KMC Mania

🚦Kawashiorkor vs Marasmus

⏺Kawashiorkor⏩deficient in protein
⏺Marasmus⏩deficient in calories and protein

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🚦Mendelson's syndrome

⏺It is a chemical pneumonitis resulting from aspiration of gastric contents.

⏺Radiographic features :
Range from multifocal bilteral pulmonary opacities to massive pulmonary edema.

⏺Complications:
can result in death( with massive aspiration), apnea, shock, secondary pneumonia or ARDS

⏺Treatment : Require oxygen with high ventilation pressure.

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🚦Shoulder Dystocia management:

🚦Intra-Uterine Growth Restriction/Retardation (IUGR)

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🚦Polyhydramnios

●Polyhydramnios is typically caused by decreased fetal swallowing or increased fetal urination.

The most common etiologies are: fetal malformations and/or genetic disorders, maternal diabetes mellitus, multiple gestation, and fetal anemia. Rare causes include congenital viral infection or Bartter syndrome.

●If there is a subjective impression of polyhydramnios, we suggest that an objective measure such as an amniotic fluid index (AFI) be performed. We use single deepest pocket ≥8 cm or AFI ≥24 cm. Objective indices are standardized and provide a measurement that can be followed on serial examinations, even though sensitivity and positive predictive value (PPV) are suboptimal.

●A comprehensive sonographic evaluation is recommended to determine whether fetal anomalies or fetal hydrops is present. Suggested laboratory evaluations depend upon sonographic findings and may include screening for gestational diabetes, testing for fetomaternal hemorrhage if fetal anemia is suspected, maternal serology to determine exposure to infectious agents (eg, syphilis, parvovirus, cytomegalovirus, toxoplasmosis, rubella), and appropriate tests for hereditary anemias (eg, alpha thalassemia) or metabolic abnormalities.

●We recommend offering karyotype analysis in cases of severe polyhydramnios or if there are associated anatomic anomalies, if knowledge of the karyotype will affect management.

●The outcome of pregnancies complicated by polyhydramnios varies according to the severity and underlying etiology of the excessive fluid accumulation. Possible complications include maternal respiratory compromise, preterm labor, premature rupture of membranes (PROM), fetal malposition, and umbilical cord prolapse and/or postpartum uterine atony.

●We suggest treatment for polyhydramnios in singleton pregnancy only if there is preterm labor or significant maternal discomfort.

●The therapeutic option is determined by the gestational age, degree of discomfort, and sensitivity or contraindication to prostaglandin synthetase inhibitors.

●For severe symptomatic polyhydramnios at less than 32 weeks of gestation, we suggest amnioreduction (to normalize fluid volume) and treatment with indomethacin to maintain normal amniotic fluid volume (AFV). A course of corticosteroids is given prior to amnioreduction because of the increased risk of preterm birth.

●During indomethacin therapy, we monitor AFV at least weekly and titrate the indomethacin dose to AFV changes. We also monitor ductal Doppler flow at 2-7 days intervals, with increased surveillance after 28 weeks of gestation, to look for early evidence of constriction. It may be possible to discontinue indomethacin treatment if polyhydramnios does not recur as the indomethacin is tapered. Indomethacin is discontinued no later than 32 weeks because of the risk of premature ductal constriction.

●For severe symptomatic polyhydramnios between 32-34 weeks of gestation, we suggest amnioreduction. After 34 weeks, we offer amniocentesis for fetal lung maturity and deliver if maturity is confirmed. We suggest not administering indomethacin because of the high risk of premature closure of the ductus arteriosus at this gestational age. However, in select cases, this risk may be outweighed by the risk associated with multiple amniocenteses or prematurity. In these cases, ductal Doppler flow should be followed at least weekly to detect early evidence of constriction.



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🚦Restless leg syndrome

Restless leg syndrome is also known as Willis Ekbom disease.

It is a neurological disease. Restless leg syndrome causes an unpleasant disturbing sensation in the legs with a strong urge to move them. In many cases, this urge is more intense during sleep. When it interferes with sleep it causes disturbance in sleep and leads to daytime sleepiness and fatigue. It is more common in middle age or later. Clinically this condition presents as periodic movements of the legs and an overwhelming urge to move the legs. And also feel unusual sensations like tingling, crawling or pulling sensation in your legs.

The lack of sleep and restlessness caused by Restless leg syndrome may lead to certain chronic health conditions like anxiety, stress and depression.

The exact cause of Restless leg syndrome is not known, but studies suggest a genetic predisposition and environmental triggers. Other factors are alcohol, caffeine, and certain drugs.

Risk factors for Restless leg syndrome include family history, medications, age and gender. (women are twice as likely as men to get Restless leg syndrome).

Treatment of RLS starts from home itself. Self-care methods like reduced intake of alcohol, caffeine and eating a well-balanced diet along with some physical exercise will help up to some extent. When these methods fail you should seek medical attention.



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