Managing Chickenpox in Pregnancy: Treatment and Care

Chickenpox is a common childhood disease caused by the varicella-zoster virus. When a pregnant woman contracts chickenpox, it can have detrimental effects on the fetus. However, with proper management and care, the risk of complications can be minimized.

Oral acyclovir is recommended for pregnant women who develop chickenpox within 24 hours of the rash appearing and are at or over 20 weeks’ gestation. Symptomatic relief, such as adequate fluid intake, wearing light cotton clothing, and using paracetamol or soothing moisturizers, can also help alleviate discomfort.

Immediate admission to secondary care is necessary for women with severe symptoms, immunosuppression, haemorrhagic rash, or neurological or respiratory symptoms. Women with mild disease can be cared for in the community and should avoid contact with susceptible individuals until the rash has crusted over.

An immediate fetal growth scan is not necessary unless there are other obstetric indications or concerns. Women who develop chickenpox in pregnancy should have a fetal growth scan at least 5 weeks after the primary infection to detect any possible fetal defects.

Varicella immunisation is not useful in this scenario, as it is a method of passive protection against chickenpox and not a treatment. Termination of pregnancy is not indicated for chickenpox in pregnancy, but the patient should be informed of the risks to the fetus and possible congenital abnormalities.

Overall, proper management and care can help minimize the risk of complications from chickenpox in pregnancy. It is important for pregnant women to seek medical care if symptoms worsen or if there are any concerns.

If the foetus is in a breech position at 36 weeks, it is recommended to undergo external cephalic version. However, before 36 weeks, the foetus may naturally move into the correct position, making the procedure unnecessary. It is not necessary to schedule a Caesarean section immediately, but if ECV is unsuccessful, a decision must be made regarding the risks of a vaginal delivery with a breech presentation or a Caesarean section.

Breech presentation occurs when the caudal end of the fetus is in the lower segment, and it is more common at 28 weeks than near term. Risk factors include uterine malformations, placenta praevia, and fetal abnormalities. Management options include spontaneous turning, external cephalic version (ECV), planned caesarean section, or vaginal delivery. The RCOG recommends informing women that planned caesarean section reduces perinatal mortality and early neonatal morbidity, but there is no evidence that the long-term health of babies is influenced by how they are born. ECV is contraindicated in certain cases, such as where caesarean delivery is required or there is an abnormal cardiotocography.

Screening for Hepatitis C is not a standard practice during pregnancy, as per NICE guidelines, due to insufficient evidence of its clinical and cost-effectiveness. However, screening for Hepatitis B is conducted during the booking appointment to reduce the risk of mother-child transmission through post-natal interventions. While chlamydia screening is not routinely offered in antenatal care, individuals under 25 years of age are provided with information about their local National Chlamydia Screening Programme, given the higher prevalence of chlamydia in this age group. There is currently no regular screening programme for Group B streptococcus in the UK.

Antenatal Screening Policy

Antenatal screening is an important aspect of prenatal care that helps identify potential health risks for both the mother and the developing fetus. The National Screening Committee (NSC) has recommended a policy for antenatal screening that outlines the conditions for which all pregnant women should be offered screening and those for which screening should not be offered.

The NSC recommends that all pregnant women should be offered screening for anaemia, bacteriuria, blood group, Rhesus status, and anti-red cell antibodies, Down’s syndrome, fetal anomalies, hepatitis B, HIV, neural tube defects, risk factors for pre-eclampsia, syphilis, and other conditions depending on the woman’s medical history.

However, there are certain conditions for which screening should not be offered, such as gestational diabetes, gestational hypertension, and preterm labor. These conditions are typically managed through regular prenatal care and monitoring.

It is important for pregnant women to discuss their screening options with their healthcare provider to ensure that they receive appropriate care and support throughout their pregnancy. By following the NSC’s recommended policy for antenatal screening, healthcare providers can help identify potential health risks early on and provide appropriate interventions to ensure the best possible outcomes for both mother and baby.

A first-degree perineal tear typically does not need suturing.

In the case of this woman, she has a first-degree perineal tear that only affects the surface of the perineum and does not involve any muscles. Therefore, no repair is necessary as these types of tears usually heal on their own.

The answer glue on the ward is incorrect because first-degree perineal tears do not require closure and should be left to heal naturally. Additionally, glue is not suitable for use in the perineal area and is only appropriate for small, straight, superficial, low-tension wounds.

Similarly, staples in theatre is also incorrect as first-degree perineal tears do not require repair and will heal on their own. Staples are not recommended for use in the perineal region.

