Asthma is a chronic inflammatory disease of the airways that is characterized by increased responsiveness of the tracheobronchial tree to multiple stimuli and is the most common chronic condition in pregnancy. The pathophysiology of asthma is complex and involves airway inflammation, intermittent airflow obstruction, and bronchial hyperresponsiveness. The disease is episodic, being characterized by acute exacerbations intermingled with symptom-free periods. Most asthma attacks prove to be short-lived, lasting minutes to hour.
Viral hepatitis is the leading cause of liver inflammation and liver cancer requiring transplantation, which can affect pregnant people also. There are six identified viral hepatitis—A, B, C, D, E, G. Each varies in its epidemiology, clinical course, and long-term sequelae. Important considerations in pregnancy include the degree of liver inflammation, risk of fulminant hepatitis, vertical transmission risk, treatment, and prevention. Most acute infections are subclinical. Hepatitis A virus (HAV) and hepatitis E virus (HEV) are important causes of maternal infections in endemic regions, and HEV can be associated with considerable maternal morbidity and mortality. Hepatitis D virus (HDV) is an incomplete virus that when co-infected with hepatitis B virus (HBV) can cause disease that is more severe and can lead to fulminant hepatic necrosis.
Hormonal and mechanical changes can promote urinary stasis and vesicoureteral reflux. These changes, along with an already short urethra (approximately 3-4 cm in females) and difficulty with hygiene due to a distended pregnant belly, help make UTIs the most common bacterial infections during pregnancy. Untreated bacteriuria, during pregnancy, is associated with risks to both the fetus and the mother, including pyelonephritis, preterm birth, low birth weight, and increased perinatal mortality. Pregnant patients are considered immunocompromised UTI hosts because of the physiologic changes associated with pregnancy.
Concerns during these pregnancies include the risk of fetal malformation, miscarriage, perinatal death, and increased seizure frequency. In pregnant women, the volume of distribution and the hepatic metabolism of antiepileptic drugs (AEDs) are increased. This, along with decreased compliance with AEDs because of concerns about their effects on the fetus, leads to an increase in seizure frequency, which is observed in as many as 17-33% of pregnancies.
Pregnant women are commonly diagnosed with Thrombocytopenia, or a low blood platelet count, because screening is done as part of the initial clinical evaluation with automated blood counts. Thrombocytopenia can result from a wide range of conditions, with several of them related to pregnancy. Platelets are nonnucleated cells derived from megakaryocytes in the bone marrow and normally live in the peripheral circulation for as long as 10 days. Platelets play a critical initiating role in the hemostatic system.
Pregnancy increases the risk of venous thromboembolism (VTE) 4- to 5-fold over that in the non-pregnant state. The two manifestations of VTE are deep venous thrombosis (DVT) and pulmonary embolus (PE), which include complications such as pulmonary hypertension, post-thrombotic syndrome, and venous insufficiency. Although most reports suggest that VTE can occur at any trimester in pregnancy, studies suggest that VTE is more common during the first half of pregnancy.
Pregnancy is a state that conveys 4-5 times the risk of venous thromboembolism.
Acute abdomen in the case of a pregnant patient with acute abdomen is a clinical scenario that overlaps specialties. Acute Abdomen is defined as any serious acute intra-abdominal condition attended by pain, tenderness, and muscular rigidity, and for which emergency surgery must be considered
Adrenal disease, including disorders such as congenital adrenal hyperplasia (CAH), Addison disease, Cushing syndrome, pheochromocytoma, and primary hyperaldosteronism, can reduce female fertility or severely impact maternal and fetal health during pregnancy.
Antiphospholipid syndrome (APS) is an autoimmune disorder that is associated with pregnancy complications, including preeclampsia, thrombosis, autoimmune thrombocytopenia, fetal growth restriction, and fetal loss. Depending on its association with other autoimmune disorders, this is classified as Primary APS, diagnosed in patients demonstrating the clinical and laboratory criteria for the disease without other recognized autoimmune disease and Secondary APS.
In any normal pregnancy, blood volume increases, which results in a concomitant hemodilution. Although red blood cell (RBC) mass increases during pregnancy, plasma volume increases more, resulting in a relative anemia which results in a physiologically lowered hemoglobin (Hb) level, hematocrit (Hct) value, and RBC count, but it has no effect on the mean corpuscular volume (MCV). In an iron-replete population, anemia defined as a value less than the fifth percentile is a hemoglobin level of 11 g/dL or less in the first trimester, 10. 5 g/dL or less in the second trimester, and 11 g/dL or less in the third trimester.
Thyroid disorders are the second most common endocrinologic disorders found in pregnancy. With Overt hypothyroidism estimated to occur in 0.3-0.5% of pregnancies, Subclinical hypothyroidism in 2-3%, Hyperthyroidism is present in 0.1-0.4%. Graves disease accounts for more than 85%, whereas Hashimoto thyroiditis is the most common cause of hypothyroidism.
Bacterial infections can affect pregnant women from implantation of the fertilized ovum through the time of delivery and peripartum period. This may also affect the fetus and newborn.
Cardiovascular Disease is one of the leading causes of death during pregnancy and the postpartum period. Profound changes occur in the maternal circulation that have the potential to adversely affect maternal and fetal health, especially in the presence of underlying heart conditions.