The document discusses the rising levels of anemia in India based on data from the 2021 National Family Health Survey. Some key points:
- Anemia has increased among children, pregnant women, and men by 2-9% according to the survey. The largest spike was among children aged 6 months to 5 years, rising from 58.6% to 67.1%.
- Anemia among women aged 15-19 rose from 54.1% to 59.1%, and among all women aged 15-49 from 53.1% to 57%. Anemia in pregnant women increased from 50.4% to 52.2%.
- In rural areas, 68.3% of children and 64.2
This document summarizes a review article on polycystic ovary syndrome (PCOS). PCOS is a common endocrine and metabolic disorder in premenopausal women, affecting 8-13% of reproductive-aged women. It is characterized by a combination of signs including androgen excess and ovarian dysfunction. Lifestyle management including diet and exercise is emphasized as the cornerstone of PCOS treatment by international guidelines. The review discusses the pathophysiology, symptoms, characterization and management of PCOS.
The document discusses how genetic testing and targeted therapies have revolutionized the diagnosis and treatment of breast cancer. It describes two cases of women diagnosed with breast cancer and how genetic testing identified a BRCA1 mutation in one family, allowing for increased screening and preventative options. Precision medicine through companion diagnostics now enables targeted therapies that work more precisely with less side effects compared to traditional chemotherapy.
1) Romania has high rates of cervical cancer mortality compared to other European countries due to undervaluation of preventive care like Pap smears.
2) A study found that only 20% of Romanian women have ever had a Pap smear, with many lacking awareness or believing smears are unnecessary.
3) Barriers to screening included costs, fear of diagnosis, and perceptions that doctors are overburdened. The health system is underfunded and screening program exists only on paper.
This document summarizes a panel discussion on HPV vaccination in India. Some key points:
- Cervical cancer is a major problem in India, with over 122,000 new cases and 67,000 deaths annually.
- HPV is the primary cause of cervical cancer. Vaccination induces high antibody levels to protect against HPV types 16 and 18, which cause 70% of cervical cancers.
- The best age for vaccination is 11-12 years, before sexual debut. Catch-up vaccination is recommended through age 26.
- Common side effects of HPV vaccination are mild and temporary. Rare severe allergic reactions may occur.
- Vaccination is recommended even for sexually active women and women in monogamous relationships to
This document discusses maternal near miss (MNM), which refers to women who nearly die but survive severe complications during pregnancy or childbirth. The World Health Organization recommends criteria for identifying MNM cases, including disease-specific conditions, management-based interventions, and organ dysfunction. Studying MNM provides advantages over solely examining maternal mortality, as MNM cases are more common and can reveal deficiencies in healthcare. Identifying and reviewing MNM cases can help reduce maternal mortality by informing actions to address gaps and improve quality of care. The document reviews several studies of MNM cases in Egypt which found the most common morbidities were related to preeclampsia, hemorrhage, and organ dysfunctions like coagulation issues. MNM
Impact of female genital cutting on maternal and reproductive health Aboubakr Elnashar
This document discusses female genital cutting (FGC) and its impact on maternal and reproductive health. It provides definitions and classifications of FGC, and examines its prevalence, reasons, and health impacts. Specifically, it notes that FGC is still commonly practiced in many regions, especially in parts of Africa and the Middle East, and that over 140 million women and girls worldwide have undergone some form of FGC. However, FGC can cause both short-term and long-term health complications, including pain, bleeding, infections, sexual dysfunction, infertility, and psychological trauma. While cultural traditions and false beliefs about controlling female sexuality are main drivers, the document recommends criminalizing FGC and increasing education to discourage the harmful practice.
This document summarizes a review article on polycystic ovary syndrome (PCOS). PCOS is a common endocrine and metabolic disorder in premenopausal women, affecting 8-13% of reproductive-aged women. It is characterized by a combination of signs including androgen excess and ovarian dysfunction. Lifestyle management including diet and exercise is emphasized as the cornerstone of PCOS treatment by international guidelines. The review discusses the pathophysiology, symptoms, characterization and management of PCOS.
The document discusses how genetic testing and targeted therapies have revolutionized the diagnosis and treatment of breast cancer. It describes two cases of women diagnosed with breast cancer and how genetic testing identified a BRCA1 mutation in one family, allowing for increased screening and preventative options. Precision medicine through companion diagnostics now enables targeted therapies that work more precisely with less side effects compared to traditional chemotherapy.
1) Romania has high rates of cervical cancer mortality compared to other European countries due to undervaluation of preventive care like Pap smears.
2) A study found that only 20% of Romanian women have ever had a Pap smear, with many lacking awareness or believing smears are unnecessary.
3) Barriers to screening included costs, fear of diagnosis, and perceptions that doctors are overburdened. The health system is underfunded and screening program exists only on paper.
This document summarizes a panel discussion on HPV vaccination in India. Some key points:
- Cervical cancer is a major problem in India, with over 122,000 new cases and 67,000 deaths annually.
- HPV is the primary cause of cervical cancer. Vaccination induces high antibody levels to protect against HPV types 16 and 18, which cause 70% of cervical cancers.
- The best age for vaccination is 11-12 years, before sexual debut. Catch-up vaccination is recommended through age 26.
- Common side effects of HPV vaccination are mild and temporary. Rare severe allergic reactions may occur.
- Vaccination is recommended even for sexually active women and women in monogamous relationships to
This document discusses maternal near miss (MNM), which refers to women who nearly die but survive severe complications during pregnancy or childbirth. The World Health Organization recommends criteria for identifying MNM cases, including disease-specific conditions, management-based interventions, and organ dysfunction. Studying MNM provides advantages over solely examining maternal mortality, as MNM cases are more common and can reveal deficiencies in healthcare. Identifying and reviewing MNM cases can help reduce maternal mortality by informing actions to address gaps and improve quality of care. The document reviews several studies of MNM cases in Egypt which found the most common morbidities were related to preeclampsia, hemorrhage, and organ dysfunctions like coagulation issues. MNM
Impact of female genital cutting on maternal and reproductive health Aboubakr Elnashar
This document discusses female genital cutting (FGC) and its impact on maternal and reproductive health. It provides definitions and classifications of FGC, and examines its prevalence, reasons, and health impacts. Specifically, it notes that FGC is still commonly practiced in many regions, especially in parts of Africa and the Middle East, and that over 140 million women and girls worldwide have undergone some form of FGC. However, FGC can cause both short-term and long-term health complications, including pain, bleeding, infections, sexual dysfunction, infertility, and psychological trauma. While cultural traditions and false beliefs about controlling female sexuality are main drivers, the document recommends criminalizing FGC and increasing education to discourage the harmful practice.
The document discusses HPV vaccine recommendations and current issues. It provides an overview of HPV vaccine licensure and recommendations, safety data showing the vaccines are very safe, and low national and state HPV vaccination rates, especially for certain populations. Rates in Indiana are among the lowest in the US. It recommends new strategies are needed to increase HPV vaccine acceptance and reduce disparities.