The answer suture in theatre is also incorrect as first-degree perineal tears typically do not require suturing and can be left to heal on their own. If suturing is necessary for a first-degree tear, it can be done on the ward by a trained practitioner. Only third or fourth-degree tears require repair in a theatre setting under regional or general anaesthesia.

Perineal tears are a common occurrence during childbirth, and the Royal College of Obstetricians and Gynaecologists (RCOG) has developed guidelines to classify them based on their severity. First-degree tears are superficial and do not require any repair, while second-degree tears involve the perineal muscle and require suturing by a midwife or clinician. Third-degree tears involve the anal sphincter complex and require repair in theatre by a trained clinician, with subcategories based on the extent of the tear. Fourth-degree tears involve the anal sphincter complex and rectal mucosa and also require repair in theatre by a trained clinician.

There are several risk factors for perineal tears, including being a first-time mother, having a large baby, experiencing a precipitant labour, and having a shoulder dystocia or forceps delivery. It is important for healthcare providers to be aware of these risk factors and to provide appropriate care and management during childbirth to minimize the risk of perineal tears. By following the RCOG guidelines and providing timely and effective treatment, healthcare providers can help ensure the best possible outcomes for both mother and baby.

Misoprostol is a synthetic E1 prostaglandin that can be used for various obstetric purposes, including medical termination of pregnancy, induction of labor, and medical management of miscarriage. It works by inducing contractions in the myometrium to expel the products of conception and ripening and dilating the cervix. However, it can cause side effects such as diarrhea, nausea, vomiting, flatulence, and headaches, and in rare cases, uterine rupture. In the case of a miscarriage, expectant management is the first-line option, but medical or surgical management may be necessary in certain situations. Vaginal misoprostol is the most commonly used medical management, and patients should be informed of the potential risks and given appropriate pain relief and antiemetics. Surgical management is not first-line and carries risks such as perforation of the uterus, failure of the procedure, infection, bleeding, damage to the cervix, and venous thromboembolism. Expectant management should be offered and reviewed after 7-14 days, and if bleeding and pain settle, no further treatment is necessary. Mifepristone, an antiprogesterone medication, should not be used in the management of a missed or incomplete miscarriage.

A category 2 caesarean section is the best management for a woman with an undiagnosed breech birth in labour who is not fully dilated. The decision to perform the caesarean section should be made within 75 minutes and the procedure should be arranged accordingly. Adopting an all-fours position or attempting external cephalic version with enhanced monitoring are not appropriate in this case. McRoberts manoeuvre is also not the correct management for breech birth.

Caesarean Section: Types, Indications, and Risks

Caesarean section, also known as C-section, is a surgical procedure that involves delivering a baby through an incision in the mother’s abdomen and uterus. In recent years, the rate of C-section has increased significantly due to an increased fear of litigation. There are two main types of C-section: lower segment C-section, which comprises 99% of cases, and classic C-section, which involves a longitudinal incision in the upper segment of the uterus.

C-section may be indicated for various reasons, including absolute cephalopelvic disproportion, placenta praevia grades 3/4, pre-eclampsia, post-maturity, IUGR, fetal distress in labor/prolapsed cord, failure of labor to progress, malpresentations, placental abruption, vaginal infection, and cervical cancer. The urgency of C-section may be categorized into four categories, with Category 1 being the most urgent and Category 4 being elective.

It is important for clinicians to inform women of the serious and frequent risks associated with C-section, including emergency hysterectomy, need for further surgery, admission to intensive care unit, thromboembolic disease, bladder injury, ureteric injury, and death. C-section may also increase the risk of uterine rupture, antepartum stillbirth, placenta praevia, and placenta accreta in subsequent pregnancies. Other complications may include persistent wound and abdominal discomfort, increased risk of repeat C-section, readmission to hospital, haemorrhage, infection, and fetal lacerations.

Vaginal birth after C-section (VBAC) may be an appropriate method of delivery for pregnant women with a single previous C-section delivery, except for those with previous uterine rupture or classical C-section scar. The success rate of VBAC is around 70-75%.

Understanding Miscarriage: Types and Recurrence Rates

Miscarriage is a common experience for many women, but it can still be a difficult and emotional event. It is defined as any pregnancy loss that occurs before 24 weeks of gestation. There are several types of miscarriage, including threatened, inevitable, incomplete, complete, missed, anembryonic, septic, and recurrent. Recurrent miscarriage, which is defined as three or more consecutive losses, is a particular concern for many women. The risk of recurrence is important to consider when offering parental counseling, as it can impact the chances of a successful pregnancy. For women without specific cause for recurrence, the percentage chance of a live birth in a subsequent pregnancy decreases with each miscarriage: 85% after one, 75% after two, and 60% after three. It’s important to remember that while miscarriage can be distressing, the chances of a successful pregnancy increase with each attempt.

