How to deal with covid cases who want to get pregnant and those who already are pregnant : A dllema
Vaccine or No vaccine : we will answer this in this talk
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Anu Test Tube Baby Centre
Presentation given in 2017. Management of infertility using assisted reproductive technologies.
What is the role of antagonist in IUI and IVF - tips and tricks to optimize its use.
platelet rich plasma is being used in infertility management extensively without sound evidence of its value. In this talk, we will discuss the real impact of using PRP in IVF
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
IVF will remain the solution for infertile couples. But its future will dramatically be directed to fertile couples !!!! This talk will discuss these issues
Antagonist - Tips and tricks to optimize use in Intra Uterine Insemination (I...Anu Test Tube Baby Centre
Presentation given in 2017. Management of infertility using assisted reproductive technologies.
What is the role of antagonist in IUI and IVF - tips and tricks to optimize its use.
platelet rich plasma is being used in infertility management extensively without sound evidence of its value. In this talk, we will discuss the real impact of using PRP in IVF
OVERVIEW
Aim
Definition
Prerequisites
Individualisation of patient.
Ohss free IUI. Clinic
{Strict cancellation of cycle if OHSS is suspected}
Newer trends
Sucess Rates in IUI with COH
PROGNOTIC FACTORS to increase Pregnancy Rates..& discussion
IVF will remain the solution for infertile couples. But its future will dramatically be directed to fertile couples !!!! This talk will discuss these issues
In Vitro Fertilization (IVF) ovarian stimulation protocols - Assisted reprodu...Anu Test Tube Baby Centre
Presentation given in 2016 on protocols used for ovarian stimulation when undertaking in vitro fertilization (IVF) for management of infertility when using assisted reproductive technologies.
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
Dr. K.D.Nayar is an Infertility Specialist, Gynecologist and Obstetrician in Janak Puri, Delhi and has an experience of 38 years in these fields. Dr. K.D.Naya.
Multiple births—the delivery of twins, triplets, or more—is common with fertility treatments. During the use of assisted reproductive technology (ART)—such as in vitro fertilization (IVF)—multiple births primarily result from transfer of more than one embryo during the procedure
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
In Vitro Fertilization (IVF) ovarian stimulation protocols - Assisted reprodu...Anu Test Tube Baby Centre
Presentation given in 2016 on protocols used for ovarian stimulation when undertaking in vitro fertilization (IVF) for management of infertility when using assisted reproductive technologies.
Precautions after ivf pregnancy , lifecare centre ,IVF icsiLifecare Centre
PREGNANCY Outcome following
IVF-ICSI
HURDLES IN EARLY PREGNANCY
lifecare IVF centre
lifecare centre ,Multiple Pregnancy
Pregnancy
&
Co-morbidity
obestetric & neonatal outcome following IVF-ICSI
Dr. K.D.Nayar is an Infertility Specialist, Gynecologist and Obstetrician in Janak Puri, Delhi and has an experience of 38 years in these fields. Dr. K.D.Naya.
Multiple births—the delivery of twins, triplets, or more—is common with fertility treatments. During the use of assisted reproductive technology (ART)—such as in vitro fertilization (IVF)—multiple births primarily result from transfer of more than one embryo during the procedure
Intrauterine insemination (IUI) is procedure which involves placing sperm inside a woman's uterus to facilitate fertilization. The ovaries are stimulated with tablets and injections and then monitored for the probable time of ovulation. For more info visit :-//www.newhopeivf.com/intrauterine-insemination-iui.html
Covid19 and pregnancy: There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous.
As per ICMR Guidelines Pregnant women do not appear more likely to contract the infection than the general population. However, pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19. Reported cases of COVID-19 pneumonia in pregnancy are milder and with good recovery.Pregnant women with heart disease are at highest risk (congenital or acquired). In other types of coronavirus infection (SARS, MERS), the risks to the mother appear to increase in particular during the last trimester of pregnancy. There are case reports of preterm birth in women with COVID-19 but it is unclear whether the preterm birth was always iatrogenic, or whether some were spontaneous.The coronavirus epidemic increases the risk of perinatal anxiety and depression, as well as domestic violence. It is critically important that support for women and families is strengthened as far as possible; that women are asked about mental health at every contact. A small study of nine pregnant women in Wuhan, China, with confirmed COVID-19 found no evidence of the virus in their breast milk, cord blood or amniotic fluid. According to WHO, pregnant women
do not appear to be at higher risk of severe disease.