Menopausal Harmone Therapy & Indian Gynaecologists Dr Sharda Jain Lifecare Centre
This document discusses menopause and menopausal hormone therapy (MHT). It provides information on:
1) The average age of menopause for Indian women is 46.2 years. Premature menopause, which occurs before age 40, increases risks for cardiovascular disease, diabetes, and metabolic syndrome.
2) Lessons learned from the WHI study show that the risks of MHT depend on factors like age of starting treatment, type of estrogen and progestogen used, and whether the uterus is present. Not all progestogens have the same safety profile.
3) The choice of progestogen is important as some, like medroxyprogesterone acetate (MPA), may
This document profiles Dr. Laxmi Shrikhande, an obstetrician and gynecologist in India. It lists her extensive qualifications and experience, including various leadership roles in Indian medical organizations. It also outlines her achievements, such as numerous awards and over 450 guest lectures delivered. The document highlights her publications, including 13 national and 11 international publications, as well as her work sensitizing over 200,000 adolescents on health issues.
This document discusses adolescent polycystic ovary syndrome (PCOS). It defines adolescent PCOS and notes its prevalence ranges from 1.8-15% depending on diagnostic criteria, ethnicity, and increasing prevalence of childhood obesity. The presentation, diagnosis, evaluation, and treatment of adolescent PCOS are discussed in detail. Key treatment approaches include lifestyle modifications focused on weight loss through diet and exercise, hormonal contraceptives to manage menstrual irregularities and hirsutism/acne, and metformin to treat insulin resistance and restore ovulation.
Evidence linked treatment for endometriosis-associated infertilityApollo Hospitals
Endometriosis is conventionally defined as the presence of
tissue lesions or nodules that are histologically similar to
the endometrium, but are present at sites outside the uterus.It is a chronic, often recurring disease of complex and unclear aetiology. Endometriosis is a highly variable condition in terms of age and mode of presentation, range of symptoms, anatomical sites, response to treatment and likelihood of recurrence.
This document summarizes management strategies for menopausal symptoms in breast cancer survivors. It discusses pharmacological options like clonidine, oxybutynin, antidepressants, black cohosh, and phytoestrogens. It also covers mind-body practices like cognitive behavioral therapy and hypnosis. Non-hormonal treatments for vulvo-vaginal symptoms are discussed, as well as short-term low dose local estrogen therapy. Management of menopausal symptoms requires a personalized approach balancing symptom relief and safety.
1. The document discusses threatened and unexplained recurrent miscarriages. It provides information on the definition, incidence, types, causes, prognosis, and management of threatened and recurrent miscarriages.
2. For threatened miscarriages, the use of progestins is the most promising treatment and can significantly reduce the rate of miscarriage compared to placebo. For unexplained recurrent miscarriages, the prognosis is generally good without intervention, as many cases are due to chromosomal abnormalities rather than underlying maternal issues.
3. Basic investigations should be performed to investigate potential causes of recurrent miscarriage such as anatomical abnormalities, endocrine disorders, infections, thrombophilias, and alloimmune factors. However, for most cases
This document provides information about an individual, Dr. Laxmi Shrikhande, including her professional experience and accomplishments. It lists her current position as Medical Director of Shrikhande Fertility Clinic in Nagpur, Maharashtra. It also outlines several awards and honors she has received for her work in women's health and roles she has held in various medical organizations. The document then provides an introduction to her upcoming presentation on iron deficiency anemia (IDA) in pregnancy.
This document summarizes a presentation on anemia in women given at the Upper Egypt Congress of Clinical Nutrition. The presentation covered:
1) Prevalence of anemia globally and in Egypt, especially in women and children, noting it remains high.
2) Targets for reducing anemia prevalence by 2025 under the global nutrition plan and challenges in achieving these targets.
3) Complications of anemia, especially related to pregnancy outcomes.
4) Modern approaches to diagnosis, prevention and treatment of iron deficiency anemia, including iron supplementation and new formulations to improve compliance and reduce side effects.
Helicobacter Pylori (HP) and Hyperemesis Gravidarum (HG)Aboubakr Elnashar
Helicobacter pylori (HP) infection may be associated with hyperemesis gravidarum (HG), a severe form of nausea and vomiting during pregnancy. HP infection is common worldwide and has been linked to peptic ulcers and gastritis. While some studies have found an association between HP infection and HG, other studies have found no association. Treating HP infection in pregnant women with refractory HG using combinations of antibiotics like amoxicillin and metronidazole, along with H2 receptor antagonists, has shown rapid improvement in some cases. Screening all HG cases for HP is not practical, but may be considered for refractory cases or those with risk factors like older age or pe
The Women's Health Initiative (WHI) was a 15-year study from 1991-2010 that examined the effects of postmenopausal hormone therapy (HT) and lifestyle interventions on health outcomes in postmenopausal women. The WHI hormone therapy trials found that estrogen plus progestin therapy increased risks of heart disease, stroke, blood clots and breast cancer. Estrogen-alone therapy increased risks of stroke and blood clots but did not change heart disease risk. Subsequent research has found that risks may depend on factors like age at start of therapy, duration of use, and type of progestin used. Current recommendations are to use the lowest effective dose of HT for the shortest time to treat menop
Endometriosis in the peri menopause/ post menopauseArunSharma10
Post menopausal endometriosis
Endometriosis during menopause
Endometriosis in menopause
Endometriosis after menopause
Endometriosis
Endometriosis and cancer
Is endometriosis a problem of reproductive years only?
Explanation for endometriosis after menopause
Prevalence of endometriosis
Coelomic metaplasia theory
Estrogen threshold theory
HRT and post menopausal endometriosis
Tamoxifen & postmenopausal endometriosis
Uterine-Sparing Surgery for Adenomyosis Prof. Aboubakr ElnasharAboubakr Elnashar
This document discusses uterine-sparing surgery for adenomyosis to improve fertility. It describes how adenomyosis can negatively impact fertility and IVF success rates. There are two types of uterine-sparing surgery discussed - complete excision (adenomyomectomy) for localized adenomyosis and partial excision (cytoreductive surgery) for diffuse adenomyosis. The techniques, indications, complications, and outcomes of these surgeries are examined, including improved fertility and pregnancy rates compared to hormonal therapies. However, risks like uterine rupture during subsequent pregnancy must be considered. Overall, the document concludes uterine-sparing surgery is a feasible option for improving fertility in qualified patients with adenomyosis, but it requires
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.
Breast cancer metastasis and drug resistanceSpringer
This document summarizes epidemiological studies on breast cancer in women. It finds that breast cancer incidence and mortality rates increase with age and are higher among white women than black women in the US. Known risk factors for breast cancer identified through epidemiological studies include race, family history, genetics, reproductive factors like age of menarche and menopause, breastfeeding, oral contraceptive and hormone use, alcohol consumption, physical inactivity, obesity, and height. Certain genetic mutations are also implicated in some breast cancer cases.
