Women’s health in pregnancy and post-partum

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Womens health in pregnancy and post-partum

• Michelle Wise BSc MD FRCSC MSc
• Senior Lecturer, Department of Obstetrics
  Gynaecology, U of A
• Consultant Obstetrician Gynaecologist, National
  Womens Health, ADHB

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Outline

• Iodine supplements in pregnancy
• Nausea and vomiting of pregnancy
• First trimester screening
• Gestational weight gain
• Planning a VBAC
• Postnatal contraception

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Iodine supplement

• Essential for normal brain development
• Moderate iodine deficiency and goitre found in
  12/170 pregnant women nationwide (Pettigrew et
  al. 2006)
• Iodine levels of breast-fed infants lt half that
  of formula-fed infants (Skeaff 2005)
• Choose iodised table salt at home

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Nausea and vomiting of pregnancy

• Dont forget vitamin B6 (pyridoxine)

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First Trimester Screening (FTS)

• Offered routinely to all pregnant women
  regardless of age
• Combines
• Maternal age
• Nuchal translucency at 11 - 136 weeks
• PAPP-A and free ßhCG at 9 136 weeks

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Maternal Serum Screening, by age
Ontario Womens Health Equity Report 2010
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FTS

• 85-90 of Down syndrome pregnancies are detected
  using FTS, compared to
• 50 with age alone
• 75 with MSS
• 5 of screening results will be ? risk
• To be followed by discussion of options for
  diagnostic testing and clinical management
• 98 of ? risk babies will be unaffected

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RANZCOG A Decision Aid Testing in pregnancy
for fetal abnormalities
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FTS

• If twins, need to know chorionicity to correct
  MoM values of blood tests
• Additional factors that modify aneuploidy risk
  assessment
• Previous pregnancy w T21 or T18
• Assisted reproduction
• Maternal weight

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Obesity in Pregnancy
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Obesity in pregnancy

• Set goals for gestational weight gain
• Early diabetes testing
• add HbA1c and fasting 2h OGTT to booking bloods
  to exclude T2DM
• Measure weight at each visit
• Monitor for maternal and fetal complications
• GDM, HTN, stillbirth, C/S, PPH)
• Timely referral

Centre for Maternal and Child Enquiries 2010
Guideline on management of women with obesity in
pregnancy
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Gestational weight gain
Limited or no weight gain in obese women is
associated with improved pregnancy outcomes
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Planning a VBAC

• What is the risk of uterine rupture in women
  having attempt at Vaginal Birth After Caesarean
  (VBAC)

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Risk of uterine rupture with VBAC attempt

• Bujold et al. 2002
• 1,527 women w 1 prev C/S having TOL
• Cohort study with chart review
• Bujold et al. 2010
• 1,768 women w 1 prev C/S having TOL
• Cohort study with chart review

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Inter-delivery interval, months
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Inter-delivery interval, months
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Planning VBAC

• 2o analyses from two large multicentre studies
  further support ? risk for rupture with shorter
  inter-pregnancy intervals
• Conclusion important to counsel and provide
  effective contraception post-caesarean

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Lactational Amenorrhea Method (LAM)

• 98 effective during first 6 months if all 3
  criteria met
• Menses have not returned
• Exclusive breastfeeding
• Baby feeding during the night (lt 6 hrs)
• When to start COC

LAM Interagency Working Group www.irh.org
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Planning VBAC
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For more information

• www.ranzcog.edu.au
• www.rcog.org.uk
• www.healthed.govt.nz
• www.consensus.nih.gov/2010/vbac.htm
• www.nationalwomenshealth.adhb.govt.nz
• Or contact me m.wise_at_auckland.ac.nz
• Or attend
• Update in Womens Health for Primary Care (12
  November 2011)
• Postgraduate diploma in Obstetrics and
  MedicalGynaecology