This document discusses the teratogenic risks of various medications. It describes how alcohol consumption can cause fetal alcohol syndrome and spectrum disorders. Certain anticonvulsants, antifungals, antihypertensives, NSAIDs, chemotherapy agents, antivirals and hormones are also described as carrying risks of birth defects if taken during pregnancy. The effects of lithium, SSRIs and antipsychotics on neonates are summarized as well. Throughout, specific malformations and risks associated with different medication classes are outlined.
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018Võ Tá Sơn
This document provides guidelines for the clinical management of nausea and vomiting of pregnancy (NVP). It defines NVP as a common condition affecting 50-80% of pregnancies. It can range from mild to severe hyperemesis gravidarum, which requires hospitalization in 0.3-3% of cases. The document reviews the etiology, risk factors, differential diagnosis, and impact of NVP. It provides recommendations for treating NVP based on the severity of symptoms, including lifestyle changes, anti-nausea medications, hydration, and hospitalization for severe cases. The guidelines aim to improve treatment while reassuring patients that NVP usually does not negatively impact the pregnancy or fetus.
Pre-Eclampsia and Hypertensive Disease in Pregnancymeducationdotnet
This document discusses pre-eclampsia and hypertensive disease in pregnancy. It begins by outlining normal blood pressure changes during pregnancy and then defines different types of hypertension including chronic hypertension, pregnancy-induced hypertension, and pre-eclampsia. Pre-eclampsia is described as a multi-system disorder specific to pregnancy caused by placental dysfunction. The document details diagnostic criteria, clinical features, complications, investigations, and stepwise management of pre-eclampsia including delivery timing and postpartum care. Management involves treating hypertension, preventing eclampsia with magnesium sulfate if needed, and delivery to cure the condition, balancing risks of preterm birth.
Infantile and congenital hemangiomas managment.pptxMohammad Daboos
This product discuss the definitions, theories, pathogenisis, pathology and methods of diagnosis of Infantile and Congenital hemangiomas, and explain when and how to treat both infantile and Congenital Hemangiomas. In addition to describe hemangioma in espicial sites as [parotid, GIT and Hepatic Hemangioma] So, i advice all pediatric, plastic, and dermatologist to revise this lecture and update his knowledge.
Anemia in pregnancy.pptx by dr. ashok mosesAshok Moses
Anemia is a common medical disorder in pregnancy that increases risks for both mother and baby. The document defines anemia in pregnancy according to WHO standards and describes the main causes as decreased red blood cell production or increased destruction, with 90% of cases due to iron deficiency. Evaluation involves hematological indices and iron studies. Management focuses on iron supplementation orally or parenterally depending on severity, with blood transfusions for severe cases. Specific attention is given to nutritional deficiencies like iron, folate, vitamin B12 and hemoglobinopathies.
Pre-eclampsia is a pregnancy complication characterized by new onset hypertension and involvement of other organ systems after 20 weeks of gestation. It is caused by poor remodeling of the uterine spiral arteries during placental development, resulting in reduced blood flow to the placenta. This can affect multiple maternal organ systems by damaging the endothelial cells that line blood vessels. Key signs include hypertension, proteinuria, thrombocytopenia, and elevated liver enzymes. Diagnosis is based on blood pressure readings and urine or blood tests checking for signs of kidney or liver dysfunction. Monitoring pre-eclampsia involves serial blood tests to track organ function and fetal well-being.
Hypertensive disorders in pregnancy are classified into four main categories: gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to maternal endothelial dysfunction and is a leading cause of maternal and fetal morbidity and mortality. Risk factors include obesity, family history, and chronic hypertension. Treatment involves frequent monitoring, antihypertensive medications like labetalol, methyldopa, and nifedipine, and delivery if condition worsens or reaches term.
This document discusses idiopathic thrombocytopenic purpura (ITP), now called immune thrombocytopenic purpura. ITP is an autoimmune disorder where the immune system mistakenly destroys platelets. There are two types: acute ITP typically affects young children and often resolves on its own, while chronic ITP affects older females and symptoms include excessive bleeding. Diagnosis involves low platelet counts and no single confirmatory test. Treatment focuses on corticosteroids, splenectomy to remove the spleen which produces antibodies, or IV immunoglobulin for emergency cases.
A 3 year old female child presented with red spots on her lower limbs that appeared in the morning. She had a history of an upper respiratory infection around 3 weeks prior. On examination she was normal. Her platelet count was 20k and other blood tests including hemoglobin were normal. This presentation is suggestive of idiopathic thrombocytopenic purpura (ITP), the most common cause of acute onset thrombocytopenia in a previously well child. ITP often occurs 1-4 weeks after a viral infection, with the peak age being 1-4 years old. The pathophysiology involves an autoantibody developing against platelets, leading to their destruction in the spleen.
Non nghen trong thai ky - nausea and vomiting of pregnancy - ACOG guideline 2018Võ Tá Sơn
This document provides guidelines for the clinical management of nausea and vomiting of pregnancy (NVP). It defines NVP as a common condition affecting 50-80% of pregnancies. It can range from mild to severe hyperemesis gravidarum, which requires hospitalization in 0.3-3% of cases. The document reviews the etiology, risk factors, differential diagnosis, and impact of NVP. It provides recommendations for treating NVP based on the severity of symptoms, including lifestyle changes, anti-nausea medications, hydration, and hospitalization for severe cases. The guidelines aim to improve treatment while reassuring patients that NVP usually does not negatively impact the pregnancy or fetus.
Pre-Eclampsia and Hypertensive Disease in Pregnancymeducationdotnet
This document discusses pre-eclampsia and hypertensive disease in pregnancy. It begins by outlining normal blood pressure changes during pregnancy and then defines different types of hypertension including chronic hypertension, pregnancy-induced hypertension, and pre-eclampsia. Pre-eclampsia is described as a multi-system disorder specific to pregnancy caused by placental dysfunction. The document details diagnostic criteria, clinical features, complications, investigations, and stepwise management of pre-eclampsia including delivery timing and postpartum care. Management involves treating hypertension, preventing eclampsia with magnesium sulfate if needed, and delivery to cure the condition, balancing risks of preterm birth.
Infantile and congenital hemangiomas managment.pptxMohammad Daboos
This product discuss the definitions, theories, pathogenisis, pathology and methods of diagnosis of Infantile and Congenital hemangiomas, and explain when and how to treat both infantile and Congenital Hemangiomas. In addition to describe hemangioma in espicial sites as [parotid, GIT and Hepatic Hemangioma] So, i advice all pediatric, plastic, and dermatologist to revise this lecture and update his knowledge.
