61 Urinary Tract Infections

All pregnant women should be offered routine screening for asymptomatic bacteriuria by an MSU culture in early pregnancy, followed by prompt treatment. UTI in pregnancy has been shown to be associated with pre-term birth and low birth weight, although this is controversial1,3,4. Generally, if adequately treated, there are no significant effects on the fetus. If the mother has reflux nephropathy as a predisposing cause for UTI there is an increased risk that the baby may also suffer from this...

Infectious Conditions

De Valk H, Goulet V, Vaillant V, Perra A, Simon F, Desenclos JC and Martin P 2005 Surveillance of Listeria infections in Europe. Eurosurveillance, 10(10) 251-255 accessed 12-03-2006 accessed 12-03-2006 4. Braden C R 2003 Listeriosis. Paediatric Infectious Disease Journal, 22(8) 745 - 746 accessed 12-03-2006 6. Hawker J, Begg N, Blair I, Reintjes R and Weinberg J 2005 Communicable Disease Control Handbook. Oxford Blackwell Science 148-150 7. Benenson AS (Ed) 1995 Control of Communicable Diseases...

Preconception Issues And Care

Although a safe and effective vaccine does exist for chicken-pox it is not widely used in the UK. The vaccine is contrain-dicated in pregnancy and pregnancy should be avoided for three months after vaccination. The vaccine is not currently available to seronegative women in the UK planning a pregnancy. The UK Department of Health, however, recommends Varicella zoster vaccine to be given to seronegative health care workers who have direct contact with patients11. Women who have not had...

Nonpregnancy Treatment And Care

As chickenpox in childhood is a mild, self-limiting illness all that is generally required is control of the pyrexia and pruritus, e.g. with paracetamol and antihistamines if necessary. Care needs to be taken to avoid secondary infection of the lesions, advice on hygiene should be given and antibiotics if secondary infection does occur. As adults tend to have a more severe illness, oral aciclovir may be given within 24 hours of developing the rash11. If complications develop then hospital...

Explanation Of Condition

Chickenpox, also known as varicella, is a common childhood illness caused by infection with Varicella zoster virus. This is a DNA virus from the herpes family. The mode of transmission is mainly via respiratory droplets or by direct contact and is therefore highly contagious. Reactivation of the virus, which has remained latent in the dorsal root or cranial nerve ganglion, causes shingles. This often occurs many years after the initial infection. Chickenpox may be acquired by contact with...

126 Chickenpox 159

Varicella zoster immunoglobulin (VZIg) should be used to prevent chickenpox in susceptible women who have had significant exposure. It should be given within ten days of exposure for maximal effect12. It has no place in treatment once chickenpox has developed. Oral aciclovir decreases the duration and severity of symptoms in women who develop chickenpox in pregnancy. To be effective it needs to be given within 24 hours of the rash developing. It may also decrease the risk of serious...

Pulmonary Arterial Hypertension

Pulmonary arterial hypertension is due mainly to changes in the pulmonary arterioles. It may be idiopathic (IPAH) or familial (FPAH), often with autosomal dominant inheritance, and there may be worsening of the disease in subsequent generations5. PAH is often associated (APAH) with one or more triggering factors (+ - a genetic pre-disposition), resulting in endothelial injury, vasoconstriction and vascular remodelling. The main triggers are Connective tissue diseases such as scleroderma, CREST,...

Gestational Thrombocytopenia

Gestational thrombocytopenia is also known as incidental thrombocytopenia of pregnancy4. It is exclusive to pregnancy and presents in the late second or third trimesters. The decreased platelet count is associated with haemodilution, and with increased platelet 'trapping,' and with destruction in the placenta1. Usually asymptomatic, diagnosis often arises from a routine antenatal FBC5 or can be retrospective, after delivery4. The platelet levels gradually fall reaching 50-150 x 109 l by term....

Pain Therapy Ladder for Pregnancy

Risk Factor B (or D with prolonged use, or high doses at term)2 Use Intravenous patient controlled analgesia or a combination of slow- and rapid- release oral preparations for acute short-term interventions1 Dose 50-100 mg initially, increasing to 360 mg controlled release once daily, Risk Factor C Caution Nausea (take with food), test blood levels1 Use Neuropathic pain, visceral spasm, headache prophylaxis treatment1 Dose 75 mg once daily (second trimester only)1 Use Musculoskeletal pain and...

