Pregnancy is a unique period in a woman’s life. Many changes are happening to her body that may affect the pharmacology of medications. During pregnancy, a woman’s gastric pH is increased and gastric motility is reduced which may interfere with the rate and extent of medication absorption. Maternal plasma volume is increased leading to changes in the volume of distribution. In addition, increases in progesterone and estradiol levels may affect the hepatic metabolism of some medications. Glomerular filtration rate is increased due to increase renal blood flow which may affect renally cleared medications. Despite the changes, the pharmacology of most medications is not altered enough to require dosing changes.1 The placenta is an organ of exchange allowing the mother to pass nutrients and medications to the fetus; therefore, medications administered to pregnant women have the potential to affect the growing fetus. The fetus is generally at the greatest risk of developing teratogenic effects from medications during the first trimester, but it is drug specific. The use of medications in pregnancy should be evaluated for the benefits and risks to both the mother and fetus. Upon evaluation, some medications may be used sparingly during some trimesters and contraindicated in others. 2 All efforts should be made to optimize the risk benefit ratio. Drugs with low molecular weight, low maternal protein binding, low ionization, and high lipophilicity are more likely to cross the placenta and cause pharmacologic affects.1 The developing fetus’s body systems are not mature; therefore, the fetus may lack the ability to metabolize medications causing teratogenic effects. 2 The FDA has categorized the potential teratogenic risk of medications by an A, B, C, D, X system.
Treatment of many dermatologic conditions is elective. Some drugs which used by the dermatologist for the patient who is pregnant or lactating may have potentially harmful effects on the mother and fetus or nursing infant. Likewise, not every pregnancy (in the absence of drug therapy) results
Ovral-L (Ethinyl Estradiol and Levonorgestrel Tablets)Clearsky Pharmacy
Ovral-L (Ethinyl Estradiol and Levonorgestrel Tablets) is a combination hormone medication which is indicated for use by females of reproductive potential to prevent pregnancy. It is also used for the treatment of moderate acne vulgaris in women greater than 14 years of age who, have no known contraindications to oral contraceptive therapy, desire contraception, and have achieved menarche.
Treatment of many dermatologic conditions is elective. Some drugs which used by the dermatologist for the patient who is pregnant or lactating may have potentially harmful effects on the mother and fetus or nursing infant. Likewise, not every pregnancy (in the absence of drug therapy) results
Ovral-L (Ethinyl Estradiol and Levonorgestrel Tablets)Clearsky Pharmacy
Ovral-L (Ethinyl Estradiol and Levonorgestrel Tablets) is a combination hormone medication which is indicated for use by females of reproductive potential to prevent pregnancy. It is also used for the treatment of moderate acne vulgaris in women greater than 14 years of age who, have no known contraindications to oral contraceptive therapy, desire contraception, and have achieved menarche.
Prescribing safely in pregnancy and lactationMini Sood
Slides for medical students dealing with pregnant and postpartum women. Safe drugs for common conditions. Presentation with interactive quiz. 48 slides
Depo-Provera CI (Medroxyprogesterone Acetate Injectable Suspension) The Swiss Pharmacy
Depo-Provera Contraceptive Injection (Medroxyprogesterone Acetate injectable Suspension) is a progestin indicated for use by females of reproductive potential to prevent pregnancy. It is also used to treat endometriosis, abnormal uterine bleeding, abnormal sexuality in males, and certain types of cancer.
Depo Provera Contraceptive Injection (Medroxyprogesterone Acetate) is used to prevent pregnancy. This medicine works by preventing the growth and release of an egg (ovulation) during the menstrual cycle.
Prescribing safely in pregnancy and lactationMini Sood
Slides for medical students dealing with pregnant and postpartum women. Safe drugs for common conditions. Presentation with interactive quiz. 48 slides
Depo-Provera CI (Medroxyprogesterone Acetate Injectable Suspension) The Swiss Pharmacy
Depo-Provera Contraceptive Injection (Medroxyprogesterone Acetate injectable Suspension) is a progestin indicated for use by females of reproductive potential to prevent pregnancy. It is also used to treat endometriosis, abnormal uterine bleeding, abnormal sexuality in males, and certain types of cancer.
Depo Provera Contraceptive Injection (Medroxyprogesterone Acetate) is used to prevent pregnancy. This medicine works by preventing the growth and release of an egg (ovulation) during the menstrual cycle.
drugs safety in pregnancy medications medication in pregnancy treatment during pregnancy healthy pregnancy teratogen teratogenecity teratogenic drugs in pregnancy drugs and congenital malformation
challenges in obstetric prescription
Beautiful Slide Show By Editor Dr. Ragini Agrawal And Dr. Tamkeen khan
Dr. Ragini Agrawal, Chairperson Food , Drug & medico surgical Equipment Committee 2009-2011
Oral surgery during pregnancy
Dr. Ahmed M. Adawy
Professor Emeritus, Dep. Oral & Maxillofacial Surg.
Former Dean, Faculty of Dental Medicine
Al-Azhar University
Pregnancy, also known as gestation, is the time during which a fetus develops inside a woman's uterus. Pregnancy is typically divided into three trimesters. The common belief has been that, if an oral surgery procedure is recommended, but it’s not an emergency, the second trimester is the ideal time. Pregnancy however, is not a disease and pregnant woman should not be treated differently than the general population. In short, it could be concluded that:
• Dental care is safe and essential during pregnancy
• Pregnancy is not a reason to defer routine dental care or treatment
• Diagnostic measures, including needed dental x-rays, can be undertaken safely
• Emergency care should be provided at any time during pregnancy
Management of anaemia in pregnancy BY DR ALKA MUKHERJEE DR APURVA MUKHERJEE N...alka mukherjee
Prenatal vitamins typically contain iron. Taking a prenatal vitamin that contains iron can help prevent and treat iron deficiency anemia during pregnancy. In some cases, your health care provider might recommend a separate iron supplement. During pregnancy, you need 27 milligrams of iron a day.
Good nutrition also can prevent iron deficiency anemia during pregnancy. Dietary sources of iron include lean red meat, poultry and fish. Other options include iron-fortified breakfast cereals, prune juice, dried beans and peas.
The iron from animal products, such as meat, is most easily absorbed. To enhance the absorption of iron from plant sources and supplements, pair them with a food or drink high in vitamin C — such as orange juice, tomato juice or strawberries. If you take iron supplements with orange juice, avoid the calcium-fortified variety. Although calcium is an essential nutrient during pregnancy, calcium can decrease iron absorption.
How is iron deficiency anemia during pregnancy treated?