Anemia in pregnancy.pptx by dr. ashok mosesAshok Moses
Anemia is a common medical disorder in pregnancy that increases risks for both mother and baby. The document defines anemia in pregnancy according to WHO standards and describes the main causes as decreased red blood cell production or increased destruction, with 90% of cases due to iron deficiency. Evaluation involves hematological indices and iron studies. Management focuses on iron supplementation orally or parenterally depending on severity, with blood transfusions for severe cases. Specific attention is given to nutritional deficiencies like iron, folate, vitamin B12 and hemoglobinopathies.
Pre-eclampsia is a pregnancy complication characterized by new onset hypertension and involvement of other organ systems after 20 weeks of gestation. It is caused by poor remodeling of the uterine spiral arteries during placental development, resulting in reduced blood flow to the placenta. This can affect multiple maternal organ systems by damaging the endothelial cells that line blood vessels. Key signs include hypertension, proteinuria, thrombocytopenia, and elevated liver enzymes. Diagnosis is based on blood pressure readings and urine or blood tests checking for signs of kidney or liver dysfunction. Monitoring pre-eclampsia involves serial blood tests to track organ function and fetal well-being.
Hypertensive disorders in pregnancy are classified into four main categories: gestational hypertension, preeclampsia, chronic hypertension, and chronic hypertension with superimposed preeclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. It is caused by abnormal placentation leading to maternal endothelial dysfunction and is a leading cause of maternal and fetal morbidity and mortality. Risk factors include obesity, family history, and chronic hypertension. Treatment involves frequent monitoring, antihypertensive medications like labetalol, methyldopa, and nifedipine, and delivery if condition worsens or reaches term.
This document discusses idiopathic thrombocytopenic purpura (ITP), now called immune thrombocytopenic purpura. ITP is an autoimmune disorder where the immune system mistakenly destroys platelets. There are two types: acute ITP typically affects young children and often resolves on its own, while chronic ITP affects older females and symptoms include excessive bleeding. Diagnosis involves low platelet counts and no single confirmatory test. Treatment focuses on corticosteroids, splenectomy to remove the spleen which produces antibodies, or IV immunoglobulin for emergency cases.
A 3 year old female child presented with red spots on her lower limbs that appeared in the morning. She had a history of an upper respiratory infection around 3 weeks prior. On examination she was normal. Her platelet count was 20k and other blood tests including hemoglobin were normal. This presentation is suggestive of idiopathic thrombocytopenic purpura (ITP), the most common cause of acute onset thrombocytopenia in a previously well child. ITP often occurs 1-4 weeks after a viral infection, with the peak age being 1-4 years old. The pathophysiology involves an autoantibody developing against platelets, leading to their destruction in the spleen.
This document discusses thyroid disorders in pregnancy. It notes that hypothyroidism affects 0.05% of pregnant women while hyperthyroidism, mainly Graves' disease, affects 0.05-0.2%. Postpartum thyroiditis occurs in 5-10% of women. The thyroid gland normally enlarges in pregnancy due to increased vascularity. HCG and estrogen levels rise, decreasing TSH and free T4 levels. Treatment aims to maintain euthyroidism. Hyperthyroidism is treated mainly with antithyroid drugs like PTU or carbimazole. Hypothyroidism is treated with levothyroxine. Postpartum thyroiditis can cause transient hyperthyroidism or hyp
This document discusses cardiac disease in pregnancy. It notes that cardiac disease affects 1-2% of pregnancies and is a leading cause of maternal mortality. Rheumatic heart disease is the most common in many countries. Physiological changes in pregnancy like increased cardiac output place extra burden on the heart. Close monitoring and management of cardiac patients is needed before, during and after pregnancy to optimize outcomes for both mother and baby. A multidisciplinary team approach is important for treating women with heart disease through pregnancy.
Pathophysiology of thromboembolism during pregnancywendwesen alemu
Basic info's about virchows traid,risk factors for TE during pregnancy,hypercoagulabiltiy states,APAS,factor V Leiden, protein C,and Antithrombin iii deficiency
1. Hypertension in pregnancy can manifest as gestational hypertension, preeclampsia, or eclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation.
2. The pathophysiology of preeclampsia involves abnormal placentation leading to placental ischemia and endothelial dysfunction. This causes widespread effects including vasoconstriction and signs/symptoms affecting multiple organ systems.
3. Diagnosis of preeclampsia is based on new hypertension and proteinuria developing after 20 weeks of gestation. Evaluation of patients involves assessment of signs/symptoms and laboratory/imaging tests to determine severity and monitor for complications affecting maternal/fetal health.
Multiple pregnancies can involve twins, triplets or more. Twin pregnancies are the most common type of multiple pregnancy and can be either dizygotic (fraternal) or monozygotic (identical). Dizygotic twins result from fertilization of two eggs while monozygotic twins result from fertilization and splitting of a single egg. Risk factors for twin pregnancies include increasing maternal age, parity, infertility treatments and genetics. Complications can include preterm birth, low birth weight, fetal growth issues and birth defects. Care involves frequent monitoring and deciding whether vaginal delivery is possible based on fetal positioning.
Anemia in pregnancy by oouth unit d medical students o&gTolulope Balogun
Anemia is a major health problem in pregnancy worldwide. It is associated with increased risks of maternal and infant mortality as well as adverse outcomes like premature delivery and low birth weight. The document discusses the definitions, prevalence, causes, effects, diagnosis and treatment of anemia in pregnancy. The most common type is iron deficiency anemia, which can be treated with oral or parental iron supplementation as well as folic acid depending on the severity of the anemia. Timely treatment is important to improve outcomes for both mother and baby.
This document summarizes a presentation on large for date uterus. It discusses various topics including the definition of large for date uterus, incidence, etiologies and pathogenesis, risk factors, clinical manifestations and diagnosis, complications, and management. Some key points include:
- Large for date uterus refers to a fundal height more than 2 cm larger than average based on gestational age.
- Risk factors for large for date uterus include obesity, diabetes, post-term gestation, multiparity, and large parent size.
