How to mange a pregnant patient exposed to Rubella virus?
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Pregnant women exposed to rubella virus should be tested for rubella immunity. If the test shows immunity, no further action is needed. If the test shows no immunity, close monitoring of the pregnancy is recommended to check for signs of fetal infection or damage from the rubella virus.
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Antibiotic Prophylaxis during the second and third trimester to reduce adverse pregnancy outcomes and morbidity Cochrane Systematic Review 2015
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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
Gonadotrophins in PCOS
This document discusses gonadotropin protocols for ovulation induction in polycystic ovary syndrome (PCOS). It describes step-up, step-down, and combined step-up/step-down protocols. Low-dose step-up protocols starting at 37.5-75 IU per day are now preferred over conventional high-dose protocols due to lower risks of multiple follicle development, multiple pregnancies, and ovarian hyperstimulation syndrome (OHSS). Strict monitoring of follicle growth and estrogen levels allows early cycle cancellation to further reduce OHSS risk while maintaining effectiveness of about 70% monofollicular ovulation and 20% pregnancy rates.
Updates on management of Adolescent PCOS An evidence based approach
This document discusses guidelines for the management of adolescent polycystic ovary syndrome (PCOS) from an evidence-based perspective. It covers the diagnosis, evaluation, and treatment of adolescent PCOS according to guidelines from various medical societies. For diagnosis, the guidelines emphasize avoiding a premature diagnosis and monitoring for physiological changes versus PCOS. Evaluation involves screening for comorbidities like obesity, depression, sleep disorders, diabetes and cardiovascular risk. Treatment options include lifestyle changes, hormonal contraceptives, metformin, and sometimes a combination depending on the individual's age, symptoms and risks.
Obesity and Reproduction
This document discusses the effects of obesity on reproduction. It notes that obesity can affect menstruation, sexual function, fertility, and pregnancy in both males and females. It outlines specific ways that obesity impacts menstruation, sexual desire and function, semen quality, testicular volume, hormone levels, and risk of infertility in males. In females, it discusses how obesity can contribute to irregular cycles, PCOS, impaired sexual function, poor response to fertility treatments, and increased risk of complications during pregnancy and delivery. The document provides recommendations for managing obesity both before and during pregnancy to help mitigate risks.
Ultrasonography of the ovary
Ultrasonography is useful for evaluating the normal ovary and detecting abnormalities. A normal ovary appears hypoechoic and contains multiple small follicles. During ovulation, a corpus luteum forms which appears as a solid or cystic structure. Polycystic ovary syndrome is diagnosed based on the number of follicles present. Ultrasonography can also detect cysts, masses, ectopic pregnancies and other ovarian pathologies. It is an important tool for assessing ovarian function and guiding fertility treatments.
RCT of the effects of Metformin Vs COCs in adolescent PCOS women through a 2...
This randomized controlled trial compared the effects of metformin and combined oral contraceptives (COCs) in adolescent women with polycystic ovary syndrome (PCOS) over 24 months. 119 adolescent girls were randomly assigned to receive metformin, COCs, or no treatment (control group). Both metformin and COCs significantly improved cycle regularity and hirsutism compared to the control group. However, metformin was associated with significant improvement in insulin sensitivity, while COCs deteriorated insulin sensitivity. The study concludes that metformin and COCs have comparable effects on symptoms, but metformin may have metabolic advantages in adolescent PCOS patients.
Management of normal labour
This document provides information on the management of normal labor. It defines labor and delivery and outlines the cardinal movements of labor. It discusses assessing and monitoring labor through the stages including fetal wellbeing, maternal wellbeing, and labor progress using a partogram. It covers managing each stage of labor including the first stage of dilation, the second stage of delivery, and the third stage of delivery of the placenta. Key points like positioning, pushing techniques, and care of the newborn are summarized.
