Fasting glucose more than 126 mg/dL, postprandial glucose more than 160 mg/dL, or glycosylated hemoglobin (HbA1c) more than 7%

Hyperglycemia (a significant risk factor in development of vascular complications)

In addition to lifestyle counseling, metformin therapy for prevention of type 2 diabetes may be considered in those with IGT, IFG, or HBA1C 5.7–6.4%, especially for those with BMI greater than 35 kg/m2, age younger than 60 years, and in women with prior GDM, according to the ADA.[1]

torticollis

ˌtɔːtɪˈkɒlɪs/

nounMEDICINE

a condition in which the head becomes persistently turned to one side, often associated with painful muscle spasms.

left shift of the polymorphonuclear - Google Search

Tennis elbow or lateral epicondylitis is a condition in which the outer part of the elbow becomes sore and tender

Golfer's elbow (medial epicondylitis) causes pain and inflammation in the tendons that connect the forearm to the elbow. The pain centers on the bony bump on the inside of your elbow and may radiate into the forearm. It can usually be treated effectively with rest.

treatmet for tenis elbow

treatment for golfers elbow

A counter-force brace or "elbow strap" to reduce strain at the elbow epicondyle, to limit pain provocation and to protect against further damage.

counter force bace and elbow strap

Tanner scale - Wikipedia, the free encyclopedia

nepritic syndrom

Antibiotics (eg, penicillin) are used to control local symptoms and to prevent spread of infection to close contacts. Antimicrobial therapy does not appear to prevent the development of GN, except if given within the first 36 hours. Antibiotic treatment of close contacts of the index case may help prevent development of PSGN.

Other agents

Loop diuretics may be required in patients who are edematous and hypertensive in order to remove excess fluid and to correct hypertension.

Vasodilator drugs (eg, nitroprusside, nifedipine, hydralazine, diazoxide) may be used if severe hypertension or encephalopathy is present.

Glucocorticoids and cytotoxic agents are of no value, except in severe cases of PSGN.

Diet and Activity

Sodium and fluid restriction should be advised for treatment of signs and symptoms of fluid retention (eg, edema, pulmonary edema). Protein restriction for patients with azotemia should be advised if there is no evidence of malnutrition.

Enalapril, like other angiotensin converting enzyme inhibitors, may decrease serum aldosterone levels, resulting in mild to moderate hyperkalemia.

The tubular toxicity of gentamicin presents two aspects: (i) the death of tubular epithelial cells, mainly within the proximal segment, with a very important inflammatory component associated and (ii) the nonlethal, functional alteration of key cellular components involved in water and solute transport.

sertraline ↔ Alcohol (Ethanol)

Moderate Drug Interaction

Using sertraline together with ethanol may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people may also experience impairment in thinking, judgment, and motor coordination. You should avoid or limit the use of alcohol while being treated with sertraline. Do not use more than the recommended dose of sertraline, and avoid activities

Contraindications and drug interactions

The following drugs may precipitate serotonin syndrome in people on SSRIs:[103][104]

Linezolid

Monoamine oxidase inhibitors (MAOIs) including moclobemide, phenelzine, tranylcypromine, selegiline and methylene blue

Lithium

Sibutramine

MDMA (ecstasy)

Dextromethorphan

Tramadol

Pethidine/meperidine

St. John's wort

Yohimbe

Tricyclic antidepressants (TCAs)

Serotonin-norepinephrine reuptake inhibitors (SNRIs)

Buspirone

Triptan

Mirtazapine

Painkillers of the NSAIDs drug family may interfere and reduce efficiency of SSRIs and may compound the increased risk of gastrointestinal bleeds caused by SSRI use.[55][57][105] NSAIDs include:

Aspirin

Ibuprofen (Advil, Nurofen)
Naproxen (Aleve)

RVH is characterized by a left parasternal or subxiphoid heave. Hepatojugular reflux and pulsatile liver are signs of RV failure with systemic venous congestion.

Sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract

Sigmoid volvulus is the most common form of volvulus of the gastrointestinal tract; it is responsible for 8% of all intestinal obstructions. Sigmoid volvulus is particularly common in elderly persons. Patients present with abdominal pain, distention, and absolute constipation.[1, 2] Predisposing factors to sigmoid volvulus include chronic constipation, megacolon, and an excessively mobile colon. Plain abdominal radiograph findings are usually diagnostic.

Lorazepam is in a group of drugs called benzodiazepines (ben-zoe-dye-AZE-eh-peens). It affects chemicals in the brain that may become unbalanced and cause anxiety.

Lorazepam is used to treat anxiety disorders.

Psoriatic arthritis is most commonly a seronegative oligoarthritis found in patients with psoriasis, with less common, but characteristic, differentiating features of distal joint involvement and arthritis mutilans. Psoriatic arthritis (see the image below) develops in at least 5% of patients with psorias

treatment for psoriticatheritis

Medical treatment regimens include the use of NSAIDs and disease-modifying antirheumatic drugs (DMARDs). Although traditional therapy has consisted of NSAIDs and local corticosteroid injections, with DMARDs being reserved for NSAID-resistant cases, the finding that 40% of patients may develop erosive and deforming arthritis suggests that early, more aggressive treatment with DMARDs may be warranted.

DMARDs include methotrexate, sulfasalazine, cyclosporine, and leflunomide, as well as biologic agents (eg, anti–TNF-alpha medications,

Galactosemia (British galactosaemia) is a rare genetic metabolic disorder that affects an individual's ability to metabolize the sugar galactose properly. Galactosemia follows an autosomal recessive mode of inheritance that confers a deficiency in an enzyme responsible for adequate galactose degradation.

Infants are routinely screened for galactosemia in the United States, and the diagnosis is made while the person is still an infant. Infants affected by galactosemia typically present with symptoms of lethargy, vomiting, diarrhea, failure to thrive, and jaundice.

A galactosemia test is a blood test (from the heel of the infant) or urine test that checks for three enzymes that are needed to change galactose sugar that is found in milk and milk products into glucose, a sugar that the human body uses for energy. A person with galactosemia doesn't have one of these enzymes. This causes high levels of galactose in the blood or urine

Long term complication of galactosemia includes:

Speech deficits[10]

Ataxia

Dysmetria

Diminished bone density

Premature ovarian failure

Cataract

unconjugated bilirubin can be deposited in the brain, particularly in the basal ganglia, causing kernicteru

In severe cases, there is irritability, increased muscle tone causing the baby to lie with an arched back (opisthotonos), seizures and coma. Infants who survive may develop choreoathetoid cerebral palsy (due to damage to the basal ganglia), learning difficulties and sensorineural deafness. Kernicterus used to be an important cause of brain damage in infants with severe rhesus haemolytic disease, but has become rare since the introduction of prophylactic anti-D immunoglobulin for rhesus-negative mothers

Antibodies may develop to rhesus antigens other than D and to the Kell and Duffy blood groups, but haemolysis is usually less severe.

G6PD deficiency (see Ch. 22) – Mainly in people originating in the Mediterranean, Middle-East and Far East or in African-Americans.

Spherocytosis – This is considerably less common than G6PD deficiency (see Ch. 22). There is often, but not always, a family history. The disorder can be identified by recognising spherocytes on the blood film.

phyciologic jandice is the most common

The term ‘physiological jaundice’ can only be used after other causes have been considered.

Bruising and polycythaemia (venous haematocrit is >0.65) will exacerbate the infant’s jaundice. The very rare Crigler–Najjar syndrome, in which the enzyme glucuronyl transferase is deficient or absent, may result in extremely high levels of unconjugated bilirubin

Light (wavelength 450 nm) from the blue–green band of the visible spectrum converts unconjugated bilirubin into a harmless water-soluble pigment excreted predominantly in the urine.

Exchange transfusion is required if the bilirubin rises to levels which are considered potentially dangerous. Blood is removed from the baby in small aliquots, (usually from an arterial line or the umbilical vein) and replaced with donor blood (via peripheral or umbilical vein). Twice the infant’s blood volume (2 × 80 ml/kg) is exchanged. Donor blood should be as fresh as possible and screened to exclude CMV, hepatitis B and C and HIV infection

In rhesus haemolytic disease, it was found that kernicterus could be prevented if the bilirubin was kept below 340 µmol/L (20 mg/d

Breast milk jaundice’ is the most common cause, affecting up to 15% of healthy breast-fed infants; the jaundice gradually fades and disappears by 4–5 weeks of age.

