Computer generated transcript

Warning!
The following transcript was generated automatically from the content and has not been checked or corrected manually.

OK. So you're on F two, you're an F two working in an S and Gyne, a 25 year old lady has come in and asking you regarding the screen for Down Syndrome and wants to know when is the screen for Down Syndrome usually performed? So if you can just tell me approximately, when do you think it is, there are different scree uh you know uh it's a prenatal screening. There's, there's two different types. Uh we'll go through them in a bit but if you can have a go and tell me approximately when be during the gestation, uh does it happen? So you've got a couple of people saying B OK, that's good. Any other suggestions? Yeah. Well done. Good. Yeah. OK. So most of you think it's beef so we can get it to the answer. So a I was kind of a bit man. Yeah. OK, good. Let's see if you got that right? OK. Excellent. OK. So going through the prenatal screening. So do, do you guys know what the uh two different types of types are that are available? But it is a screen that's available? Ok. Yeah. So a screening for Down Syndrome is usually between 11 and 13 plus six weeks, gestation. Ok. Um And this is how this is when usual usually happens for prenatal screening. Uh with the combined or cord to, this should be offered to pregnant people. Uh women after appropriate counseling, um you know, a screening is used to assess the risk of Down Syndrome. The combined test is generally used earlier in pregnancy. Whilst the quadruple test is used in those slightly later in pregnancy. So if, if a woman presents a little bit later in the pregnancy, you can offer her quadruple. But it's usually during the earlier part of pregnancy, we offer them these um the the combined, if you find that you do screening, if you think that there is a higher risk that this m mom might have, might be having a baby with a Down Syndrome, then we can offer them a diagnostic test. Ok. So it's essential to differentiate between a screening and a diagnostic test. Ok. So combined test can be used to assess for the risk of things like Down Syndrome. A Tau and Edward syndrome. Ok. So know that these three. Ok. Um The biochemical markers that we use is the beta HCG PPE and the nuchal um trans ultrasound as well as crown lump uh lump, crown rump length. Ok. Um And then for the quadruple test, it is only used to screen for Down Syndrome. So it's the quadruple, it is purely for Down Syndrome. Ok. So the combined one, you can use that to test for or to look for Down Syndrome. But Tau as well as Edward, whereas the quadruple is purely you're looking for down. Ok. Down Syndrome and the component for the test are a FP HCG Inhibin A and conjugated trial. So there's four components for this, the chondr. OK. And remember for the quadruple one, there is no um ultrasound. Ok. Whereas for the combined one, we had a nuclear translucency. Ultrasound. OK. So just, just know your screening. I mean, it doesn't come up a lot, but it is one of the common question that can come up in your exams. The Down syndrome screening. OK. It's kind of a this is like an interjection between obstetrics and pediatrics. OK. Excellent. Very good. So next question, a 25 year old woman called Aya attends Antenatal clinic. Her BP is 100 and 72/100 and 20 she's complaining of headaches and blurred vision. The patient is admitted for monitoring BP, which of the following alongside hypertension will suggest preeclampsia. OK. So again, at the obstetrics and this is actually a common obstetrics emergency that you need to be aware of. Um something that I actually saw when I was doing all my obs and I replacement. I'm not sure if you guys have had that already. I actually saw quite a few women when I was working in the m the obstetrics m quite a few women actually presenting with preeclampsia. So it's so important uh diagnosis to be aware of and to know. So please, if you could just tell me what you think? OK. So see. OK. Good, good. Any other guesses anyone else? Yeah. OK. Very good. So just before we go to uh go into the whole thing, do you know what preeclampsia is? What, what is the definition of preeclampsia? Is it the definition of a preeclampsia? Do you guys wanna have a go in the chart if you know already? So the it's uh there's two main components. So it's hypertension and proteinuria. So they, these are the two components that are usually present with or without edema. So, you know, edema doesn't, is not present all the time, but occasionally you, you know, you might not get edema but yeah, hypertension plus he uh sorry, proteinuria, not hematuria, hypertension plus proteinuria with or without edema is a definition of preeclampsia. OK. So if a woman has a high BP and the high BP is usually under over 100 and 40/100 and 40 systolic, OK. A new onset of hypertension and this is given that she's not already hypertensive. OK. Any BP that's over 100 and 40 systolic with uh plus a proteinuria with or without edema is classified as preeclampsia. So what happens is there is a uh dysfunction in the placenta? Um of the mother and widespread maternal dysfunction. Ok. And it can cause maternal morbidity and mortality. Severe cases can result in seizures, ok? Multi organ failure and poopy. So it's really essential that you pick this up quite early and you recognize this and treat it. Ok. Um So I'm just going through a little bit about. Um so we've already discussed the diagnosis here and the importance of recognizing it early and preventing it from kind of proceed, you know, developing into things like eclampsia or Hellp syndrome. Ok. Um So, so some of the other differentials that you can kind of think about is chronic hypertension. So some women might already have hypertension, they might have hypertension even before they were pregnant. So you need to consider that it might be just additional hypertension, which is a new onset hypertension after 20 weeks, gestation, preeclampsia or uh however, is new onset hypertension uh on chronic over chronic hypertension after 20 weeks with proteinuria, um uter placental um dysfunction. Um And you notice that preeclampsia may occur up to 4 to 6 weeks after giving birth. Ok. So it's slightly different from chronic hypertension and gestation hypertension. Ok. So you supposed that you differentiate between them? Ok. Fine. So, um and I've given a little bit about um how to actually treat. Um So, you know, um so, so in terms of investigations, the main investigation we do is obviously the BP, we do vital signs, urine dip stick, we do album and creatinine ratio. Ok? And we do a 24 hour urine collection. Uh you can think about doing imaging like ultrasound or CT if you're concerned. Ok. But I think the main main thing here is depending on the BP. Ok. So depending on how high the BP is, you might consider giving them antihypertensives. Ok? If the the BP remains quite high, then you can give them. And do you know what, uh, antihypertensive we give, it's on the slides already. But do you guys know which hypertensive it is for, um, preeclampsia? Any guesses? Yeah, it's labetalol. Yeah. Well done. It's libido to just the oral labetalol. That is the hyper hypertensive of choice alongside giving them antihypertensive. You need to regularly monitor their BP at least every 48 hours. Ok. At every 48 hours, they, at least that's at least every 48 hours anyway. During the early stage, you might be measuring it even more frequently. Actually, you might be measuring it every few hours. But, um, until the BP has gone down to less than 100 and 35 systolic, you need to be measuring the BP at least every 48 hours. So you need to repeat the FBC and E and T, at least twice a week. I've written here three times a week and that's fine, but at least twice a week actually is the rule. Ok? And, um, you know, if you are, um you need to carry out an ultrasound and a CDG of the fetus, um a two week interval to make sure that the fetus is healthy. Ok. Um Yeah. So I think depending on how high the BP is, you will also can consider about whether you need to admit this woman or whether you