By Kelly, Claire; Clifford, Amie; Yau, Christopher; Hallam, Sally
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Fetal/neonatal: – Hypothyroidism: k intellectual and growth impairment during childhood; this is usually due to maternal iodine deficiency. – Hyperthyroidism: k neonatal thyrotoxicosis (rare); this may occur if maternal thyroid-stimulating antibodies cross the placenta; k tachycardia; k prematurity; k stillbirth. = Investigations: = Maternal: – thyroid-stimulating hormone (TSH); – FT4 and FT3 (free thyroid hormone) levels; – TSH, FT4 and FT3 may need to be checked each trimester in women already on thyroid medication.
Risk factors for GBS infection in neonates: = previous baby affected by GBS; = GBS detected in the urine during current pregnancy. 388C). Complications: = Fetal/perinatal/neonatal: – Neonatal GBS infection: k septicaemia; k pneumonia; k meningitis. Diagnosis: = vaginal/rectal swabs. Management: = routine screening is not recommended; = if GBS is detected incidentally 0 consider intra-partum penicillin prophylaxis; = if previous baby affected by GBS infection 0 offer intra-partum penicillin prophylaxis; = use clindamycin if the woman is allergic to penicillin.
Progression of existing retinopathy. – Nephropathy. – Caesarean section/instrumental delivery. – Difficult labour. 2 Endocrine conditions 23 MICRO-facts Maternal glucose is able to cross the placenta and enter the fetal circulation, but maternal insulin cannot. = Fetal/neonatal: – Congenital abnormalities: k neural tube defects; k heart defects. – Pre-term labour. – Reduced fetal lung maturity. – Macrosomia (see Fig. 1): k ‘large baby’. Increased blood glucose in fetal cirulation Hyperinsulinaemia in fetal circulation Increased fetal fat deposition Macrosomia Further complications: Shoulder dystocia Polyhydramnios Caesarean section Fig.