If you are taking a prenatal vitamin that contains iron and you are anemic, your health care provider might recommend testing to determine other possible causes. In some cases, you might need to see a doctor who specializes in treating blood disorders (hematologist). If the cause is iron deficiency, additional supplemental iron might be suggested. If you have a history of gastric bypass or small bowel surgery or are unable to tolerate oral iron, you might need intravenous iron administration. Oral iron is recommended as the first line treatment, with repeated checking of Hb at 2 to 3 weeks after starting treatment to assess compliance, correct administration and response to treatmentOnce Hb reaches the normal range, it is recommended that iron replacement should continue for three months and until at least six weeks postpartumIntravenous (IV) iron is recommended for women who could not tolerate or respond to oral iron, and for those with moderately severe to severe anemia (Hb ≤ 90 g/LHb be measured within 24 to 48 hours after delivery in women with blood loss more than 500 mL, those with uncorrected anemia detected during pregnancy or those with symptoms suggestive of anemia postnatallyOral iron is recommended for women with Hb <100 g/L postpartum, who are hemodynamically stable, asymptomatic or mild symptomatic
Anemia signs and symptoms include:
• Fatigue
• Weakness
• Pale or yellowish skin
• Irregular heartbeats
• Shortness of breath
• Dizziness or lightheadedness
• Chest pain
• Cold hands and feet
• Headache
Keep in mind, however, that symptoms of anemia are often similar to general pregnancy symptoms. Regardless of whether or not you have symptoms, you'll have blood tests to screen for anemia during pregnancy. If you're concerned about your level of fatigue or any other symptoms, talk to your health care provider.
Secondary amenorrhoea by dr alka mukherjee dr apurva mukherjeealka mukherjee
The first step in the evaluation of any patient with secondary amenorrhea is a urine pregnancy test. Every contraceptive method has a failure rate, and anyone who is menstruating is potentially fertile, regardless of age. [5][6]
If the pregnancy test is negative, consider the clinical picture: hirsutism, acne, and a long history of infrequent and irregular menses suggest polycystic ovarian syndrome. By the Rotterdam criteria, a patient may be diagnosed with PCOS if she has two of the following: clinical or chemical hyperandrogenism, oligo- or amenorrhea, or polycystic ovaries on ultrasound. So if a patient has evidence of hirsutism and oligo- or amenorrhea, she can be diagnosed with PCOS without further laboratory testing or imaging.
If history and physical exam are not consistent with PCOS, a TSH should be ordered. Both hyper- and hypothyroidism can lead to menstrual dysfunction.
If TSH is normal, check a serum prolactin. Elevated serum prolactin suggests prolactinoma.
Early pregnancy loss by dr alka mukherjee dr apurva mukherjee nagpur ms indiaalka mukherjee
Early pregnancy loss, or loss of an intrauterine pregnancy within the first trimester, is encountered commonly in clinical practice. Obstetricians and gynecologists should understand the use of various diagnostic tools to differentiate between viable and nonviable pregnancies and offer the full range of therapeutic options to patients, including expectant, medical, and surgical management.
Early pregnancy loss is defined as a nonviable, intrauterine pregnancy with either an empty gestational sac or a gestational sac containing an embryo or fetus without fetal heart activity within the first 12 6/7 weeks of gestation 1. In the first trimester, the terms miscarriage, spontaneous abortion, and early pregnancy loss are used interchangeably, and there is no consensus on terminology in the literature.
Pprom by dr alka mukherjee dr apurva mukherjee nagpur indiaalka mukherjee
Preterm premature rupture of the membranes (PPROM) is a pregnancy complication. In this condition, the sac (amniotic membrane) surrounding your baby breaks (ruptures) before week 37 of pregnancy. Once the sac breaks, you have an increased risk for infection. You also have a higher chance of having your baby born early.
In most cases of PPROM, the cause is not known.
These things may increase risk:
• Having a preterm birth in a previous pregnancy
• Having an infection in your reproductive system
• Vaginal bleeding during pregnancy
• Smoking during pregnancy
Symptoms can occur a bit differently in each pregnancy. They can include:
• A sudden gush of fluid from your vagina
• Leaking of fluid from your vagina
• A feeling of wetness in your vagina or underwear
Call your healthcare provider right away if you have these symptoms.
The symptoms of this health problem may be similar to symptoms of other conditions. See your healthcare provider for a diagnosis.
Diagnosis
• pH (acid-base) balance testing. The pH balance of amniotic fluid is different from vaginal fluid and urine. Your healthcare provider will put the fluid on a test strip to check the balance.
• Looking at a sample under a microscope. When amniotic fluid is dry, it has a fern-like pattern.
• ultrasound exam. This is done to check the amount of amniotic fluid around baby.
Public education on breast cancer hindi by dr alka mukherjee nagpur ms i...alka mukherjee
Abnormal lump — Breast cancer can be discovered when a lump or other change in the breast or armpit is found by a woman herself or by her healthcare provider. In addition to a lump, other abnormal changes may include dimpling of the skin, a change in the size or shape of one breast, retraction (pulling in) of the nipple when it previously pointed outward, or a discoloration of the skin of the breast not related to infection or skin conditions such as psoriasis or eczema.Mammogram — A mammogram is a very low-dose X-ray of the breast. The breast tissue is compressed for the X-ray, which decreases the thickness of the tissue and holds the breast in position, so the radiologist can find abnormalities more accurately. Each breast is compressed between two panels and X-rayed from two directions (top-down and side-to-side) to make sure all the tissue is examined. Mammograms are currently the best screening modality to detect breast cancer. Some mammograms capture images digitally, offering better clarity, the ability to adjust the image, and a decreased likelihood that the woman will need to return on a different day for repeat pictures.
Cancer cervix awareness in hindi by dr alka mukherjee nagpur ms indiaalka mukherjee
Cervical cancer occurs when the cells in the cervix grow abnormally or out of control. The cervix is part of the female reproductive system. The exact cause of cervical cancer is unknown. Certain strains of the human papillomavirus (HPV), a sexually transmitted disease, cause the majority of cervical cancer.
A new vaccine is available to prevent infection against the two types of HPV that are responsible for the majority of cervical cancer cases and the two types of HPV that are responsible for the majority of genital wart cases. A pap smear test is a preventive measure that can detect precancerous or cancerous cells. Precancerous cells are 100% curable.
Telehealth medico legal aspects by dr alka mukherjee nagpur ms indiaalka mukherjee
The term telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole. Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. According to the World Health Organization, telehealth includes, “Surveillance, health promotion and public health functions.”
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation and a host of other clinical services that can be provided remotely via secure video and audio connections.
Evolution and current practices in emergency contraceptives BY DR ALKA MUKHER...alka mukherjee
ey facts
Emergency contraception (EC) can prevent up to over 95% of pregnancies when taken within 5 days after intercourse.
EC can be used in the following situations: unprotected intercourse, concerns about possible contraceptive failure, incorrect use of contraceptives, and sexual assault if without contraception coverage.
Methods of emergency contraception are the copper-bearing intrauterine devices (IUDs) and the emergency contraceptive pills (ECPs).
A copper-bearing IUD is the most effective form of emergency contraception available.
The emergency contraceptive pill regimens recommended by WHO are ulipristal acetate, levonorgestrel, or combined oral contraceptives (COCs) consisting of ethinyl estradiol plus levonorgestrel.