Chronic Hypertension versus Pregnancy Induced Hypertension PIH

In the first trimester of pregnancy the marked vasodilatation and drop in vascular resistance sees blood pressure fall in both normotensive and hypertensive women, (the drop being greater in the CHT group)1. As such hypertension may not be seen until the third or late in the second trimester. CHT can therefore only be diagnosed with reference to non-pregnant BP readings and this requires either prenatal BPs or more commonly detailed postnatal follow-up. Pharmacological management of CHT and PIH...

Endocrine Disorders

Parker KL and Kovacs WJ 2002 Addison's disease (adrenal insufficiency) in Wass JAM and Shalet SM (Eds) Oxford Textbook of Endocrinology and Diabetes. Oxford Oxford University Press 837-844. 2. Molitch ME 1998 Pituitary disease in pregnancy. Seminars in Perinatology, 22 157-170 1. Bevan JS 2002 Prolactinomas in Wass JAM and Shalet SM (Eds) Oxford Textbook of Endocrinology and Diabetes. Oxford Oxford University Press 172-181 1. Rasmussen B, Jensen R, Schroll et al. 1991 Epidemiology of headache...

95 Osteoporosis 115

Osteoporosis associated with pregnancy Vertebral collapse presenting for the first time in pregnancy is rare and making the diagnosis is all important. Characteristically, vertebral collapse occurs in the third trimester but may occur any time until after delivery. Sudden, severe back pain in the thoracic and or lumbar spinal region, persisting for some weeks or even months, are the main clinical features. Pregnancy-related osteoporosis of the hip For cases of sudden onset of pain in the hip,...

Immune Thrombocytopenic Purpura

Immune thrombocytopenic purpura (ITP) was formerly called idiopathic thrombocytopenic purpura. It can have an acute presentation, often occurring in children, and may follow a viral infection6. Alternatively, it can be chronic and mainly affects young to middle-aged women, with the incidence increasing with age8. It is this version the midwife may encounter in the pre-conception period. It may also present for the first time in pregnancy. ITP results from the body producing IgG autoantibodies...

Respiratory Disorders

Hou SH 1994 Pregnancy in women on haemodialysis and peritoneal dialysis. Bailliere's Clinical Obstetrics and Gynaecology, 2. Jungers P and Chaveau D 1997 Pregnancy in renal disease. Kidney International, 52 871-885 3. Hussey MJ and Pombar X 1998 Obstetric care for renal allograft recipients or for women treated with haemodialysis or peritoneal dialysis during pregnancy. Advanced Renal Replacement Therapy, 5 3-13 4. Hou S 1999 Pregnancy in chronic renal insufficiency and end stage renal disease....

Replacement of Renal Function by Dialysis

In medicine, dialysis is a method of replacing renal function that has been lost due to either acute or chronic renal failure. Dialysis works on the principle of diffusion of low molecular weight solutes down a concentration gradient across a semipermeable membrane. Fluid can be removed by exerting a hydrostatic or osmotic gradient across the membrane. Blood is present on one side of the semi-permeable membrane and dialysis fluid on the other. The concentration of undesired solutes, such as...

Serious Side Effects

All of the first-line drugs except ethambutol can cause liver toxicity. This is idiosyncratic and not dose-related. Therefore, liver function is monitored with tests before and throughout the treatment period. Ethambutol can cause retro-bulbar neuritis, and acuity needs to be tested before treatment. Patients and carers need to be mindful of potential problems with vision and consider stopping treatment and referring to an eye specialist should problems arise. Isoniazid can cause a neuropathy...

Blood Pressure Devices for Use in Pregnancy and Obesity

Lewis G and Drife J (Eds) 2004 Why Mothers Die 2000-2002, 6th Report. Confidential Enquiries into Maternal and Child Health. RCOG Press Table 1.4 2. Lewis G and Drife J (Eds) 2004 Midwifery summary in Why Mothers Die 2000-2002 6th Report. Confidential Enquiries into Maternal and Child Health. London, RCOG Press 2 3. Lewis G (Ed) 2007 Saving Mothers' Lives Reviewing Maternal Deaths to Make Motherhood Safer. 7th Report of the Confidential Enquiries into Maternal and Child Health. London CEMACH 1....

