The document discusses the development of a new drug (DR) but provides no other context or details about the drug, its intended use, results of trials, or other pertinent information needed for a useful summary. With only the acronym "DR" provided, a meaningful 3 sentence summary cannot be generated.
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.
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.
DIC during Pregnancy is the most dreaded complication and matter to clear the concepts is required.
the slides clear and give a better idea about disseminated intravascular coagulation.
hope you find all your answers to queries in these slides.
UTIs in pregnancy is common and a serious cause of maternal and perinatal morbidity and mortality.
Clinical presentations include asymptomatic bacteriuria , acute cystitis and pyelonephritis
DIC during Pregnancy is the most dreaded complication and matter to clear the concepts is required.
the slides clear and give a better idea about disseminated intravascular coagulation.
hope you find all your answers to queries in these slides.
UTIs in pregnancy is common and a serious cause of maternal and perinatal morbidity and mortality.
Clinical presentations include asymptomatic bacteriuria , acute cystitis and pyelonephritis
It is estimated that 20% of American women and 7% of American men suffer from venous disease. Venous disease results in symptoms such as aching, fatigue, swelling, and pain in the legs which can interfere with daily living.Cosmetic issues may affect quality of life.
At least 20% of patients with venous disease will develop leg ulcers. This presentation outlines the normal anatomy and physiology of venous drainage of the extremities as well as the common venous disorders such as varicose veins and deep vein thrombosis.
A Complete & Effective Study Of Venous ThromboembolismMedical and Health
VENOUS THROMBOEMBOLISM: CAUSES, SYMPTOMS, DIAGNOSIS & TREATMENT
In this article, we’ll discuss thrombosis, thrombosis vs embolism, thrombosis definition, and thrombosis coronary. Our main headings are venous thromboembolism disease, venous thromboembolism symptoms, venous thromboembolism causes, venous thromboembolism diagnosis and treatment for venous thromboembolism. For complete article, head over to the given link, https://diseases8804.blogspot.com/2021/08/a-complete-effective-study-of-venous.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
3. DEFINITION
It is the formation of a blood clot or clots within the venous vascular cavity.
Incidence
Exact incidence isn’t known because most studies are limited by the inherent
inaccuracy of clinical diagnoses.
1 in 1000 pregnancies.
Pregnancy is a hypercoagulable state
A pregnant woman has a fivefold risk of DVT compared to general population.
Caesarean section increases the incidence by 1-2%
Mortality
Death from DVT is attributable to massive pulmonary embolism.
4. Epidemiology
Pregnancy and puerperium are well-established risk
factors for venous thromboembolism (VTE)
The age-adjusted incidence ranges from 5 to 50 times
higher in pregnant versus non-pregnant women
5. Epidemiology
Complicates 1 in 500-2000 pregnancies
More common post partum
Antepartum risk is equally distributed across
trimesters
Twice as higher after a caesarean section than vaginal
delivery
6. Hemostasis
Formation of clots in the walls of damaged blood
vessels
Prevention of blood loss
Maintaining blood in a fluid state within the vascular
system
7. Hemostasis
Components of hemostasis
Vascular spasm
Initiation and formation of platelet plug
Propagation of coagulation cascade
Termination of antithrombotic control mechanisms
Removal of clot by fibrinolysis
9. Hemostasis
Control mechanisms and termination of clotting
Antithrombin, heparin and glucosaminoglycan heparan
sulfate
Activated protein C and S
Tissue factor pathway inhibitor
Prostacyclin and thromboxane
Nitric oxide
11. Anatomical changes in
pregnancy and peuperium
Venous Stasis
Gravid uterus
Low capacitance vessels
Immobilisation
Endothelial injury
vascular injury and changes at the uteroplacental surface
during delivery
instrumental, or surgical delivery
12. Coagulation changes in
pregnancy
Increase in levels of Fibrinogen by 50% (450mg/dl
cf. 300mg/dl)
Other factors increased: Factor VII, VIII, IX, X
Factor II (prothrombin) increased slightly
Factors XI, XII & protein S reduced
Resistance to activated protein C.