Furthermore, WHO reports that currently there is no known difference between the clinical manifestations of COVID-19 in pregnant and non-pregnant women of reproductive age
ACOG is advising caution based on the impact of other respiratory illnesses (including influenza/ SARS outbreak of 2002–2003), stating that “pregnant women should be considered an at-risk population for COVID-19
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Minji Kang, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Coronavirus disease (COVID-19) is caused by the SARS-CoV-2 virus and can infect people of all ages, including pregnant women. The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have been monitoring the impact of COVID-19 on pregnant women and their fetuses.
Pregnant women with COVID-19 may experience similar symptoms to non-pregnant individuals, such as fever, cough, and difficulty breathing. However, there is currently no evidence to suggest that pregnant women are at a higher risk of severe illness or death from COVID-19 than the general population.
There is also no evidence to suggest that pregnant women are more likely to transmit the virus to their fetuses, although there is some evidence of vertical transmission from mother to newborn.
The risk of severe illness from COVID-19 for the fetus is thought to be low, and the majority of pregnant women who have tested positive for COVID-19 have had healthy pregnancies and deliveries.
However, pregnant women with COVID-19 are at an increased risk of preterm labor and delivery, which can have implications for the health of the newborn.
It's important for pregnant women to take precautions to avoid infection with COVID-19, such as wearing a mask, practicing social distancing, and washing hands frequently. Pregnant women should also follow the guidance of their healthcare provider and the recommendations of public health authorities.
It's also important to note that the knowledge about COVID-19 and its impact on pregnancy is still evolving, and pregnant women should consult with their health care provider for the most up-to-date guidance.
we need to update our knowledge regarding management of endometriosis.
Which is better: medications or surgery? let's see what can this talk tell us about
what is the efficacy of Dienogest for management of endometriosis? let's see what research can tell us
Is it better that other modalities of management?
How to prevent occurrence of severe ovarian hyperstimulation in IVF. Is there a way ? this talk will present a pilot randomised study that may shed the light on this
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
4. Patient response to therapy and recovery:
• CRP, IL6, D-Dimer, neutrophils
• TLC, Lymphocytes, Platelet, eosinophils
• Ferritin last parameter to return to normal
6. South Africa only of the population vaccinated while UK
8.8% 72%
DR in south Africa more than UK although the same number of population.
7. Case Fatality rate
• COVID-19: 0.7 to 3.4% (>5% in Wuhan itself during peak)
• Will be higher without access to healthcare, oxygen and ventilators
• Spanish Influenza 1918: >2.5% Mostly younger people
• Seasonal Influenza: 0.1-0.2%
9. Not STD
• To be (STD), a virus has to be detected in seminal or vaginal fluids
from asymptomatic or symptomatic people and transmitted through
intercourse or insemination.
• 98.0% (293/299) of the seminal fluids, 16/17 testicular biopsies, all
89 prostatic fluids, 98.3% (57/58) of the vaginal fluids, all 35 cervical
smears, and all 16 oocyte samples tested negative for SARS-CoV-2.
• None of the studies confirmed sexual transmission of SARS-CoV-2.
10. Link to Reproduction
• For SARS-CoV-2 cell entry, the angiotensin-converting-enzyme 2
receptor (ACE2) and transmembrane serine protease 2 (TMPRSS2) are
needed.
• The presence of ACE2 receptor and TMPRSS2 in both male and
female reproductive tract cells has raised concerns that the Covid 19
infection may compromise human fertility and pregnancy.
13. Infertility
• Affect 7-10% of populations
• Even in pandemic as Covid 19, it remains a social problem
• Initially, suspension of infertility services was recommended
• 2021, they are resumed
• Why?
14. Infertility
• In the next few years, we may experience reduced fertilization,
implantation and live birth rates
• Why? SARS virus receptors were found on human gametes and
embryos
15. Risk : real or theory?
• Male fertility
• Female
• IVF outcome
• Cryopreservation
16. Male Fertility
• SARS-CoV-2, through an activation of pathogenic pathways, may
increase sperm DNA fragmentation, which in turn may affect
fertilizing potential.
• Those having severe infection, Male fertility may be temporarily
reduced due to inflammatory responses following infection.
19. Female
• The endometrium is highly susceptible to SARS-CoV-2 cell entry;
however, it remains unclear whether this could alter receptivity and
embryo implantation.
20. IVF outcome : 2021, August
Female IVF treatment parameters were comparable to the pre-Covid-
19 infection cycle performance. Sperm concentration and motility
demonstrated lower mean counts following Covid-19 infection.