Screening for gestational diabetes an update by dr alka mukherjee nagpur ms i...alka mukherjee
Gestational Diabetes Mellitus (GDM) is defined as any glucose intolerance with the onset or first recognition during pregnancy. This definition helps for diagnosis of unrecognized pre-existing Diabetes also. Hyperglycemia in pregnancy is associated with adverse maternal and prenatal outcome. It is important to screen, diagnose and treat Hyperglycemia in pregnancy to prevent an adverse outcome. There is no international consensus regarding timing of screening method and the optimal cut-off points for diagnosis and intervention of GDM. DIPSI recommends non-fasting Oral Glucose Tolerance Test (OGTT) with 75g of glucose with a cut-off of ≥ 140 mg/dl after 2-hours, whereas WHO (1999) recommends a fasting OGTT after 75g glucose with a cut-off plasma glucose of ≥ 140 mg/dl after 2-hour. The recommendations by ADA/IADPSG for screening women at risk of diabetes is as follows, for first and subsequent trimester at 24-28 weeks a criteria of diagnosis of GDM is made by 75 g OGTT and fasting 5.1mmol/l, 1 hour 10.0mmol/l, 2 hour 8.5mmol/l by universal glucose tolerance testing. Critics of these criteria state that it causes over diagnosis of GDM and unnecessary interventions, the controversy however continues. The ACOG still prefer a 2 step procedure, GCT with 50g glucose non-fasting if value > 7.8mmol/l followed by 3-hour OGTT for confirmation of diagnosis. In conclusion based on Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study as mild degree of dysglycemia are associated with adverse outcome and high prevalence of Type II DM to have international consensus It recommends IADPSG criteria, though controversy exists. The IADPSG criteria is the only outcome based criteria, it has the ability to diagnose and treat GDM earlier, thereby reducing the fetal and maternal complications associated with GDM. This one step method has an advantage of simplicity in execution, more patient friendly, accurate in diagnosis and close to international consensus. Keeping in the mind the diversity and variability of Indian population, judging international criteria may not be conclusive, thus further comparative studies are required on different diagnostic criteria in relation to adverse pregnancy outcomes
Hague convention for inter country adoption by dr alka mukherjee nagpur ms indiaalka mukherjee
The Hague Convention on the Protection of Children and Co-operation in Respect of Intercountry Adoption (Convention) is an international agreement to safeguard intercountry adoptions. Concluded on May 29, 1993 in The Hague, the Netherlands, the Convention establishes international standards of practices for intercountry adoptions. The United States signed the Convention in 1994, and the Convention entered into force for the United States on April 1, 2008The Convention applies to all adoptions by U.S. citizens habitually resident in the United States of children habitually resident in any country outside of the United States that is a party to the Convention (Convention countries). Adopting a child from a Convention country is similar in many ways to adopting a child from a country not party to the Convention. However, there are some key differences. In particular, those seeking to adopt may receive greater protections if they adopt from a Convention country.
The Convention requires that countries who are party to it establish a Central Authority to be the authoritative source of information and point of contact in that country. The Department of State is the U.S. Central Authorityfor the Convention.
The Convention aims to prevent the abduction, sale of, or trafficking in children, and it works to ensure that intercountry adoptions are in the best interests of children.
The Convention recognizes intercountry adoption as a means of offering the advantage of a permanent home to a child when a suitable family has not been found in the child's country of origin. It enables intercountry adoption to take place when, among other steps:
1. The child has been deemed eligible for adoption by the child's country of origin; and
2. Due consideration has been given to finding an adoption placement for the child in its country of origin.
The role of judiciary & the legal procedure in an adoption case by dr alka mu...alka mukherjee
Central Adoption Resource Authority (CARA) is the nodal agency to monitor and regulate in-country and intra-country adoption and is a part of Ministry of Women and child care.
Following are the certain essential conditions in order to be eligible to adopt a child:
• The procedure for adoption is different in case of Indian citizen, NRI or a foreign citizen and a child can be adopted by any of the three.
• Irrespective of their gender or marital status, any person is eligible to adopt.
• Provided that a couple is adopting a child, they should have completed two years of stable marriage and both should agree for the adoption.
• 25 years should be the minimum age difference between the child and the adoptive parents.
WHEN CAN A CHILD BE ELIGIBLE TO BE ADOPTED?
• Any orphan, surrendered or abandoned child is legally declared free for adoption by the child welfare committee as per the guidelines of the Central Government of India.
• A child without a legal parent or a guardian or the parents are not capable of taking care of the child anymore is said to be an orphan.
• When a child is deserted or unaccompanied by parents or a guardian and the child welfare committee has declared the child to be abandoned, a child is considered to be abandoned.
• Renounce on account of physical, social and emotional factors that are beyond the control of parents or the guardian is called a surrendered child as declared by the child welfare committee.
• In case of adoption, a child requires to be “legally free”. A child is considered to be legally free if even after trying their level best the police fails to find the true parent or guardian of the child.
WHAT ARE THE NORMAL CONDITIONS TO BE FULFILLED BY PARENTS?
• The adoptive parents need to be mentally, physically and emotionally stable.
• The adoptive parents should be financially stable.
• The adoptive parents should not be suffering from any life- threatening diseases.
• Apart from cases of special needs children, couples with three or more kids are not allowed for adoption.
• A single female is allowed to adopt a child of any gender but a single male is not allowed to adopt a girl child.
• The maximum age limit of a single parents should be 55 years.
Laws , rules & regulations governing adoptions in india by dr alka mukherjee ...alka mukherjee
ADOPTION IN INDIA
The custom and practice of adoption in India dates back to the ancient times. Although the act of adoption remains the same, the objective with which this act is carried out has differed. It usually ranged from the humanitarian motive of caring and bringing up a neglected or destitute child, to a natural desire for a kid as an object of affection, a caretaker in old age, and an heir after death.[iii]
But since adoption comes under the ambit of personal laws, there has not been a scope in the Indian scenario to incorporate a uniform law among the different communities which consist of this melting pot. Hence, this law is governed by various personal laws of different religions.
Adoption is not permitted in the personal laws of Muslims, Christians, Parsis and Jews in India. Hence they usually opt for guardianship of a child through the Guardians and Wards Act, 1890.
Indian citizens who are Hindus, Jains, Sikhs, or Buddhists are allowed to formally adopt a child. The adoption is under the Hindu Adoption and Maintenance Act of 1956 that was enacted in India as a part of the Hindu Code Bills. It brought about a few reforms that liberalized the institution of adoption.
Tuberculosis in prenancy by dr alka mukherjee dr apurva mukherjee nagpur ms i...alka mukherjee
Prevention of Tuberculosis
The BCG vaccine has been incorporated into the National immunization policy of many countries, especially the high burden countries, thereby conferring active immunity from childhood. Nonimmune women travelling to tuberculosis endemic countries should also be vaccinated. It must, however, be noted that the vaccine is contraindicated in pregnancy [72].