Image: Causes of neonatal jaundice | Illustrated Textbook of Paediatrics

jaundice more than 2 weeks

billiary atresia

breast milk jaundice

infection

congenital hyperbilirubisam

hypothyridism

normal’ frequency of defecation is highly variable and varies with age. Infants have an average of four stools per day in the first week of life, but this falls to an average of two per day by 1 year of age

macrogol laxative, e.g. polyethylene glycol + electrolytes (Movicol Paediatric Plain)

macrogol laxative, e.g. polyethylene glycol + electrolytes (Movicol Paediatric Plain). An escalating dose regimen is administered over 1–2 weeks or until impaction resolves. If this proves unsuccessful, a stimulant laxative, e.g. senna, or sodium picosulphate, may also be required. If the polyethylene glycol + electrolytes is not tolerated, an osmotic laxative can be substituted.

The absence of ganglion cells from the myenteric and submucosal plexuses of part of the large bowel results in a narrow, contracted segment.

normally innervated, dilated colon. In 75% of cases, the lesion is confined to the rectosigmoid, but in 10% the entire colon is involved.

Hirschsprung disease

Absence of myenteric plexuses of rectum and variable distance of colon

Presentation – usually intestinal obstruction in the newborn period following delay in passing meconium. In later childhood – profound chronic constipation, abdominal distension and growth failure

Diagnosis – suction rectal biopsy.

Diagnosis is made by demonstrating the absence of ganglion cells, together with the presence of large, acetylcholinesterase-positive nerve trunks on a suction rectal biopsy. Anorectal manometry or barium studies may be useful in giving the surgeon an idea of the length of the aganglionic segment but are unreliable for diagnostic purposes.

thalassemia blood picture - Google Search

there are two type of enuresis

1.primary enuressis

2.daytime enuresis

Secondary (onset) enuresis

Emotional upset, the commonest cause

Summary

Enuresis

Daytime enuresis

Consider causes – developmental or psychogenic, bladder instability or neuropathy, urinary tract infection, constipation, ectopic ureter.

Secondary (onset) enuresis

Consider – emotional upset, UTI, polyuria from an osmotic diuresis in diabetes mellitus or a renal concentrating disorder.

Daytime enuresis

This is a lack of bladder control during the day in a child old enough to be continent (over the age of 3–5 years). Nocturnal enuresis is also usually present.

A neuropathic bladder (bladder is enlarged and fails to empty properly, irregular thick wall and is associated with spina bifida and other neurological conditions)

The management of nocturnal enuresis is straightforward but needs to be painstaking to succeed. After the age of 4 years, enuresis resolves spontaneously in only 5% of affected children each year. In practice, treatment is rarely undertaken before 6 years of age.

enuresis alarm. This is a sensor, usually placed in the child’s pants or under the child, which sounds an alarm when it becomes wet

Desmopressin

Short-term relief from bedwetting, e.g. for holidays or sleepovers, can be achieved by the use of the synthetic analogue of antidiuretic hormone, desmopressin, taken as tablets or sublingually. This achieves a suppressant effect rather than a lasting cur

Nocturnal enuresis

Common, males more than females

Most affected children are psychologically and physically normal

Treatment usually considered only at >6 years of age

Management – explanation, star charts, enuresis alarm, sometimes desmopressin.

Faecal soiling

It is abnormal for a child to soil after the age of 4 year

A bedwetting alarm(conditioning apparaters), commonly referred to as the bell and pad method,[by whom?] is a behavioral treatment for nocturnal enuresis.

Tympanometry is an examination used to test the condition of the middle ear[1] and mobility of the eardrum (tympanic membrane) and the conduction bones by creating variations of air pressure in the ear canal.

Duodenal atresia, also known as duodenojejunal atresia, is the congenital absence or complete closure of a portion of the lumen of the duodenum. It causes increased levels of amniotic fluid during pregnancy (polyhydramnios) and intestinal obstruction in newborn babies.

