tailieunhanh - Oxford Challenging Concepts in Obstetrics and Gynaecology Cases with Expert Commentary: Part 2

(BQ) Continued part 1, part 2 of the document Emergency medicine and critical care with 100 common cases has contents: Upper abdominal pain, gripping abdominal pain and vomiting, severe epigastric pain, acute severe leg pain, testicular pain after playing football, and other contents. Invite you to refer. | Oxford Challenging Concepts in Obstetrics and Gynaecology Cases with Expert Commentary Part 2 CA SE Pulmonary hypertension 11 in pregnancy Ruth Curry Expert Commentary Philip Steer Guest Expert Lorna Swan Case history A 28-year-old nulliparous woman attended her local hospital at 10 weeks gestation for her initial antenatal check in a midwife-led clinic. She was once told at a school medical aged 12 years -old that she had a heart murmur but this had never been investigated. Prior to pregnancy she had been fit and well although she had never enjoyed sports. She was not on any regular medication and had no family history of any medical problems. Because of her history the midwife referred her to the con- sultant obstetrician who saw her at 16 weeks gestation. On auscultation of the heart she had an ejection systolic murmur examination was otherwise unremarkable and a routine echocardiogram was requested. Because the echo was not requested urgently it was not performed until 22 weeks of ges- tation. It revealed a large atrioventricular septal defect AVSD with a large atrial component a common atrioventricular valve and pulmonary hypertension PH . She was subsequently referred urgently to the combined cardiac obstetric service at her local tertiary centre. Learning point Cardiac disease and pregnancy The incidence of heart disease during pregnancy in the UK has remained constant at over several decades 1 . However the recent UK Confidential Enquiries into Maternal and Child Health identified cardiac disease as the commonest cause of maternal death with a maternal mortality rate in the triennium 2006 2008 of per million maternities up from per million in the 1987 1990 Expert comment enquiry 2 . When unaccompanied by any There has been a progressive decline in deaths related to congenital cardiac disease Table with other abnormality an ejection acquired cardiac diseases such as myocardial infarction cardiomyopathy and aortic dissection leading .