This document discusses SLE (systemic lupus erythematosus) and infertility. It notes that SLE commonly affects women of childbearing age and can impact fertility through several mechanisms, including disease activity, medications like cyclophosphamide that may cause ovarian failure, and hormonal or renal issues. The document provides details on evaluating and managing infertility risks for SLE patients, such as using lower doses of cyclophosphamide or gonadotropin-releasing hormone agonists to protect fertility, and outlines fertility preservation and assisted reproduction options while controlling lupus disease activity and other risks. The conclusion emphasizes the need to consider how to minimize all factors that may increase infertility risk when managing reproductive-aged women with SLE.
Polycystic Ovarian Syndrome (PCOS) is a complex and challenging syndrome with no clear definition or universally agreed upon treatment approach. An integrated care model is needed to address PCOS, bringing together specialists from various fields to manage the diverse and long-term effects of the condition. PCOS presents with many phenotypes and potential underlying causes, making it difficult to classify and treat as a single disease. Current diagnostic methods and treatment outcomes also have limitations. A multidisciplinary approach considering PCOS's associations with metabolic, cardiovascular, and psychological comorbidities is required to improve care.
1. Adolescent PCOS is defined as unexplained persistent hyperandrogenic anovulation in females aged 10-19. It affects 2.2-18% of adolescents depending on diagnostic criteria.
2. Presentation includes menstrual irregularities, chronic anovulation, hyperandrogenism like acne and hirsutism, and hyperandrogenemia. Diagnosis is challenging due to normal puberty changes resembling PCOS.
3. Treatment focuses on restoring weight, regulating cycles, and reducing hyperandrogenism signs to prevent long-term health issues. Lifestyle changes, hormonal contraceptives, metformin, and anti-androgens are commonly used treatment
This document discusses adolescent endometriosis (AE), noting that it is a common condition with many unanswered questions. AE can involve lesions of all stages of severity, from minimal to severe. While some reports have found only early stage lesions in AE, more recent studies show a significant portion have advanced stage disease. AE seems to have a progressive natural course. Risk factors include early menarche, family history, and mullerian anomalies. Common symptoms are pain, which is often resistant to medical therapy, and pelvic masses seen on ultrasound. Laparoscopy is the gold standard for diagnosis but often shows atypical lesions. Treatment involves medications, with surgery as an option for persistent or severe cases. Recurrence is a
Anaemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Wo...Lifecare Centre
ANAEMIA : its prevalence across age and gender group has increased. Aneamia has increased by 2-9% among children , Pregnant women and men according to data shared in the National Family health survey 5 (NFHS-5) released November 24, 2021
Anemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Women : Dr Sharda Jain
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
The document discusses HPV vaccine recommendations and current issues. It provides an overview of HPV vaccine licensure and recommendations, safety data showing the vaccines are very safe, and low national and state HPV vaccination rates, especially for certain populations. Rates in Indiana are among the lowest in the US. It recommends new strategies are needed to increase HPV vaccine acceptance and reduce disparities.
Menopausal Harmone Therapy & Indian Gynaecologists Dr Sharda Jain Lifecare Centre
This document discusses menopause and menopausal hormone therapy (MHT). It provides information on:
1) The average age of menopause for Indian women is 46.2 years. Premature menopause, which occurs before age 40, increases risks for cardiovascular disease, diabetes, and metabolic syndrome.
2) Lessons learned from the WHI study show that the risks of MHT depend on factors like age of starting treatment, type of estrogen and progestogen used, and whether the uterus is present. Not all progestogens have the same safety profile.
3) The choice of progestogen is important as some, like medroxyprogesterone acetate (MPA), may
This document profiles Dr. Laxmi Shrikhande, an obstetrician and gynecologist in India. It lists her extensive qualifications and experience, including various leadership roles in Indian medical organizations. It also outlines her achievements, such as numerous awards and over 450 guest lectures delivered. The document highlights her publications, including 13 national and 11 international publications, as well as her work sensitizing over 200,000 adolescents on health issues.
This document discusses adolescent polycystic ovary syndrome (PCOS). It defines adolescent PCOS and notes its prevalence ranges from 1.8-15% depending on diagnostic criteria, ethnicity, and increasing prevalence of childhood obesity. The presentation, diagnosis, evaluation, and treatment of adolescent PCOS are discussed in detail. Key treatment approaches include lifestyle modifications focused on weight loss through diet and exercise, hormonal contraceptives to manage menstrual irregularities and hirsutism/acne, and metformin to treat insulin resistance and restore ovulation.
Evidence linked treatment for endometriosis-associated infertilityApollo Hospitals
Endometriosis is conventionally defined as the presence of
tissue lesions or nodules that are histologically similar to
the endometrium, but are present at sites outside the uterus.It is a chronic, often recurring disease of complex and unclear aetiology. Endometriosis is a highly variable condition in terms of age and mode of presentation, range of symptoms, anatomical sites, response to treatment and likelihood of recurrence.
This document summarizes management strategies for menopausal symptoms in breast cancer survivors. It discusses pharmacological options like clonidine, oxybutynin, antidepressants, black cohosh, and phytoestrogens. It also covers mind-body practices like cognitive behavioral therapy and hypnosis. Non-hormonal treatments for vulvo-vaginal symptoms are discussed, as well as short-term low dose local estrogen therapy. Management of menopausal symptoms requires a personalized approach balancing symptom relief and safety.
1. The document discusses threatened and unexplained recurrent miscarriages. It provides information on the definition, incidence, types, causes, prognosis, and management of threatened and recurrent miscarriages.
2. For threatened miscarriages, the use of progestins is the most promising treatment and can significantly reduce the rate of miscarriage compared to placebo. For unexplained recurrent miscarriages, the prognosis is generally good without intervention, as many cases are due to chromosomal abnormalities rather than underlying maternal issues.
3. Basic investigations should be performed to investigate potential causes of recurrent miscarriage such as anatomical abnormalities, endocrine disorders, infections, thrombophilias, and alloimmune factors. However, for most cases
This document provides information about an individual, Dr. Laxmi Shrikhande, including her professional experience and accomplishments. It lists her current position as Medical Director of Shrikhande Fertility Clinic in Nagpur, Maharashtra. It also outlines several awards and honors she has received for her work in women's health and roles she has held in various medical organizations. The document then provides an introduction to her upcoming presentation on iron deficiency anemia (IDA) in pregnancy.
This document summarizes a presentation on anemia in women given at the Upper Egypt Congress of Clinical Nutrition. The presentation covered:
1) Prevalence of anemia globally and in Egypt, especially in women and children, noting it remains high.
2) Targets for reducing anemia prevalence by 2025 under the global nutrition plan and challenges in achieving these targets.
3) Complications of anemia, especially related to pregnancy outcomes.
4) Modern approaches to diagnosis, prevention and treatment of iron deficiency anemia, including iron supplementation and new formulations to improve compliance and reduce side effects.