- Clinical findings may include abnormal fundal height on exam and estimated fetal weight greater than 4500g on ultrasound. Management involves monitoring, insulin therapy if diabetes is present, and sometimes induction of
Preeclampsia is a disorder that is unique to human pregnancy, and the only known cure for this complication is delivery. Preeclampsia affects approximately 4% to 5% of pregnancies . The Preeclampsia Foundation states that: “Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.” As is evident from the statement that, preeclampsia is a major contributor to maternal and fetal morbidity and mortality worldwide. In India, the incidence of preeclampsia is reported to be 8-10% among the pregnant women. According to a study, the prevalence of hypertensive disorders of pregnancy was 7.8% with preeclampsia in 5.4% of the study population in India
This document discusses hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, HELLP syndrome, eclampsia, and chronic hypertension. It covers the definitions, classifications, risk factors, clinical presentations, and management approaches for these conditions. Hypertensive disorders affect 5-10% of pregnancies and represent a spectrum of conditions characterized by new-onset hypertension and often proteinuria after 20 weeks of gestation. Preeclampsia is the most common disorder, occurring in 2-7% of pregnancies, and can range from mild to severe disease.
This document discusses preeclampsia, a hypertensive disorder that occurs during pregnancy. It defines preeclampsia as hypertension and proteinuria arising after 20 weeks of gestation. Preeclampsia can progress to eclampsia, which involves seizures. Risk factors include primigravidity and family history. Symptoms include headaches and visual disturbances. Diagnosis involves blood pressure monitoring and urine analysis. Delivery is the only cure for preeclampsia. Management focuses on controlling blood pressure, monitoring the fetus, and timely delivery. Complications for the mother include eclampsia, HELLP syndrome, and stroke, while risks for the baby include growth restriction and stillbirth.
This document discusses the diagnosis and management of thrombocytopenia (low platelet count) during pregnancy. Thrombocytopenia occurs in 7-10% of pregnancies and can be caused by conditions specific to pregnancy like gestational thrombocytopenia (75% of cases) or preeclampsia (15-20% of cases), as well as other rarer causes. While most cases have no adverse outcomes, occasionally a low platelet count can be part of a more serious disorder. The document provides guidance on evaluating and monitoring pregnant women with thrombocytopenia, as well as managing treatment depending on the severity and cause of the low platelet count.
1. Thyroid function changes during pregnancy due to increases in thyroid binding globulin, human chorionic gonadotropin, and other factors. This can cause hyperthyroidism or hypothyroidism.
2. Hyperthyroidism occurs in 0.2% of pregnancies, often due to Graves' disease. It increases risk of complications. Hypothyroidism occurs in 2-3% and also increases risks if not treated.
3. Postpartum thyroiditis involves transient hyperthyroidism and/or hypothyroidism after delivery. Long term hypothyroidism can occur. Thyroid cancer diagnosis and treatment requires consideration of pregnancy.
The document discusses uremic and dialysis-associated pericarditis. Key points include:
- Pericarditis is inflammation of the pericardium and can be caused by uremia or inadequate dialysis. It commonly causes chest pain and may develop effusions or tamponade.
- Diagnosis involves echocardiogram, EKG changes and ruling out other causes. Treatment is intensive dialysis, medications like NSAIDs or colchicine, and pericardiocentesis for large effusions or tamponade.
- Prognosis is generally good with early management but pericarditis was once common in renal failure and can still cause morbidity or mortality if
Peripartum cardiomyopathy (PPCM) is a type of heart disease that affects women during the last month of pregnancy or in the first few months after delivery. It is characterized by a weakened and enlarged heart muscle, which makes it difficult for the heart to pump blood efficiently to the rest of the body. The exact cause of PPCM is unknown, but it is believed to be related to the hormonal changes and increased demands on the heart that occur during pregnancy. Symptoms of PPCM can include shortness of breath, fatigue, chest pain, swelling in the legs and feet, and palpitations. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. In severe cases, advanced treatments such as implantable devices or heart transplantation may be necessary. With early diagnosis and treatment, most women with PPCM can recover completely and go on to lead healthy lives.during pregnancy.
The diagnosis of PPCM is based on clinical symptoms, such as shortness of breath, fatigue, chest pain, and edema, along with imaging studies, such as echocardiography. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. These medications can include beta-blockers, ACE inhibitors, diuretics, and inotropic agents. In severe cases, advanced treatments such as mechanical circulatory support or heart transplantation may be necessary.
The prognosis for PPCM varies depending on the severity of the disease and the presence of underlying comorbidities. However, with early diagnosis and appropriate treatment, most women with PPCM can recover completely and go on to lead healthy lives. The recurrence rate of PPCM in subsequent pregnancies is approximately 20%, and women who have had PPCM are advised to avoid future pregnancies or undergo careful monitoring and management during pregnancy.
There are still many unanswered questions about PPCM, including its exact cause, optimal diagnostic and treatment strategies, and long-term outcomes. Further research is needed to better understand this complex and potentially life-threatening condition.
In conclusion, PPCM is a rare but serious form of heart disease that can occur during or after pregnancy. Early recognition and management of this condition are critical in preventing complications and improving outcomes for both the mother and the baby. Future research will continue to shed light on the pathophysiology and optimal management of PPCM.
Congenital diaphragmatic hernia (CDH) is a birth defect that affects about 1 in 2,000-5,000 live births. It occurs when the diaphragm fails to fully form, allowing abdominal organs to migrate into the chest cavity and compress lung development. Untreated CDH has a high mortality rate of nearly 70%. Prenatal diagnosis by ultrasound is possible as early as the second trimester. Postnatal treatment may involve mechanical ventilation, nitric oxide, surfactant therapy, and in severe cases, extracorporeal membrane oxygenation (ECMO) or surgery to repair the diaphragmatic defect. Long-term outcomes include risks of chronic lung disease, feeding difficulties, growth
Maternal thyroid physiology is modulated during pregnancy by increases in hCG, urinary iodide excretion, and thyroxine-binding globulin. Thyroid disorders complicating pregnancy include hyperthyroidism, hypothyroidism, and postpartum thyroiditis. Hyperthyroidism is treated during pregnancy with antithyroid medications to maintain normal thyroid hormone levels. Hypothyroidism requires increasing levothyroxine doses during pregnancy. Postpartum thyroiditis involves transient hyperthyroid and hypothyroid phases due to thyroid autoimmunity after delivery.
This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines term and preterm PROM and discusses the diagnosis, causes, complications, and management of PROM. The key points are:
- PROM is diagnosed based on a history of leakage and physical exam findings like pooling of fluid. Tests like nitrazine and fern tests can also help diagnose.
