This document discusses myomas (uterine fibroids). It notes that myomas are benign smooth muscle tumors that originate in the uterus and are sensitive to estrogen and progesterone. Symptoms can include bleeding, pain, pressure, and infertility. Diagnosis is usually made through imaging like ultrasound or MRI. Treatment options include observation, drug therapy, uterine artery embolization, or surgical removal of the fibroids. The document also discusses complications that can arise if fibroids are present during pregnancy, such as pain, bleeding, preterm birth, and pregnancy loss.
Chorioamnionitis and PROM - Nahrain UniversityAli Al-Shimmary
Chorioamnionitis is an inflammation of the fetal membranes caused by bacterial infection, usually ascending from the vagina during prolonged labor. It complicates 1-4% of births in the US and 40-70% of preterm births following premature rupture of membranes or spontaneous labor. Risk factors include prolonged rupture of membranes, prolonged labor, nulliparity, smoking, and bacterial vaginosis. Diagnosis is based on maternal fever, uterine tenderness, and fetal tachycardia. Treatment involves intravenous antibiotics until delivery. Complications for both mother and fetus include sepsis, pneumonia, and cerebral palsy. Premature rupture of membranes can occur preterm or at term and increases risks of infection, cord prolapse
1) The use of tocolytic drugs is associated with prolonging pregnancy up to 7 days but does not significantly impact preterm birth rates or neonatal outcomes.
2) Tocolysis should only be considered if delaying birth will allow for completing a course of corticosteroids or in utero transfer to another hospital.
3) Nifedipine and atosiban are effective tocolytic options, with fewer maternal side effects than beta-agonists, though long-term neonatal outcomes remain unclear for all tocolytic drugs.
This document discusses management considerations for pregnancies following previous caesarean sections. It finds that pregnancies after a previous classical/hysterotomy scar carry a higher risk of uterine rupture compared to those with a previous lower segment transverse scar. For classical scars, an elective repeat caesarean is recommended at 38 weeks. Those with a previous lower segment scar can attempt a vaginal birth after caesarean (VBAC) if certain criteria are met, like a prior nonrecurring indication and adequate monitoring resources. Strict monitoring during labour is needed for all previous scar pregnancies to detect any signs of scar rupture.
The document provides an outline and content for a seminar on the management of abnormal labor and use of the partograph. It discusses the definition of normal versus abnormal labor and covers various etiologies of abnormal labor including abnormal patterns of labor, abnormalities of the birth canal or passenger, and abnormalities of uterine contractions. Specific abnormal labor patterns like prolonged latent phase, protraction disorders, arrest disorders, and precipitate labor are defined and their causes and management described. The document also reviews assessing and managing other abnormalities that can complicate labor such as cephalopelvic disproportion, fetal malpositions and malpresentations.
Venous thromboembolism is a major cause of maternal mortality. Pregnancy increases the risk of deep vein thrombosis due to physiological changes that cause venous stasis and a hypercoagulable state. The risk is highest in the antenatal period and after cesarean delivery. Diagnosis involves Doppler ultrasound or CT scan and treatment involves low molecular weight heparin for at least 6 weeks. Prevention through thromboprophylaxis is recommended for women with prior VTE or thrombophilia.
This document discusses previous cesarean delivery and a woman's options for her current pregnancy. It outlines the risks and benefits of an elective repeat cesarean section (ERCS) versus a trial of labor after cesarean (TOLAC), which could result in a vaginal birth after cesarean (VBAC). Key factors that influence the likelihood of a successful VBAC are described, such as the number and type of previous c-sections, prior vaginal delivery, and inter-delivery interval. Guidelines for candidacy and contraindications for TOLAC are provided. Continuous fetal monitoring and careful assessment of labor progress are recommended for women attempting VBAC.
Immune hydrops fetalis is a condition where excess fluid builds up in fetal tissues due to maternal antibodies destroying fetal red blood cells. It can be caused by Rh incompatibility between mother and fetus. The excess hemolysis of fetal red blood cells leads to anemia, liver and spleen damage, heart failure and fluid buildup. Ultrasound is used to diagnose hydrops fetalis by detecting fluid in two fetal compartments. Treatment involves monitoring the fetus and performing intrauterine blood transfusions if needed to improve fetal hemoglobin levels and resolve hydrops. Routine Rh immunoprophylaxis can prevent Rh sensitization and immune hydrops in subsequent pregnancies.
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
Chorioamnionitis and PROM - Nahrain UniversityAli Al-Shimmary
Chorioamnionitis is an inflammation of the fetal membranes caused by bacterial infection, usually ascending from the vagina during prolonged labor. It complicates 1-4% of births in the US and 40-70% of preterm births following premature rupture of membranes or spontaneous labor. Risk factors include prolonged rupture of membranes, prolonged labor, nulliparity, smoking, and bacterial vaginosis. Diagnosis is based on maternal fever, uterine tenderness, and fetal tachycardia. Treatment involves intravenous antibiotics until delivery. Complications for both mother and fetus include sepsis, pneumonia, and cerebral palsy. Premature rupture of membranes can occur preterm or at term and increases risks of infection, cord prolapse
1) The use of tocolytic drugs is associated with prolonging pregnancy up to 7 days but does not significantly impact preterm birth rates or neonatal outcomes.
2) Tocolysis should only be considered if delaying birth will allow for completing a course of corticosteroids or in utero transfer to another hospital.
3) Nifedipine and atosiban are effective tocolytic options, with fewer maternal side effects than beta-agonists, though long-term neonatal outcomes remain unclear for all tocolytic drugs.
This document discusses management considerations for pregnancies following previous caesarean sections. It finds that pregnancies after a previous classical/hysterotomy scar carry a higher risk of uterine rupture compared to those with a previous lower segment transverse scar. For classical scars, an elective repeat caesarean is recommended at 38 weeks. Those with a previous lower segment scar can attempt a vaginal birth after caesarean (VBAC) if certain criteria are met, like a prior nonrecurring indication and adequate monitoring resources. Strict monitoring during labour is needed for all previous scar pregnancies to detect any signs of scar rupture.
The document provides an outline and content for a seminar on the management of abnormal labor and use of the partograph. It discusses the definition of normal versus abnormal labor and covers various etiologies of abnormal labor including abnormal patterns of labor, abnormalities of the birth canal or passenger, and abnormalities of uterine contractions. Specific abnormal labor patterns like prolonged latent phase, protraction disorders, arrest disorders, and precipitate labor are defined and their causes and management described. The document also reviews assessing and managing other abnormalities that can complicate labor such as cephalopelvic disproportion, fetal malpositions and malpresentations.
Venous thromboembolism is a major cause of maternal mortality. Pregnancy increases the risk of deep vein thrombosis due to physiological changes that cause venous stasis and a hypercoagulable state. The risk is highest in the antenatal period and after cesarean delivery. Diagnosis involves Doppler ultrasound or CT scan and treatment involves low molecular weight heparin for at least 6 weeks. Prevention through thromboprophylaxis is recommended for women with prior VTE or thrombophilia.