The prevention, however, goes beyond this as it is essentially a disease of poverty. Improved living condition is, therefore, encouraged with good ventilation, while overcrowding should be avoided. Improvement in nutritional status is another important aspect of the prevention.
Pregnant women living with HIV are at higher risk for TB, which can adversely influence maternal and perinatal outcomes [73]. As much as 1.1 million people were diagnosed with the co-infection in 2009 alone [2]. Primary prevention of HIV/AIDS is, therefore, another major step in the prevention of tuberculosis in pregnancy. Screening of all pregnant women living with HIV for active tuberculosis is recommended even in the absence of overt clinical signs of the disease.
Isoniazid preventive therapy (IPT) is another innovation of the World Health Organisation that is aimed at reducing the infection in HIV positive pregnant women based on evidence and experience and it has been concluded that pregnancy should not be a contraindication to receiving IPT. However, patient's individualisation and rational clinical judgement is required for decisions such as the best time to provide IPT to pregnant women
Torch infections during pregnancy by dr alka mukherjee nagpur ms indiaalka mukherjee
TORCH Syndrome refers to infection of a developing fetus or newborn by any of a group of infectious agents. "TORCH" is an acronym meaning (T)oxoplasmosis, (O)ther Agents, (R)ubella (also known as German Measles), (C)ytomegalovirus, and (H)erpes Simplex. Infection with any of these agents (i.e., Toxoplasma gondii, rubella virus, cytomegalovirus, herpes simplex viruses) may cause a constellation of similar symptoms in affected newborns. These may include fever; difficulties feeding; small areas of bleeding under the skin, causing the appearance of small reddish or purplish spots; enlargement of the liver and spleen (hepatosplenomegaly); yellowish discoloration of the skin, whites of the eyes, and mucous membranes (jaundice); hearing impairment; abnormalities of the eyes; and/or other symptoms and findings. Each infectious agent may also result in additional abnormalities that may be variable, depending upon a number of factors (e.g., stage of fetal development
How to develope your personality by dr alka mukherjee nagpur ms indiaalka mukherjee
Personality is what makes a person a unique person, and it is recognizable soon after birth. A child's personality has several components: temperament, environment, and character. Temperament is the set of genetically determined traits that determine the child's approach to the world and how the child learns about the world. There are no genes that specify personality traits, but some genes do control the development of the nervous system, which in turn controls behavior.
A second component of personality comes from adaptive patterns related to a child's specific environment. Most psychologists agree that these two factors—temperament and environment—influence the development of a person's personality the most. Temperament, with its dependence on genetic factors, is sometimes referred to as "nature," while the environmental factors are called "nurture."
While there is still controversy as to which factor ranks higher in affecting personality development, all experts agree that high-quality parenting plays a critical role in the development of a child's personality. When parents understand how their child responds to certain situations, they can anticipate issues that might be problematic for their child. They can prepare the child for the situation or in some cases they may avoid a potentially difficult situation altogether. Parents who know how to adapt their parenting approach to the particular temperament of their child can best provide guidance and ensure the successful development of their child's personality.
Finally, the third component of personality is character—the set of emotional, cognitive, and behavioral patterns learned from experience that determines how a person thinks, feels, and behaves. A person's character continues to evolve throughout life, although much depends on inborn traits and early experiences. Character is also dependent on a person's moral development .
Personality by dr alka mukherjee nagpur ms indiaalka mukherjee
The word personality itself stems from the Latin word persona, which refers to a theatrical mask worn by performers in order to either project different roles or disguise their identities.
At its most basic, personality is the characteristic patterns of thoughts, feelings, and behaviors that make a person unique. It is believed that personality arises from within the individual and remains fairly consistent throughout life.
While there are many different definitions of personality, most focus on the pattern of behaviors and characteristics that can help predict and explain a person's behavior.
Explanations for personality can focus on a variety of influences, ranging from genetic explanations for personality traits to the role of the environment and experience in shaping an individual's personality.
Qualitative blood loss in obstetric hemorrhage by dr alka mukherjee indiaalka mukherjee
• Quantitative methods of measuring obstetric blood loss have been shown to be more accurate than visual estimation in determining obstetric blood loss.
• Studies that have compared visual estimation to quantitative measurement have found that visual estimation is more likely to underestimate the actual blood loss when volumes are high and overestimate when volumes are low.
• Although quantitative measurement is more accurate than visual estimation for identifying obstetric blood loss, the effectiveness of quantitative blood loss measurement on clinical outcomes has not been demonstrated.
• Implementation of quantitative assessment of blood loss includes the following two items: 1) use of direct measurement of obstetric blood loss (quantitative blood loss) and 2) protocols for collecting and reporting a cumulative record of blood loss postdelivery.
Dysmenorrhea and related disorders by dr alka mukherjee dr apurva mukherjee n...alka mukherjee
Dysmenorrhea is a common symptom secondary to various gynecological disorders, but it is also represented in most women as a primary form of disease. Pain associated with dysmenorrhea is caused by hypersecretion of prostaglandins and an increased uterine contractility. The primary dysmenorrhea is quite frequent in young women and remains with a good prognosis, even though it is associated with low quality of life. The secondary forms of dysmenorrhea are associated with endometriosis and adenomyosis and may represent the key symptom. The diagnosis is suspected on the basis of the clinical history and the physical examination and can be confirmed by ultrasound, which is very useful to exclude some secondary causes of dysmenorrhea, such as endometriosis and adenomyosis. The treatment options include non-steroidal anti-inflammatory drugs alone or combined with oral contraceptives or progestins.
Dyspareunia & vulvodynia by dr alka mukherjee dr apurva mukherjee nagpur m.s....alka mukherjee
Pain during or after sexual intercourse is known as dyspareunia. Although this problem can affect men, it is more common in women. Women with dyspareunia may have pain in the vagina, clitoris or labia. There are numerous causes of dyspareunia, many of which are treatable. Common causes include the following:
• Vaginal dryness
• Atrophic vaginitis, a common condition causing thinning of the vaginal lining in postmenopausal women
• Side effects of drugs such as antihistamines and tamoxifen (Nolvadex and other brands)
• An allergic reaction to clothing, spermicides or douches
• Endometriosis, an often painful condition in which tissue from the uterine lining migrates and grows abnormally inside the pelvis
• Inflammation of the area surrounding the vaginal opening, called vulvar vestibulitis
• Skin diseases, such as lichen planus and lichen sclerosus, affecting the vaginal area
• Urinary tract infections, vaginal yeast infections, or sexually transmitted diseases
• Psychological trauma, often stemming from a past history of sexual abuse or trauma
Symptoms
Women with dyspareunia may feel superficial pain at the entrance of the vagina, or deeper pain during penetration or thrusting of the penis. Some women also may experience severe tightening of the vaginal muscles during penetration, a condition called vaginismus.
