This document summarizes the key points about hyperemesis gravidarum, a severe form of nausea and vomiting during pregnancy. It discusses the etiology, risk factors, presentation, complications, diagnosis, and treatment of the condition. Regarding treatment, the document outlines supportive approaches like IV hydration and nutrition, as well as potential pharmacologic interventions including pyridoxine, antihistamines, ondansetron, corticosteroids, and metoclopramide if other options fail. Prognosis is typically good with treatment, though untreated cases can lead to malnutrition, vitamin deficiencies, and adverse fetal outcomes.
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
PANEL DISCUSSION
MANAGEMENT OF PCOS - WOMB to TOMB
MODERATOR : Sharda Jain
PANELISTS : Dr.Chitra setia
Dr Puneet Arora
Dr. Ila Gupta
Dr. Rupam Arora
Dr. Archana Sharma
Dr. Sangeeta Gupta
Dermatologists
Dr. V.K. Upadhyay
Dr. S. Kandhari
Polycystic Ovarian Syndrome is heterogeneous, multisystem endocrinopathy in women of reproductive age characterized by chronic anovulation resulting in infertility, irregular bleeding, obesity and hirsutism. Most common, although the least understood, cause of androgen excess. Initially it was described in 1935.Also known as Stein-Leventhal syndrome
The slide includes:
Introduction
Incidence
Pathophysiology
Pathology
Clinical features
Investigation
Treatment
Science, practice and evidence are dynamic processes. This is typically vivid when it relates to Polycystic Ovarian Syndrome. PCOS is the commonest hyperandrogenic disorder in women and one of the most common causes of ovulatory infertility. Although polycystic ovaries were first described by the Italian scientist Vallisneri in 1721, it was largely forgotten until the 1930s, and then renamed after its rediscoverers as Stein-Leventhal syndrome. Even then, it still wasn’t until the invention of the ultrasound scanner in the 1980s and consensus of diagnosis in the early 1990s that PCOS was recognized on a wider scale in women of reproductive age. When attempting to diagnose with precision something that is complex, it is important that we first clearly define what it is we are trying to diagnose. PCOS is today seen as a heterogeneous syndrome where a range of symptoms may be present or absent, and may overlap with other conditions, it is perhaps best viewed as a spectrum of symptoms, pathologic findings and laboratory abnormalities. PCOS can be difficult to conceptualize, even for experts, as shown by the fact that there have been several different ways of diagnosing it over the years.
More recently, the fundamental role of hyperandrogenism has been pointed out.
However, PCOS compromises other pathological conditions that strongly modify the phenotype and play a dominant role in the pathophysiology of the disorder, including insulin resistance and hyperinsulinemia, obesity and metabolic disorders, all favoring together with androgen excess, an increased susceptibility to develop type 2 diabetes mellitus (T2DM) and, possibly, cardiovascular diseases. PCOS by itself may also have some genetic component as documented by familial aggregation and recent genetic studies. All the clinical features may however change throughout the lifespan, starting from adolescence to postmenopausal age. Therefore, PCOS should be considered as a lifetime disorder.
I sincerely hope that with the recommended readings attached and lecture, you will be able to strengthen your knowledge, thereby providing evidence-based medicine practice for the management of PCOS in a successful manner to improve and better women’s Health care. The best investment you can make is an investment in yourself. The more you learn, the more you’ll earn (Warren Buffett), so read as much as you can.
Thank You.
Regards: Rafi Rozan
medical management of infertility,think before surgery!!!!ShitalSavaliya1
Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Science, practice and evidence are dynamic processes. This is typically vivid when it relates to Polycystic Ovarian Syndrome. PCOS is the commonest hyperandrogenic disorder in women and one of the most common causes of ovulatory infertility. Although polycystic ovaries were first described by the Italian scientist Vallisneri in 1721, it was largely forgotten until the 1930s, and then renamed after its rediscoverers as Stein-Leventhal syndrome. Even then, it still wasn’t until the invention of the ultrasound scanner in the 1980s and consensus of diagnosis in the early 1990s that PCOS was recognized on a wider scale in women of reproductive age. When attempting to diagnose with precision something that is complex, it is important that we first clearly define what it is we are trying to diagnose. PCOS is today seen as a heterogeneous syndrome where a range of symptoms may be present or absent, and may overlap with other conditions, it is perhaps best viewed as a spectrum of symptoms, pathologic findings and laboratory abnormalities. PCOS can be difficult to conceptualize, even for experts, as shown by the fact that there have been several different ways of diagnosing it over the years.