- Causes of PROM can include infections, smoking, collagen deficiencies, mechanical stress from twins or polyhydramnios.
- Complications include infections, preterm labor and delivery, and respiratory distress in preterm infants.
- Management depends on gestational age,
This document discusses various medications and substances that can cause harm to fetal development, including alcohol, anticonvulsants, antifungals, ACE inhibitors, NSAIDs, antineoplastics, and antimicrobials. It describes specific risks like fetal alcohol syndrome, congenital abnormalities from valproic acid, and the "gray baby syndrome" from chloramphenicol. Each category discusses particular drugs that pose risks and the types of defects or issues they may cause.
Teratology is the study of birth defects and their causes. Some key points:
- Around 5% of newborns have a detectable birth defect, though the cause is unknown for 70% of cases. Less than 1% are due to medications.
- Teratogens are agents that cause permanent changes to embryonic or fetal development, and can cause malformations (teratogen), altered growth (trophogen), or interference with organ maturation (hadegen).
- Studying teratogenicity in humans is difficult due to ethical concerns, so animal studies are also used but not definitive. Counseling women exposed to potential teratogens is important to avoid anxiety.
This document discusses thyroid disorders in pregnancy. It notes that hypothyroidism affects 0.05% of pregnant women while hyperthyroidism, mainly Graves' disease, affects 0.05-0.2%. Postpartum thyroiditis occurs in 5-10% of women. The thyroid gland normally enlarges in pregnancy due to increased vascularity. HCG and estrogen levels rise, decreasing TSH and free T4 levels. Treatment aims to maintain euthyroidism. Hyperthyroidism is treated mainly with antithyroid drugs like PTU or carbimazole. Hypothyroidism is treated with levothyroxine. Postpartum thyroiditis can cause transient hyperthyroidism or hyp
This document discusses cardiac disease in pregnancy. It notes that cardiac disease affects 1-2% of pregnancies and is a leading cause of maternal mortality. Rheumatic heart disease is the most common in many countries. Physiological changes in pregnancy like increased cardiac output place extra burden on the heart. Close monitoring and management of cardiac patients is needed before, during and after pregnancy to optimize outcomes for both mother and baby. A multidisciplinary team approach is important for treating women with heart disease through pregnancy.
Pathophysiology of thromboembolism during pregnancywendwesen alemu
Basic info's about virchows traid,risk factors for TE during pregnancy,hypercoagulabiltiy states,APAS,factor V Leiden, protein C,and Antithrombin iii deficiency
1. Hypertension in pregnancy can manifest as gestational hypertension, preeclampsia, or eclampsia. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation.
2. The pathophysiology of preeclampsia involves abnormal placentation leading to placental ischemia and endothelial dysfunction. This causes widespread effects including vasoconstriction and signs/symptoms affecting multiple organ systems.
3. Diagnosis of preeclampsia is based on new hypertension and proteinuria developing after 20 weeks of gestation. Evaluation of patients involves assessment of signs/symptoms and laboratory/imaging tests to determine severity and monitor for complications affecting maternal/fetal health.
Multiple pregnancies can involve twins, triplets or more. Twin pregnancies are the most common type of multiple pregnancy and can be either dizygotic (fraternal) or monozygotic (identical). Dizygotic twins result from fertilization of two eggs while monozygotic twins result from fertilization and splitting of a single egg. Risk factors for twin pregnancies include increasing maternal age, parity, infertility treatments and genetics. Complications can include preterm birth, low birth weight, fetal growth issues and birth defects. Care involves frequent monitoring and deciding whether vaginal delivery is possible based on fetal positioning.
Anemia in pregnancy by oouth unit d medical students o&gTolulope Balogun
Anemia is a major health problem in pregnancy worldwide. It is associated with increased risks of maternal and infant mortality as well as adverse outcomes like premature delivery and low birth weight. The document discusses the definitions, prevalence, causes, effects, diagnosis and treatment of anemia in pregnancy. The most common type is iron deficiency anemia, which can be treated with oral or parental iron supplementation as well as folic acid depending on the severity of the anemia. Timely treatment is important to improve outcomes for both mother and baby.
This document summarizes a presentation on large for date uterus. It discusses various topics including the definition of large for date uterus, incidence, etiologies and pathogenesis, risk factors, clinical manifestations and diagnosis, complications, and management. Some key points include:
- Large for date uterus refers to a fundal height more than 2 cm larger than average based on gestational age.
- Risk factors for large for date uterus include obesity, diabetes, post-term gestation, multiparity, and large parent size.
- Clinical findings may include abnormal fundal height on exam and estimated fetal weight greater than 4500g on ultrasound. Management involves monitoring, insulin therapy if diabetes is present, and sometimes induction of
Preeclampsia is a disorder that is unique to human pregnancy, and the only known cure for this complication is delivery. Preeclampsia affects approximately 4% to 5% of pregnancies . The Preeclampsia Foundation states that: “Globally, preeclampsia and other hypertensive disorders of pregnancy are a leading cause of maternal and infant illness and death. By conservative estimates, these disorders are responsible for 76,000 maternal and 500,000 infant deaths each year.” As is evident from the statement that, preeclampsia is a major contributor to maternal and fetal morbidity and mortality worldwide. In India, the incidence of preeclampsia is reported to be 8-10% among the pregnant women. According to a study, the prevalence of hypertensive disorders of pregnancy was 7.8% with preeclampsia in 5.4% of the study population in India
This document discusses hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, HELLP syndrome, eclampsia, and chronic hypertension. It covers the definitions, classifications, risk factors, clinical presentations, and management approaches for these conditions. Hypertensive disorders affect 5-10% of pregnancies and represent a spectrum of conditions characterized by new-onset hypertension and often proteinuria after 20 weeks of gestation. Preeclampsia is the most common disorder, occurring in 2-7% of pregnancies, and can range from mild to severe disease.
This document discusses preeclampsia, a hypertensive disorder that occurs during pregnancy. It defines preeclampsia as hypertension and proteinuria arising after 20 weeks of gestation. Preeclampsia can progress to eclampsia, which involves seizures. Risk factors include primigravidity and family history. Symptoms include headaches and visual disturbances. Diagnosis involves blood pressure monitoring and urine analysis. Delivery is the only cure for preeclampsia. Management focuses on controlling blood pressure, monitoring the fetus, and timely delivery. Complications for the mother include eclampsia, HELLP syndrome, and stroke, while risks for the baby include growth restriction and stillbirth.