– First degree: a tear that only affects the vaginal mucosa
– Second degree: a tear that extends into the subcutaneous tissue
– Third degree: a laceration that reaches the external anal sphincter
– Fourth degree: a laceration that goes through the external anal sphincter and reaches the rectal mucosa

Perineal tears are a common occurrence during childbirth, and the Royal College of Obstetricians and Gynaecologists (RCOG) has developed guidelines to classify them based on their severity. First-degree tears are superficial and do not require any repair, while second-degree tears involve the perineal muscle and require suturing by a midwife or clinician. Third-degree tears involve the anal sphincter complex and require repair in theatre by a trained clinician, with subcategories based on the extent of the tear. Fourth-degree tears involve the anal sphincter complex and rectal mucosa and also require repair in theatre by a trained clinician.

There are several risk factors for perineal tears, including being a first-time mother, having a large baby, experiencing a precipitant labour, and having a shoulder dystocia or forceps delivery. It is important for healthcare providers to be aware of these risk factors and to provide appropriate care and management during childbirth to minimize the risk of perineal tears. By following the RCOG guidelines and providing timely and effective treatment, healthcare providers can help ensure the best possible outcomes for both mother and baby.

Epidural anaesthesia is contraindicated in labour only if the patient has coagulopathy. Other than that, epidural anaesthesia is a highly effective method for pain management during labour. In fact, it is one of the regional anaesthetic techniques available, with non-regional techniques being more commonly used. Non-regional techniques include inhaled nitrous oxide and systemic analgesics like pethidine. However, epidural anaesthesia has been associated with longer labour and increased operative vaginal delivery. There is no evidence to suggest that epidural analgesia increases the risk of Caesarean delivery or post-partum backache. For more information, refer to the Epidural Analgesia in Labour guideline.

Understanding Labour and its Stages

Labour is the process of giving birth, which is characterized by the onset of regular and painful contractions that are associated with cervical dilation and descent of the presenting part. Signs of labour include regular and painful uterine contractions, a show (shedding of mucous plug), rupture of the membranes (not always), and shortening and dilation of the cervix.

Labour can be divided into three stages. The first stage starts from the onset of true labour to when the cervix is fully dilated. The second stage is from full dilation to delivery of the fetus, while the third stage is from delivery of the fetus to when the placenta and membranes have been completely delivered.

Monitoring is an essential aspect of labour. Fetal heart rate (FHR) should be monitored every 15 minutes (or continuously via CTG), contractions should be assessed every 30 minutes, maternal pulse rate should be assessed every 60 minutes, and maternal blood pressure and temperature should be checked every 4 hours. Vaginal examination (VE) should be offered every 4 hours to check the progression of labour, and maternal urine should be checked for ketones and protein every 4 hours.

In summary, understanding the stages of labour and the importance of monitoring can help ensure a safe and successful delivery.

Continuous CTG monitoring is recommended during labour if any of the following conditions are present or develop: suspected chorioamnionitis or sepsis, a temperature of 38°C or higher, severe hypertension with a reading of 160/110 mmHg or above, use of oxytocin, or significant meconium. In addition, the 2014 update to the guidelines added fresh vaginal bleeding as a new point of concern, as it may indicate placental rupture or placenta previa, both of which require monitoring of the baby.

Cardiotocography (CTG) is a medical procedure that measures pressure changes in the uterus using either internal or external pressure transducers. It is used to monitor the fetal heart rate, which normally ranges between 100-160 beats per minute. There are several features that can be observed during a CTG, including baseline bradycardia (heart rate below 100 beats per minute), which can be caused by increased fetal vagal tone or maternal beta-blocker use. Baseline tachycardia (heart rate above 160 beats per minute) can be caused by maternal pyrexia, chorioamnionitis, hypoxia, or prematurity. Loss of baseline variability (less than 5 beats per minute) can be caused by prematurity or hypoxia. Early deceleration, which is a decrease in heart rate that starts with the onset of a contraction and returns to normal after the contraction, is usually harmless and indicates head compression. Late deceleration, on the other hand, is a decrease in heart rate that lags behind the onset of a contraction and does not return to normal until after 30 seconds following the end of the contraction. This can indicate fetal distress, such as asphyxia or placental insufficiency. Variable decelerations, which are independent of contractions, may indicate cord compression.