PREVENTION OF MALE INFERTILITY
1. The document discusses ways to prevent male infertility, including reducing environmental pollutants, treating medical conditions early like undescended testes, vaccinating against diseases causing orchitis, treating sexually transmitted diseases, avoiding trauma, limiting exposure to occupational toxins and drugs affecting sperm production, and cryopreserving sperm before cancer treatments.
2. Key strategies include early orchidopexy for undescended testes to reduce risks of infertility, treating orchitis early to prevent testicular atrophy, using condoms and treating STDs to prevent duct obstruction, and cryopreserving sperm prior to chemotherapy or radiotherapy.
3. Preventing infertility is better than treatment and many causes can be avoided through public health measures
Fibroid and infertility
This document discusses types of fibroids and their impact on fertility. It describes 3 main types of fibroids - submucosal, intramural, and subserosal - and provides details on their classification systems. The document also summarizes several mechanisms by which fibroids can affect fertility, including effects on fertilization and implantation. It reviews findings on the relationship between fibroid characteristics like location, size, and number and fertility outcomes like pregnancy rates. The document concludes by outlining treatment options for fibroids impacting fertility, including expectant management, medical therapies, and various surgical approaches.
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Antibiotic Prophylaxis during the second and third trimester to reduce adver...
Antibiotic Prophylaxis during the second and third trimester to reduce adver...
Helicobacter Pylori (HP) and Hyperemesis Gravidarum (HG)
Helicobacter Pylori (HP) and Hyperemesis Gravidarum (HG)
Updates on management of Adolescent PCOS An evidence based approach
Updates on management of Adolescent PCOS An evidence based approach
RCT of the effects of Metformin Vs COCs in adolescent PCOS women through a 2...
RCT of the effects of Metformin Vs COCs in adolescent PCOS women through a 2...
More from Aboubakr Elnashar
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGIST
The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
hepatitis B.pdf
1. Hepatitis B in pregnancy can impact both mother and child. Vertical transmission from mother to child is a major risk, occurring in 30% of cases without intervention.
2. Diagnosis involves screening all pregnant women for HBsAg. For HBsAg positive mothers, further testing of HBV DNA viral load, HBeAg status, and liver enzymes can assess risk of transmission.
3. Prevention of mother-to-child transmission focuses on antiviral therapy starting at 28 weeks for mothers with high viral load, administration of HBIG and HBV vaccines within 12 hours of birth, and completion of the vaccine series for the infant.
hepatitis c2022.pdf
Hepatitis C and pregnancy can affect both mother and fetus. While pregnancy does not typically affect the course of HCV infection, HCV can increase maternal risks like gestational diabetes and postpartum hemorrhage. It may also increase fetal risks such as preterm delivery and low birthweight. Management includes screening all pregnant women for HCV, treating the mother if needed to reduce viral load and risk of transmission, and monitoring the fetus for complications. Delivery by cesarean is not routinely recommended, and breastfeeding is considered safe if nipples are intact.
Adenomyosis associated infertility
A 32-year-old woman presented with primary infertility of 1.5 years. Ultrasound and MRI findings indicated adenomyosis. Adenomyosis can be associated with infertility by decreasing chances of conception and increasing risk of miscarriage. The patient underwent failed ovulation induction and IUI cycles. The document discusses recommended treatment protocols including IVF with a long agonist or antagonist protocol, as well as potential surgical options like conservative surgery if additional IVF cycles fail. Conservative surgery may improve fertility in women under 40 who desire future pregnancy.
Endometriosis associated infertility: ESHRE2022
The document is a lecture on the treatment of endometriosis-associated infertility according to 2022 ESHRE guidelines. It discusses various treatment options including medical treatment with hormonal therapies, surgery, assisted reproductive technologies (ART), and fertility preservation. Key recommendations include that ovarian suppression should not be used to improve fertility. Surgery and ART may be considered depending on the stage of endometriosis and patient factors. Extensive counseling is recommended when discussing fertility preservation options.