This document discusses previous cesarean delivery and a woman's options for her current pregnancy. It outlines the risks and benefits of an elective repeat cesarean section (ERCS) versus a trial of labor after cesarean (TOLAC), which could result in a vaginal birth after cesarean (VBAC). Key factors that influence the likelihood of a successful VBAC are described, such as the number and type of previous c-sections, prior vaginal delivery, and inter-delivery interval. Guidelines for candidacy and contraindications for TOLAC are provided. Continuous fetal monitoring and careful assessment of labor progress are recommended for women attempting VBAC.
Immune hydrops fetalis is a condition where excess fluid builds up in fetal tissues due to maternal antibodies destroying fetal red blood cells. It can be caused by Rh incompatibility between mother and fetus. The excess hemolysis of fetal red blood cells leads to anemia, liver and spleen damage, heart failure and fluid buildup. Ultrasound is used to diagnose hydrops fetalis by detecting fluid in two fetal compartments. Treatment involves monitoring the fetus and performing intrauterine blood transfusions if needed to improve fetal hemoglobin levels and resolve hydrops. Routine Rh immunoprophylaxis can prevent Rh sensitization and immune hydrops in subsequent pregnancies.
Preterm labor is the labor that starts before the 37th completed week. In this presentation, we will discover causes, pathogenesis, diagnosis, clinical features, and management principles for preterm labor along with the most recent evidence.
This document discusses chorioamnionitis (intra-amniotic infection), including its pathogenesis, risk factors, clinical findings, diagnosis, and evaluation. Chorioamnionitis occurs when pathogens ascend from the vagina and infect the amniotic fluid and fetal membranes. It complicates 40-70% of preterm births and 1-4% of term births. Diagnosis is based on maternal fever and may include leukocytosis, fetal tachycardia, and uterine tenderness. Evaluation of amniotic fluid can confirm infection through culture, Gram stain, or glucose/white blood cell counts. Histologic examination after birth also helps diagnosis.
This document discusses the management of Rh negative mothers during pregnancy. It begins by providing background on the Rh factor and genetics. It then explains the pathophysiology of isoimmunization that can occur when an Rh negative mother carries an Rh positive baby. The remainder of the document outlines the careful management and monitoring required during pregnancy, including prophylactic anti-D injections, Doppler ultrasound scans of the fetus, potential invasive procedures, timing of delivery, and neonatal care. The goal is to prevent sensitization of the mother and complications for the fetus like anemia.
This document discusses trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section for women with a prior cesarean delivery. It notes that 60-80% of women who attempt TOLAC will have a successful vaginal birth. The risks of TOLAC include uterine rupture, failed trial of labor requiring emergency cesarean, and slightly increased risk of complications for the baby. The risks of elective repeat cesarean include increased risks for placenta problems and complications in future pregnancies. The document provides an overview of the risks, benefits, and success rates to help women decide which option is safest for their individual situation.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
Acute abdomen in pregnancy poses diagnostic and therapeutic challenges due to physiological changes and a need to minimize risk to the fetus. Common causes include appendicitis, cholecystitis, intestinal obstruction, and other non-obstetric issues. A thorough history, physical exam, and focused imaging are important for diagnosis. Treatment priorities include resuscitation, antibiotics if indicated, and timely surgery if conservative measures fail or the fetus is compromised. Laparoscopic and open surgical techniques can both be used to manage many conditions while minimizing risks. Multidisciplinary care is important for optimal maternal and fetal outcomes.
Cervical insufficiency, also known as cervical incompetence, is a condition where the cervix is unable to retain a pregnancy at term due to a functional or structural defect. It is characterized by painless dilatation of the cervix resulting in premature rupture of membranes and delivery, usually occurring in the second or third trimester. Cervical cerclage procedures aim to surgically suture the cervix closed to prevent premature opening. There are several techniques for cervical cerclage placement depending on the location and indication, including McDonald, Shirodkar, emergency/rescue cerclages, and pessary or balloon alternatives. Cerclage procedures can be done through the vagina or abdomen depending
Abnormal labor or dystocia can be caused by problems with uterine contractions (uterine dysfunction), issues with the baby's size or position (fetopelvic disproportion), or a narrow pelvis (contracted pelvis). Common types include protracted or arrested dilation, shoulder dystocia, and breech presentation. Obstructed labor occurs when progress stalls despite adequate contractions, typically due to a mechanical obstruction, and can lead to serious maternal complications if not addressed. Management may involve resuscitation, expedited delivery depending on fetal/maternal status, and transfer to a higher level facility for those in advanced labor.
Venous Thromboembolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE). Pregnancy is a risk factor for VTE due to physiological changes in the coagulation system that promote clotting. The risk is highest in the first trimester through 6 weeks postpartum. Management involves risk assessment, diagnosis, anticoagulation therapy like heparin, prevention through prophylaxis for high risk women, and consideration of risk factors when stopping treatment.
Uterine fibroids are benign smooth muscle tumors of the uterus that are very common. They occur in around 30% of women over 30 years of age. Symptoms include heavy bleeding, pelvic pressure, pain, and infertility. Treatment options depend on symptoms and desire for future fertility, and include medical management, myomectomy (surgical removal of fibroids), hysterectomy (removal of the uterus), uterine artery embolization, and newer minimally invasive procedures such as focused ultrasound and radiofrequency ablation. Complications can arise from degenerative changes, vascular changes, inflammation, or rarely malignant changes within the fibroids.
The document provides an overview of common gynecological complaints and anatomical variations seen in pediatric and adolescent patients. It describes the normal development of the genitalia from birth through puberty and lists various congenital anomalies such as imperforate hymen, transverse vaginal septum, and uterine abnormalities. Common complaints addressed include vulvovaginitis, labial agglutination, trauma, and foreign bodies. Evaluation and treatment approaches are also discussed.
This document provides guidelines for urinary tract infections (UTIs) during pregnancy. It discusses that UTIs are the most common medical complications of pregnancy and are associated with risks like preterm delivery. It outlines recommendations for screening, diagnosing, and treating asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis during pregnancy. Treatment is recommended for asymptomatic bacteriuria to reduce risks, and symptomatic UTIs should be promptly treated with appropriate antibiotics based on culture and sensitivity testing. Post-treatment cultures are advised to confirm resolution of infections.
under and post graduate best presentation ever about the assisted vaginal delivery,operative vaginal delivery, or instrumental vaginal delivery.
done by waill salan al.timeemi/stager 2014-2015/ Iraq-al.qadisiyyah college of medicine.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
This document provides guidance on evaluating and managing common adolescent gynecologic issues. It discusses indications and techniques for pelvic exams and evaluating vaginal discharge. It also reviews causes and treatments for gynecologic pain, abnormal uterine bleeding, amenorrhea, polycystic ovary syndrome, and more. Key topics include ovarian cysts, ectopic pregnancy, endometriosis, and approaches to chronic pelvic pain.