This document discusses the diagnosis and management of thrombocytopenia (low platelet count) during pregnancy. Thrombocytopenia occurs in 7-10% of pregnancies and can be caused by conditions specific to pregnancy like gestational thrombocytopenia (75% of cases) or preeclampsia (15-20% of cases), as well as other rarer causes. While most cases have no adverse outcomes, occasionally a low platelet count can be part of a more serious disorder. The document provides guidance on evaluating and monitoring pregnant women with thrombocytopenia, as well as managing treatment depending on the severity and cause of the low platelet count.
1. Thyroid function changes during pregnancy due to increases in thyroid binding globulin, human chorionic gonadotropin, and other factors. This can cause hyperthyroidism or hypothyroidism.
2. Hyperthyroidism occurs in 0.2% of pregnancies, often due to Graves' disease. It increases risk of complications. Hypothyroidism occurs in 2-3% and also increases risks if not treated.
3. Postpartum thyroiditis involves transient hyperthyroidism and/or hypothyroidism after delivery. Long term hypothyroidism can occur. Thyroid cancer diagnosis and treatment requires consideration of pregnancy.
The document discusses uremic and dialysis-associated pericarditis. Key points include:
- Pericarditis is inflammation of the pericardium and can be caused by uremia or inadequate dialysis. It commonly causes chest pain and may develop effusions or tamponade.
- Diagnosis involves echocardiogram, EKG changes and ruling out other causes. Treatment is intensive dialysis, medications like NSAIDs or colchicine, and pericardiocentesis for large effusions or tamponade.
- Prognosis is generally good with early management but pericarditis was once common in renal failure and can still cause morbidity or mortality if
Peripartum cardiomyopathy (PPCM) is a type of heart disease that affects women during the last month of pregnancy or in the first few months after delivery. It is characterized by a weakened and enlarged heart muscle, which makes it difficult for the heart to pump blood efficiently to the rest of the body. The exact cause of PPCM is unknown, but it is believed to be related to the hormonal changes and increased demands on the heart that occur during pregnancy. Symptoms of PPCM can include shortness of breath, fatigue, chest pain, swelling in the legs and feet, and palpitations. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. In severe cases, advanced treatments such as implantable devices or heart transplantation may be necessary. With early diagnosis and treatment, most women with PPCM can recover completely and go on to lead healthy lives.during pregnancy.
The diagnosis of PPCM is based on clinical symptoms, such as shortness of breath, fatigue, chest pain, and edema, along with imaging studies, such as echocardiography. Treatment for PPCM usually involves medications to improve heart function and supportive care to manage symptoms. These medications can include beta-blockers, ACE inhibitors, diuretics, and inotropic agents. In severe cases, advanced treatments such as mechanical circulatory support or heart transplantation may be necessary.
The prognosis for PPCM varies depending on the severity of the disease and the presence of underlying comorbidities. However, with early diagnosis and appropriate treatment, most women with PPCM can recover completely and go on to lead healthy lives. The recurrence rate of PPCM in subsequent pregnancies is approximately 20%, and women who have had PPCM are advised to avoid future pregnancies or undergo careful monitoring and management during pregnancy.
There are still many unanswered questions about PPCM, including its exact cause, optimal diagnostic and treatment strategies, and long-term outcomes. Further research is needed to better understand this complex and potentially life-threatening condition.
In conclusion, PPCM is a rare but serious form of heart disease that can occur during or after pregnancy. Early recognition and management of this condition are critical in preventing complications and improving outcomes for both the mother and the baby. Future research will continue to shed light on the pathophysiology and optimal management of PPCM.
Congenital diaphragmatic hernia (CDH) is a birth defect that affects about 1 in 2,000-5,000 live births. It occurs when the diaphragm fails to fully form, allowing abdominal organs to migrate into the chest cavity and compress lung development. Untreated CDH has a high mortality rate of nearly 70%. Prenatal diagnosis by ultrasound is possible as early as the second trimester. Postnatal treatment may involve mechanical ventilation, nitric oxide, surfactant therapy, and in severe cases, extracorporeal membrane oxygenation (ECMO) or surgery to repair the diaphragmatic defect. Long-term outcomes include risks of chronic lung disease, feeding difficulties, growth
Maternal thyroid physiology is modulated during pregnancy by increases in hCG, urinary iodide excretion, and thyroxine-binding globulin. Thyroid disorders complicating pregnancy include hyperthyroidism, hypothyroidism, and postpartum thyroiditis. Hyperthyroidism is treated during pregnancy with antithyroid medications to maintain normal thyroid hormone levels. Hypothyroidism requires increasing levothyroxine doses during pregnancy. Postpartum thyroiditis involves transient hyperthyroid and hypothyroid phases due to thyroid autoimmunity after delivery.
This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines term and preterm PROM and discusses the diagnosis, causes, complications, and management of PROM. The key points are:
- PROM is diagnosed based on a history of leakage and physical exam findings like pooling of fluid. Tests like nitrazine and fern tests can also help diagnose.
- Causes of PROM can include infections, smoking, collagen deficiencies, mechanical stress from twins or polyhydramnios.
- Complications include infections, preterm labor and delivery, and respiratory distress in preterm infants.
- Management depends on gestational age,
This document discusses various medications and substances that can cause harm to fetal development, including alcohol, anticonvulsants, antifungals, ACE inhibitors, NSAIDs, antineoplastics, and antimicrobials. It describes specific risks like fetal alcohol syndrome, congenital abnormalities from valproic acid, and the "gray baby syndrome" from chloramphenicol. Each category discusses particular drugs that pose risks and the types of defects or issues they may cause.
Teratology is the study of birth defects and their causes. Some key points:
- Around 5% of newborns have a detectable birth defect, though the cause is unknown for 70% of cases. Less than 1% are due to medications.
- Teratogens are agents that cause permanent changes to embryonic or fetal development, and can cause malformations (teratogen), altered growth (trophogen), or interference with organ maturation (hadegen).
