Pre-existing medical conditions and pregnancy

1. Big picture

Pre-existing medical conditions and pregnancy means chronic maternal diseases that are already present before conception and may affect pregnancy, fetal development, delivery, anesthesia, postpartum recovery, and long-term maternal health.

The key exam idea is:

Pregnancy is a physiological stress test. A disease that is stable outside pregnancy may decompensate during pregnancy.

The correct oral-exam approach is always:

Pre-existing maternal disease
        ↓
Preconception counselling if possible
        ↓
Optimize disease control before pregnancy
        ↓
Stop teratogenic drugs / switch to pregnancy-safe drugs
        ↓
Risk-stratify mother and fetus
        ↓
Multidisciplinary antenatal surveillance
        ↓
Plan timing, place, and mode of delivery
        ↓
Postpartum monitoring and contraception counselling

The most important sentence:

Good maternal disease control before conception is one of the best ways to prevent congenital anomalies, miscarriage, fetal growth problems, preterm birth, stillbirth, and maternal decompensation.

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