The document discusses intrauterine fetal demise (IUFD), defined as the death of a fetus weighing over 500g or over 24 weeks gestation before the onset of labor. It notes that the cause is unknown in 25-60% of cases. Identifiable causes include maternal conditions like diabetes or hypertension, fetal conditions like birth defects or infections, and placental conditions like abruption or insufficiency. Evaluation of an IUFD involves examining the mother's medical history and current pregnancy, evaluating the stillborn infant, investigating the placenta, and certain laboratory tests. Management depends on factors like gestation, number of fetuses, and the parents' wishes regarding expectant or active management such as labor induction. Complications can
This presentation describes in detail about managing Rh negative pregnancy- to identify and manage Rh non-isommunized and Rh isoimmunized pregnancies, with recent advances
The document discusses the evaluation and management of non-immune hydrops fetalis (NIHF). It begins by defining NIHF and listing common ultrasound findings. It then discusses evaluating the fetus for various potential causes of NIHF, including chromosomal abnormalities, anemia, twin-twin transfusion syndrome, cardiovascular defects, infections, and tumors. A thorough clinical evaluation of the mother and fetus is recommended to identify treatable conditions. Counseling should explain available options which may include termination of pregnancy for untreatable cases or antenatal management and treatment when possible. A step-wise investigation is outlined including detailed ultrasound, Doppler, fetal echocardiogram, and maternal/fetal testing to identify the underlying cause.
This summary reviews several studies on how asthma is affected during pregnancy. The studies show rates of asthma worsening from 14-41% of patients, unchanged in 26-43%, and
Hepatitis B in Pregnancy discusses the epidemiology, natural history, transmission, impact on pregnancy, and management of HBV infection during pregnancy. It notes that perinatal transmission is the primary mode of HBV transmission in many areas. The document recommends immunoprophylaxis for infants using HBIG and vaccination to reduce transmission risk from 70-90% to 5-10%. For HBV-infected women, antiviral therapy late in pregnancy can further lower transmission risk, though does not ensure prevention. Correct infant immunization allows for breastfeeding.
Hydrops fetalis: Immune and nonimmune fetal hydrops Hale Teka Raya
This document discusses hydrops fetalis, which refers to edema of the fetus. There are two main types - immune and nonimmune hydrops. Immune hydrops is caused by red blood cell alloimmunization due to the formation of antibodies against fetal red blood cell antigens. This can cause hemolytic anemia and hydrops fetalis in the fetus. Nonimmune hydrops has many possible causes including genetic, structural, and infectious etiologies. The diagnosis and management of hydrops fetalis depends on determining the underlying cause through various diagnostic tests and the gestational age and condition of the fetus.
This document discusses the acute abdomen in pregnancy. It notes that abdominal pain is difficult to evaluate during pregnancy due to physiological changes from the enlarging uterus and effects of progesterone. It outlines potential causes of abdominal pain including miscarriage, ectopic pregnancy, preeclampsia, placental abruption, uterine rupture, and surgical conditions. It emphasizes that the goal is to identify life-threatening causes requiring intervention while discussing concerns for fetal safety during diagnosis and management. A thorough history, physical exam, lab tests, and imaging can help diagnose the source of pain.
This document discusses chorioamnionitis (intra-amniotic infection), including its pathogenesis, risk factors, clinical findings, diagnosis, and evaluation. Chorioamnionitis occurs when pathogens ascend from the vagina and infect the amniotic fluid and fetal membranes. It complicates 40-70% of preterm births and 1-4% of term births. Diagnosis is based on maternal fever and may include leukocytosis, fetal tachycardia, and uterine tenderness. Evaluation of amniotic fluid can confirm infection through culture, Gram stain, or glucose/white blood cell counts. Histologic examination after birth also helps diagnosis.
This document discusses the management of Rh negative mothers during pregnancy. It begins by providing background on the Rh factor and genetics. It then explains the pathophysiology of isoimmunization that can occur when an Rh negative mother carries an Rh positive baby. The remainder of the document outlines the careful management and monitoring required during pregnancy, including prophylactic anti-D injections, Doppler ultrasound scans of the fetus, potential invasive procedures, timing of delivery, and neonatal care. The goal is to prevent sensitization of the mother and complications for the fetus like anemia.
This document discusses trial of labor after cesarean section (TOLAC) versus elective repeat cesarean section for women with a prior cesarean delivery. It notes that 60-80% of women who attempt TOLAC will have a successful vaginal birth. The risks of TOLAC include uterine rupture, failed trial of labor requiring emergency cesarean, and slightly increased risk of complications for the baby. The risks of elective repeat cesarean include increased risks for placenta problems and complications in future pregnancies. The document provides an overview of the risks, benefits, and success rates to help women decide which option is safest for their individual situation.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
- Induction of labor is recommended for post-term pregnancies (greater than 42 weeks) due to increased risks of complications. Risks increase further as pregnancy progresses beyond 42 weeks.
- For low-risk pregnancies between 41-42 weeks, induction can be considered but is not necessarily recommended since perinatal outcomes do not significantly differ from 40-41 weeks. The risks and benefits should be discussed with the patient.
- Fetal surveillance with non-stress tests and ultrasound amniotic fluid measurements twice weekly is recommended for pregnancies beyond 42 weeks declining induction. Delivery is recommended if any test results cause concern for the fetal environment.
Acute abdomen in pregnancy poses diagnostic and therapeutic challenges due to physiological changes and a need to minimize risk to the fetus. Common causes include appendicitis, cholecystitis, intestinal obstruction, and other non-obstetric issues. A thorough history, physical exam, and focused imaging are important for diagnosis. Treatment priorities include resuscitation, antibiotics if indicated, and timely surgery if conservative measures fail or the fetus is compromised. Laparoscopic and open surgical techniques can both be used to manage many conditions while minimizing risks. Multidisciplinary care is important for optimal maternal and fetal outcomes.
Cervical insufficiency, also known as cervical incompetence, is a condition where the cervix is unable to retain a pregnancy at term due to a functional or structural defect. It is characterized by painless dilatation of the cervix resulting in premature rupture of membranes and delivery, usually occurring in the second or third trimester. Cervical cerclage procedures aim to surgically suture the cervix closed to prevent premature opening. There are several techniques for cervical cerclage placement depending on the location and indication, including McDonald, Shirodkar, emergency/rescue cerclages, and pessary or balloon alternatives. Cerclage procedures can be done through the vagina or abdomen depending
Abnormal labor or dystocia can be caused by problems with uterine contractions (uterine dysfunction), issues with the baby's size or position (fetopelvic disproportion), or a narrow pelvis (contracted pelvis). Common types include protracted or arrested dilation, shoulder dystocia, and breech presentation. Obstructed labor occurs when progress stalls despite adequate contractions, typically due to a mechanical obstruction, and can lead to serious maternal complications if not addressed. Management may involve resuscitation, expedited delivery depending on fetal/maternal status, and transfer to a higher level facility for those in advanced labor.