- Studying teratogenicity in humans is difficult due to ethical concerns, so animal studies are also used but not definitive. Counseling women exposed to potential teratogens is important to avoid anxiety.
drugs safety in pregnancy medications medication in pregnancy treatment during pregnancy healthy pregnancy teratogen teratogenecity teratogenic drugs in pregnancy drugs and congenital malformation
Teratogenicity refers to substances that can cause birth defects. Drugs are tested for their teratogenic potential through animal studies and classified based on risk category. Common human teratogens include thalidomide, isotretinoin, warfarin, lithium, and alcohol. Teratogenicity tests involve treating pregnant rodents and examining fetuses for malformations. The FDA and ICH guidelines specify testing protocols including multigenerational studies and assessing developmental toxicity during organogenesis. Understanding teratogenic mechanisms and improving animal study accuracy helps prevent birth defects in humans.
This is a lecture note on Intrauterine Fetal death. It discusses about the causes, the management of future pregnancies. At the end of the lecture note are standard textbooks for further reading.
This document summarizes drugs in pregnancy, including metabolism changes during pregnancy, effects of drugs on fetuses, teratology evaluation, classifications of medicines by the FDA, counseling for drug exposure, known teratogens, and commonly used drugs in pregnancy. Key points covered include the most sensitive periods for fetuses, FDA drug classifications, counseling for drug exposure, and evaluating drug effects on fetuses. A quiz at the end tests knowledge on drug choices for conditions in pregnancy and emphasizing risks to a woman on warfarin.
Teratology is the study of abnormalities in physiological development, including birth defects and developmental disorders. It examines the causes of abnormal development, including therapeutic drugs, environmental factors, infections, and genetic disorders. Experimental teratology uses animal models like mice and studies like pregnancy registries to understand how potential teratogens may cause developmental effects in humans. The thalidomide catastrophe highlighted that mammalian embryos can be highly vulnerable to environmental agents and helped establish safety testing procedures for evaluating risks to fetal development.
This document summarizes key points about pharmacology and drug use during pregnancy. It discusses how drugs can potentially harm the fetus, especially during organogenesis in the first trimester. Certain drugs like alcohol and cigarettes are definitely teratogenic. Most small drugs pass through the placenta. The document then covers organogenesis, fetal development, delivery, recognizing teratogenic drugs, and provides guidance on commonly used drug classes in pregnancy like analgesics, antibiotics, anti-epileptics, and cardiovascular drugs.
This document discusses drug prescribing in pregnancy and lactation. It covers several topics:
1) Over 50% of pregnant women take prescribed or non-prescribed drugs that can affect the fetus, with about 2-3% of birth defects resulting from drugs taken during pregnancy.
2) Pregnancy causes changes in absorption, distribution, metabolism and excretion of drugs that impact dosing.
3) Drugs can cross the placenta, with varying degrees of transfer to the fetus depending on the drug's properties.
4) Drugs taken during pregnancy, especially in the first trimester, can cause teratogenic effects or birth defects in the developing fetus. The FDA categorizes drug risk
This document discusses drugs that can induce birth defects and the challenges of epidemiological research on this topic. It notes that 3-4% of live births experience major birth defects, and 40-90% of women consume at least one drug during pregnancy. Various drug classes like antibiotics, anticoagulants, NSAIDs, alcohol, and high-dose vitamin A are mentioned as potential teratogens. Methodological issues addressed include the rarity of specific birth defects requiring large sample sizes, recall bias in studies, and the need for cohort and case-control study designs. Solutions discussed involve different types of cohort studies and reviewing case reports to better understand adverse drug effects and design further research.
This document discusses teratogenesis, which refers to structural or functional defects in a developing embryo or fetus caused by environmental factors. It identifies several categories of teratogens, including drugs/chemicals, ionizing radiation, infections, and pollutants. Specific teratogens are mentioned such as alcohol, retinoic acid, and rubella virus. The timing and amount of exposure to a teratogen, as well as genetics, influence the risk of prenatal defects. The study of teratogenesis is called teratology.
The document discusses the teratogenicity of psychotropic drugs. It notes that while mental illness in mothers poses risks, discontinuing medication during pregnancy may not be possible. The guiding principles are to minimize exposure to untreated illness and psychotropics, continue prior effective medications, and monitor infants for potential drug effects if exposed during lactation or late pregnancy. Risks include teratogenesis, perinatal effects, and potential long-term neurodevelopmental impacts, though studies have shown mixed results. Among SSRIs, paroxetine carries greater risks while sertraline and citalopram generally pose less risk and are considered first-line treatments.
This document discusses teratogens and teratogenic drugs. It begins by defining a teratogen as an agent that can disturb fetal development. It then discusses the FDA pregnancy categories and mechanisms of action of teratogenic drugs. Specific examples of teratogenic drugs are given for different categories, along with their mechanisms and potential effects on the fetus. The document stresses the importance of carefully considering drug use during pregnancy and providing counseling on risks and benefits.
Use of prescribed psychotropics during pregnancyRiaz Marakkar
This document discusses the use of prescribed psychotropic medications during pregnancy. It begins by providing context on global pharmaceutical consumption patterns. It then discusses the prevalence of maternal mental health problems and the need for more research on risks of psychotropic medication use during pregnancy. The document categorizes medications from A to X based on risks in pregnancy. It discusses specific risks of various antidepressants, mood stabilizers, antipsychotics and other drug classes. It also addresses considerations for pharmacotherapy in pregnancy, balancing severity of the condition with risks. The document concludes by discussing risks and guidelines regarding breastfeeding while taking psychiatric medications.
This topic includes Introduction, common side effects from maternal medications on infants, guidelines for medication during lactation, effects of various medications on lactation and neonates
Dr. Maria Hordinsky provides an informative, straightforward presentation of everything you need to know about alopecia areata, including risks and benefits of current and evolving off-label treatment options. Dr. Hordinsky is Professor and Chair of the Department of Dermatology at the University of Minnesota and is recognized for her clinical expertise in alopecia areata.
Expecting Parents Guide to Birth Defects ebookPerey Law
This document provides information about birth defects including types, preventable causes, evidence of risks from certain medications and other factors, and resources for expecting parents. It discusses common birth defects affecting the heart, abdomen, head and spine. It outlines evidence that prescription antidepressants, anticonvulsants, painkillers and other medications increase risks of various birth defects. Other preventable causes discussed are smoking, drinking, illegal drugs, diabetes, and advanced maternal age. The goal is to raise awareness of steps expecting parents can take to minimize birth defect risks through medical care, nutrition, lifestyle factors, and informing themselves of teratogenic medication risks.
Teratology is the study of abnormalities in fetal development and birth defects. Some key causes of birth defects include certain medications (such as thalidomide, diethylstilbestrol, valproic acid), infections (rubella, toxoplasmosis), and environmental factors (alcohol). There are critical periods in development when the fetus is most susceptible to teratogens. Understanding how teratogens act can help prevent birth defects and develop new safe drugs for pregnant women.