Down syndrome | Illustrated Textbook of Paediatrics | Genetics

Myopia is a condition in which, opposite of hyperopia,an image of a distant object becomes focused in front of the retina, making distant objects appear out of focus. Myopia is the most common refractive error seen in children and can be corrected with eyeglasses or contact lenses.

fx of down

brachycephaly - Google Search

epicanthic fold down syndrome - Google Search

hypernatrimia cause to hypernatrimic dehydration  and convulsent

The following three mechanisms may lead to hypernatremia, alone or in concert:

Pure water depletion (eg, diabetes insipidus)

Water depletion exceeding sodium depletion (eg, diarrhea)

Sodium excess (eg, salt poisoning)

Short stature is usually defined as a height below the second centile (i.e. two standard deviations (SD) below the mean) or 0.4th centile (−2.6 SD)

Measuring height velocity is a sensitive indicator of growth failure

A height velocity persistently below the 25th centile is abnormal and that child will eventually become short.

The height centile of a child must be compared with the weight centile and an estimate of their genetic target centile and range calculated from the height of their parents. This is calculated as the mean of the father’s and mother’s height with 7 cm added for the mid-parental target height of a boy, and 7 cm subtracted for a girl. The 9th–91st centile range of this estimate is given by ±10 cm in a boy and ±8.5 cm in a girl (see examples in

Short stature is usually defined as a height below the second centile (i.e. two standard deviations (SD) below the mean) or 0.4th centile (−2.6 SD)

A height velocity persistently below the 25th centile is abnormal and that child will eventually become short.

The height centile of a child must be compared with the weight centile and an estimate of their genetic target centile and range calculated from the height of their parents. This is calculated as the mean of the father’s and mother’s height with 7 cm added for the mid-parental target height of a boy, and 7 cm subtracted for a girl. The 9th–91st centile range of this estimate is given by ±10 cm in a boy and ±8.5 cm in a girl

syndromes causebto short stature

turner

noonan

Russell viper

down

These children have delayed puberty, which is often familial, usually having occurred in the parent of the same sex. It is commoner in males.

affected child will have delayed sexual changes compared with his peers, and bone age would show moderate delay

Growth hormone deficiency

This may be an isolated defect or secondary to panhypopituitarism. Pituitary function may be abnormal in congenital mid-facial defects or as a result of a craniopharyngioma

Craniopharyngioma usually presents in late childhood and may result in abnormal visual fields

Corticosteroid excess, Cushing syndrome

This is usually iatrogenic, as corticosteroid therapy is a potent growth suppressor.

Cushing syndrome during puberty can result in permanent loss of height (

Chronic illnesses which may present with short stature include:

Coeliac disease, which usually presents in the first 2 years of life, but can present late with growth failure. Coeliac disease may result in short stature without gastrointestinal symptoms

Crohn disease

Chronic renal failure – may be present in the absence of a history of renal disease.

Extreme short stature

There are a few rare conditions that cause extreme short stature in children. These include absolute resistance to growth hormone (Laron syndrome), and primordial dwarfism. Idiopathic short stature (ISS) refers to short stature that does not have Growth hormone resistanc

Disproportionate short stature

If the legs are extremely short, treatment by surgical leg lengthening may be appropriate. The back may be short from severe scoliosis or some storage disorders, such as the mucopolysaccharidoses.

x ray wrist and hand

1.some delay in constititutional delay and delay in puberty

2.marked delay in hypothyroidism and groth homone deficiencyand other endocrine deficiency

Tonsillitis

Common pathogens are group A β-haemolytic streptococci and the Epstein–Barr virus (infectious mononucleosis). Group A β-haemolytic streptococcus can be cultured from many tonsils;

acute otitis media (OM). This is most common at 6–12 months of age

Pathogens include viruses, especially RSV and rhinovirus, and bacteria including pneumococcus, non-typeable H. influenzae and Moraxella catarrhalis. Serious

Grommets

Bronchiolitis

90% are aged 1–9 months (bronchiolitis is rare after 1 year of age). Respiratory syncytial virus (RSV) is the pathogen in 80% of cases. The remainder are accounted for by human metapneumovirus, parainfluenza virus, rhinovirus, adenovirus, influenza virus