Decreased platelet per unit volume
13. Pathophysiology
Vascular clotting develops mainly due to circulating stasis, infection, vascular
damage, or increased coagulabiltiy of blood
All elements of Virchow’s triad; circulatory stasis, vascular damage and
hypercoagulability of blood are present during pregnancy and puerperium.
Virchow’s triad is more in pregnancy due to:-
i. Increased clotting factors VII, VIII and X
ii. Increase in caliber of capacitance vessels produces vascular stasis.
iii. Reduced fibrinolytic activity
iv. Pressure of the gravid uterus on pelvic veins reduces venous return
v. Antenatal rest, prolonged labour, dehydration, excessive blood loss, pressure
on the calf muscles during delivery, delay in mobilization, trauma and pelvic
infection.
vi. Vascular injury after delivery
Sites
Posterior tibial and popliteal veins of the calf muscle and extend proximally as
far as the femoral or iliac veins or rarely even in into the IVC(Inferior Vena
Cava).
Pelvic veins due to diminished blood flow in the hyper-trophied uterine veins
extending into the iliac veins
14. HISTORY
The symptoms and signs of Deep Venous thrombosis(DVT) are related to
the degree of obstruction to venous outflow and inflammation of the
vessel wall. Clinical diagnoses of DVT is neither specific or sensitive
with the false positive rate as high as 50%. Many patients are
asymptomatic however the history may include the classical features
which are;-
o Edema/Leg swelling of affected site of the legs
o Leg pain (50% of patients) and pain on dorsiflexion of the
leg(Homan’s sign)
o Tenderness(75% of patients)
o Local cyanosis
o Fever
o Warmth and erythema of the skin can be present over area of
thrombosis
15. Risk factors
Immobilization
Surgery
Obesity
Prior history of VTE
Trauma
Thrombophilias
Prior use of oral
contraceptives
Pregnancy or
postpartum status
Stroke
Malignancy
16. PREDISPOSING FACTORS
Thrombophilia
Inherited thrombophilias are conditions that increase
the risk of thromboembolic disease.
During pregnancy, the thrombogenic potential of
these disorders is enhanced because of pregnancy-
associated changes in several coagulation factors.
There are two types of thrombophlias:
Acquired thrombompilias.
Inherited thrombompilias
17. Acquired Thrombophilias
Also called antiphospholipid syndrome.
Presence in the serum of at least one type of
autoantibody known as an antiphospholipid antibody
(aPL).
Lupus anticoagulant antibodies
Anticardiolipin antibody antibodies
Their presence predispose to risk of thromboembolism
and other obstetric morbidities( recurrent abortions,
preeclampsia, stillbirths)
18. Inherited Thrombophilias
Are genetic conditions that increase the risk of
thromboembolic disease. And other obstetric
morbidities( abortions, Preeclamsia, IUGR,stillbirths)
Factor V Leiden, the most common cause of activated
protein C resistance
Prothrombin gene mutation (PGM)
Antithrombin (AT) deficiency
Protein C deficiency
Protein S deficiency
20. Reason
Increased venous stasis in the left leg due to
compression of the left iliac vein by the right iliac
artery,
Compression of the inferior vena cava by the gravid
uterus itself
21. EXAMINATION FINDINGS/SIGNS
1) Edema of affected limb usually unilateral.Commoner on the left as the
left common iliac vein is crossed by the right common iliac & left
internal iliac arteries thus increasing resistance to flow. A
circumference of 2-3cm greater in the affected limb than in the normal
limb 10 cm from the tibial tuberosity and 20cm from ASIS(Anterior
Superior Iliac Spine)
2) Pain and tenderness usually confined to the calf muscles or acting along
the course of the deep veins in the medial thigh.
3) Fever usually low grade.