Venous Thromboembolism (VTE) refers to deep vein thrombosis (DVT) and pulmonary embolism (PE). Pregnancy is a risk factor for VTE due to physiological changes in the coagulation system that promote clotting. The risk is highest in the first trimester through 6 weeks postpartum. Management involves risk assessment, diagnosis, anticoagulation therapy like heparin, prevention through prophylaxis for high risk women, and consideration of risk factors when stopping treatment.
Uterine fibroids are benign smooth muscle tumors of the uterus that are very common. They occur in around 30% of women over 30 years of age. Symptoms include heavy bleeding, pelvic pressure, pain, and infertility. Treatment options depend on symptoms and desire for future fertility, and include medical management, myomectomy (surgical removal of fibroids), hysterectomy (removal of the uterus), uterine artery embolization, and newer minimally invasive procedures such as focused ultrasound and radiofrequency ablation. Complications can arise from degenerative changes, vascular changes, inflammation, or rarely malignant changes within the fibroids.
The document provides an overview of common gynecological complaints and anatomical variations seen in pediatric and adolescent patients. It describes the normal development of the genitalia from birth through puberty and lists various congenital anomalies such as imperforate hymen, transverse vaginal septum, and uterine abnormalities. Common complaints addressed include vulvovaginitis, labial agglutination, trauma, and foreign bodies. Evaluation and treatment approaches are also discussed.
This document provides guidelines for urinary tract infections (UTIs) during pregnancy. It discusses that UTIs are the most common medical complications of pregnancy and are associated with risks like preterm delivery. It outlines recommendations for screening, diagnosing, and treating asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis during pregnancy. Treatment is recommended for asymptomatic bacteriuria to reduce risks, and symptomatic UTIs should be promptly treated with appropriate antibiotics based on culture and sensitivity testing. Post-treatment cultures are advised to confirm resolution of infections.
under and post graduate best presentation ever about the assisted vaginal delivery,operative vaginal delivery, or instrumental vaginal delivery.
done by waill salan al.timeemi/stager 2014-2015/ Iraq-al.qadisiyyah college of medicine.
Sickle cell anemia is an autosome linked recessive trait that can be transmitted from parents to the offspring when
both the partners are carrier for the gene (or heterozygous). The disease is controlled by a single pair of allele, HbA
and HbS. Out of the three possible genotypes only homozygous individuals for HbS (HbS, HbS) show the diseased phenotype. The ability to predict the clinical course of SCD during pregnancy is difficult. It is mandatory to follow up the patient closely from the very beginning i.e. from preconception to antenatal till labor. SCD is associated with both maternal and fetal complications and is associated with an increased incidence of perinatal mortality, premature
labor, fetal growth restriction and acute painful crises during pregnancy.
This document provides guidance on evaluating and managing common adolescent gynecologic issues. It discusses indications and techniques for pelvic exams and evaluating vaginal discharge. It also reviews causes and treatments for gynecologic pain, abnormal uterine bleeding, amenorrhea, polycystic ovary syndrome, and more. Key topics include ovarian cysts, ectopic pregnancy, endometriosis, and approaches to chronic pelvic pain.
The document discusses intrauterine fetal demise (IUFD), defined as the death of a fetus weighing over 500g or over 24 weeks gestation before the onset of labor. It notes that the cause is unknown in 25-60% of cases. Identifiable causes include maternal conditions like diabetes or hypertension, fetal conditions like birth defects or infections, and placental conditions like abruption or insufficiency. Evaluation of an IUFD involves examining the mother's medical history and current pregnancy, evaluating the stillborn infant, investigating the placenta, and certain laboratory tests. Management depends on factors like gestation, number of fetuses, and the parents' wishes regarding expectant or active management such as labor induction. Complications can
This presentation describes in detail about managing Rh negative pregnancy- to identify and manage Rh non-isommunized and Rh isoimmunized pregnancies, with recent advances
The document discusses the evaluation and management of non-immune hydrops fetalis (NIHF). It begins by defining NIHF and listing common ultrasound findings. It then discusses evaluating the fetus for various potential causes of NIHF, including chromosomal abnormalities, anemia, twin-twin transfusion syndrome, cardiovascular defects, infections, and tumors. A thorough clinical evaluation of the mother and fetus is recommended to identify treatable conditions. Counseling should explain available options which may include termination of pregnancy for untreatable cases or antenatal management and treatment when possible. A step-wise investigation is outlined including detailed ultrasound, Doppler, fetal echocardiogram, and maternal/fetal testing to identify the underlying cause.
This summary reviews several studies on how asthma is affected during pregnancy. The studies show rates of asthma worsening from 14-41% of patients, unchanged in 26-43%, and
Hepatitis B in Pregnancy discusses the epidemiology, natural history, transmission, impact on pregnancy, and management of HBV infection during pregnancy. It notes that perinatal transmission is the primary mode of HBV transmission in many areas. The document recommends immunoprophylaxis for infants using HBIG and vaccination to reduce transmission risk from 70-90% to 5-10%. For HBV-infected women, antiviral therapy late in pregnancy can further lower transmission risk, though does not ensure prevention. Correct infant immunization allows for breastfeeding.
Hydrops fetalis: Immune and nonimmune fetal hydrops Hale Teka Raya
This document discusses hydrops fetalis, which refers to edema of the fetus. There are two main types - immune and nonimmune hydrops. Immune hydrops is caused by red blood cell alloimmunization due to the formation of antibodies against fetal red blood cell antigens. This can cause hemolytic anemia and hydrops fetalis in the fetus. Nonimmune hydrops has many possible causes including genetic, structural, and infectious etiologies. The diagnosis and management of hydrops fetalis depends on determining the underlying cause through various diagnostic tests and the gestational age and condition of the fetus.
This document discusses the acute abdomen in pregnancy. It notes that abdominal pain is difficult to evaluate during pregnancy due to physiological changes from the enlarging uterus and effects of progesterone. It outlines potential causes of abdominal pain including miscarriage, ectopic pregnancy, preeclampsia, placental abruption, uterine rupture, and surgical conditions. It emphasizes that the goal is to identify life-threatening causes requiring intervention while discussing concerns for fetal safety during diagnosis and management. A thorough history, physical exam, lab tests, and imaging can help diagnose the source of pain.
Uterine myomas, or fibroids, are benign tumors that arise from the smooth muscle cells of the uterus. They are the most common tumors of the uterus and female pelvis. Fibroids can cause heavy bleeding, pelvic pressure and pain, and reproductive issues like infertility. While the exact cause is unknown, risk factors include age, race, obesity, and reproductive history. Treatment options depend on symptoms and fertility goals, and may include medical management, surgical removal of the fibroids (myomectomy), or hysterectomy.
Genetic disease and other inborn errorsMahimaGirase
This document provides an overview of genetic diseases and inborn errors of metabolism. It discusses genetic disorders, including that most are rare and can be hereditary or caused by new mutations. Inborn errors of metabolism are caused by defects in enzyme-coding genes. The document also examines genetic epidemiology, cardiovascular disease, cancer, chronic diseases, environmental teratogens, genetic diseases, ethical issues in genetic testing, genetic research, research questions for genetic disorders, the aims and scope of genetic research, findings from genetic studies, and concludes that genetic testing will play a greater role in healthcare.
