بالمقابل أكو مرض ثاني يسموه Charcot-Marie-Tooth disease
يعتبر أكثر مرض عصبي وراثي شيوعًا:

The foot of Charcot vs Charcot-Marie-tooth
*وحدة عكس اللخ*

A condition of protracted nausea and vomiting of pregnancy with the triad of more than 5% prepregnancy weight loss, dehydration and electrolyte imbalance.

Risk factors:

- Multiple pregnancy
- Nulliparity
- Obesity
- Metabolic disturbances
- History of HG in a previous pregnancy
- Trophoblastic disorders
- Psychological disorders
- History of migraine

Thus fetal growth restriction may occur, maternal hyponatraemia, thiamine deficiency which leads to Wernicke's encephalopathy, kidney failure, central pontine myelinolysis (CPM), stroke, vasospasms of cerebral arteries, seizures, coagulopathy, hypoglycemia, and Mallory-Weiss tears which may cause haematemesis.

There are many conditions may cause NVP:
UTI, DKA, Thyrotoxicosis, Addison, pyelonephritis, hepatitis, preeclampsia, migraine, vestibular diseases and others.
So according to that we should do appropriate tests for exclusion.
Those tests include: Urinalysis, Random blood sugar, Serum electrolytes, Liver function tests, Serum amylase, and even US to exclude H.mole and multiple pregnancy.

Actually—and paradoxically—FGR is not a complication of HG.

And CPM is not a direct complication of it. It's an iatrogenic injury that results in correcting sodium levels too quickly

شنو NVP؟...

دور عليها…

دكتبي الاختصار مال شنو يالله

Maternal metabolism changes substantially during pregnancy. Early gestation can be viewed as an anabolic state in the mother with an increase in maternal fat stores and small increases in insulin sensitivity. Hence, nutrients are stored in early pregnancy to meet the feto-placental and maternal demands of late gestation and lactation. In contrast, late pregnancy is better characterized as a catabolic state with decreased insulin sensitivity (increased insulin resistance). An increase in insulin resistance results in increases in maternal glucose and free fatty acid concentrations, allowing for greater substrate availability for fetal growth.

Shoulder dystocia
Is the impaction of the anterior fetal shoulder against the symphysis pubis after delivery of the head.

It is detected early by observing the head tightly pulled back against the perineum, this is called “Turtle sign”.

Management

HELPERR
H: call for help
E: evaluation for episiotomy
L: legs (McRobers maneuver)
- hyperflexion of the hips
-abduction of hips
- flexion of the knees.
P: external pressure on the suprapubic area.
E: enter “rotational maneuver”
R: remove posterior arm (deliver it)
R: roll the mother on her all fours ( hands and knees).

If all above procedures failed :
- Symphysiotomy
- fetal clavicle fracture
- Zavanelli maneuver ( push the head inside the uterus and proceed with emergency caesarean.

اتذكر الدكتورة گالت اذا مات الطفل نگص راسة ونطلع الباقي بالـ caesarean

Diagram of subdural haematoma

Antero-posterior radiogram of the skull. A bilateral chronic subdural haematoma has been evacuated through two burr holes. Air has entered through these and revealed the bilateral depression on the convexity of cerebral hemispheres produced by the two haematomas.