4) Homan’s sign i.e. discomfort in the calf muscles on forced dorsiflexion of
the foot with the knee straight. (1/3 of patients with DVT)
5) Cyanosis of the affected limb
6) Warmth on the affected limb
22. DIFFERENTIAL DIAGNOSES
o Cellulitis (may coexist)
o Ruptured Baker's cyst (both may coexist) - especially in individuals with pre-
existing rheumatoid disease of the knee
o Spontaneous/post-traumatic calf haematoma
o Osteomyelitis
o Pyomyositis
o Pulmonary embolism
o Thrombophlebitis superficial or septic
o Lymphangitis
o Varicose veins
o Lymphedema
o Achilles tendonitis
o Arterial insufficiency
o Asymptomatic peripheral edema secondary to CHF, Liver failure, renal failure
or nephrotic syndrome.
23. INVESTIGATIONS
1) Imaging Studies
a) Doppler U/S - Gold standard
The flow of blood as detected by reflection of waves on rbcs is absent in DVT.
b) Impedance Plethysmography
Is based on recording changes in blood volume of an extremity, which are directly
related to venous outflow. Standardized graphs are used to discriminate
normal IPG study results from abnormal results.
c) IV contrast Venography
Is most definitive mtd of dx venous thrombosis bt 1-2% of patients develop
phlebitis following procedure
d) MRI
Reserved for specific occasions which ultra-sound findings are equivocal or
negative ultra-sound findings but strong clininical suspicion.
e) CT-SCAN
Requires contrast agents and ionizing radiation. DXT exposure to the foetus is
negligible unless pelvic veins are imaged.
24. 2) Lab Studies
D-dimer Blood test
Are fibrin degradation products (FDP)
D-dimer fibrin fragments are present in fresh fibrin clot and in fibrin degradation
products or cross-linked fibrin.Monoclonal abs specific for the D-dimer
fragment are used to differentiate fibirn-specific clot form non-cross linked
fibrin and from fibrinogen. Thus has high sensitivity for venous
thromboembolism.
Low sensitivity
25. Treatment
Rationale
Prevent further clot extension
Prevention of acute pulmonary Embolism(PE) cos
association with high mortality > 60%.
Reducing the risk of recurrent thrombosis
Limiting development of late complications e.g.
postphlebitic syndrome, chronic venous insufficiency.
26. TREATMENT
Consists of anti-coagulation, bed rest and analgesia.
1) Supportive management
Consists of elevating the affected limb(s), serial measurements, elastic stockings and
analgesia. Thus will alleviate the oedema and improve venous return & promote
early ambulation.
2) Definitive management i.e. Anti-coagulation
a) Heparin
used in the Acute phase
Can use either Unfractionated Heparin(UFH) or Low molecular weight
heparin(LMWT)
i)Using UFH, start with 10,000-15,000IU IV followed by contionous IV infusion of
10,000IU/ 4-6hrly. Aim is to make the APTT/KCCT 1.5-2X the control values
UFH can also be used s.c @ 10,000-15,000IU tds. Heparin cannot cross the placenta due
to its high molecular weight (16000-40000 daltons)
Pharmacodynamics
Anti-thrombin (an endogenous inhibitor of coagulation) inhibits clotting factor
proteases by forming equimolar stable complexes with them. Heparin catalyzes the
anti-thrombin-protease reaction without being consumed. Anti thrombin inhibits
the intrinsic pathway{Factor IIa (Thrombin), Factor IXa (Christmas factor), Factor
Xa (Stuart-Prower factor)}
Heparin enhances Anti-Thrombin activity.
27. Pharmacokinetics of UFH
Onset of action - 30mins
T1
/2 - 1.5hrs
Duration of action - 8hrs
Adverse effects
o Thrombocytopenia- is immune mediated and develops 6-10 days presenting
with artertial thrombosis-White Clot syndrome. It results from irreversible
aggregration of platelets induced by heparin
o Osteoporosis-prolonged use
o Hyper K+- inhibits aldosterone secretion
o Hypersensitivity
o Alopecia (rare)
Antidote;
Protamine sulphate 1mg/100U heparin IVI given within 15mins; Max dose; 50mg
(if exceeded may itself have anticoagulant effect).