Thromboembolic Disorders

Walker ID 1993 Guidelines on the prevention, investigation and management of thrombosis associated with pregnancy. Maternal and Neonatal Haemostasis Working Party of the Haemostasis and Thrombosis Task Force. Journal of Clinical Pathology, 46(6), 489-496 2. Ginsberg JS, Brill-Edwards P, Burrows RF, Bona R, Prandoni P, Buller HR and Lensing A 1992 Venous thrombosis during pregnancy leg and trimester of presentation. Thrombosis and Haemostasis, 67 519 -520 3. Ikard RW, Ueland K, and Folse R. 1971...

Musculoskeletal Disorders

Young G and Jewell D 2002 Interventions for preventing and treating pelvic and back pain in pregnancy. Cochrane Database Systemic Review (1) CD1139. Oxford Update Software 2. Brayshaw E 2003 Exercises for Pregnancy and Childbirth A Practical Guide for Educators. London Books for Midwives Elsevier 27-28 3. Henderson C and Macdonald S 2004 Mayes' Midwifery. A Textbook for Midwives. London Bailliere Tindall 270 4. Mantle J, Haslam J and Barton S 2003 Physiotherapy in Obstetrics and Gynaecology,...

Addictive Disorders

Gerada C and Ashworth M 1997 ABC of mental health addiction and dependence - illicit drugs. British Medical Journal, 315 297-300 2. Han S 1999 Demographic and psychosocial characteristics of substance-abusing pregnant women. Clinics in Perinatology, 26 55-74 3. Department of Health 1999 Drug Misuse and Dependence -Guidelines on Clinical Management. London The Stationery Office www.dh.gov.uk prod_consum_dh groups 4. Royal College of Obstetricians and Gynaecologists 2006 Statement No.5 Alcohol...

Carpal Tunnel Syndrome

Carpal tunnel syndrome results from compression of the median nerve as it passes from the forearm into the hand via the carpal tunnel at the wrist6. It results in pain, pins and needles, weakness and numbness of the thumb and fingers forefinger, middle finger and half of the ring finger supplied by the median nerve. In severe cases, wasting of the muscle at the base of the thumb thenar eminence can occur6. A decrease in the size of the carpal tunnel or an increase in the volume within the...

Iugr

Haemodialysis - HD requirements will increase, and to help stabilise the blood values dialysis would be performed approximately six days a week compared with three occasions per week as described above Peritoneal dialysis - As the pregnancy advances, then smaller, more frequent fluid exchanges may need to be performed changing to haemodialysis may have to be considered If renal transplantation is imminent it may be sensible to wait until after transplantation before trying for a pregnancy...

Jane Scullion BAHons RGN MSc

Respiratory Nurse Consultant at University Hospitals of Leicester NHS Trust Honorary Senior Lecturer at De Montfort University Clinical Research Fellow at Aberdeen University Jane Scullion is a Respiratory Nurse Consultant working across the interface of primary and secondary care with patients with chronic respiratory diseases and developing respiratory services. She has published widely and presented both nationally and internationally. Specialist Midwife - Diabetes at the University...

51 The Breathless Pregnant Woman

In most cases breathlessness in pregnancy is due to a normal physiological response2. Pathological causes need to be considered when there is a clinical suspicion. The risk-benefit ratio of investigations for breathlessness needs to be evaluated. Most radiological investigations expose the woman and baby to radiation, which needs to be minimised, but chest radiography is generally regarded as safe. In extreme circumstances, in the setting of respiratory failure, whether the woman and baby are...

46 Functional Heart Disease Cardiomyopathy

Cardiomyopathy symptoms are often seen in uncomplicated pregnancies. The significance may only be recognised late, when cardio-myopathy presents in an advanced state and treatment is difficult. Puerperal cardiomyopathy manifests in the third trimester, the fetus is relatively mature and can be delivered reasonably safely prior to, or at, commencement of treatment. Referral and collaboration with cardiologist, obstetric, anaesthetic and paediatric teams for combined care Clear care pathways to...

