[醫如往常] Senior Clerkship Day 21: Ob/Gyn Preeclampsia

Grand round cases

Hypercoiled cord

Termination

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Beta thalassemia Chromosome 11p15.5

Alpha thalassemia Chromosome16p13.3

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FAP familial adenomatous polyps

APC gene

AD 5q21-22 tumor suppressor gene

Colon cancer average 39 yo

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Double balanced translocation

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楊醫師 禾馨新生院長

Toxemia, preeclampsia 妊娠毒血症

FMH fetal Medicine foundation

Perinatologist: Maternal–fetal medicine (MFM)

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Down syndrome

Ultrasound soft marker (week 11-14)

• Nuchal translucency related to congenital heart disease
• Nasal bone
• Ductus venosus
• Tricuspid regurgitation in week 8

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NIPS; non invasive Prenatal Testing

cfDNA; Cell free DNA

NIFTY test; Non-invasive fetal trisomy test

NIPT; Non-Invasive Prenatal Testing

NIPD; Non-invasive prenatal diagnosis

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Amniocentesis

0.1% complications

PROM, abortion at week 12

NTUH從古自今兩例產婦死亡 

柯教授診所一個月做一千次

(5000-8000元)

國健局補助5000元

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Microdeletion syndrome

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Preterm labor syndrome

7% before week 37

0.7% before week 30

Check Cervical length at week 18-22

T→Y→V→U shape

<2cm preterm risk↑

Cervical incontinence→do McDonald surgery

Fetal fibronectin (fFN)

Week 22-35 positive 早產機率很高

High negative predictive rate

Negative保證不會早產

99.9% within 1 week

99.5% within 2 weeks

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Preeclampsia

Week 12 早期評估, week 24 晚期評估

Uterine artery PI index > 2.5

High resistance, high risk

隨著週數應該要變小

Low PLGF, High risk

Low dose aspirin, decrease 80% risk

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Preeclampsia戴總醫師

CC: 頭痛，腳腫，血壓高, blurred vision, nocturia

Red flag: blurred vision, headache

Aminocentasis ≥34 yo, 國健局補助, week 16-18

Hypertension 140/90

High degree Hypertension 160/110

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小心中風

Mg neuroperection

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D-dimer, predictive of HELLP syndrome

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Creatinine delay

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Uterine artery Doppler

sFT1

PIGF

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Placental grade 3 >39 week

Calcification

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