Mist, antibiotics, steroids and nebulised bronchodilators, such as salbutamol or ipratropium, have not been shown to reduce the severity or duration of the illness.

atelectasis or empyema should have a repeat chest X-ray after 4–6 week

Consider pneumonia in children with neck stiffness or acute abdominal pain.

empyma

The pathogens causing pneumonia vary according to the child’s age:

Newborn – organisms from the mother’s genital tract, particularly group B streptococcus, but also Gram-negative enterococci

Infants and young children – respiratory viruses, particularly RSV, are most common, but bacterial infections include Streptococcus pneumoniae or Haemophilus influenzae. Bordetella pertussis and Chlamydia trachomatis can also cause pneumonia at this age. An infrequent but serious cause is Staphylococcus aureus

Children over 5 years – Mycoplasma pneumoniae, Streptococcus pneumoniae and Chlamydia pneumoniae are the main causes.

At all ages Mycobacterium tuberculosis should be considere

osteomyelitis, there is infection of the metaphysis of long bones. The most common sites are the distal femur and proximal tibia, but any bone may be affected

osteomyelitis may spread to cause septic arthritis. Most infections are caused by Staphylococcus aureus, but other pathogens include Streptococcus and Haemophilus influenzae if not immunised. In sickle cell anaemia, there is an increased risk of staphylococcal and salmonella osteomyelitis.

Osgood–Schlatter disease

This is osteochondritis of the patellar tendon insertion at the knee, often affecting adolescent males who are physically active (particularly football or bask

Viral infections are the most common cause of meningitis, and most are self-resolving. Bacterial meningitis may have severe consequences

meningitis. The choice of antibiotics will depend on the likely pathogen. A third-generation cephalosporin, e.g. cefotaxime or ceftriaxone, is the preferred choice to cover the most common bacterial causes. Although still rare in the UK, pneumococcal resistance to

Prophylactic treatment with rifampicin to eradicate nasopharyngeal carriage is given to all household contacts for meningococcal meningitis and Haemophilus influenzae infection.

Household contacts of patients who have had group C meningococcal meningitis should be vaccinated with the meningococcal group C vaccine.

Meningitis

Clinical features: non-specific in children under 18 months

Borrelia burgdorferi (Lyme disease),

All children with encephalitis should therefore be treated initially with high-dose intravenous aciclovir, since this is a very safe treatment

Toxic shock syndrome

Toxin-producing Staphylococcus aureus and group A streptococci can cause this syndrome, which is characterised by:

Fever >39°C

Hypotension

Image: Clinical features & complications of measles. | Illustrated…

measels

comlication of measels

measles

Clinical features: fever, cough, runny nose, conjunctivitis, marked malaise, Koplik spots, maculopapular rash

in australia

MMR at 12 months

MMRV at 18 monthz

mumps

The incubation period is 15–24 days

Only one side may be swollen initially, but bilateral involvement usually occurs over the next few days.

Infectivity is for up to 7 days after the onset of parotid swelling

encephalitis common complication follong mumps

ochiyis is usually unilateral

MMR

measles

mumps

Rhubella(German measels)

Rubella=german measles

incubation 15 to 20 days

respiratory spread

maculer papuler rash initially start in the face and then spread through body

non itching

lympadenopathy specially sub occipitaland postauriculer nodes

Complications are rare in childhood but include arthritis, encephalitis, thrombocytopenia and myocarditis

Giardiasis is a major diarrheal disease found throughout the world. The flagellate protozoan Giardia intestinalis­­ (previously known as G lamblia),

Giardiasis usually represents a zoonosis with cross-infectivity between animals and humans. Giardiaintestinalis has been isolated from the stools of beavers, dogs, cats, and primates.

giadiasis

High-risk groups for giardiasis include travelers to highly endemic areas, immunocompromised individuals, and certain sexually active homosexual men

The traditional basis of diagnosis is identification of Giardia intestinalis trophozoites or cysts in the stool of infected patients via a stool ova and parasite (O&P) examination. Stool antigen enzyme-linked immunosorbent assays also are available.