Helicobacter Pylori (HP) and Hyperemesis Gravidarum (HG)Aboubakr Elnashar
Helicobacter pylori (HP) infection may be associated with hyperemesis gravidarum (HG), a severe form of nausea and vomiting during pregnancy. HP infection is common worldwide and has been linked to peptic ulcers and gastritis. While some studies have found an association between HP infection and HG, other studies have found no association. Treating HP infection in pregnant women with refractory HG using combinations of antibiotics like amoxicillin and metronidazole, along with H2 receptor antagonists, has shown rapid improvement in some cases. Screening all HG cases for HP is not practical, but may be considered for refractory cases or those with risk factors like older age or pe
The Women's Health Initiative (WHI) was a 15-year study from 1991-2010 that examined the effects of postmenopausal hormone therapy (HT) and lifestyle interventions on health outcomes in postmenopausal women. The WHI hormone therapy trials found that estrogen plus progestin therapy increased risks of heart disease, stroke, blood clots and breast cancer. Estrogen-alone therapy increased risks of stroke and blood clots but did not change heart disease risk. Subsequent research has found that risks may depend on factors like age at start of therapy, duration of use, and type of progestin used. Current recommendations are to use the lowest effective dose of HT for the shortest time to treat menop
Endometriosis in the peri menopause/ post menopauseArunSharma10
Post menopausal endometriosis
Endometriosis during menopause
Endometriosis in menopause
Endometriosis after menopause
Endometriosis
Endometriosis and cancer
Is endometriosis a problem of reproductive years only?
Explanation for endometriosis after menopause
Prevalence of endometriosis
Coelomic metaplasia theory
Estrogen threshold theory
HRT and post menopausal endometriosis
Tamoxifen & postmenopausal endometriosis
Uterine-Sparing Surgery for Adenomyosis Prof. Aboubakr ElnasharAboubakr Elnashar
This document discusses uterine-sparing surgery for adenomyosis to improve fertility. It describes how adenomyosis can negatively impact fertility and IVF success rates. There are two types of uterine-sparing surgery discussed - complete excision (adenomyomectomy) for localized adenomyosis and partial excision (cytoreductive surgery) for diffuse adenomyosis. The techniques, indications, complications, and outcomes of these surgeries are examined, including improved fertility and pregnancy rates compared to hormonal therapies. However, risks like uterine rupture during subsequent pregnancy must be considered. Overall, the document concludes uterine-sparing surgery is a feasible option for improving fertility in qualified patients with adenomyosis, but it requires
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.
Breast cancer metastasis and drug resistanceSpringer
This document summarizes epidemiological studies on breast cancer in women. It finds that breast cancer incidence and mortality rates increase with age and are higher among white women than black women in the US. Known risk factors for breast cancer identified through epidemiological studies include race, family history, genetics, reproductive factors like age of menarche and menopause, breastfeeding, oral contraceptive and hormone use, alcohol consumption, physical inactivity, obesity, and height. Certain genetic mutations are also implicated in some breast cancer cases.
This document discusses SLE (systemic lupus erythematosus) and infertility. It notes that SLE commonly affects women of childbearing age and can impact fertility through several mechanisms, including disease activity, medications like cyclophosphamide that may cause ovarian failure, and hormonal or renal issues. The document provides details on evaluating and managing infertility risks for SLE patients, such as using lower doses of cyclophosphamide or gonadotropin-releasing hormone agonists to protect fertility, and outlines fertility preservation and assisted reproduction options while controlling lupus disease activity and other risks. The conclusion emphasizes the need to consider how to minimize all factors that may increase infertility risk when managing reproductive-aged women with SLE.
Polycystic Ovarian Syndrome (PCOS) is a complex and challenging syndrome with no clear definition or universally agreed upon treatment approach. An integrated care model is needed to address PCOS, bringing together specialists from various fields to manage the diverse and long-term effects of the condition. PCOS presents with many phenotypes and potential underlying causes, making it difficult to classify and treat as a single disease. Current diagnostic methods and treatment outcomes also have limitations. A multidisciplinary approach considering PCOS's associations with metabolic, cardiovascular, and psychological comorbidities is required to improve care.
1. Adolescent PCOS is defined as unexplained persistent hyperandrogenic anovulation in females aged 10-19. It affects 2.2-18% of adolescents depending on diagnostic criteria.
2. Presentation includes menstrual irregularities, chronic anovulation, hyperandrogenism like acne and hirsutism, and hyperandrogenemia. Diagnosis is challenging due to normal puberty changes resembling PCOS.
3. Treatment focuses on restoring weight, regulating cycles, and reducing hyperandrogenism signs to prevent long-term health issues. Lifestyle changes, hormonal contraceptives, metformin, and anti-androgens are commonly used treatment
This document discusses adolescent endometriosis (AE), noting that it is a common condition with many unanswered questions. AE can involve lesions of all stages of severity, from minimal to severe. While some reports have found only early stage lesions in AE, more recent studies show a significant portion have advanced stage disease. AE seems to have a progressive natural course. Risk factors include early menarche, family history, and mullerian anomalies. Common symptoms are pain, which is often resistant to medical therapy, and pelvic masses seen on ultrasound. Laparoscopy is the gold standard for diagnosis but often shows atypical lesions. Treatment involves medications, with surgery as an option for persistent or severe cases. Recurrence is a
Anaemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Wo...Lifecare Centre
ANAEMIA : its prevalence across age and gender group has increased. Aneamia has increased by 2-9% among children , Pregnant women and men according to data shared in the National Family health survey 5 (NFHS-5) released November 24, 2021
Anemia Free India Focuusing on 12 gm Haemoglobin for Children , Girls & Women : Dr Sharda Jain
Anemia Free India Gynaecologist to focuss on *12gm Haemoglobin at Delivery I...Lifecare Centre
Important Highlights
Prophylactic Iron and Folic Acid Supplementation in all six target age groups.
Intensified year-round Behaviour Change Communication (BCC) Campaign for:(a) improving compliance to IFA and deworming, (b) enhancing appropriate infant and young child feeding practices, (c) encouraging increase in intake of iron-rich food through diet and/or fortified foods (d) ensuring delayed cord clamping .
Testing and treatment of anaemia, using digital methods and point of care treatment, with special focus on pregnant women and school-going adolescents.
Addressing non-nutritional causes of anaemia
in endemic pockets with special focus on malaria, hemoglobinopathies and fluorosis
The document discusses the National Iron Plus Initiative in India to address anemia. It provides background on the high prevalence and burden of anemia globally and in India. Some key points discussed include:
- Anemia is most commonly caused by iron deficiency and affects over 1.9 billion people worldwide, with the highest burden in Asia and Africa.
- In India, over 50% of pregnant women and young children suffer from anemia.
- Consequences of anemia include increased mortality and morbidity, as well as reductions in work and economic productivity.
- The National Iron Plus Initiative was launched in 2013 to strengthen India's efforts through strategies like weekly iron supplementation and nutrition counseling.