Chronic pelvic pain by dr alka mukherjee dr apurva mukherjee nagpur m.s. indiaalka mukherjee
Chronic pelvic pain in women is defined as persistent, noncyclic pain perceived to be in structures related to the pelvis and lasting more than six months. Often no specific etiology can be identified, and it can be conceptualized as a chronic regional pain syndrome or functional somatic pain syndrome. It is typically associated with other functional somatic pain syndromes (e.g., irritable bowel syndrome, nonspecific chronic fatigue syndrome) and mental health disorders (e.g., posttraumatic stress disorder, depression). Diagnosis is based on findings from the history and physical examination. Pelvic ultrasonography is indicated to rule out anatomic abnormalities. Referral for diagnostic evaluation of endometriosis by laparoscopy is usually indicated in severe cases. Curative treatment is elusive, and evidence-based therapies are limited. Patient engagement in a biopsychosocial approach is recommended, with treatment of any identifiable disease process such as endometriosis, interstitial cystitis/painful bladder syndrome, and comorbid depression. Potentially beneficial medications include depot medroxyprogesterone, gabapentin, nonsteroidal anti-inflammatory drugs, and gonadotropin-releasing hormone agonists with add-back hormone therapy. Pelvic floor physical therapy may be helpful. Behavioral therapy is an integral part of treatment. In select cases, neuromodulation of sacral nerves may be appropriate. Hysterectomy may be considered as a last resort if pain seems to be of uterine origin, although significant improvement occurs in only about one-half of cases. Chronic pelvic pain should be managed with a collaborative, patient-centered approach.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
2. DR ALKA MUKHERJEE
MBBS DGO FICOG FICMCH PGDCR PGDMLS MA(PSY)
Director & Consultant At Mukherjee Multispecialty Hospital
MMC ACCREDITATED SPEAKER
MMC OBSERVER MMC MAO – 01017 / 2016
Present Position
Director of Mukherjee Multispecialty Hospital
Hon.Secretary INTERNATIONAL COUNCIL FOR HUMAN RIGHTS
Hon.Secretary NARCHI NAGPUR CHAPTER (2018-2020)
Hon.Secretary AMWN (2018-2021)
Hon.Secretary ISOPARB (2019-2021)
Life member, IMA, NOGS, NARCHI, AMWN & Menopause Society,
India, Indian medico-legal & ethics association(IMLEA), ISOPRB,
HUMAN RIGHTS
Founder Member of South Rapid Action Group, Nagpur.
On Board of Super Specialty, GMC, IGGMC, AIIMS Nagpur,
NKPSIMS, ESIS and Treasury, Nagpur for “ WOMEN SEXUAL
HARASSMENT COMMITTEE.”
mukherjeehospital@yahoo.com
www.mukherjeehospital.com
https://www.facebook.com/
Mukherjee Multispeciality
https://www.instagram.com/
Achievement
Winner of NOGS GOLD MEDAL – 2017-18
Winner of BEST COUPLE AWARD in Social
Work - 2014
APPRECIATION Award IMA - MS
Past Position
Organizing joint secretary ENDO-GYN
2019
Vice President IMA Nagpur (2017-2018)
Vice President of NOGS(2016-2017)
Organizing joint secretary ENDO-GYN
Organizing secretary AMWICON – 2019
3. KEY LEARNING POINTS
• Women taking medication should have indications and
doses reviewed
• Caution should be exercised when prescribing any
medication during pregnancy
• Report adverse outcomes following prescribing.
4. INTRODUCTION
• When considering prescribing a drug to a pregnant woman,
several factors must be considered:
a) Gestational age
b) Route of administration
c) Absorption rate
d) Effect of pregnancy on absorption/elimination and
distribution
e) Whether drug crosses the placenta and/or is secreted into
breast milk
f) Dose and duration of therapy
5. • Potential harm to fetus/infant from drug
• Potential harm to mother if drug withheld
• Are safer alternatives available?
• Ultimately, you need to determine if benefits of the drug
outweigh its risks.
6. DRUG PHARMACOKINETICS AND PREGNANCY
• Although gastric emptying time is reduced in pregnancy, this
has little effect on drug absorption.
• Factors that affect drug distribution:
1. Increased absorption of bronchodilators by the lungs.
2. Change in plasma volume, body fat, and albumin levels
3. Increase in glomerular filtration rate in pregnancy by 50%
4. This can aid decisions to start, continue, discontinue, or
alter medication in pregnancy but should not be relied on
exclusively, as each case should be analysed separately and
risks vs benefits calculated.
7. MANAGEMENT
• Ideally, review women on medication prior to pregnancy so
a) Can be reviewed,
b) Optimized, and/or
c) Altered prior to pregnancy
d) Give the woman time to become stable on any new
medication.
8. TABLE 1 UNITED STATES FOOD AND DRUG
ADMINISTRATION CLASSIFI CATIONS
FDA category Pregnancy category definition
A A Controlled studies showed no risk to humans. No studies in pregnant
women have shown an
increased risk of fetal anomalies
X X Drugs contraindicated in human pregnancy. Studies have shown
risk of fetal abnormalities. Drugs
contraindicated in pregnancy and in women who may become
pregnant
D D Clear evidence of risk in humans. Adequate studies in pregnant
women have identified risk, but
these may be outweighed by benefits of therapy
C C Risks cannot be ruled out in humans. Animal studies have shown
an adverse effect, and no studiesin pregnant women or no studies in
animals or pregnant women
B No evidence of risk in humans. Animal studies have shown no risk to the fetus;
however, no good studies in pregnant women or animal studies have shown an
adverse effect, but this has not been confirmed in human studies
9. • Discourage women from simply stopping their medications
in pregnancy, as risks of this may outweigh any potential
benefit.
• Only prescribe drugs to pregnant women when the
indications are clear.
• When possible, use drugs which have been well trialed in
pregnancy.
• Use the smallest effective dose for the shortest possible
time.
• If necessary, consult with other specialists prior to
commencing, altering, or ceasing medication.
• Report adverse effects to external agencies
• Consider additional scans if a patient is on drugs in class C, D,
or X.