24. Closed “sealed” cryo system
• Prevent semen suspension to get in contact with liquid nitrogen
• Thus prevent cross contamination
• Apart from sprem washing steps which are common in all centers
25. Consensus : August 2021
• men and women should have access to fertility services, and such
access should be irrespective of the vaccine.
• screening all patients prior to cycle initiation
• Avoid initiating treatment of women with severe comorbidities as
bronchial asthma until the pandemic is under control
26. Special subgroups
• Poor responders
• Fertility preservation
• IVF should be offered without delay
27. COVID-19 vaccines and fertility,
June 2021
• There is no evidence to suggest that COVID-19 vaccines will affect fertility or
fertility treatment
• The RCOG advise there is no plausible mechanism by which current vaccines
could cause any impact on women’s fertility
29. Which type of vaccine
• No information on which type could affect male or female fertility
more
• mRNA COVID-19 vaccines (Comirnaty from Pfizer/BioNTech and
COVID-19 Vaccine Moderna) and viral vector vaccines (COVID-19
Vaccine AstraZeneca, COVID-19 Vaccine Janssen)
• Killed virus vaccines: Sinopharm, sinofak, Sputink
30. Moreover
• no information on the role of vaccination in patients and staff who
have had COVID-19 disease and could have developed immunity
31. To date
• the possible effects of COVID-19 on the ovary or residual ovarian
reserve have not been investigated.
• survivors of COVID-19 should be evaluated for their short- and long-
term ovarian and testicular function
32. Menstrual disorders
•
• The current evidence does not suggest an increased
risk of either menstrual disorders or unexpected
vaginal bleeding following the vaccines
33. COVID-19 vaccination in women who
are planning pregnancy
• Women who are planning pregnancy or in the
immediate postpartum period can be vaccinated
without fear
• The question is : If a woman finds out she is
pregnant after she has started a course of vaccine??
What to do?
34. Medical Staff
• Surgical Mask if no N95 and for
regular exposure
• https://infectioncontrol.ucsfmedi
calcenter.org/covid/donning-and-
doffing-novel-coronavirus-covid-
19-videos
38. More dangerous during pregnancy
• hospital admission and severe illness are more common in pregnant women
(compared to those not pregnant
• stillbirth and preterm birth is more likely (2x more) (compared to pregnant
women without COVID-19).
• Pregnant women with underlying medical conditions are at higher risk of severe
illness.
• RCOG, 2021
41. Warning signs
-
Increased O2 demands by 50% over 1-2h
O2 sat < 94% despite O2 support
>4.0L O2 by facemask
MEOWS: Maternal Early Obstetrical Warning Score
2 yellow or 1 red alert
triggers MD evaluation
Surveillance:
Location depends on the local facility:
special ward with O2 facilities
44. Clexan 60
- Any pregnant patient admitted to hospital for any indication is at risk for VTE
- In COVID- “hypercoagulable” state
Recommend: VTE prophylaxis for women admitted with moderate to severe disease
- duration depends on clinical scenario
Corticosteroid Guidance for Pregnancy during COVID-19 Pandemic
Jennifer Jury McIntosh, DO, MD DOI https://doi.org/ 10.1055/s-0040-1709684.
- lowest quality of evidence... authors opinion...
- leap from high dose/duration in ICU patient
SUPPORT THE USE OF CELESTONE IF AN
IDENTIFIED RISK FOR PRETERM BIRTH
48. Termination
Principles:
a. If < 28w GA & can maintain mechanical ventilation: ….. risk of prematurity > risk of IUFD
b. If <28w GA & can NOT maintain mechanical ventilation…. ? Would delivery improve ventilation status
c. If > 28w GA & can maintain mechanical ventilation …. Consider delivery if signs of non-reassuring fetal status*
d. If >28 w GA & CAN NOT maintain mechanical ventilation: …. Consider delivery to manage ventilation **
** NOT to improve maternal disease process, not to alter fetal/neonatal outcome, but to facilitate the ventilation
*** if delivering < 34w GA, give MgSO4 4g bolus before delivery- over 1 hour to limit maternal respiratory depression
1. COVID-19 infection is NOT a direct indication for delivery
2. Decision to deliver is individualized based on maternal & fetal status, GA
49. Intrapartum Management:
- Regardless of GA: CEFM based on case reports of fetal compromise in women with
COVID-19 diagnosis (8/18 – 44% incidence)
- Maternal vital signs (HR, BP, RR, O2 sat) q 1h. Oxygen to keep O2 sat >94%
- Hourly fluid status to avoid fluid overload (affects ventilation, work of breathing)
- Encourage spinal anesthesia
- No indication for C/S unless to improve maternal resuscitation efforts
- Consideration: shorten the second stage
50. Key Points for Newborn to COVID
1. Based on: No evidence of virus in cord blood
Fetus was exposed to cord blood
Limited evidence of vertical transmission
2. Support breastfeeding*
3. Support skin to skin
* https://www.cps.ca/en/documents/position/breastfeeding-when-mothers-have-suspected-or-proven-covid-19
Mother to wear mask
SUPPPORT DELAYED CORD CLAMPING
51. Postpartum Thromboprophylaxis:
Recommend:
1. OB indications for VTE prophylaxis
2. If no OB indications:
a. mild COVID disease – not required
b. moderate & severe disease- recommend as shown to decrease morbidity & mortality
53. Facts
• Vaccination is effective in preventing COVID-19 mortality
• COVID-19 vaccines do NOT contain live coronavirus
• Other non-live vaccines (whooping cough, influenza) are safe for pregnant
women and their unborn babies.