- However, the initiative requires strengthening in
Role of clinical pharmacist in prevalence of anemiapharmaindexing
This study examined the role of clinical pharmacists in addressing anemia prevalence among the female population. A review of 400 prescriptions over 3 months found that 64% of women had anemia, with prevalence highest among women aged 20-30 years. Anemia severity was also associated with lower socioeconomic status and illiteracy. The study concludes that clinical pharmacists can play an important role in counseling female patients, especially during pregnancy and menstruation, to increase awareness of anemia complications and promote prevention.
Role of clinical pharmacist in prevalence of anemiapharmaindexing
This study analyzed 400 prescriptions from female patients to determine the prevalence of anemia. The key findings were:
- 64% of women studied had anemia, defined as a hemoglobin level below 11g/dL.
- The highest prevalence of anemia (55.6%) was found in women aged 20-30 years.
- Moderate anemia (25.6% of cases) and severe anemia (55.6% of cases) were most common.
- Factors like age, education level, and socioeconomic status were significantly associated with higher rates of anemia.
The study concluded there is a need for pharmacists to provide counseling to raise awareness among
This document summarizes a study examining vitamin B12 deficiency in patients with primary hypothyroidism. The study found:
1) Nearly 40% of the 116 hypothyroid patients studied had low vitamin B12 levels, indicating a high prevalence of B12 deficiency in this group.
2) Common symptoms of B12 deficiency like numbness and impaired memory were seen in both B12 deficient and sufficient hypothyroid patients, making symptoms a poor guide to determining B12 status.
3) Treatment with B12 injections led to reported improvement in symptoms in over half of B12 deficient patients, and some non-deficient patients also reported improvement, suggesting a possible placebo effect.
The study concludes that
presentation of Anemia and classificationSajadBhat46
This document presents information on evaluating and correlating the anemic profile in pregnant women. It discusses:
- Anemia being a major public health problem worldwide, especially among pregnant women in developing countries.
- The types and risk factors of anemia during pregnancy, including iron deficiency, folate deficiency, vitamin B12 deficiency, and how they can impact both mother and fetus.
- The objectives of studying and correlating the anemic profile of pregnant women in different trimesters and those with gestational diabetes.
- The materials, methods, and parameters that will be included in the study such as Hb, CBC, iron profile, folic acid levels, and blood sugar.
Iron deficiency anemia (IDA) is the most common type of anemia globally, affecting approximately 1.6 billion people. It results from prolonged negative iron balance in the body due to inadequate intake, decreased absorption, increased demand, or losses. Diagnosis involves a complete blood count and serum iron studies showing microcytic anemia and low iron stores. Treatment focuses on oral iron supplementation of 200 mg elemental iron daily for 3-6 months to replenish stores and resolve symptoms, with intravenous options for intolerances or malabsorption. Education aims to prevent recurrences through lifestyle modifications.
This document discusses iron deficiency anemia (IDA), including its definition, epidemiology, etiology, diagnosis, and treatment. Some key points include:
- IDA is the most common type of anemia worldwide, affecting approximately 1.6 billion people. It occurs when iron levels and stores in the body are depleted.
- Risk factors for IDA include blood loss, inadequate iron intake, increased iron demands, and impaired iron absorption. Young children, women of childbearing age, and those with chronic blood loss are most at risk.
- IDA is diagnosed based on low hemoglobin and iron indicator levels. Treatment involves oral or intravenous iron supplementation to replenish iron stores. Managing the underlying cause is also important for preventing
IDA is the most common form of anemia worldwide, affecting approximately 50% of anemia cases. It results from prolonged negative iron balance in the body due to factors like inadequate iron intake, decreased absorption, increased demand, or blood loss. Diagnosis involves a complete history, physical exam, and lab tests showing low indicators of iron stores like serum ferritin and iron, along with an elevated TIBC. Treatment aims to replenish iron stores and typically consists of oral iron supplementation of 200mg elemental iron per day for 3-6 months.
This document discusses anemia in pregnancy. It defines anemia and notes that about half of all pregnant women worldwide are anemic. Causes of anemia in pregnancy include iron deficiency, other nutritional deficiencies, infection, and blood loss. Untreated anemia can lead to complications for both mother and baby like preterm delivery and low birth weight. Screening and treatment of anemia is important. Oral iron supplementation is usually first line treatment for iron deficiency anemia in pregnancy.
Background: Anemia is a common Feature of chronic kidney disease, but the management of anemia in children is complex. Erythropoietin and Supplemental iron are used to maintain hemoglobin levels. The aim of this study to determine the Frequency of anemia and possible Risk Factors Among children with End stage renal disease.
Methods: A total of 96 children, 61males (63.5%) and 35 Females (36.5%), were attended at hemodialysis units in Khartoum state were enrolled in the study and Frequency of anemia was estimated by analyzing CBC on blood counter (sysmex). The concentration of iron profile, C-reactive protein and parathyroid hormone was measured using COBAS INTEGRA 400 PLUS and COBAS E411.
Results: 99% of children were anemic, 4.17% of them were suffering from iron deficiency anemia and there are other causes contributing to anemia in ESRD patients which are inflammation and hyperparathyroidism.
Conclusion: The prevalence of anemia in children on hemodialysis in Sudan appears to be higher than that reported in other studies despite extensive use of rHuEPO and iron supplementation.
Anemia in Women of Reproductive Age Group at GCUOG 16/07/2022.pptxNiranjan Chavan
Anemia in pregnancy is one of the most important factors related to maternal morbidity and mortality.
Oral iron provides an inexpensive and effective means of restoring iron balance in a patient with iron deficiency without complicating comorbid conditions.
IV iron is appropriate for patients who are unable to tolerate gastrointestinal side effects of oral iron.
Prevalence of anemia in adolescent girls and its co relation with demographic...Younis I Munshi
Among 1000 adolescent girls studied in India:
- 60% were found to be anemic, with 18.4% mild, 41.3% moderate and 0.4% severe.
- Anemia prevalence was highest among girls from lower socioeconomic classes.
- Poor nutritional status as measured by BMI, skin fold thickness and neck circumference correlated with higher risk of anemia. Adolescent girls are vulnerable to anemia due to growth and menstrual blood loss.
Prevalence of Anamiea and Its Predictors in Pregnant Women Attending Antenata...iosrjce
Background: Anemia impairs cognitive development, reduces physical work capacity and in severe cases
increases risk of mortality particularly during prenatal period. In India, 16% of maternal deaths are attributed
to anemia. However, high prevalence of anemia among pregnant women persists in India despite the
availability of effective, low-cost interventions for prevention and treatment. Aknowledge of them
sociodemographic factors associated with anemia will help to formulate multipronged strategies to attack this
important public health problem in pregnancy.
Objective: To assess the prevalence of anaemia and its predicting factors among pregnant women attending
antenatal clinic at Tertiary care center.