giadiasis

Metronidazole is the most commonly prescribed antibiotic for this condition; however, tinidazole is now approved i

giadia cause both acute and chtonic diarrhea

chronic giadia cause foamy diarrhoea

cloxa debeloped for straphylococal infection

Infectious mononuliosis

EBV is transmitted via intimate contact with body secretions, primarily oropharyngeal secretions

Circulating B cells spread the infection throughout the entire reticular endothelial system (RES), ie, liver, spleen, and peripheral lymph nodes. EBV infection of B lymphocytes results in a humoral and cellular response to the virus. The humoral immune response directed against EBV structural proteins is the basis for the test used to diagnose EBV infectious mononucleosis. However, the T-lymphocyte response is essential in the control of EBV infection;

Most patients with Epstein-Barr virus (EBV) infectious mononucleosis are asymptomati

The incubation period of EBV infectious mononucleosis is 1-2 months. Many patients cannot recall close contact with individuals with pharyngitis

EBV infection ... periorbital musculer pain is there

ebv infection features - Google Search

Splenomegaly is a late finding in EBV infectious mononucleosi

most common organism for non neonatal bacterial meningitis is  Haemophilus influenzae.

its not the Neisseria meningitidis or s. pneumoniae

croup is mostly cause by parainfluenza virus

Roseola is a common childhood disease. The cause is primary infection with human herpesvirus 6 (HHV-6). The classic presentation of roseola infantum is a 9- to 12-month-old infant who acutely develops a high fever and often a febrile seizure. After 3 days, a rapid defervescence occurs, and a morbilliform rash appears (see the image below).

Discrete rose-pink macules/maculopapules character

aafter 2 to 3 days fever disappear and erythimatus rash appear

Erythema multiforme | Illustrated Textbook of Paediatrics

Erythema nodosum | Illustrated Textbook of Paediatrics | Skin disorders

Neuroblastoma and related tumours arise from neural crest tissue in the adrenal medulla and sympathetic nervous system.

Neuroblastoma is most common before the age of 5 years

neuroblastoma

most children have an abdominal mass, but the primary tumour can lie anywhere along the sympathetic chain from the neck to the pelvis. Classically, the abdominal primary is of adrenal origin, but at presentation the tumour mass is often large and complex, crossing the midline and enveloping major blood vessels

Characteristic clinical and radiological features with raised urinary catecholamine levels suggest neuroblastoma.

neuroblastoma

majority of children over 1 year present with advanced disease and have a poor prognosis.

wilms tummur =nephroblastoma

Wilms tumour originates from embryonal renal tissue and is the commonest renal tumour of childhood. Over 80% of patients present before 5 years of age and it is very rarely seen after 10 years of age.

willms tummour

Prognosis is good, with more than 80% of all patients cured.

Chlamydiae are small gram-negative obligate intracellular microorganisms that preferentially infect squamocolumnar epithelial cells

Chlamydial transmission usually is caused by sexual contact through oral, anal, or vaginal intercourse. Neonatal infection (eg, conjunctivitis or pneumonia) may occur secondary to passage through the birth canal of an infected mother.

C trachomatis cervicitis/urethritis/epididymitis (D-K biovars): Lower genital tract or uncomplicated

C trachomatis salpingitis/endometritis (D-K biovars): Upper genital tract or complicated

Treatment of genitourinary chlamydial infection is clearly indicated when the infection is diagnosed or suspected. The CDC recommends azithromycin and doxycycline as first-line drugs for the treatment of chlamydial infection.[32] Medical treatment with these agents is 95% effective. Second-line drugs (eg, erythromycin, penicillins, and sulfamethoxazole) are less effective and have more adverse effects. Rifalazil, a rifamycin that is highly active against C trachomatis and has a long half-life, has shown promise as a single-dose treatment for chlamydial nongonococcal urethritis and is currently being evaluated in women with uncomplicated genital infection.[

clamidia infection in pregnacy treating with azithroycine and amoxacilline

Pregnancy treatment considerations

Guidelines from the CDC recommend azithromycin 1 g orally or amoxicillin 500 mg orally three times a day for 7 days as the preferred drug regimens for treating chlamydial infections in pregnancy, with erythromycin as an alternative.[32, 44, 45] Doxycycline, ofloxacin, and levofloxacin are contraindicated in pregnancy. Clindamycin is only partially effective in eradicating C trachomatis in men with nongonococcal urethritis, but it appears to be as efficacious as erythromycin in pregnant and nonpregnant women with C trachomatis infection

group B strepto coccus infection in pregnancy

Group B streptococcus (GBS) is a type of bacterial infection that can be found in a pregnant woman’s vagina or rectum. This bacteria is normally found in the vagina and/or rectum of about 25% of all healthy, adult women.