Adaptations of cellular growth and diffrentiationrashree-singh
This document discusses various types of cellular adaptation in response to environmental changes. It defines key adaptations like hypertrophy, hyperplasia, atrophy, and metaplasia. Hypertrophy involves cell enlargement while hyperplasia is an increase in cell number. Atrophy is a decrease in cell size and number. Metaplasia is the reversible replacement of one cell type with another. Adaptations can be physiological from things like exercise or pathological from issues like hypertension. The mechanisms of adaptations involve growth factors, hormones, and changes in protein expression levels. Cellular adaptations allow tissues to survive stresses but can sometimes progress to disease if the stressors remain.
The document discusses thyroid disorders globally and in the Philippines. Some key points:
- The Philippine prevalence of thyroid dysfunction is 8.53%, with subclinical hyperthyroidism and hypothyroidism being most common.
- Filipino patients tend to present with more advanced thyroid cancer at a younger age compared to other populations.
- Thyroid problems are relatively common during pregnancy, with careful management of hypo- and hyperthyroidism needed to prevent maternal and fetal complications.
The document provides tips for using a PowerPoint presentation (ppt) for active learning sessions on medical topics. Some key points:
- Blank slides can be included between topic slides to engage students by asking what they know and discussing it before showing additional details.
- This approach allows for 3 rounds of revision with questioning in between to reinforce learning.
- It is useful for both individual study and classroom sessions.
- Bibliographic references are included in the notes section.
This is a lecture note on Intrauterine Fetal death. It discusses about the causes, the management of future pregnancies. At the end of the lecture note are standard textbooks for further reading.
nursing class cellularadaptation and apoptosis.pptxvandana thakur
The document discusses various types of cellular adaptations:
1. Adaptations are reversible changes in cells that allow them to respond to environmental changes through alterations in size, number, function or metabolism. This includes physiological adaptations to hormones and pathological adaptations that help cells survive.
2. Cells can adapt through hyperplasia (cell growth), hypertrophy (cell enlargement), atrophy (cell shrinkage), metaplasia (one cell type changing to another), and dysplasia (abnormal cell growth).
3. Apoptosis is a form of programmed cell death where cells activate an intrinsic suicide pathway in response to signals or stress, undergoing changes like chromatin condensation and blebbing before being phagocy
Imapct of Thyroid disorder on Reproduction-DrSelim.pdfShahjadaSelim1
Thyroid disorders are the commonest endocrine disorders in all people, though less talked about.
Thyroid disease is the second most common endocrine disorder after diabetes in pregnancy but more common than Diabetes in the community.
Female related infertility accounted for 37% and combined male and female factors for 35% of the causes of infertility.
The document provides guidance on evaluating endometrial biopsy specimens. It discusses that the functionalis layer of the endometrium from the fundus is ideal for diagnosis. Proliferative phase dating is not possible while secretory phase dating is. Findings of fat in the specimen indicates uterine perforation. Endometrial polyps, hyperplasia, and carcinomas are discussed along with mimics. Immunostains can help in certain cases. The clinician should be notified of significant findings and limitations of the specimen.
This document provides an overview of general pathology. It discusses the definition and branches of pathology, including cellular pathology, morbid anatomy, microbiology, haematology, chemical pathology, immunology, and genetics. It also defines key terms such as pathology, etiology, pathogenesis, and pathophysiology. Additionally, it covers cellular responses to stress like adaptation, injury, and death through necrosis and apoptosis. The mechanisms of cellular adaptations like hypertrophy, hyperplasia, atrophy and metaplasia are explained. Finally, it discusses the various causes of cell injury.
This document describes a case of hydatidiform mole in a 20-year-old patient who presented with 2 weeks of vaginal bleeding. Examination and ultrasound revealed an enlarged uterus consistent with molar pregnancy. Laboratory tests showed elevated beta-hCG levels. The patient underwent suction curettage where vesicular tissue was removed. She recovered well and was discharged with follow-up instructions. The document also provides background information on hydatidiform mole including definitions, risk factors, types, pathogenesis and clinical presentation.
Clinical presentation and giagnostic sopRolandoDiaz49
This document provides an overview of the clinical presentation and diagnosis of polycystic ovarian syndrome (PCOS). PCOS is a common endocrinopathy in reproductive-aged women, characterized by menstrual irregularities, infertility, hirsutism and obesity. The exact causes are unknown but involve abnormalities in gonadotropin secretion and ovarian function. Diagnosis requires two of three criteria - oligo/anovulation, clinical or biochemical signs of hyperandrogenism, and polycystic ovaries. PCOS presents challenges to diagnose in adolescents and perimenopausal women due to normal hormonal fluctuations during these stages of life.
Dr. Juhi Agrawal discusses endometriosis, a condition where endometrial tissue grows outside the uterus. It responds to hormones like normal endometrial tissue, causing bleeding and pain. The exact cause is unknown, but theories include retrograde menstruation and genetic and immunological factors. Common symptoms include pelvic pain and infertility. Diagnosis involves physical exam, imaging like ultrasound and MRI, though the only way to confirm is through laparoscopy and biopsy of lesions. Risk factors include early menarche and family history. Treatment focuses on pain relief and hormone suppression to stop tissue growth and bleeding.
This document discusses pelvic organ prolapse (POP), including its epidemiology, risk factors, grading, and management. POP affects 12% of women in their lifetime in the US and is the third most common reason for hysterectomy. Risk factors include vaginal childbirth, increasing age, obesity, and connective tissue disorders. POP is graded using the Pelvic Organ Prolapse Quantification system from stage 1 to 4. Treatment includes nonsurgical options like pessaries and pelvic floor exercises or surgical procedures like sacrocolpopexy or colporrhaphy depending on the location and severity of the prolapse.
Menstrual cycle, fertilization and implantationHale Teka
This document discusses the menstrual cycle, fertilization, and implantation. It provides detailed information on the ovarian and uterine cycles, including the follicular and luteal phases. The follicular phase involves follicle development and selection of a dominant follicle, while the luteal phase involves corpus luteum formation and progesterone secretion. The uterine cycle mirrors these changes, with a proliferative phase under estrogen dominance and a secretory phase when progesterone rises. Ovulation occurs in the late follicular phase in response to an LH surge. If fertilization does not occur, the corpus luteum regresses, ending the luteal phase and initiating menstruation.
This document summarizes the evaluation of an infertile couple. It discusses taking a medical history from both partners focusing on gynecological, sexual, reproductive, medical, and lifestyle factors. Physical exams of both partners examine signs of infertility. Testing includes evaluating ovulation, ovarian reserve, tubal and pelvic factors, and uterine abnormalities. Methods discussed are basal body temperature, ovulation predictor kits, progesterone tests, endometrial biopsy, sonography, hysterosalpingography, and sonohysterography. The goal is to determine the etiology of infertility which can be female, male, or both factors in roughly equal proportions.