Study Design: Descriptive cross-sectional study
Methods: A hospital based cross-sectional study design was conducted from January 2014 – September 2014
among 5788 pregnant womens who had been attending antenatal clinic. Red blood cell morphology and Hgb
level determination were assessed following the standard procedures. Socio-demographic data was collected by
using a structured questionnaire. The data entered and analyzed by using the SPSS version 16.0 statistical
software. P<0.05 was considered as statistically significant.
Result: Overall prevalence of anemia among the pregnant women was found to be 86.37%. Factors such as
diet, level of education of women and their husbands and socioeconomic status were found to be significantly
associated with the prevalence of anemia in pregnancy.
Conclusion: The present study showed high prevalence of anemia and the majority of them were of the
moderate type (hemoglobin: 10-10.9 g/dl). Low socioeconomic class, illiteracy, Multiparous were significantly
associated with high prevalence of anemia during pregnancy in Indian women.
Diabetes is a rapidly and serious health problem in Pakistan. This chronic condition is associated with serious long-term complications, including higher risk of heart disease and stroke. Aggressive treatment of hypertension and hyperlipideamia can result in a substantial reduction in cardiovascular events in patients with diabetes 1. Consequently pharmacist-led diabetes cardiovascular risk (DCVR) clinics have been established in both primary and secondary care sites in NHS Lothian during the past five years. An audit of the pharmaceutical care delivery at the clinics was conducted in order to evaluate practice and to standardize the pharmacists’ documentation of outcomes. Pharmaceutical care issues (PCI) and patient details were collected both prospectively and retrospectively from three DCVR clinics. The PCI`s were categorized according to a triangularised system consisting of multiple categories. These were ‘checks’, ‘changes’ (‘change in drug therapy process’ and ‘change in drug therapy’), ‘drug therapy problems’ and ‘quality assurance descriptors’ (‘timer perspective’ and ‘degree of change’). A verified medication assessment tool (MAT) for patients with chronic cardiovascular disease was applied to the patients from one of the clinics. The tool was used to quantify PCI`s and pharmacist actions that were centered on implementing or enforcing clinical guideline standards. A database was developed to be used as an assessment tool and to standardize the documentation of achievement of outcomes. Feedback on the audit of the pharmaceutical care delivery and the database was received from the DCVR clinic pharmacist at a focus group meeting.
This document discusses nutrition-related health problems, focusing on micronutrient deficiencies. It provides details on iron deficiency, including causes, signs, diagnosis, and global prevalence. Interventions to address nutritional anemia are outlined, including prophylactic iron and folic acid supplementation, deworming, behavior change communication, testing and treatment programs targeting different groups, and mandatory fortification of foods provided through government programs. The goal is to reduce the high prevalence of anemia, especially in children, women, and pregnant women, and mitigate its detrimental health effects.
Abstract— Anemia in pregnancy is commonly considered as risk factor for poor pregnancy outcome and can threaten the maternal and fetal life also. So this present cases control study was carried at R. K. Joshi District Hospital Dausa (Rajasthan) India, with the aim to find out the effect of anemia in Antenatal period on pregnancy outcomes. For this study, 50 Antenatal Cases (ANCs) with anemia were selected as study group among ANCs attending for delivery in district hospital Dausa. For control group age and BMI matched 50 normal healthy ANCs without anemia were selected from the same area. ANCs with any other diseases were excluded from the study. It was found in this study that although proportion of ANCs with LSCS, PPH and Sepsis were higher in anemic ANCs but it was not found significant. Likewise IUGR, LBW babies, premature births and still births were more in anemic ANCs but it was found significant only in case of LBW babies. So it can be concluded that anemia in ANCs effect weight of newborn babies born by ANC with anemia.
Dr NNC Hyperhomocysteinemia & Pregnancy 06082023.pptxNiranjan Chavan
This document discusses homocysteine levels during pregnancy and related complications. It notes that elevated homocysteine is associated with pregnancy issues like preeclampsia, preterm delivery, and growth restriction due to its effects on the vascular endothelium. Testing homocysteine levels early in pregnancy may help identify women at higher risk. Supplementation with active forms of vitamins B6, B9, and B12 is recommended to lower homocysteine levels and reduce complications, as inadequate levels of these vitamins can cause hyperhomocysteinemia.
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3. ANAEMIA : its prevalence across age and gender
group has increased.
Aneamia has increased by 2-9% among
children ,
Pregnant women and
men
according to data shared in the National Family
health survey 5 (NFHS-5)
released November 24, 2021
4. In rural area of India ,
68.3% children are
Anaemic , while the
urban load stands at
64.2 % according to
NFHS-5
5. The largest spike is seen in children
between the ages of 6months and 59
months,
Now 67.1 % are Anaemic , as
compared to
58.6% in NFHS – 4 conducted in
2015-2016.
In rural areas
68.3% children are anaemic ,
while the urban load stands at 64.2 %
6. The Second highest increase is
recorded in women between the
ages of 15 and 19th ,
up from 54.1 in 2015 -2016 to
59.1 in 2019-2021.
Here too , more young women
in rural areas (56.5 %) are
Aneamic as compared to urban
areas (60.2%)
7. All women between the ages of 15 and 49 years
reported a four % increase in incidence of Anaemia ,
up from 53.1% in 2015 to 2016
to 57 % in 2019 - 2021
8. PREGNANCY : The % of
pregnant women between
the ages of 15 and 49 years
who are anemic
has increased to 52.2% now
from 50.4%in 2015 -2016
9. MEN , irrespective of age group , have reported the lowest
increase in the incidence anemia at 2.3 % for those between
the ages of 15 and 49 – up to 25% now from
22.7% in 2015 -2016 .
Among them , younger men , between 15 and 19, have
shown a 1.9% increase to 31.1% now from 29.2%
10. WHO. The global prevalence of anaemia in 2011. Geneva: World Health Organization;2015.
Anemia affects around 1 billion children and women globally
INDIA USP
:anaemia/Malnutrition
Level of public health
significance:
Severe
Anemia: A Global Burden
11. Work performance
Child development
School PerformanceIQ
Child mortality
Maternal mortality
Perinatal mortality
Other factors
A new conceptual model of IDA and its effects.
Tissue Iron
Deficiency
Moderate&
Severe
Anemia
12. DEFINITION OF ANAEMIA
W.H.O.
