The important role of postnatal counselling after Caesarean section including contraceptive advice to avoid short interpregnancy intervals is addressed. In suspected morbid adherence of the placenta, imaging with colour flow Doppler and MRI, and the multidisciplinary planning for operative delivery in a suitably equipped unit, are highlighted. Fact files and care pathways for each condition are based on national guidelines and good-practice evidence. Patient information is provided. Post-delivery procedures and complications Stergios K. Doumouchtsis, and S. Arulkumaran Print Publication Year: 2016 Published Online: Oct 2016 ISBN: eisbn: DOI: /med/ This chapter explores post-delivery procedures and complications, including retained placenta, postpartum haemorrhage (PPH), vaginal and perineal lacerations, uterine inversion, vulval or perineal haematoma, and resuscitation of the newborn. Obstetric Emergencies Jerry Nolan and Jasmeet Soar (eds) Print Publication Year: 2012 Published Online: Jul 2012 ISBN: eisbn: DOI: /med/ Emergency Caesarean section - Emergency Caesarean section in mothers with valvular heart disease - Massive obstetric haemorrhage - Placenta praevia and placenta accreta - Retained placenta - Ectopic pregnancy - Pregnancy-induced hypertension, pre-eclampsia, and eclampsia Maternal autoimmune disorders DOI: /med/ This chapter includes autoimmune conditions which have special relevance for pregnancy, especially lupus, antiphospholipid syndrome, anti-ro antibodies, rheumatoid arthritis, Sjögren s syndrome, dermatomyositis, and polymyositis. Epidemiology, complex and varied manifestations, diagnostic criteria, maternal and fetal outcomes, the impact of pregnancy on these conditions and vice versa are described. Individual fact files and care pathways for effective multidisciplinary management are provided for each condition, based on national and international guidelines, up-to-date literature, and best practice evidence. Pre-pregnancy assessment and preparation for pregnancy, essential investigations and ongoing materno-fetal monitoring and assessment are described. Medications including antihypertensives, disease-modifying agents, aspirin, LMWH, or steroids used for symptom Page 4 of 5

5 control or for prophylaxis are discussed, as are drugs contraindicated in pregnancy and lactation. Documentation and the communication of key information for intrapartum and neonatal care are detailed, especially where there is an increased risk of neonatal lupus or heart block. Patient information is provided for each condition. Other fetal conditions DOI: /med/ This chapter addresses six wide-ranging conditions including non-immune fetal hydrops, irregular fetal heat rhythm, fetal and neonatal alloimmune thrombocytopenia, reduced fetal movements, prolonged pregnancy, and abnormal biochemistry markers in otherwise low-risk trisomy serum screening tests. Fact files discuss aetiology, epidemiology, investigations, and management options including appropriate referral to tertiary centres. Care pathways incorporate management options, systematic evaluation, investigations and prognosis for each condition. Sustained fetal ectopic heartbeats can lead to heart failure and hydrops fetalis. Fetal tachyarrhythmias/bradyarrhythmias are described. Significant fetal/ neonatal mortality and morbidity associated with neonatal alloimmune thrombocytopenia (NAITP) are highlighted. First- and second-trimester markers for possible complications and the need to balance surveillance against creating parental anxiety are summarized. The relationship between maternal perception of decreased fetal movements and adverse outcome is discussed. Increased perinatal mortality observed with prolonged pregnancies and evidence to support interventions after 41 weeks versus expectant management are explored. Patient information is provided. Page 5 of 5