This document discusses pelvic organ prolapse (POP), including its epidemiology, risk factors, grading, and management. POP affects 12% of women in their lifetime in the US and is the third most common reason for hysterectomy. Risk factors include vaginal childbirth, increasing age, obesity, and connective tissue disorders. POP is graded using the Pelvic Organ Prolapse Quantification system from stage 1 to 4. Treatment includes nonsurgical options like pessaries and pelvic floor exercises or surgical procedures like sacrocolpopexy or colporrhaphy depending on the location and severity of the prolapse.
Menstrual cycle, fertilization and implantationHale Teka
This document discusses the menstrual cycle, fertilization, and implantation. It provides detailed information on the ovarian and uterine cycles, including the follicular and luteal phases. The follicular phase involves follicle development and selection of a dominant follicle, while the luteal phase involves corpus luteum formation and progesterone secretion. The uterine cycle mirrors these changes, with a proliferative phase under estrogen dominance and a secretory phase when progesterone rises. Ovulation occurs in the late follicular phase in response to an LH surge. If fertilization does not occur, the corpus luteum regresses, ending the luteal phase and initiating menstruation.
This document summarizes the evaluation of an infertile couple. It discusses taking a medical history from both partners focusing on gynecological, sexual, reproductive, medical, and lifestyle factors. Physical exams of both partners examine signs of infertility. Testing includes evaluating ovulation, ovarian reserve, tubal and pelvic factors, and uterine abnormalities. Methods discussed are basal body temperature, ovulation predictor kits, progesterone tests, endometrial biopsy, sonography, hysterosalpingography, and sonohysterography. The goal is to determine the etiology of infertility which can be female, male, or both factors in roughly equal proportions.
Revised fetal hydrops (immune and nonimmune)Hale Teka
This document discusses Rh sensitization and fetal hydrops. It begins with definitions of key terms and concepts. It then covers the historical milestones in understanding Rh sensitization, including the discovery of the Rh blood group and the link between RhD antibodies in Rh-negative women and fetal hydrops. The document outlines the pathophysiology and management of Rh sensitization, including intrauterine transfusions. It also discusses nonimmune hydrops and its various potential etiologies.
This document discusses premature rupture of membranes (PROM), defined as spontaneous rupture of membranes before the onset of labor. PROM complicates 8-10% of pregnancies and contributes to 10-20% of preterm births. It inherently increases risks of perinatal infection, abruptio placenta, umbilical cord compression, and respiratory distress. Diagnosis involves history, sterile speculum exam to visualize fluid and test pH/ferning, and ultrasound-guided dye tests may confirm. Management depends on gestational age and involves monitoring for infection risks and timing of delivery.
Intrauterine growth restriction (IUGR) refers to fetal growth that fails to reach the fetus's growth potential. There are two main types - symmetrical and asymmetrical IUGR. Symmetrical IUGR affects all body parts equally while asymmetrical IUGR spares the brain by preferentially shunting nutrients to the head. IUGR can be diagnosed through ultrasound measurements, history and physical exam. Management may include testing to find the cause, ongoing monitoring, and delivery depending on fetal status. Complications of IUGR include increased risk of stillbirth, asphyxia, and problems for the newborn like hypoglycemia.
Aph (abruptio placenta + placenta previa)Hale Teka
This document discusses obstetric hemorrhage due to placental abruption. It begins by describing the physiological changes in pregnancy that increase risk of hemorrhage. It then defines placental abruption as premature separation of the placenta prior to delivery. Risk factors, clinical manifestations, diagnosis, complications and management are discussed. Key points include placental abruption occurring in 1 in 100 births, risk factors like hypertension, smoking and trauma, and management involving monitoring, steroids, tocolysis, and delivery depending on gestational age and maternal-fetal status.
This document discusses the history and incidence of cesarean delivery. It begins with an overview of the evolution of cesarean delivery terminology and techniques. It describes how rates have risen dramatically in recent decades to over 30% currently in the United States. Factors contributing to increased rates include rising primary cesarean rates, increased maternal obesity and diabetes, and decreased trials of vaginal birth after cesarean. The document provides guidelines for safely preventing unnecessary cesareans by allowing adequate time in labor, limiting elective early deliveries, and promoting vaginal birth techniques.
This document summarizes guidelines for antenatal care from Dr. Hale Teka, an obstetrician and gynecologist. It discusses the background and goals of antenatal care. It then compares focused antenatal care, involving 4 visits, to comprehensive care aiming to provide a positive pregnancy experience. The document provides 49 recommendations organized into categories like nutrition, assessments, preventive measures, and systems interventions. New evidence supports a minimum of 8 antenatal contacts to improve outcomes. Early ultrasound before 24 weeks is now recommended to estimate gestation and check for anomalies.
This document discusses preinvasive and invasive lesions of the vulva. It provides details on:
- The classification and characteristics of vulvar intraepithelial neoplasia (VIN), including usual type (uVIN) and differentiated type (dVIN).
- The diagnosis of VIN through visual examination, vulvoscopy, biopsy and histology. High grade VIN lesions are generally treated to prevent progression to invasive cancer.
- The management of VIN includes local destruction, excision, laser ablation or topical therapies depending on the grade and extent of the lesion. Recurrence rates vary based on the modality used.
Vaginal cancer (preinvasive and invasive)Hale Teka
This document discusses preinvasive and invasive lesions of the vagina. It covers topics such as adenosis, vaginal intraepithelial neoplasia (VaIN), human papillomavirus (HPV) and its role in vaginal cancer, diagnosis of VaIN using techniques like colposcopy and biopsy, and management of low and high grade VaIN. It also discusses invasive vaginal cancer including risk factors, diagnosis, staging, treatment including surgery and chemoradiation, and prognosis.
This document provides an overview of principles of chemotherapy. It discusses the biology of cancer growth and cell kinetics, explaining how chemotherapy targets actively replicating cancer cells. It then covers the clinical use of chemotherapy in different settings like induction, adjuvant, neoadjuvant and palliative care. Key principles of pharmacology including drug dosing, administration routes, metabolism and toxicity management are reviewed. Several classes of chemotherapeutic drugs are described in detail, including their mechanisms of action and side effect profiles.