More recently, the fundamental role of hyperandrogenism has been pointed out.
However, PCOS compromises other pathological conditions that strongly modify the phenotype and play a dominant role in the pathophysiology of the disorder, including insulin resistance and hyperinsulinemia, obesity and metabolic disorders, all favoring together with androgen excess, an increased susceptibility to develop type 2 diabetes mellitus (T2DM) and, possibly, cardiovascular diseases. PCOS by itself may also have some genetic component as documented by familial aggregation and recent genetic studies. All the clinical features may however change throughout the lifespan, starting from adolescence to postmenopausal age. Therefore, PCOS should be considered as a lifetime disorder.
I sincerely hope that with the recommended readings attached and lecture, you will be able to strengthen your knowledge, thereby providing evidence-based medicine practice for the management of PCOS in a successful manner to improve and better women’s Health care. The best investment you can make is an investment in yourself. The more you learn, the more you’ll earn (Warren Buffett), so read as much as you can.
Thank You.
Regards: Rafi Rozan
medical management of infertility,think before surgery!!!!ShitalSavaliya1
Nowdays infertility is major issues world wide,It covers both male and female infertility causes,investigation and related treatments.it also includes recent options available at infertility centres.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
PowerPoint presentation of emesis in pregnancy given at resident presentation, obstetrics and gynecology directorate, Komfo Anokye Teaching Hospital
risk factors, symptoms, management of severe vomiting with dehydration and weight loss in pregnancy
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018Võ Tá Sơn
Cập nhật hướng dẫn điều trị guideline ACOG 2018 nôn nghén trong thai kỳ, vitamin B6, nausea and vomiting of pregnancy
Phác đồ điều trị nôn nghén quá độ trong thai kỳ ACOG
www.votason.net
Pregestational diabetes a major obstetrical problem now a days. These PPT contains modern as well as Ayurveda aspect for preventing a pregnant women & her baby from developing complications.
Fight against polycystic ovary syndrome problems (pcos pcod)furocyst01
It may cause issues with your intervals and make it hard to become pregnant. PCOS can also cause undesirable changes in how you look. When it is not treated, over the years it may result in other health issues, like diabetes and cardiovascular disease. Most women with Polycystic Ovary Syndrome Problems develop many tiny cysts in their ovaries. That’s why it’s known as PCOS. The cysts aren’t dangerous but contribute to hormone imbalances. Early identification and treatment can help control the symptoms and avoid long-term issues.
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal Lifecare Centre
Intrahepatic Cholestasis of Pregnancy : Dr Sharda Jain & Dr Jyoti Agarwal
Intrahepatic cholestasis of pregnancy (ICP) is characterized by Pruritus and an elevation in serum bile acid concentrations, typically developing in the late second and/or third trimester and rapidly resolving after delivery.
Intrahepatic Cholestasis of Pregnancy - Prof Surekha TayadeSurekhaTayade4
This presentation is for undergraduates, postgraduates, consultants and nurses and describes incidence, etiology, pathophysiology, complications and management of intrahepatic cholestasis of pregnancy /obstetric cholestasis
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
3. ACOG 2015
-persistent nausea and vomiting not caused by other underlying
medical conditions
-ketonuria as a measure of acute starvation, and
-at least a 5% weight loss from the pre-pregnancy weight.
Dutta
-severe type of vomiting of pregnancy which has got deleterious
effect on the health of the mother and/or incapacitates her in day to
day activities.