Revised fetal hydrops (immune and nonimmune)Hale Teka
This document discusses Rh sensitization and fetal hydrops. It begins with definitions of key terms and concepts. It then covers the historical milestones in understanding Rh sensitization, including the discovery of the Rh blood group and the link between RhD antibodies in Rh-negative women and fetal hydrops. The document outlines the pathophysiology and management of Rh sensitization, including intrauterine transfusions. It also discusses nonimmune hydrops and its various potential etiologies.
This document discusses premature rupture of membranes (PROM), defined as spontaneous rupture of membranes before the onset of labor. PROM complicates 8-10% of pregnancies and contributes to 10-20% of preterm births. It inherently increases risks of perinatal infection, abruptio placenta, umbilical cord compression, and respiratory distress. Diagnosis involves history, sterile speculum exam to visualize fluid and test pH/ferning, and ultrasound-guided dye tests may confirm. Management depends on gestational age and involves monitoring for infection risks and timing of delivery.
This document discusses the teratogenic risks of various medications. It describes how alcohol consumption can cause fetal alcohol syndrome and spectrum disorders. Certain anticonvulsants, antifungals, antihypertensives, NSAIDs, chemotherapy agents, antivirals and hormones are also described as carrying risks of birth defects if taken during pregnancy. The effects of lithium, SSRIs and antipsychotics on neonates are summarized as well. Throughout, specific malformations and risks associated with different medication classes are outlined.
Intrauterine growth restriction (IUGR) refers to fetal growth that fails to reach the fetus's growth potential. There are two main types - symmetrical and asymmetrical IUGR. Symmetrical IUGR affects all body parts equally while asymmetrical IUGR spares the brain by preferentially shunting nutrients to the head. IUGR can be diagnosed through ultrasound measurements, history and physical exam. Management may include testing to find the cause, ongoing monitoring, and delivery depending on fetal status. Complications of IUGR include increased risk of stillbirth, asphyxia, and problems for the newborn like hypoglycemia.
This document discusses hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, HELLP syndrome, eclampsia, and chronic hypertension. It covers the definitions, classifications, risk factors, clinical presentations, and management approaches for these conditions. Hypertensive disorders affect 5-10% of pregnancies and represent a spectrum of conditions characterized by new-onset hypertension and often proteinuria after 20 weeks of gestation. Preeclampsia is the most common disorder, occurring in 2-7% of pregnancies, and can range from mild to severe disease.
Aph (abruptio placenta + placenta previa)Hale Teka
This document discusses obstetric hemorrhage due to placental abruption. It begins by describing the physiological changes in pregnancy that increase risk of hemorrhage. It then defines placental abruption as premature separation of the placenta prior to delivery. Risk factors, clinical manifestations, diagnosis, complications and management are discussed. Key points include placental abruption occurring in 1 in 100 births, risk factors like hypertension, smoking and trauma, and management involving monitoring, steroids, tocolysis, and delivery depending on gestational age and maternal-fetal status.
This document discusses the history and incidence of cesarean delivery. It begins with an overview of the evolution of cesarean delivery terminology and techniques. It describes how rates have risen dramatically in recent decades to over 30% currently in the United States. Factors contributing to increased rates include rising primary cesarean rates, increased maternal obesity and diabetes, and decreased trials of vaginal birth after cesarean. The document provides guidelines for safely preventing unnecessary cesareans by allowing adequate time in labor, limiting elective early deliveries, and promoting vaginal birth techniques.
This document summarizes guidelines for antenatal care from Dr. Hale Teka, an obstetrician and gynecologist. It discusses the background and goals of antenatal care. It then compares focused antenatal care, involving 4 visits, to comprehensive care aiming to provide a positive pregnancy experience. The document provides 49 recommendations organized into categories like nutrition, assessments, preventive measures, and systems interventions. New evidence supports a minimum of 8 antenatal contacts to improve outcomes. Early ultrasound before 24 weeks is now recommended to estimate gestation and check for anomalies.
This document discusses preinvasive and invasive lesions of the vulva. It provides details on:
- The classification and characteristics of vulvar intraepithelial neoplasia (VIN), including usual type (uVIN) and differentiated type (dVIN).
- The diagnosis of VIN through visual examination, vulvoscopy, biopsy and histology. High grade VIN lesions are generally treated to prevent progression to invasive cancer.
- The management of VIN includes local destruction, excision, laser ablation or topical therapies depending on the grade and extent of the lesion. Recurrence rates vary based on the modality used.
Vaginal cancer (preinvasive and invasive)Hale Teka
This document discusses preinvasive and invasive lesions of the vagina. It covers topics such as adenosis, vaginal intraepithelial neoplasia (VaIN), human papillomavirus (HPV) and its role in vaginal cancer, diagnosis of VaIN using techniques like colposcopy and biopsy, and management of low and high grade VaIN. It also discusses invasive vaginal cancer including risk factors, diagnosis, staging, treatment including surgery and chemoradiation, and prognosis.
This document provides an overview of principles of chemotherapy. It discusses the biology of cancer growth and cell kinetics, explaining how chemotherapy targets actively replicating cancer cells. It then covers the clinical use of chemotherapy in different settings like induction, adjuvant, neoadjuvant and palliative care. Key principles of pharmacology including drug dosing, administration routes, metabolism and toxicity management are reviewed. Several classes of chemotherapeutic drugs are described in detail, including their mechanisms of action and side effect profiles.
This document discusses a case report on ovarian tumors written by Hale Teka, M.D., a resident physician. It covers various types of ovarian tumors including low malignant potential tumors, epithelial ovarian cancer, germ cell tumors, and sex-cord stromal tumors. For epithelial ovarian cancer, it describes risk factors, symptoms, diagnostic testing, histology, staging, patterns of spread, and management. It also provides details on germ cell tumors such as dysgerminoma, including epidemiology, diagnosis, imaging, classification, and management.
Endometrial ca (hyperplasia and invasive ca)Hale Teka
1. Endometrial cancer is the most common gynecologic malignancy in the US, with obesity and advancing age as major risk factors.
2. Diagnosis is usually made with endometrial biopsy after a patient presents with postmenopausal bleeding.
3. Treatment depends on cancer stage, with 75% presenting as stage I and cured with surgery including hysterectomy and lymph node dissection. More advanced cases require chemotherapy and/or radiation.
This document discusses preinvasive lesions of the cervix, including the squamocolumnar junction, squamous metaplasia, human papillomavirus (HPV), and cervical intraepithelial neoplasia. It describes the natural history of HPV infection and progression from latent infection to neoplastic infection. Key points covered are HPV types, transmission, prevalence, diagnosis, and approaches to treatment and prevention.
This document discusses preinvasive lesions of the cervix, including the squamocolumnar junction, squamous metaplasia, human papillomavirus (HPV), and cervical intraepithelial neoplasia. It describes the anatomy and histology of the cervix, risk factors for HPV infection, HPV transmission, and the three possible outcomes of HPV infection - latent, productive, and neoplastic infection which can lead to cervical cancer. HPV is the most common sexually transmitted infection and high-risk types can cause cervical cancer if a persistent infection is established.