10. Care pathway for medications
in pregnancy
Need for medication in
pregnancy
Seen preconception Not seen preconception
Review, optimize, alter, or
stop medication and allow
to stabilize prior to
pregnancy
Review medication and
determine possible risk of
continuing medication
throughout pregnancy vs
risks of stopping or altering
medication
11. Only prescribe drugs when
indications are clear
Use drugs well trialled in
pregnancy Use the lowest dose
possible for the shortest time
12. Generic (Brand) Pregnancy
Category
Crosses
placenta
Reported adverse effects to mom or baby
from use in pregnancy
Place in therapy
Nitrofurantoin (Macrobid) B Yes Fetus: Hemolytic anemia
Sulfamethoxazole (SMX)/
trimethoprim (TMP)
(Bactrim DS/ Septra DS)
C SMX:
Unknown
TMP: Yes
Fetus: SMX: jaundice, hemolytic anemia,
and possibly kernicterus TMP: neural tube
defects (NTD), oral clefts, cardiac defects,
and urinary tract defects
Not recommended in pregnancy
Metronidazole (Flagyl) B Yes Fetus: Low birth weight babies, spontaneous
abortions, and carcinogenic possibilities
Safe for use only in 2nd and 3rd
trimester
Topical‐(Metrogel) Not mutagenic or teratogenic Contraindicated in 1st trimester
Clindamycin (Cleocin,
Clindagel, Cleocin‐T)
B Yes Fetus: Increase in neonatal infection and
low birth weight seen with vaginal
preparation1,12
For BV as oral alternative, but not
the topical
Group B strep. disease in patients
with penicillin allergy
Tetracyclines D Yes Fetus: Hypospadia(1st trimester only),
inguinal hernia, limb hypoplasia, teeth
discoloration(2nd,3rd)cataracts, cleft palates,
spina bifida, polydactyly
Maternal: liver toxicity, irreversible shock
Not recommended in pregnancy
13. Cephalosporins B Yes None reported Generally considered safe in
pregnancy unless penicillin
allergic
Penicillins +/‐
Betalactamase inhibitor
B Yes None reported Safest class of abx in pregnancy
if not allergic
Tx of choice for syphilis
(desensitize if penicillin allergic)
Macrolides Azithro,
Erythro: B
Claritro: C
Yes Fetus: Cardiovascular abnormalities and
cleft palate with Clarithromycin.
Fluoroquinolones C Yes Erosion of weight‐bearing cartilage in
rats and dogs, but no human reports
Not recommended in
pregnancy
Aminoglycosides
(Amikacin, Gentamicin,
and Tobramycin)
D Yes Fetus: ototoxicity/deafness (damage of
8th CN) Neuromuscular weakness,
respiratory depression with concomitant
gentamicin and Mag sulfate
Do not use in pregnancy not
unless the benefit outweighs
the risk to the fetus.
14. Generic (Brand)
Pregnancy
category
Crosses placenta Reported adverse effects to mom or baby from
use in pregnancy
Place in therapy
Carbamazepine
(Tegretol)
D Yes: levels 50‐80% of
maternal, highest in
fetal liver and kidneys
Fetus: dysmorphic facial features, cranial
defects, cardiac defects, spina bifuda,
fingernail hypoplasia, developmental delay,
mild mental retardation, neural tube defects
Compatible – Maternal Benefit >>
Embryo/Fetal Risk If drug is required during
pregnancy it should not be withheld because the
benefits of preventing seizures outweigh potential
fetal harm
Ethosuximide (Zarontin) C Unknown Fetus: spontaneous hemorrhage, patent ductus
arteriosus, cleft lip/palate, mongoloid facies,
short neck, altered palmar crease and accessory
nipple, hydrocephalus
Limited human data. Probably compatible.
Succinamide anticonvulsants: DOC for tx of
petit mal epilepsy in 1st trimester
Felbamate (Felbatol) C Unknown Fetus: mental retardation. Maternal: aplastic
anemia, acute liver failure
Limited Human Data – Animal Data Suggest
Moderate Risk. Drug crosses placenta in animals, not
yet described in humans. But should occur because
of LMW
Phenytoin (Dilantin) D Unknown Fetus: congenital abnormlaities, hemorrhage at
birth, neurodevelopment abnormalities
Compatible – Maternal Benefit >> Embryo/Fetal Risk
Dose‐related
teratogenic
effect
Maternal: folic acid deficiency Significant Risks: major/minor congenital
abnormalities, hemorrhage at birth,
neurodevelopment
Maintain lowest level required to prevent
seizures in order to lessen risk of fetal anomalies
Fosphenytoin (Cerebyx) D Unknown Fetus: congenital malformations, orofacial
clefts, cardiac defects, minor anomalies, mental
deficiency
Benefits from use in pregnant women may be
acceptable despite the risk (e.g., if the drug is needed
in a life‐threatening situation or for a
Maternal: An increase in seizure frequency may
occur during pregnancy because of altered
phenytoin pharmacokinetics
serious disease for which safer drugs cannot be used
or are ineffected)
Gabapentin (Neurontin) C Unknown Limited human data does not allow an
assessment as to the safety of gabapentin
Limited Evidence: If required, benefits appear > fetal
risks
Lamotrigine (Lamictal) C Yes Fetus: frequency of major defects among 1st
trimester monotherapy exposure was 2.9% (12
of 414)
Human Data Suggest Low Risk; Adjust dose to
maintain clinical response
Levetiracetam (Keppra) C Unknown Risk to human fetus/embryo unknown Risk to human embryo/fetus is unknown
Oxcarbamazepine
(Trileptal)
C Yes Fetus: no major congenital malformations
reported, mild facial defects observed in one
case
No epoxide metabolites: lower risk of teratogenicity
compared to other agents, Supplement with folic
acid
Phenobarbital
(Luminal Sodium)
D Yes Fetus: congenital defects, hemorrhage at birth,
addiction, AE of neurobehavioral development
Maternal: Benefit > Risk
Benefits >Risk during at lowest effective level
Pregabalin (Lyrica) C Unknown Animal studies – fetal abnormalities, skeletal
malformations, male‐mediated teratogenicity
No human studies
Use only if maternal benefit>fetal risk
15. Tiagabine (Gabitril) C Unknown Fetus: one incidence with unspecified
malformations, otherwise unknown
Safest course: Avoid in 1st trimester; later
trimesters unknown,
Primidone
(Mysoline)
D Unknown Newborn: neurologic manifestations
(overactivity /tumor); mechanism for
hemorrhagic effects is due to suppression
of VitK‐dependent clotting factors,
recommend administration of VitK to
infant immediately after birth
If benefits > risks (e.g., drug needed in
lifethreatening situation or serious disease with
no safer drug)
Topiramate
(Topamax)
C Yes Hypospadias in males (relationship not
established); Data too limited to assess
embryo/fetus risk
Avoid if possible in 1st trimester
Valproic Acid
(Depakene)
D Yes Fetus: neural tube defects, minor facial
defects, defects of the head, face, digits,
urogenital tract, mental and physical
growth
Benefits > Risks (e.g., drug needed in
lifethreatening situation or serious disease
with no safer drug)
Zonisamide
(Zonegran)
C Unknown Congenital anomalies possible Avoid if possible in 1st trimester
Trimethadione D Unknown Fetus: mental retardation, craniofacial
defects, genitourinary defects, malformed
hands, clubfoot
Contraindicated in 1st trimester1
Clonazepam
(Klonopin)
D Unknown Human data suggest low risk; fetal and
neonatal toxicity has been reported
Safest course is to avoid during the 1st
trimester; however, if indicated, it should not
be withheld because of pregnancy
Lorazepam (Ativan) D Yes Fetus: high IV doses may cause “floppy
infant” syndrome, higher incidence of
respiratory distress
Benefits > Risks (e.g., drug needed in
lifethreatening situation or serious disease with
no safer drug)
Carbamazepine
(Tegretol)
D Yes Fetus: minor craniofacial defects, fingernail
hypoplasia, developmental delay, mild
mental retardation
If required, Benefits > risks
16. Generic (Brand) Class Pregnancy
Category
Cross
es
place
nta
Reported adverse effects to mom or
baby from use in pregnancy
Place in therapy
Diphenhydramine
(Benadryl)
Antihistamine B Yes 1st trimester – cleft palate,
cardiovascular defects, oral clefts, spina
bifida, polydacytly, limb reduction
defects and hypospadias.