Adenxal mass guidelines2020
This document summarizes guidelines for managing adnexal masses from the SOGC in 2020. It discusses examining patients with adnexal masses through history, physical exam, investigations including ultrasound, lab tests, cancer antigen 125 levels, and the risk of malignancy index. Ultrasound is emphasized for distinguishing benign from malignant features, with IOTA criteria outperforming RMI. Referral to a gynecologic oncologist is recommended for suspected malignancy based on sonographic features, family history, clinical findings or indeterminate ultrasound results.
Aesthetic gynecology controversy
This document discusses controversies in aesthetic gynecology procedures. It begins by defining aesthetic gynecology as procedures that alter female genital appearance or structure for non-medical reasons. The document then outlines the increasing popularity of these procedures in recent years. It notes both opponents and proponents of these procedures and their differing views on issues like patient autonomy and lack of evidence. The document concludes by summarizing various medical organizations' ethical guidelines, which state that the safety and effectiveness of many aesthetic gynecology procedures have not been established and caution is warranted.
Hormonal assay in clinical gyn
This document discusses a lecture on hormonal assays in clinical gynecology given by Prof. Aboubakr Elnashar. It provides information on various hormones including prolactin, TSH, AMH, FSH, LH, estrogens, progesterone, and androgens. For each hormone, the document discusses their source, reference ranges, clinical uses, and conditions they may be associated with. It also provides summaries of key points about each hormone test and their roles in evaluating endocrine conditions like infertility, menstrual disorders, and menopause.
FIRST TRIMESTER ANC OF IVF
1. The document discusses the routine care and special considerations for antenatal care (ANC) of pregnancies achieved through in vitro fertilization (IVF).
2. Special considerations for IVF pregnancies include increased risk of complications like ovarian hyperstimulation syndrome, multiple pregnancies, and genetic abnormalities which require specialized counseling and screening.
3. ANC for IVF pregnancies should be provided by specialists familiar with both obstetrics and IVF in order to monitor for pregnancy complications and provide psychosocial support related to fertility treatments.
Unnecessary investigations in reproductive medicine
The document discusses unnecessary investigations in reproductive medicine. It provides examples of tests that should not be routinely performed when evaluating infertility, during IVF treatment, in cases of recurrent implantation failure, and recurrent pregnancy loss. Specific tests that are deemed unnecessary include post-coital testing, thrombophilia testing without a clinical indication, immunological testing, and advanced sperm function tests for initial infertility evaluations. The document also recommends limiting hormonal assessments during IVF cycle monitoring.
Infertility prevention
This document discusses prevention of female infertility and contains information on several topics:
1. Age-associated infertility and the decline of fertility with increasing female age. Early childbearing and egg freezing are recommended.
2. Tubal factor infertility caused by infections like pelvic inflammatory disease which can be prevented by screening and treating STDs. Adhesions from surgery can also be prevented using techniques that minimize trauma.
3. Other causes of infertility like endometriosis, ovarian issues, and uterine factors are discussed along with prevention strategies.
Female infertility
This document discusses female infertility, including causes like endometriosis, ovarian factors, tubal factors, and uterine factors. It provides guidelines for evaluating infertility, including taking a history, physical exam, and testing. For ovarian factor infertility, it discusses assessing ovulation through symptoms, ultrasound, and progesterone testing. Causes of anovulation like PCOS are explained. Ovarian reserve can be assessed through age, antral follicle count, and AMH levels.
Maternal near miss
This document discusses maternal near miss (MNM), which refers to women who survive severe life-threatening complications during pregnancy, childbirth, or postpartum. MNM is presented as an important tool for evaluating obstetric healthcare beyond just maternal mortality. The document outlines criteria for identifying MNM cases, indicators for assessing healthcare quality using MNM data, advantages of MNM reviews for reducing maternal mortality, and findings from studies on MNM in various hospitals that identified leading complications and opportunities for improvement. MNM reviews are described as complementary to maternal death reviews for gaining insights to reduce preventable morbidity and mortality.