28. ii) LMWT heparin (enoxaparin (clexane®), dalteparin)
o Inhibit FXa but have less effect on anti-thrombin & on coagulation in general
o Convenient to use - SC OD/BD
o Longer duration of action
o Does not require monitoring
o Reduce dose in renal insufficiency
o Disadvantage is their high cost.
b) Oral anticoagulation
Warfarin- Coumarin derivative
Is started once the acute phase is over and the APTT/KCCT IS 1.5-2X the control.
Warfarin is continued for 3-4 days while on Heparin s.c. unitl the INR IS 2-3X
the control then Heparin can be discontinued.
Initial dose is 5mg od and is titrated to get an INR OF 2-3X the control
Pharmacodynamics
Blocks the γ-carboxylation of several glutamate residues in extrinsic pathway
(Vitamin K dependent) factors II, VII, IX, & X as well as the endogenous
anticoagulant protein C & S. The blockade results in incomplete molecules that
are biologically inactive in coagulation.
29. Warfarin is use in pregnancy:
Controversial cos associated teratogenicity.
Use after first trimester, convert patient back to Heparin at 36 weeks in
preparation for labor to avoid bleeding- neonate and mother.
Instituted after delivery till end of puerperium.
o Lifelong in recurrent DVT, proximal DVT
Pharmacokinetics
Onset of action - 48-72hrs
T1
/2 - 36hrs
Adverse effects
o Hypercoagulability within the first few days of administration due to the rapid
degradation of Protein C & S which have a short half life in plasma (2.5-3hrs)
thus heparin is administered together with Warfarin for first 3-4 days.
30. Warfarin Antidote
o Stop the drug and administer large doses of vitamin K1 (phytonadione) 10mg -
takes 6-8hrs to take effect (disadvantage) & FFP or factor IX concentrates or
cryoprecipitates
o In emergencies, use fresh frozen plasma(FFP) or fresh blood.
31. warfarin embryopathy
Warfarin crosses placenta and has teratogenic
potential.
There is convincing evidence that warfarin
administration between the sixth and ninth weeks of
gestation is potentially teratogenic
The most common developmental abnormalities affect
bone and cartilage; causing chondromalacia punctata,
with stippled epiphyses and nasal and limb hypoplasia
32. warfarin embryopathy
central nervous system (CNS) abnormalities
(including optic atrophy, microcephaly, mental
retardation, spasticity, and hypotonia)
Fetal or neonatal hemorrhage is a concern when
warfarin is administered in the third trimesters.
So avoided in pregnancy when Heparin admnistration
possible.
Avoid before week 14-16, convert to Heparin injection
at 36 weeks as you await labor.
33. c) Other treatment modalities are;
Venous thrombectomy still has a role in the management of patients with
extensive iliofemoral disease in which limb loss is imminent
IVC filters may be used in;
o Active bleeding
o When anti-coagulants fail
o To minimize risk of PE during venous thrombectomy
PROPHYLAXIS
o Heparin 5000IU s.c. bd
o Junior Aspirin 1 tablet od
o Claxane (LMWT Heparin) 40 mg od s.c.
PROGNOSIS
All patients with proximal vein DVT are at long term risk of chronic venous
innsufficiency.
Approximately 20% of untreated proximal(above the calf) DVTs progress to
pulmonary emboli, and 10-20% of these are fatal. With anti-coagulation
therapy the mortality is decreased 5- to 10- fold.
34. COMPLICATIONS
o Acute Pulmonary embolism
o Systemic embolism
o Chronic venous insufficiency
o Post- phlebitic syndrome( i.e. pain and edema in the affected limb without new
clot formation)
o Soft tissue ischaemia associated with massive clot and very high venous
pressures phlegmasia cerulea dolens
PREVENTION
o Avoid prolonged bed rest
o Early ambulation following Surgery
CONCLUSION
DVT is a clinical condition which needs early diagnoses so as to reduce the
incidence of pulmonary embolism and death.