DOC if parenteral antihistamines
are indicated
Maternal: premature labor Meclizine and cyclizine: viable
alternatives
Chlorpheniramine
(Chlorphen,
AllerChlor)
Antihistamine B Unkn
own
Fetal: polydactyly, GI defects, eye and
ear defects, inguinal hernia,
hydrocephaly, congenital dislocation of
the hip and malformation of the female
genitalia.
Meclizine and cyclizine do not
require a restriction on use in
pregnant women and would be
viable alternatives
Fexofenadine
(Allegra)
Antihistamine C Unkn
own
No well‐controlled studies published;
avoid in first trimester
Consider diphenhydramine or
chlorpheneramine
Loratadine (Alavert,
Claritin)
Antihistamine C Unkn
own
Fetal: Cleft palate, microtia,
microphthalmia, deafness, triscuspid
dysplia, diaphragmatic hernia.
Consider diphenhydramine or
chlorpheneramine
B in
2nd/3rd
Not recommended in 1st trimester
Cetirizine (Zyrtec) Antihistamine C Unkn
own
1st trimester – spontaneous abortion,
ectopic kidney, undescended testes
Consider diphenhydramine or
chlorpheneramine
B in 2nd
and 3rd
Exposure too low assess potential risks Not recommended in the 1st
trimester
Dextromethorphan
(Robitussin,
Pediacare)
Anti‐tussive C Unkn
own
generally safe based on observation DOC for cough during pregnancy;
combination products containing
alcohol should be avoided during
pregnancy; avoid liquid alcohol
containing preparations
17. Benzonatate
(Tessalon Perles)
Anti‐tussive C Unkn
own
There has not been sufficient clinical
experience to establish the safety of
benzonatate in general during
pregnancy
If possible, use of benzonatate
during pregnancy should be
avoided
Codeine /
Hydrocodone rx
cough syrups
Anti‐tussive C; D at
higher
doses for
longer
time
Unkno
wn
1st trimester – physical dependence,
withdrawal, growth retardation,
respiratory depression, cleft lip/palate,
dislocated hip, musculoskeletal defects.
2nd trimester – alimentary tract defects
Use only if clearly needed
Guaifenesin
(Mucinex , Humibid)
Expectorant C Unkno
wn
1st trimester –increase frequency of
inguinal hernias and cardiovascular
defects
Use only if Benefits > Risks
Saline Nasal Spray A Unkno
wn
No known adverse effects Safe to use during all trimesters in
pregnancy.
Phenylephrine
(Tannate)
Sympathomim
etic
C Unkno
wn
1st trimester – ear/eye malformation,
syndactyly, preauricular skin tag, club
foot, inguinal hernia.
Congenital hip dislocation,
musculoskeletal defects, umbilical hernia
Maternal: uterine vessel vasoconstriction
and reduced blood flow results in fetal
hypoxia
Until more information is available,
use of phenylephrine should be
avoided during pregnancy
Pseudoephedrine
(Sudafed,
Dimetapp)
Sympathomim
etic
C Unkno
wn
1st trimester – inguinal hernia,club foot.
May result in fetal hypoxia. Teratogenic is
some animal species
Nasal Steroids
Budesonide
(Rhinocort)
Fluticasone
(Flonase)
Mometasone
(Nasonex)
Triamcinolone
(Nasacort)
Cortico‐steroid C Budes: B
Triamcin: D
in 1st
trimester)
Unkno
wn
1st trimester ‐ orofacial clefts, conotruncal
defects, neural tubal defects and limb
abnormalities. Congenital malformations,
premature birth, low birth weight,
Csection, stillbirth multiple births.
Budenoside: no increased risk of these
AE.
Triamcinolone: in animals cleft palate,
umbilical hernia, undescended testes,
reduced ossification, growth retardation.
The benefits of treatment must be
carefully weighed against the
potential risks of therapy. Of the
nasal corticosteroids, budesonide
is the best choice. It is the only
inhaled corticosteroid that is
category B
18. Valproic Acid
(Depakene)
D Yes Fetus: neural tube defects, minor
facial defects, defects of the head,
face, digits, urogenital tract, mental
and physical growth
Benefits > Risks (e.g., drug needed in
lifethreatening situation or serious
disease with no safer drug)
Zonisamide
(Zonegran)
C Unknown Congenital anomalies possible Avoid if possible in 1st trimester
Trimethadione D Unknown Fetus: mental retardation,
craniofacial defects, genitourinary
defects, malformed hands, clubfoot
Contraindicated in 1st trimester1
Clonazepam
(Klonopin)
D Unknown Human data suggest low risk; fetal
and neonatal toxicity has been
reported
Safest course is to avoid during the 1st
trimester; however, if indicated, it should
not be withheld because of pregnancy
Lorazepam
(Ativan)
D Yes Fetus: high IV doses may cause
“floppy infant” syndrome, higher
incidence of respiratory distress
Benefits > Risks (e.g., drug needed in
lifethreatening situation or serious
disease with no safer drug)
Carbamazepine
(Tegretol)
D Yes Fetus: minor craniofacial defects,
fingernail hypoplasia, developmental
delay, mild mental retardation
If required, Benefits > risks
19. Generic (Brand) Class Pregnanc
y
Category
Crosses
placent
a
Reported adverse effects to mom or baby
from use in pregnancy
Place in therapy
Glyburide (Diabeta,
Micronase, Glynase)
Sulfonylurea C Yes Possible ear defects in 1st trimester, fetal
hypoglycemia
Insulin is recommended first line
by the ADA; ACOG recommends
use of this agent in D2 or GDM
Glipizide (Glucotrol) Sulfonylurea C Yes Possible ear defects in 1st trimester, no
teratogenicity in animal studies
Not recommended; limited human
data
Glimepiride (Amaryl) Sulfonylurea C Unkno
wn
Skeletal malformation in high doses Not recommended; No human
data
Metformin
(Glucophage,
Fortamet, Glumetza)
Biguanide B Unkno
wn
Neural tube defects in animals at high
doses. Few abnormalities in humans at
normal doses and likely due to poor BG
control
Insulin is recommended first line
by the ADA; ACOG recommends
use of this agent in D2 or GDM
Sitagliptin (Januvia) Dipeptidyl
peptidase IV
inhibitor
B Unkno
wn
No good studies in humans; animal studies
show no defects/complication at high doses
Possible; No human data
Pioglitazone (Actos) TZD C Unkno
wn
Developmental delay, decreased fetal
weight in animals