THE MANAGEMENT OF SEVERE PET/ECLAMPSIA
The document provides guidelines for the management of severe preeclampsia and eclampsia. It defines preeclampsia and eclampsia and describes criteria for severe disease. It recommends close maternal monitoring of blood pressure, labs, urine output and fetal wellbeing. It provides guidance on controlling blood pressure with antihypertensive drugs like labetalol, nifedipine and hydralazine. The goal is to prolong the pregnancy and deliver at the optimal time while preventing maternal and fetal complications.
cesarean birth: procedural aspects: NICE2021
This document provides guidelines for procedural aspects of caesarean sections (CS). It discusses topics such as: timing of planned CS to reduce neonatal risks; classification and timeframes for emergency CS categories; preoperative testing and preparation; regional anesthesia preferences; techniques to reduce infection risks and prevent transmission; surgical techniques for skin incision, uterine closure, and more; and thromboprophylaxis and accommodating women's preferences.
CAESAREAN SCAR DEFECT
The document discusses caesarean scar defects, also known as uterine niches. It provides information on the prevalence, risk factors, clinical presentation, diagnosis, and management of this condition. Uterine niches are common, affecting up to 70% of those with a prior c-section, and are usually asymptomatic but can sometimes cause bleeding, pain, or infertility. Diagnosis involves ultrasound imaging to identify a triangular defect in the uterine scar with decreased or absent underlying muscle. Larger niches with less residual muscle are more likely to be symptomatic.
Management of pregnancy of unknown location
This document provides guidelines for managing pregnancies of unknown location (PUL). It defines PUL as a positive beta-hCG result but no pregnancy located on ultrasound. PULs have several potential outcomes including intrauterine pregnancy (IUP), ectopic pregnancy, or persistent PUL. The M6 regression model can help stratify PULs as high or low risk for ectopic pregnancy to guide treatment. Management of PUL requires close follow-up with repeated testing until a definitive diagnosis is made.
Aerobic Vaginitis
1. Aerobic vaginitis (AV), also known as desquamative inflammatory vaginitis (DIV), is an underdiagnosed vaginal discharge syndrome caused by an imbalance of the vaginal microbiota and an inflammatory response.
2. It is characterized by a lack of lactobacilli bacteria and overgrowth of aerobic bacteria like E. coli, streptococci, and staphylococci. Women present with yellowish foul-smelling discharge, irritation, and vaginal inflammation.
3. The diagnosis of AV is made through microscopic examination showing lack of lactobacilli, presence of inflammatory cells and parabasal cells, and a vaginal pH over 4.
COVID 19 infection and pregnancy RCOG2021
This document provides guidelines for caring for pregnant women with COVID-19. It discusses that vertical transmission of COVID-19 from mother to baby is uncommon. It recommends continuing antenatal care with safety modifications and advises vaccination for pregnant women when risk of exposure is high. For pregnant women with COVID-19, it suggests treatments and monitoring based on symptoms and managing clinical deterioration. Guidelines are provided for intrapartum and postpartum care as well, including thromboprophylaxis. The overall goal is to provide care for both the health of the pregnant woman and baby while mitigating risk of COVID-19 transmission.
Imaging in pregnancy 2 in1
This document discusses various imaging modalities used during pregnancy, including their risks and benefits. It covers ionizing radiation-based methods like radiography and CT scanning, as well as ultrasound, MRI, and nuclear medicine imaging. While ionizing radiation poses risks to the fetus, careful use of these modalities when clinically indicated can still provide diagnostic benefits. Newer techniques have also reduced radiation exposure. Ultrasound is generally safe but can cause thermal or mechanical effects if overused. MRI does not use radiation but subjects the fetus to strong magnetic fields, though studies have not found adverse outcomes from standard MRI use. The key is weighing risks versus benefits for each individual case.
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