Greek word – LACK OF BLOOD
• LEVELS : 12 GM % CHILD OF 2 YEARS ,GIRLS ,WOMEN
• USP : oxygen carrying capacity is by Hb molecule
13. DEFINITION OF ANAEMIA
Greek word – LACK OF BLOOD
• Decrease in no. of RBC’s, or
• Decrease in Hb, or
• Decrease in oxygen carrying capacity of Hb molecule
15. HB –CUT OFFS
• WHO recommendation (2001)
Hb concentration should not fall below 11.0g/dL (Hct < 33%) anytime
during pregnancy
*Mild 9-10.9g/dL * Moderate 7-9g/dL
*Severe <7g/dL * Severe <4g/dL
INDIAN DOCTORSshould aim at 12 gm in pregnancy too,in case to save
Life from PPH
16. Source: India Development and Participation by Jean Dreze and Amartya Sen, OUP 2002
ANAEMIA IN PREGNANCY - 2002
17. National Family Health survey 4 MoHFW 2021
Anemia in Women: Declined in most states from NFHS-3 to
NFHS-4,but still remains high
Anaemia among Children and Adults NFHS 4 (2015-16) NFHS 5(2)
Urban (%) Rural (%) Total (%) Total (%)
Non-pregnant women age 15-49 years
(<12.0 g/dl)
51.0 54.3 53.1 57.2
Pregnant women age 15-49 years
(<11.0 g/dl)
45.7 52.1 50.3 52..2
All women age 15-49 years 50.8 54.2 53.0 55..3
National Family Health Survey - 5 (2021) data
19. MAGNITUDE
• 52% of Indian pregnant women suffer from anemia
20 % maternal deaths contributed by anemia
• Iron deficiency anemia (IDA) commonest cause of anemia in pregnancy
Most Common deficiency state in the world
Preventable and correctable cause of anemia.
DR. SHARDA JAIN – AN ACTIVIST OF ANAEMIA FREE INDIA -
90% pregnant women were Anaemic (2000) 55-57% (2021)
27. Understanding Investigations
• Send immediately for a Complete Blood Count with
Peripheral smear examination.
• Urine and stool routine examination
• Antenatal investigations as per protocol
29. Information from CBC Parameters
1. HB/PCV : Degree of anaemia. Correlates with patient’s symptoms.
HB : PCV ----- 1 : 3
2. MCV, MCH, Peripheral Smear: allow Morphological Classification of anemia, guide
workup and allow assessment of response to therapy
30. Peripheral smear: Shape, size, degree of pigmentation of cell types,
presence of
abnormal cells and blood parasites aid diagnosis of type of anemia
Reticulocyte count : An appropriate response (after correction) shows
appropriate erythropoietin release, a marrow capable of producing red
cell precursors, and sufficient iron stores.
32. CBC PARAMETERS IDA THALASSEMIA
RBC count < 5 million/ml >5 million /ml
RDW >14 <14
Mentzer’s Index >14 <14
MCV
MCH
MCHC NORMAL
33. Diagnosing of Iron Deficiency Anemia
Complete Blood Count:
MCV & RDW :IDA is characterised by Low MCV, Low MCH but up to 40% of pregnant women with true IDA
have normocytic indices
A combination of low MCV accompanied by elevated RDW can be used as a sufficient evidence to start
iron therapy
RDW – decreased in Thalassemia
Serum iron and TIBC : Unreliable markers
Serum iron shows diurnal variation and is affected by dietary influences
Pregnancy itself increases total iron binding capacity (TIBC) even in the absence of IDA
RDW –Red cell distribution width, MCV-Mean corpuscular volume, MCH-Mean Corpuscular Hemoglobin, TIBC – Total Iron Binding Capacity
Indian J Hematol Blood Transfus. 2018:1-2.
34. NOT ROUTINELY RECOMMENDED
• SERUM IRON
• TIBC
• % TRANSFERRIN SATURATION
Only when serum Ferritin is normal but clinical and morphological picture
strongly suggestive of Iron Deficiency Anaemia
38. SOURCES OF IRON
Green leafy vegetables
Legumes, Nuts
Jaggery , Dried Fruits
Meat , Liver ,
Poultry , Fish
SOURCES OF FOLIC ACID
Green leafy vegetables
Legumes, Nuts
Milk , Fruits
Meat , Liver , Eggs
39. •Anthelminthic medication in pregnant women with
anaemia after 12 weeks of pregnancy
•Drug of choice is single dose Mebendazole 100mg BD
for 3 days
OR Albendazole 400mg
WHO
41. 41
Absorption from Ferrous Ascorbate can be as high
as 67% in Iron deficiency anemia patients
Key:
iron-depleted stores (IDS),
normal Fe status (NIS),
Fe deficiency without anemia (IDWA),
Fe deficiency anemia (IDA)
Biol Trace Elem Res. 2013 Dec;155(3):322-6. doi: 10.1007/s12011-013-9797-2. Epub 2013 Aug 27.
42. 42
Study On Ferrous Ascorbate - PRIDE Study
Significantly more patients became non-anemic by treatment with ferrous ascorbate (93.33%) than with
carbonyl iron (46.66%).
Ferrous ascorbate replenished ferritin stores to a greater extent than carbonyl iron.
Hb increase of 5 g/dl vs. 2.8 g/dl in 60 days
IJOG 2005; 8(4):23-30
43. Study On Ferrous Ascorbate - PRIDE Study
43
Rapid rise in Hb % by 5.03 within 60 days
IJOG 2005; 8(4):23-30
44. 44
Study on Ferrous Ascorbate – HERS Trial
N = 1461
The results show that at a dose of 1 tablet daily was effective in treating anemia, with rapid
increase in hemoglobin (mean: 2.37 g/ dl; 95%C.I.: 2.25 - 2.49) within 45 days, and was well
tolerated. The maximum increase of 3.60g/dl (95%C.I.: 3.07-4.13) was observed in those
with baseline hemoglobin less than 6g/dl.
Max 3.6 g/dl rise in 45 days
HERS study Group. IJGO 2005
46. Right Ratio For More Benefits
Right Ratio Of Iron And Ascorbic Acid Is Necessary To Form Stable Ferrous Ascorbate Complex Yielding
High Efficacy And Favourable Tolerability
47. Reported % Absorption Elemental Iron
Iron % absorption reference
Ferrous ascorbate 30.6- 67% British J Haemat, 1972, 22, 81, 281-286;
European Journal of Clinical Nutrition (2004) 58,
555–558; Archives Latinoamericanos de
Nutricion, 2001, 51,217-224; Arzneim-
Forsch/Drug Res, 1987, 37 (1a), 121-129
Biol Trace Elem Res. 2013 Dec;155(3):322-6. doi:
10.1007/s12011-013-9797-2. Epub 2013 Aug 27.
Ferrous sulphate 7.7 – 10.9% Nutrition Research. 1999, 19, No. 2, pp. 179-90
Iron polymaltose 8.8% Arzneim-Forsch/Drug Res, 1987, 37 (1a), 121-
129
Ferric ammonium citrate 2.4% Archives Latinoamericanos de Nutricion, 2001,
51,217-224
Ferric hydroxide 2.4% Sacnd J Haematology, 1982, 29, 1, 18-24
Ferric orthophosphate 8.3% British J Haemat, 1972, 22, 81, 281-286
Sodium iron
pyrophosphate
6.3% British J Haemat, 1972, 22, 81, 281-286
Ferric pyrophosphate 0% British J Haemat, 1972, 22, 81, 281-286
Ferrous fumarate 3 - 6.3% British Journal of Nutrition (2003), 90, 1081–
1085
Ferrous bisglycinate 6 – 9.1 % Am J Clin Nutr 2000;71:1563–9.