Other causes should be considered because hyperemesis gravidarum
is a diagnosis of exclusion (Benson, 2013). Williams 24TH Ed
4. The incidence vary from 0.3 to 3 %.
50% of pregnant women experience nausea and
vomiting,
25% have nausea only, and
25% are unaffected
Recurrence with subsequent pregnancies ranges
from 15.2% to 81%.
timing of the start of nausea or vomiting
Symptoms almost always present before 9 weeks
of gestation
When begins for the first time after 9 weeks, other
conditions should be considered
ACOG 2015
CREASY RESNIK’s
5. ETIOPATHOGENESIS
“ multifactorial and certainly enigmatic “
1. high or rapidly rising serum levels of pregnancy-related
hormones
human chorionic gonadotropin (hCG), estrogens, progesterone, leptin,
placental growth hormone, prolactin, thyroxine, and adrenocortical
hormones (Verberg, 2005).
ghrelins, leptin, nesfatin-1, and PYY-3(Peptide YY-3) (Albayrak, 2013; Gungor,
2013).
6. 2. Biological and environmental factors
more common in westernized industrialized societies and
urban areas than rural areas
3. An ethnic or familial predilection (Grjibovski, 2008)
less common in American Indian and Eskimo populations, as
well as less common in African and some Asian populations
(but not industrialized Japan)
7. 4. Psychological components (a response to stress) play a major role
(Buckwalter, 2002; Christodoulou- Smith, 2011; McCarthy, 2011).
5. The vestibular system and olfactory system (Goodwin, 2008).
Hyperacuity of the olfactory system
Similarities to motion sickness
6. An association of Helicobacter pylori infection has also been proposed,
but evidence is not conclusive (Goldberg, 2007).
7. And for unknown reasons—perhaps estrogen-related—a female fetus
increases the risk by 1.5-fold (Schiff, 2004; Tan, 2006; Veenendaal, 2011).
8. RISK FACTORS
hyperthyroid disorders
psychiatric illnesses
previous molar disease
gastrointestinal disorders
pregestational diabetes
asthma
female fetuses(1.5 fold)
multiple fetuses
maternal smoking
older than 30 years
ACOG Practice Bulletin 2015
low to middle socioeconomic class
lower levels of education
previous pregnancies with nausea and
vomiting
first pregnancy
previous intolerance to oral
multiple-gestation pregnancies.
Ethnicity
occupational status
fetal anomalies
increased body weight
nausea and vomiting in a prior pregnancy
history of infertility
interpregnancy interval
corpus luteum in right ovary
prior intolerance to oral contraceptives
9. COMPLICATIONS
MATERNAL COMPLICATIONS
Acute kidney injury—may require dialysis
Depression—cause versus effect?
Diaphragmatic rupture
Esophageal rupture—Boerhaave syndrome
Hypoprothrombinemia—vitamin K deficiency
Hyperalimentation(artificial supply of nutrients,
typically intravenously) complications
Mallory-Weiss tears—bleeding, pneumothorax,
pneumomediastinum, pneumopericardium
Wernicke encephalopathy—thiamine deficiency
Williams 24TH Ed
FETAL
COMPLICATIONS
preterm labor
placental abruption
preeclampsia
Bolin and coworkers (2013)
10. PRESENTATION
nausea and vomiting
Other common symptoms include
ptyalism (excessive salivation)
fatigue, weakness, and dizziness.
Sleep disturbance
Hyperolfaction
Dysgeusia (distortion of the sense of taste)
Depression
Anxiety
Irritability
Mood changes
Decreased concentration
ACOG Practice Bulletin 2015
12. DIFFERENTIAL
DIAGNOSIS
Drug toxicity
Eating disorders
Gastroparesis
Migraines
Ovarian torsion
Pseudotumor cerebri
Psychological disorders
Tumors of the central nervous
system
Vestibular lesions
ACOG Practice Bulletin 2015
Acute intermittent porphyria
Acute Pancreatitis
Appendicitis
Biliary Disease
Diabetic Ketoacidosis
Esophagitis
Fatty Liver
Gastroenteritis
Gastroesophageal Reflux Disease
Hepatitis
Hyperparathyroidism
Hyperthyroidism and Thyrotoxicosis
Irritable Bowel Syndrome
Nephrolithiasis
Paralytic Ileus/Bowel Obstruction
Peptic Ulcer Disease
Preeclampsia
13. LABORATORY STUDIES
Urinalysis for ketones and specific gravity
Serum electrolytes
Liver enzymes and bilirubin
Amylase/lipase
TSH, free thyroxine
Urine culture
Calcium level
Hematocrit
Hepatitis panel
14. IMAGING STUDIES
Ultrasonography
evaluate for multiple gestations or trophoblastic disease.