This screening is performed between the 35th and 37th week of pregnancy. Studies show that testing done within 5 weeks of delivery is the most accurate at predicting the GBS status at birth.

usually check vaginal and anal swab

Approximately 1 out of every 200 babies whose mothers carry GBS and are not treated with antibiotics will develop signs and symptoms of GBS. There are, however, symptoms that may indicate you are at a higher risk of delivering a baby with GBS.

These symptoms include:

Labor or rupture of membranes before 37 weeks

Rupture of membranes 18 hours or more before delivery

Fever during labor

A urinary tract infection as a result of GBS during your pregnancy

A previous baby with GBS

The signs and symptoms of early-onset GBS to baby include:

Signs and symptoms occurring within hours of delivery

Sepsis, pneumonia, and meningitis, which are the most common complications

Breathing problems

intraparum penicilling is giving to mother to prevent GBS

Penicillin (Category B) is commonly used during pregnancy in non-allergic patients.

if labour stablish b4 the LSCS iv AB to be given to prevent GBS

CMV infection during pregnacy in Aus avout 1in 200

syphylis is very rare

toxic shock syndrom associate with tampon usage due to Staphylococcous aureus

acute fatty liver in pregnancy

life thetning serious complication of  3rd trimester

present with confusion, Uper GI bleeding,N&V , acute remnal failure,high liver enzyme,fulminan5 liver failure and encephalopayhy

immidiatly terminate the pregnacy shoild be done

jaundice and hypertention  can be seen

sever hypoglyceamia

hyperemisis gravidarum can manage with maxalone and prochlorperazin...sever casese TPN and vit b comlex

sever oligohydroamniosis is due to

1.pulmonary hypoplasia

2.limb difiormities

renal and urinary tract abjormalities

IUGR and placental insuffficiency

ABO incompatibility

occur when mother is O and baby is A or B

anti A and anti B ab naturaly present in maternal cerculation

so no need to prior sensiyization

so ABOincompitibility occur in 1st pregnacy

so maternal anti A or antiB pass to the fetal cerculation and haemolise fetal read cell

cause haemmolytic aneamia

this cause mipd haemolitytic dx

Rhesus system

cause to sever haemolytic dx

these are 3 antigens call C ,D and E on cell wall

D antigen cause to sever haemolytic dx

this occur only when mother rh negative and baby is positive

C and D antibodies cause to intrauterine bld tranfusion

when rh D + baby in 1st prgnacy mothers Rh negative bld produce D antibodies

in 2nd pregnacy when rh +baby in the uterus mother anti D IgG comes through the placenta and cause sever haemolysis

rh negative mother and homocygote DD fater always make rhD positive babis

prevention

anti D ig IM injection withing 72 hours explose to fetal bls

1st try ester miscarriege staneded dose given

secone and third trimester miscarage large dose should give

and then Kleihauer test perform( check the propotion of fetal cell present in maternal bld)

roting anti D injection given at 28 or 34 weeks in most countries

obstetric cholestasis

commonly 3rd trimest3r(32_ 36)

generalize itching,abdomen, parm, sole, anorexia, pale stool, dark urine,steatorroea

NO RaSh

jaudice is unusual

no hepatic tenderness

cause sudden IUD due to placental destruption and fetal hypoxia

matenal wise not much problem

significantly increase  ALP

mildly raise transaminase ,bilirubine and bile acid

for pruritis give imollient and antihistamin,  URSODEOXYCHOLIC ACID

REcurrent in next pregnacy very high

obstetric cholestasis cause matena

 haemorrhae