20. early pregnancy loss and ectopic pregnancy [autosaved]Hale Teka
This document discusses early pregnancy loss and ectopic pregnancy. It provides information on the types, risks, diagnosis, and management of spontaneous abortion and ectopic pregnancy. Some key points include:
- Spontaneous abortion occurs in 8-20% of recognized pregnancies and is often due to chromosomal abnormalities. Risk factors include advanced maternal age, smoking, infections, and history of loss.
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. Risk factors include prior pelvic infections, infertility treatments, and tubal surgery or damage.
- Diagnosis involves evaluating symptoms, lab tests of hCG levels and progesterone, and ultrasound imaging. Serial
This document outlines the key components of antenatal care (ANC). ANC involves comprehensive medical and psychosocial services provided to pregnant women throughout pregnancy, with the goal of a healthy mother and baby. Components of ANC include preconception counseling, nutrition guidance, infectious disease screening, fetal screening and testing, physical exams, and lifestyle modification counseling. Regular ANC visits allow care providers to monitor the health of the mother and developing fetus, identify potential complications, and optimize outcomes.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
1. Myoma
Hale T., O & G Yr-2 Resident,
Mekelle University,
College of Health Sciences, Dep't of OB-GYN
1Hale T., M.D., Resident Physician
2. • Leiomyomas are benign smooth muscle neoplasms that
typically originate from the myometrium
• Other names
– Uterine myomas
– Uterine fibroids (Misnomer)
Hale T., M.D., Resident Physician 2
3. • Incidence
– Generally cited as: 20-25%
– Based on histologic and sonographic evaluation: 70-
80%
Hale T., M.D., Resident Physician 3
4. • Pathology
– Pseuodcapsule gives myomas autonomy and easy to
be “shelled out” during surgery serving as a cleavage
plane
– Mitotic activity differentiates myomas from
leiomyosarcomas
• Rare in myomas
– Degenaration is when muscle cells are replaced with
other various degenerative substances because of
limited blood supply
Hale T., M.D., Resident Physician 4
6. • Acute pain my accompany degeneration
• Why degeneration?
– Limited blood supply, lower arterial density
– Lack of vascular organization
Hale T., M.D., Resident Physician 6
7. • Cytogenetics
– Each leiomyoma is derived from a single progenitor
myocyte
– Karyotypic defects are found in approximately
40 percent of leiomyomas
– A number of unique defects involving chromosomes
6, 7, 12, and 14 and less commonly X, 1, 3, 10, 13 have
been identified to correlate with rates and direction of
tumor growth
Hale T., M.D., Resident Physician 7
8. • Estrogen
– Uterine leiomyomas are estrogen- and progesterone-
sensitive tumors
– Sex steroid hormones likely mediate their effect by
stimulating or inhibiting transcription and production
of cellular growth factors
Hale T., M.D., Resident Physician 8
9. • Leiomyomas themselves create a hyperestrogenic
environment, which appears requisite for their growth
and maintenance
– First, compared with normal myometrium, leiomyoma
cells contain a greater density of estrogen receptors,
which results in greater estradiol binding
– Second, these tumors convert less estradiol to the
weaker estrone
– A third mechanism involves higher levels of
cytochrome P450 aromatase in leiomyomas compared
with normal myocytes
– This specific cytochrome isoform catalyzes the
conversion of androgens to estrogen in a number of
tissues Hale T., M.D., Resident Physician 9
12. • Obesity
– Increased conversion of androgens to estrogen
– Decreased hepatic production of sex hormone binding
globulin
Hale T., M.D., Resident Physician 12
13. • Progestins
– Evidences are conflicting
– Might stimulate or inhibit myoma growth
• COC
– Decrease or no effect on myoma
• MPA
– Might increase risk
– Use lowest possible dose in myoma patients
• Smoking
– Alter estrogen metabolisim and decrease risk of
myoma
Hale T., M.D., Resident Physician 13
14. Hale T., M.D., Resident Physician 14
Rarely located in
1. Vagina
2. Broad ligament
3. Vulva
4. Fallopian tubes
15. • Other rare types
– Leiomyomatosis
• Intravenous leiomyomatosis
– Uterine and other pelvic veins, the vena cava,
and even the cardiac chambers
• Benign metastasizing leiomyomas
– lungs, gastrointestinal tract, spine, and brain
• Disseminated peritoneal leiomyomatosis
Hale T., M.D., Resident Physician 15
16. • Parasitic leiomyomas are subserosal variants that attach
themselves to nearby pelvic structures from which they
derive vascular support, and then may or may not detach
from the parent myometrium
Hale T., M.D., Resident Physician 16
17. • The European Society of Hysteroscopy defines
leiomyomas as follows:
– Type 0, if the mass is located entirely within the
uterine cavity;
– Type I, if less than 50 percent is located within the
myometrium; and
– Type II, if greater than 50 percent of the mass is
surrounded by myometrium
Hale T., M.D., Resident Physician 17
19. • What causes infertility in leiomyoma?
– Amercian Society of Reproductive Medicine (2006)
1. Occlusion of tubal ostia
2. Disruption of the normal uterine contractions that
propel sperm or ova
3. Distortion of the endometrial cavity may also
diminish implantation and sperm transport
4. Endometrial inflammation and vascular changes
that may disrupt implantation
Hale T., M.D., Resident Physician 19
20. • Other manifestations
– Myomatous erythrocytosis syndrome
• This may result from excessive erythropoietin
production by the kidneys or by the leiomyomas
themselves
– Pseudo-Meigs syndrome
• The presumed etiology stems from discordancy
between the arterial supply and the venous and
lymphatic drainage from the leiomyomas
Hale T., M.D., Resident Physician 20
22. • Diagnosis
– Historically with symptomatic myomas
– Enlarged uterus with irregular border on pelvic exam
– Lab: Serum or urine hCG to rule out pregnancy
– Imaging
• Sonography
• SIS
• Hysteroscopy
• HSG
• MRI
Hale T., M.D., Resident Physician 22
23. • Management
– Observation
• Anual pelvic and sonographic evaluation
– Drug therapy
• Avoid Leupride use for > 6 months
• Add-back therapy after 3 months
– Uterine artery embolization
– Surgical removal
Hale T., M.D., Resident Physician 23
24. UAE Absolute and Relative Contraindications
Hale T., M.D., Resident Physician 24
Advantages of this procedure
Short hospital stay
Lower pain score
Early return to work
Disadvantages
Postembolization syndrome -
10%
25% require another treatment
Pregnancy complications
Increased vaginal discharge
Transitient amenorrhea
Groin hematoma
25. Magnetic Resonance Imaging-Guided Focused Ultrasound (MRgFUS)
• Advantages
– Noninvasive
– Done in conscious sedation
– Early return to work
–
• Disadvantages
– 28 percent of women seek alternative
treatments for their symptoms by 12
months following MRgFUS
– Contraindications include
• Total uterine size > 24 wks
• Desire for future fertility
• Contraindications for MRI
• Obstructions to the energy path
such as abdominal wall scars or
intraabdominal
clips,
• Moreover, leiomyoma
characteristics such as size, blood
perfusion qualities, and location
near adjacent tissues may limit
feasibility
• Although few major adverse
events have been documented,
long-term data regarding the
duration of symptom relief are
limited
Hale T., M.D., Resident Physician 25
30. Myoma In Pregnancy
Hale T., O & G Yr-2 Resident,
Mekelle University,
College of Health Sciences, Dep't of OB-GYN
30Hale T., M.D., Resident Physician
32. Introduction
• Uterine fibroids (leiomyomas) are benign smooth muscle
tumors of the uterus
• Prevalence in Pregnancy
– 1.6 – 10.7 %
– Prevalence varies depending upon the trimester of
assessment and the size threshold
Hale T., M.D., Resident Physician 32
33. • Changes in size during pregnancy
– 49-60% have negligible (defined as <10 percent)
change in volume across gestation,
– 22 to 32 % increase in size, and
– 8 to 27 % decrease in size
Hale T., M.D., Resident Physician 33
34. – Most of the growth occurs in the first trimester
– Larger fibroids (>5 cm in diameter) are more likely to
grow
– Mean increase in fibroid volume during pregnancy is
12 percent, and
– Very few fibroids increase by more than 25 percent
Hale T., M.D., Resident Physician 34
35. – 90 percent of women with fibroids detected in the first
trimester will have regression in total fibroid volume
when re-evaluated three to six months postpartum,
but
– 10 percent will have an increase in volume
– Regression may be less in women who use progestin-
only contraception.