Ferrous gluconate Less than or equal
to ferrous sulphate
Nutritional Anemia, ISBN 3-906412-33-4
Carbonyl iron 70% of ferrous
sulphate
Eur J Haematol. 1991 May;46(5):272-8.
48. Non-Nutritional Causes Of Anemia
Accelerated increase in requirement for iron during growth spurts
and pregnancy.
Loss of blood in case of heavy menstrual bleeding.
Loss of Blood during Post partum Period.
Infections such as Malaria, Hookworm infestation etc.
Teenage marriage and early pregnancy
50. Impact of Heavy Menstrual Bleeding
In India, the reported
prevalence of AUB is
≈ 20%.
Nearly 28- 40 % of the
female population
consider their
menstruation as excessive
and plan their social
activities according to their
menstrual cycles.
10 -15 % of the employed
women take time off work
because of excessive
menstrual loss thus leading
to loss of productivity.
AUB accounts for
approximately 50% of
the visits of adolescent
girls /40 % adult
women to gynecologist.
1. https://www.nhp.gov.in/disease/gynaecology-and-obstetrics/abnormal-uterine-bleeding
2. International Journal of Interdisciplinary and Multidisciplinary Studies (IJIMS), 2016, Vol 3, No.2,41-46.
3. Gaur SS et al., IOSR Journal of Dental and Medical Sciences 2020, 19(7).
51. Post Partum Haemorrhage
Postpartum
hemorrhage (PPH)
is a major cause of
maternal mortality,
accounting for 25%
of all maternal
deaths worldwide.
Postpartum
bleeding is the
quickest of
maternal killers;
can kill even a
healthy woman
within two hours, if
not treated.
Incidence of PPH is
reported as 2% - 4%
after vaginal
delivery and 6%
after cesarean
section.
WANT TO
DECREASE
MMR
CONTROL
PPH.
Ref: https://www.nhp.gov.in/disease/gynaecology-and obstetrics/postpartum-haemorrhage accessed on 01st Oct 2020
53. Focus On Tranexamic Acid (TXA)
PowerPoint templates and Guidelines 53
Anti-Fibrinolytic Drug
Indication: Prevention and treatment of haemorrhage due to general or
local fibrinolysis.
Dosage: 500-1000 mg 2-3 times daily.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2019/212895s000lbl.pdf
54. Mechanism Of Action
• TXA is a competitive inhibitor of plasminogen, and at high concentrations, is a noncompetitive
inhibitor of plasmin.
• Inhibition of both plasminogen activation and plasmin leads to stabilization of a preexisting
clot by impairing the process of fibrinolysis.
Stable Clot
56. Use In Heavy Menstrual Bleeding
TXA has been studied for the treatment of Heavy Menstrual Bleeding since the 1960s.
Callender et al. evaluated the efficacy of TXA in women with HMB in a Clinical study.
• Women received either 500 mg of TXA four times daily for the first 4 days of their menstrual cycle,
or placebo, for three menstrual cycles.
• TXA use resulted in a significant reduction in pad count
Lukes et al. randomized women with HMB to either TXA 1.3 g three times daily for 5 days during
menstruation or matching placebo.
• TXA use had a 40% reduction in menstrual blood loss compared with an 8% reduction with
placebo (P ≤ 0.01).
“When compared with oral progestin therapy, TXA was found to be more effective in reducing menstrual
blood loss.”
1. Callender ST et al. Br Med J. 1970;4(5729):214–216.
2. Lukes AS et al. Obstet Gynecol. 2010;116(4):865–875
57. 57
Acta Obstet Gynecol Scand 2016; 95:28–37.
Meta-analysis of 9 RCTs; 2365 women
Prophylactic Tranexamic acid administration:
1. Is associated with a significant decrease in postpartum blood loss (mean difference –160.27 mL, 95% CI
224.63 to 95.92)
2. A significantly lower incidence of PPH and severe PPH
3. A significantly lower hemoglobin drop
4. Significantly less need for additional uterotonic agents
We suggest consideration for adding tranexamic acid, 1 g (or 10 mg/kg) i.v. 10–20 min before skin incision
or spinal anesthesia.
58. 58
Study Population – 20,060 women
aged 16 years and older with a
clinical diagnosis of post-partum
haemorrhage after a vaginal birth
or caesarean section from 193
hospitals in 21 countries.
Objective – To evaluate effects of
early administration of Tranexamic
acid on death, hysterectomy, and
other relevant outcomes in women
with post-partum haemorrhage.
Intervention - 1g IV Tranexamic
acid or matching placebo in
addition to usual care. If bleeding
continued after 30 min, or
stopped and restarted within 24 h
of the first dose, a second dose of
1 g of Tranexamic acid or placebo
could be given.
2017 The WOMAN trial, The Lancet
59. WOMAN Trial - 2017
Results:
Death due to bleeding was significantly reduced in women given tranexamic acid [RR] 0·81
(Overall), 95% CI 0·65–1·00; p=0·045).
Women given treatment within 3 h of giving birth death due to bleeding decreased by 31 % (RR
0·69) in the tranexamic acid group.
59
Interpretation:
The administration of Tranexamic acid to women with post-partum haemorrhage reduces
deaths due to bleeding with no evidence of any adverse effects or complications.
2017 The WOMAN trial, The Lancet
60. Recommendations For Tranexamic Acid
World Health Organization :
• TXA should be used in all cases of PPH, regardless of whether the bleeding is due to genital
tract trauma or other causes after 3 hours of delivery.
• TXA should be part of the standard comprehensive PPH treatment package.
American College of Obstetricians and Gynaecologists:
“TXA should be considered in the setting of PPH when initial medical therapy fails”
60
61. New Ways Of Managing Anemia
Management With Ferrous Ascorbate:
Superior Absorption, 4 times higher than most other
irons.
Proven safety and efficacy. Achieves rapid Hb rise
No interaction with food…can be given any time
Ascorbic acid - Intrinsic free radical scavenging
property
Better tolerated than other Iron preparations and
better compliance
Management With Tranexamic Acid:
Safe and highly effective treatment for excessive
bleeding in Menstruation
Offers a first-line, non-hormonal, nonsurgical
treatment option for women with cyclic heavy
menstrual bleeding.
Tranexamic acid is safe in reducing the risk of death
in postpartum hemorrhage.
Also useful in, post-operative hemorrhage,
dysfunctional uterine bleeding and trauma.
62. Focussed Discussion On Management of IDA
• As you know, Ferrous Ascorbate is considered as the reference iron molecule; In your
clinical practice, what average increase in Hb is noted with Ferrous Ascorbate?
• We have discussed about the landmark clinical studies and right ratio of Iron and
Ascorbate; In your opinion how relevant is this in Clinical Practice?
Q.
63. • What are your real life experiences about the tolerability of Ferrous
Ascorbate?
• In which type of patient profile do you consider Tranexamic acid
alone or with MF?
• Do you think here is a role of TXA in prevention of Anemia?
Focussed Discussion On Management of IDA
Q.