Not recommended
Rosiglitazone
(Avandia)
TZD C Yes Fetal death/retardation was seen in animal
studies
Not recommended
Exenatide (Byetta) Incretin
mimetic
C Unkno
wn
Decreased fetal growth, skeletal
malformations in animal studies
Not recommended
Pramlintide (Symlin) Amylinomimeti
c
C Unkno
wn
Animals: neural tube defects, cleft palate at
high doses
Not recommended
Regular insulin
(Humulin R, Novolin
R)
Short acting
insulin
B No None reported Drug of choice
Lispro insulin
(Humalog)
Rapid acting
insulin
B No Case reports: sudden neonatal death,
growth retardation; controlled studies: as
efficacious as regular insulin
Recommended
Glulisine insulin
(Apidra)
Rapid acting
insulin
C Unkno
wn
No available studies Not recommended unless benefits
> risks
NPH insulin (Humulin
N, Novolin N)
Intermediate
acting insulin
B No None reported Recommended
Glargine insulin
(Lantus)
Long acting
insulin
C Unkno
wn
No available studies Not recommended unless benefits
> risks
Detemir insulin
(Levemir)
Intermediatelo
ng acting
insulin
C Unkno
wn
Visceral abnormalities were seen in animals Not recommended
20. Analgesics
Generic (Brand) Class Pregnancy
Category
Crosse
s
placen
ta
Reported adverse effects to maternal
or fetus from use in pregnancy
Place in therapy
Aspirin (Bufferin,
Ecotrin)
NSAID C Yes Fetal: increased perinatal mortaility,
teratogenic effects, pulmonary HTN,
bleeding risk, premature ductus
arteriosis closure
Maternal: anemia, ante/post partum
hemorrhage, prolonged labor
Should not be used in pregnancy,
consider acetaminophen
Ibuprofen (Advil,
Midol,)
NSAID B Unkno
wn
Fetal: ductus arteriosis constriction,
pulmonary HTN in 3rd trimester
Should be avoided when possible and
completely avoided during the 3rd
D in 3rd
trimester
Maternal: prolonged labor,
spontaneous abortion
trimester. Consider acetaminophen.
Naproxen (Aleve,
Anaprox, Midol,
Naprosyn,
Pamprin)
NSAID B; D in 3rd
trimester
Yes Fetal: ductus arteriosis constriction,
intracranial hemorrhage, primary
pulmonary HTN
Fetal: overdose can lead to liver toxicity
Maternal: overdose can lead to liver
toxicity
Should be avoided when possible and
completely avoided during the 3rd
trimester. Consider acetaminophen.
Acetaminophen Analgesic
antipyretic
B Yes Drug of choice for analgesia and fever
during pregnancy
Butorphanol
(Stadol)
Narcotic
analgesic
C Yes Fetal: sinusoidal fetal heart rate
pattern, addiction, respiratory
depression
Used for analgesia during labor
D if
prolonged
use
Maternal ‐ addiction
Morphine
(Duramorph,
Kadian, MS
Contin,
Oramorph SR,
Roxanol)
Narcotic
analgesic
C; D if
prolonged
use
Yes Fetal: addiction, possible relation to
inguinal hernia and respiratory
depression
Maternal: addiction
Should only be used when analgesia or
anesthetic is clearly indicated
Fentanyl (Actiq,
Duragesic)
Narcotic
analgesic
C; D if
prolonged
use
Yes Fetal: respiratory depression,
dependence and loss of fetal heart
rate variability without hypoxia
Only use when benefits > risks
Hydromorphone
(Dilaudid)
Narcotic
analgesic
C
D if
prolonged
use
Yes Fetal: respiratory depression Only use when benefits > risks
Manufacturer recommended CI in
pregnancy
21. Meperidine
(Demerol,
Meperitab)
Narcotic
analgesi
c
C; D if
prolong
ed use
Yes Fetal: respiratory depression
(time, dose dependant),
addiction, inguinal hernia
Mom: metabolite build up
that can cause seizures
Hydrocodone Narcotic
analgesi
c
C; D if
prolong
ed use
Yes Fetal: addiction, respiratory
depression
Oxycodone
(OxyContin,
OxyFast,
OxyIR,
Roxicodone)
Narcotic
analgesi
c
B; D if
prolong
ed use
Yes Fetal: addiction, respiratory
depression
Tramadol
(Ultram)
Central
analgesi
c
C Yes Fetal: dose related fetal
toxicity in animals, respiratory
depression and addiction
Should be avoided until
further evidence concerning
the dose related
fetal toxicity is available
Ergotamine
(Ergomar)
Sympath
olytic
X Yes Fetal: increase uterine tone
leading to fetal hypoxia,
teratogenic and fetal toxicity
Do not use in pregnancy
22. Generic (Brand) Class Pregnancy
Category
Crosses
placenta
Reported adverse effects to mom or baby from use in
pregnancy
Place in therapy
Human
Papillomavirus
(Gardasil)
Inactivated vaccine B Unknown Currently under study Do not use during pregnancy
Hepatitis B
(Engerix‐B,
Recombivax HB)
Inactivevaccine Unknown No risk to the mom or baby have been reported Give if indicated
ACOG recommends that vaccine should be given
pre‐ or post exposure in women at risk for
infection
Influenza
(injection) (Afluria,
Fluarix, FluLaval,
Fluvirin, Fluzone)
Inactivated vaccine C Unknown Studies of immunization of over 2000 women showed
no fetal adverse effects associated with vaccination
ACOG recommends the vaccine be given to
pregnant women in the 2nd and 3rd trimesters
during flu season. All at risk for pulmonary
complications should be vaccinated, regardless
of trimester
Influenza (nasal) (FluMist) Live vaccine C Unknown Fetal infection with live attenuated virus may occur Do not use during pregnancy
Meningococcal
(MenomuneA/C/Y/W‐135,
Menactra)
Inactivated vaccine C Unknown Risks to the fetus are unknown. Use if indicated
MMR (M‐M‐R II) Live vaccine C Unknown Fetal infection with live attenuated virus may occur Do not use during pregnancy; Avoid pregnancy
for 12 weeks after injection
Pneumococcal
Vaccine
(Pneumovax)
Inactivated vaccine C Maternal Ab
yes2
Risk to the fetus in the 1st trimester is unknown. No
adverse events reported 2
Use if indicated in high risk patients
Td (Decavac) Toxoid C Unknown No evidence of teratogenicity Use if indicated
TdP (Adacel, Boostrix) Toxoid C Maternal Ab
yes
Antibodies may also interfere with the infant’s
immune response to infant doses of DTaP, so infant
may not be protected.
Use if at high risk for pertussis
Varicella Vaccine (Varivax) Live vaccine C Unknown Fetal infection may occur Do not use in pregnancy