upper abdominal ultrasonography to evaluate the pancreas and/or biliary tree
Other imaging modalities
upper gastrointestinal endoscopy
abdominal computed tomography (CT) scanning or even magnetic resonance
imaging (MRI) may be indicated
16. FLUIDS AND NUTRITION
Many patients respond to
I.V hydration and a short period of gut rest, followed by
reintroduction of oral intake.
IV hydration often includes supplementation of electrolytes as persistent
vomiting frequently leads to a deficiency
Likewise supplementation for lost thiamine (Vitamin B1) must be
considered to reduce the risk of Wernicke's encephalopathy
(100 mg intravenously daily for two or three days)
After IV rehydration is completed, patients generally progress to frequent
small liquid or bland meals
17. Patients whose symptoms are related to delayed gastric emptying
should do better with a diet comprised of liquids and low fat solids
18. NONPHARMACOLOGIC
INTERVENTIONS
Triggers — The cornerstone
Supplements containing iron should be avoided
Dietary changes
frequent high carbohydrate, low fat, small meals.
Dietary manipulations, such as eliminating spicy foods
Fluids are better tolerated if cold, clear, and
carbonated or sour (eg, ginger ale, lemonade) and if
taken in small amounts between meals
19. Psychotherapy can also be a useful adjunctive therapy,
particularly if psychological sources of anxiety are identified
and can be ameliorated
TRADITIONAL WAYS
20. PHARMACOLOGIC TREATMENT
begin therapy with agents that appear to be effective and have shown
minimal side effects
if these are ineffective, substitute other drugs in a step-wise progression
21.
22. PYRIDOXINE AND DOXYLAMINE SUCCINATE
Pyridoxine (vitamin B6) (10 to 25 mg orally three or four times per
day) improves mild to moderate nausea, but does not significantly
reduce vomiting .
Doxylamine succinate is an antihistamine that is usually taken with
pyridoxine. The combination appears to improve efficacy
23. Antiemetic drugs, especially ondansetron (Zofran), are effective
in many women
The major drawback of ondansetron has been its cost.
Metoclopramide is sometimes used in conjunction with
antiemetic drugs; however, it has a somewhat higher incidence
of side effects.
Antihistamines (H1 antagonists) —promethazine (12.5 to 25
mg every four hours orally, I.M, or P.R) for the initial choice of
antiemetic in women who do not respond to VitB6
Antacids — Pregnant women often develop gastroesophageal
reflux (heartburn), which can worsen nausea and vomiting.
25. CORTICOSTEROIDS
have been used in women with severe and refractory hyperemesis,
although the mechanism of action is not well understood
Most obstetricians avoid chronic administration
increased risk of preterm premature rupture of membranes (PPROM)
increased risk of oral clefts when the drugs are administered before 10
weeks of gestation
26. [If administered after 10 weeks (when the palate has formed), the
usual dose is
Methylprednisolone 16 mg orally
or
intravenously every eight hours for three days
The drug can be :
stopped abruptly if there is no response,
tapered over two weeks in women who do have relief of symptoms.
27. OUTCOME AND PROGNOSIS
the availability of I.V.F and parenteral nutrition has greatly reduced
morbidity, and mortality is virtually nonexistent in patients who are
treated
If left untreated, micronutrient deficiency, Wernicke encephalopathy
(from deficiency of vitamin B1), and sequelae of malnutrition
(immunosuppression, poor wound healing) have been reported
Esophageal tears and rupture are other rare complications
28. Adverse outcomes for women with hyperemesis and low maternal
weight gain compared with those for patients without hyperemesis
include higher rates of small-for-gestational-age fetuses, low birth
weight, prematurity, and 5-minute Apgar scores less than 7
Among women who experienced hyperemesis gravidarum in their first
gestation, 15% to 19% will be affected in the second pregnancy
CREASY & RESNIK’s 7th Edition