54. Is there any evidence of safety?
• No studies on Covid 19 vaccine in pregnant women till now
• large trials which showed that these vaccines are safe and effective did not
include pregnant women
• Data from the United States, England and Scotland of more than 200,000
pregnant women vaccinated showed no adverse effects recorded.
55. However,
• no studies yet on the long term effects on babies born to women who
had a COVID-19 vaccine
• Extremely rare but serious side effects involving thrombosis (blood clots) have
been reported for the AstraZeneca vaccine
56. • About two-thirds of women who test positive for COVID-19 in pregnancy have no
symptoms at all
• One in 10 women admitted to hospital with COVID-19 require intensive care.
57. Effect of vaccination
• since 1 February 2021, 99% of pregnant women admitted to hospital with
symptomatic COVID-19 were unvaccinated.
• (Source: https://www.medrxiv.org/content/10.1101/2021.07.22.21261000v1).
58. Delta variant
• One dose of COVID-19 vaccination gives good protection against infection, but
with the most recent (Delta) variant of the virus, two doses are needed to give a
good level of immunity.
59. Breastfeeding and vaccination
• There is no known risk associated with giving non-live vaccines whilst
breastfeeding
• The woman should be informed about the absence of safety data for the
vaccine in breastfeeding women
•Studies are now suggesting the development of passive immunity in the neonate
following maternal COVID-19 infection, with documentation of the presence of SARS-
CoV-2 antibodies in cord blood and breast milk
(https://pubmed.ncbi.nlm.nih.gov/33512440)
60. No vaccine is 100% effective
• practise social distancing
• wear a face mask as necessary
• wash your hands carefully and frequently
61. Nutrition
• There is data that implicates malnutrition as a prognostic factor in
Covid 19 severity.
• Obesity is one end of the malnutrition spectrum and obese patients
frequently are micronutrient depleted.
• supplements such as vitamin C or D, zinc, or melatonin might help in
the fight against COVID-19
• Evidence is lacking? Research is needed.
62. • vitamins are important in maintaining the normal
health of pregnant women.
Fat-soluble vitamins act as immunomodulators
which help minimize the inflammation-induced
damage
yet appropriate dosage and usefulness in COVID-19
are yet to be decided.
65. Take home Message
Very limited information
- Male fertility can be affected
- Infertility management should continue
- All pregnant women should have the vaccine
- Vitamin supplements are important
66. Useful resources
Green Book COVID-19 chapter 14a https://www.gov.uk/government/publications/covid-19-the-green-book-
chapter-14a
RCOG – COVID-19 information for pregnancy and women’s health https://www.rcog.org.uk/en/guidelines-
research-services/coronavirus-covid-19-pregnancy-and-womens-health/
PHA COVID-19 Vaccination training resources https://www.publichealth.hscni.net/covid-19-
coronavirus/northern-ireland-covid-19-vaccination-programme
https://www.gov.uk/guidance/vaccination-in-pregnancy-vip PHE tracks women who have been immunised
with COVID -19 vaccine who did not know they were pregnant at the time of vaccination. Please
complete the notification and reporting form for all cases
• Coronavirus Yellow Card reporting scheme coronavirusyellowcard.mhra.gov.uk/ or call 0800 731 6789
• https://www.gov.uk/government/news/jcvi-issues-new-advice-on-covid-19-vaccination-for-pregnant-
women