Medical management of ectopic pregnancy
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This document outlines the medical management of ectopic pregnancies. It describes the criteria for using medical management, including gestational sac size and beta HCG levels. The main drug used is methotrexate, which works by depleting folate cofactors and inhibiting trophoblast growth. Methotrexate can be given as a single intramuscular dose or multiple doses over days, monitoring beta HCG levels. Other drugs like potassium chloride, prostaglandins, and hyperosmolar glucose can also be locally injected under ultrasound guidance to terminate the ectopic pregnancy. Contraindications for methotrexate are also listed.
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Diabetes in pregnancy can be gestational diabetes or pregestational diabetes. Gestational diabetes is carbohydrate intolerance that begins during pregnancy. Pregestational diabetes includes type 1 and type 2 diabetes that occurs prior to pregnancy. Screening and management of diabetes in pregnancy aims to reduce complications for both mother and baby such as premature delivery, malformations, and growth problems. Treatment involves medical nutrition therapy, blood glucose monitoring, and possibly insulin therapy. After delivery, women with gestational diabetes receive follow-up testing to determine if diabetes persists.
Multiple tablet poisoning Toxicology CME MOHANAVEL.pptx
The child ingested 15 iron tablets containing a total of 975 mg of elemental iron, which is a potentially lethal dose. Diagnostic workup included an abdominal x-ray showing tablets in the stomach and intestine, and serum iron level. Whole bowel irrigation with polyethylene glycol was used for decontamination. The chelating agent desferoxamine was administered at 15 mg/kg/hr due to the large iron ingestion and presence of symptoms. Parameters like anion gap metabolic acidosis, leukocytosis, and hyperglycemia indicate severity. The prognosis depends on the ingested dose, time to treatment, and presence of complications.
Acromegaly
Acromegaly is a condition caused by excessive growth hormone (GH) secretion after epiphyseal plate closure in adults. It results in enlargement of extremities, soft tissues, and internal organs. The presentation outlines the physiology of GH, epidemiology, etiology as pituitary adenomas in most cases, pathogenesis involving mutations, clinical features, investigations including MRI and biochemical testing, and treatment with surgery, radiation, and medical management to suppress GH and normalize IGF-1 levels. Long term monitoring is needed to manage comorbidities like cardiovascular and respiratory complications. While challenging, a multidisciplinary approach can help reduce mortality and morbidity from acromegaly.
anterior pituitary hormone
This document discusses the hypothalamic-pituitary hormones and their regulation and functions. It summarizes the hormones secreted by the anterior pituitary gland including growth hormone, prolactin, follicle-stimulating hormone, luteinizing hormone, thyroid-stimulating hormone, and adrenocorticotropic hormone. It then provides more detailed information about growth hormone, prolactin, the gonadotropins, and their regulators and clinical uses.
Medical management of congenital adrenal hyperplasia
This document discusses the medical management of congenital adrenal hyperplasia (CAH). It outlines the goals of treatment, which include replacing deficient hormones while minimizing excess and optimizing growth. For classical CAH, treatment involves glucocorticoid replacement to prevent adrenal crisis and mineralocorticoid replacement as needed. Monitoring patient responses is important to balance treatment and avoid under or overtreatment. The document also discusses management of non-classical CAH and challenges of severe cases.
Gestational diabetes mellitus (2)
This document discusses gestational diabetes mellitus (GDM). It begins by defining GDM as glucose intolerance that begins during pregnancy. The prevalence of GDM is approximately 18% globally and is increasing due to lifestyle factors. The document then discusses the classification, epidemiology, pathophysiology, screening, and management of GDM. Key points include that GDM occurs in approximately 7% of pregnancies, is associated with increased insulin resistance during pregnancy, and screening and treatment can help reduce maternal and fetal complications. Management involves medical nutrition therapy, exercise, insulin therapy if needed, and monitoring during labor and delivery.
Similar to Medical management of ectopic pregnancy (20)
Neonatal Hypoglycemia in newborn diagnosis and management
Neonatal Hypoglycemia in newborn diagnosis and management
Multiple tablet poisoning Toxicology CME MOHANAVEL.pptx
Multiple tablet poisoning Toxicology CME MOHANAVEL.pptx
Medical management of congenital adrenal hyperplasia
Medical management of congenital adrenal hyperplasia
Medical management of ectopic pregnancy
- 1. Medical management of ectopic pregnancy
- 2. Criteria for medical management • No hemodynamic instability • No tubal rupture • Fertility desired • Gestational sac < 3.5cm • Beta HCG level < 5000mIu/ml • No cardiac motion on USG • Ability and willingness to comply with follow up.
- 3. Drugs commonly used are: • Methotrexate (drug of choice) • Potassium chloride • Prostaglandin(PGF₂α) • Hyperosmolar glucose
- 4. Methotrexate mechanism of action & regimens • MOA: methotrexate depletes tetrahydrofolate cofactors for DNA & RNA synthesis and inhibits rapidly growing trpohoblast of EP. • Regimens: 1)Single dose- methotrexate i.m 50mg/m² of body surface area. o β-HCG level on D₄ and D₇ is measured, minimum difference of > 15 percent should be there o Dose to be repeated - if difference is < 15 percent b/w D₄ and D₇ . OR o fetal cardiac activity is present on D₇. o β-HCG level is repeated weekly until undetectable. 2)Multiple dose- methotrexate 1mg/kg i.m on D₁,D₃,D₅,D₇ & lecuovorin 0 .1mg/kg i.m on D₂,D₄,D₆,D₈ o β-HCG level is measured every alternate day, Until decreased upto 15 percent in 2 consecutive days o Then weekly β-HCG level estimation is done until undetectable.
- 5. Contraindication of methotrexate • Hemoperitoneum • Breast feeding • Immunodeficiency • EP > 4cm • Alcoholism • Hepatic/Renal disease • Blood disorder
- 6. Local injection • 20 percent potassium chloride 0.5 ml under USG guidance – causes asystole & resolution of ectopic • Hyperosmolar glucose 1 to 3 ml injected into the sac. • PGF₂α when injected causes contraction and vasoconstriction thus resolution of pregnancy.
- 7. Oral dose
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