The Hellp Syndrome Society

West Virginia 26032 United States of America www.hellpsyndrome.org Billington, M. and Stevenson, M. 2006 Hypertensive disorders and the critically ill woman. In Critical Care in Childbearing for Midwives. Oxford Blackwell Wiley. Gilbert, E.S. 2007 Hypertensive disorders. In Manual of High Risk Pregnancy and Delivery, 4th Edn. St. Louis, MO Moseby Elsevier. Henderson, C. and Macdonald, S. 2004 Hypertensive disorders of pregnancy. In Mayes Midwifery A textbook for Midwives, 13th Edn. Balliere...

Trudy Boyce Rgn Rm Mbe

Recently Specialist Midwife in Hypertension at the University Hospitals of Leicester NHS Trust Trudy worked as a midwife for 40 years in all areas of midwifery care including ten in the community. For the last 15 years of her career she dedicated herself to the care of women and their families who had experienced the hypertensive disorders of pregnancy. She was involved in setting up the Leicester Hypertension Clinic and founded the Leicester branch of the APEC support group. Trudy was awarded...

Miranda Hayer MSc RGN RM

Consultant Midwife, Teenage Pregnancy and Sexual Health, Honorary Senior Lecturer at De Montfort University Miranda trained as a nurse in 1985 and as a midwife in 1990. She has worked in a number of hospital and community midwifery settings before completing her MSc in Midwifery at Nottingham University. The post of Consultant Midwife in Leicester has enabled Miranda to concentrate on providing specialised services for particularly vulnerable groups and lecture on public health, teenage...

Michelle Goldie RM

Specialist Midwife, UHL NHS Trust, Leicester Michelle Goldie trained as a midwife in Leicester and currently works as a specialist midwife in substance and alcohol misuse at the University Hospitals NHS Trust, Leicester. In addition, she works in the maternal medicine clinic, has a research interest in respiratory disease and pregnancy and has published research presented at the American Thoracic Society. Andrea Goodlife RGN RM DipRenalNursing Specialist Midwife in Renal Disease at the...

Veronica Johnson Roffey BAHons Rgn Rm Rhv Fetc Dip Infection Control

Infection Control Lead Nurse, Northamptonshire NHS Trust Veronica has worked in the NHS for 30 years. After general nurse training she trained and practised as a midwife and later health visitor and consequently has worked both in hospital and the community. During her career she has also worked at Great Ormond Street Children's Hospital and also specialised in cancer genetics, public health and infection control. While a public health nurse she undertook her honours degree in Health and Social...

Rowena Doughty MSc Pgde Bahons Rgn Rm Adm Fhea

Senior Lecturer in Midwifery and Programme Leader at De Montfort University After staff nurse experience in general medicine and gerontology, the author qualified as a midwife and accrued 12 years' full-time experience in all aspects of midwifery care, before her lectureship with De Montfort University in 1997. Her specialist interests include promoting normality in midwifery, breast-feeding, resuscitation and metabolic disorders. She has published on the latter. She is also an Intermediate...

Frances A BuLock Md Frcp

Consultant Paediatric Cardiologist at Glenfield Hospital, Leicester Frances graduated from Cambridge and Oxford, and trained in Congenital Heart Disease in Bristol, Birmingham and Liverpool before coming to Leicester in 1999. Her main clinical interests are in fetal and adult congenital heart disease, which fit remarkably well together. She is the Cardiology Associate Editor for Archives of Diseases in Childhood and has written extensively in the field of congenital and fetal heart disease. She...

7 Endocrine Disorders

Rob Gregory, Diane Todd and Mairie Halliday Addison's Disease Adrenal Insufficiency Patient Organisations and Essential Reading 8 Neurological Disorders 89 Jo Matharu, Eleanor Burns-Kent and Edmund Howarth 8.1 Migraine and Headaches 90 8.3 Cerebrovascular Disease and Stroke 95 8.5 Multiple Sclerosis 100 8.6 Myasthenia Gravis 102 Patient Organisations and Essential Reading 104 9 Musculoskeletal Disorders 105 S. Elizabeth Robson, Javed Iqbal and Edmund Howarth 9.1 Back and Pelvic Pain 106 9.2...