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By Kelly, Claire; Clifford, Amie; Yau, Christopher; Hallam, Sally

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Fetal compromise. 3 Hypertensive conditions Moderate pre-eclampsia Yes >34 weeks gestation? 33 Severe pre-eclampsia No Treat hypertension Delivery at 34–36 weeks Prophylactic steroids Maternal and fetal surveillance Yes Fetal distress or maternal complications? Immediate delivery No Delivery at 34–36 weeks Fig. 4 Timing of delivery in pre-eclampsia. = = Obstetrics Delivery: – The timing of delivery is determined by both maternal and fetal well-being. – If there is mild hypertension but no fetal compromise 0 term delivery.

Symphysis pubis dysfunction: = this is pain in the pubic and sacroiliac joints; = treatment: – analgesia; – physiotherapy. Itching: = commonly benign, but can be due to obstetric cholestasis (see Chapter 3, Medical problems in pregnancy). Ankle oedema: = commonly benign: advise raising the legs; = if sudden onset, exclude pre-eclampsia. Abdominal pain: = commonly benign, but do not forget surgical causes for the acute abdomen. 6 Common symptoms in pregnancy 21 = Vaginal candidiasis: = more common in pregnancy; oral treatment is contraindicated; use imidazole pessaries.

MICRO-facts Poor seizure control is potentially more harmful to the fetus than the sideeffects of AEDs. = Obstetrics Neonatal care: – Vitamin K injections: k the maternal use of AEDs in pregnancy results in a fetal deficiency of vitamin K-dependent clotting factors. 5 LIVER CONDITIONS OBSTETRIC CHOLESTASIS = Definition: = = = = = A condition acquired during pregnancy in which bile flow out of the liver is reduced, resulting in a build-up of bile acids in the circulation. = It is characterized by the following features: – pruritus without a skin rash (especially affecting the palms and soles of the feet); – abnormal LFTs; – no alternative causes for the features above; – features resolve post-delivery.

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