Hale T., M.D., Resident Physician 35
36. Complications
• Pain
– Most common complication
– Frequency specially high in fibroids of > 5 cms
– Patients with degenerating fibroids have
• Localized pain (Majoirty)
• Mild leukocytosis,
• Fever,
• Nausea and
• Vomiting can occur
Hale T., M.D., Resident Physician 36
37. • Fibroid pain likely results from decreased perfusion in the
setting of rapid growth, leading to ischemia, necrosis (red
degeneration) and release of prostaglandins
• This hypothesis is supported by the observation that
fibroid pain typically presents in the late first or early
second trimester, which corresponds to the period of
greatest fibroid growth
• Another theory is that vessels supplying the fibroid
become partially obstructed as the uterus grows and
changes its orientation to the fibroid
Hale T., M.D., Resident Physician 37
38. • Pregnancy Loss
– Submucosal fibroids appear to be associated with
adverse effects
– Mechanisims
• Decidual atrophy
• Increased contractility and
• Increased production of catalytic enzymes
Hale T., M.D., Resident Physician 38
39. • Antepartum Bleeding
– APH more common in pregnancies with myoma
– Location of the fibroid important factor
– 72 percent of patients with retroplacental fibroids
reported vaginal bleeding compared to only 9 percent
with non-retroplacental fibroids
Hale T., M.D., Resident Physician 39
40. • Preterm Labor and Birth
– Possible mechanisims
• Fibroid uteri are less distensible than nonfibroid
uteri, so that contractions occur when the uterus
distends beyond a certain point
• Decreased oxytocinase activity in the gravid fibroid
uterus, which may result in a localized increase in
oxytocin levels thereby predisposing to premature
contractions
Hale T., M.D., Resident Physician 40
41. – Characteristics reported to increase this risk include
• Multiple fibroids,
• Placentation adjacent to or overlying a fibroid, and
• Size greater than 5 cm
Hale T., M.D., Resident Physician 41
42. • Preterm premature rupture of membranes
– The greatest risk of pPROM appears to be when the
fibroid is in direct contact with the placenta
Hale T., M.D., Resident Physician 42
43. • Placental abruption
– Location of the fibroid appears to be important factor
– The endometrium overlying a fibroid may have
reduced blood flow leading to placental ischemia and
decidual necrosis, making it more susceptible to
abruption
– Submucosal and retroplacental fibroids and fibroids
with volumes >200 mL (corresponding to 7 to 8 cm
diameter) had the highest risk of abruption in one
study
Hale T., M.D., Resident Physician 43
45. • Preeclampsia
– Increased risk was due to disruption of trophoblast
invasion by the multiple fibroids leading to inadequate
uteroplacental vascular remodeling leading to the
development of preeclampsia
Hale T., M.D., Resident Physician 45
46. • Fetal Growth Restriction
– Large fibroids (greater than 200 mL) may be associated
with delivery of small-for-gestational age infants
(<10th percentile for gestational age)
Hale T., M.D., Resident Physician 46
47. • Fetal anomalies
– Spatial restrictions from uterine fibroids can cause fetal
deformations, but this is extremely rare
– Case reports have described fetal anomalies including
limb reduction defects, congenital torticollis, and head
deformities in pregnancies with large submucosal
fibroids
Hale T., M.D., Resident Physician 47
48. • Malpresentatioin
– Large submucosal fibroids that distort the uterine
cavity have consistently been associated with fetal
malpresentation
– Increased incidence of malpresentation only if
• the uterus had multiple fibroids,
• if there was a fibroid located behind the placenta or
in the lower uterine segment, or
• if the fibroid was large (over 10 cm)
Hale T., M.D., Resident Physician 48
49. • Dysfunctional Labor
– Fibroids in the myometrium may decrease the force of
uterine contractions or disrupt the coordinated spread
of the contractile wave, thereby leading to
dysfunctional labor
– Higher rates of tachysystole (defined as >5
contractions in 10 minutes) have also been reported
Hale T., M.D., Resident Physician 49
50. • Cesarean Delivery
– Uterine fibroids are associated with an increased risk of
cesarean delivery
Hale T., M.D., Resident Physician 50
51. • PPH
– Fibroids could predispose to postpartum hemorrhage
by decreasing both the force and coordination of
uterine contractions, thereby leading to uterine atony
– Especially if the fibroids are large (>3 cm) and located
behind the placenta or the delivery is by cesarean
Hale T., M.D., Resident Physician 51
52. • Management
– Pain
• Acetaminophen
• Indomethacin
– Labor
• Avoid intrapartum myomectomy (only in rare cases
can it be done)
• Classic or Posterior incision if myoma obstructs the
lower uterine segment
Hale T., M.D., Resident Physician 52
53. • Other complications
– Disseminated intravascular coagulation,
– Spontaneous hemoperitoneum,
– Uterine inversion,
– Uterine incarceration,
– Acute renal failure, and
– Urinary retention
– Pyomyoma (suppurative leiomyoma) is rare
• Clinical findings may include Fever, leukocytosis, tachycardia,
pelvic pain, and characteristic features on imaging studies
(heterogeneous mass which may contain gas).
Hale T., M.D., Resident Physician 53
54. Thank you for listening!
Hale T., M.D., Resident Physician 54