This document discusses a case report on ovarian tumors written by Hale Teka, M.D., a resident physician. It covers various types of ovarian tumors including low malignant potential tumors, epithelial ovarian cancer, germ cell tumors, and sex-cord stromal tumors. For epithelial ovarian cancer, it describes risk factors, symptoms, diagnostic testing, histology, staging, patterns of spread, and management. It also provides details on germ cell tumors such as dysgerminoma, including epidemiology, diagnosis, imaging, classification, and management.
Endometrial ca (hyperplasia and invasive ca)Hale Teka
1. Endometrial cancer is the most common gynecologic malignancy in the US, with obesity and advancing age as major risk factors.
2. Diagnosis is usually made with endometrial biopsy after a patient presents with postmenopausal bleeding.
3. Treatment depends on cancer stage, with 75% presenting as stage I and cured with surgery including hysterectomy and lymph node dissection. More advanced cases require chemotherapy and/or radiation.
This document discusses preinvasive lesions of the cervix, including the squamocolumnar junction, squamous metaplasia, human papillomavirus (HPV), and cervical intraepithelial neoplasia. It describes the natural history of HPV infection and progression from latent infection to neoplastic infection. Key points covered are HPV types, transmission, prevalence, diagnosis, and approaches to treatment and prevention.
This document discusses preinvasive lesions of the cervix, including the squamocolumnar junction, squamous metaplasia, human papillomavirus (HPV), and cervical intraepithelial neoplasia. It describes the anatomy and histology of the cervix, risk factors for HPV infection, HPV transmission, and the three possible outcomes of HPV infection - latent, productive, and neoplastic infection which can lead to cervical cancer. HPV is the most common sexually transmitted infection and high-risk types can cause cervical cancer if a persistent infection is established.
20. early pregnancy loss and ectopic pregnancy [autosaved]Hale Teka
This document discusses early pregnancy loss and ectopic pregnancy. It provides information on the types, risks, diagnosis, and management of spontaneous abortion and ectopic pregnancy. Some key points include:
- Spontaneous abortion occurs in 8-20% of recognized pregnancies and is often due to chromosomal abnormalities. Risk factors include advanced maternal age, smoking, infections, and history of loss.
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in a fallopian tube. Risk factors include prior pelvic infections, infertility treatments, and tubal surgery or damage.
- Diagnosis involves evaluating symptoms, lab tests of hCG levels and progesterone, and ultrasound imaging. Serial
This document outlines the key components of antenatal care (ANC). ANC involves comprehensive medical and psychosocial services provided to pregnant women throughout pregnancy, with the goal of a healthy mother and baby. Components of ANC include preconception counseling, nutrition guidance, infectious disease screening, fetal screening and testing, physical exams, and lifestyle modification counseling. Regular ANC visits allow care providers to monitor the health of the mother and developing fetus, identify potential complications, and optimize outcomes.
Hale Teka, a year-1 OB-GYN resident at Mekelle University, presented on fluid and electrolyte balance. The objectives were to understand fluid physiology and pathophysiology for fluid therapy, properties of IV crystalloids and colloids, and common electrolyte abnormalities. The body maintains water and salt balance through complex mechanisms involving the kidneys, hormones, and fluid compartments. Fluid status is assessed through history, exam, monitoring of urine output and labs. Different fluid types have varying effects depending on their composition and volume of distribution.
This document presents a case study of obstetrical hemorrhage involving placenta previa. It summarizes the patient's history, including previous cesarean deliveries, and current presentation with vaginal bleeding. Ultrasound revealed the placenta was located at the cervical os. The resident discusses management of placenta previa, including expectant care and risk factors for hemorrhage. Complications like placenta accrete syndrome are also reviewed, where the placenta invades the uterine wall, increasing bleeding risks.
Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
How to Control Your Asthma Tips by gokuldas hospital.Gokuldas Hospital
Respiratory issues like asthma are the most sensitive issue that is affecting millions worldwide. It hampers the daily activities leaving the body tired and breathless.
The key to a good grip on asthma is proper knowledge and management strategies. Understanding the patient-specific symptoms and carving out an effective treatment likewise is the best way to keep asthma under control.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
“Psychiatry and the Humanities”: An Innovative Course at the University of Mo...Université de Montréal
“Psychiatry and the Humanities”: An Innovative Course at the University of Montreal Expanding the medical model to embrace the humanities. Link: https://www.psychiatrictimes.com/view/-psychiatry-and-the-humanities-an-innovative-course-at-the-university-of-montreal
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Nano-gold for Cancer Therapy chemistry investigatory projectSIVAVINAYAKPK
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The development of nanogold-based cancer therapy could revolutionize oncology by providing a more targeted, less invasive treatment option. This project contributes to the growing body of research aimed at harnessing nanotechnology for medical applications, paving the way for future clinical trials and potential commercial applications.
Cancer remains one of the leading causes of death worldwide, prompting the need for innovative treatment methods. Nanotechnology offers promising new approaches, including the use of gold nanoparticles (nanogold) for targeted cancer therapy. Nanogold particles possess unique physical and chemical properties that make them suitable for drug delivery, imaging, and photothermal therapy.
Computer in pharmaceutical research and development-Mpharm(Pharmaceutics)MuskanShingari
Statistics- Statistics is the science of collecting, organizing, presenting, analyzing and interpreting numerical data to assist in making more effective decisions.
A statistics is a measure which is used to estimate the population parameter
Parameters-It is used to describe the properties of an entire population.
Examples-Measures of central tendency Dispersion, Variance, Standard Deviation (SD), Absolute Error, Mean Absolute Error (MAE), Eigen Value
5. Alcohol
• Alcohol Consumption
̶ The most frequent nongenetic causes
of mental retardation and
preventable birth defects in the United
States
̶ fetal alcohol syndrome
• Spectrum of alcohol-related fetal
defects
̶ Fetal alcohol spectrum disorder
• Full range of prenatal alcohol
damage that may not meet the
criteria for fetal alcohol syndrome
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 5
7. • Short palpebral fissures,
• Epicanthal folds,
• Flat midface,
• Hypoplastic philtrum, and
• Thin upper vermilion border
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 7
8. • Dose Effect
̶ Fetal vulnerability to alcohol is modified by
• genetic factors,
• nutritional status,
• environmental factors,
• coexisting maternal disease, and
• maternal age
̶ The minimum amount of alcohol required to produce adverse
fetal consequences is unknown
̶ Binge drinking, however, is believed to pose particularly high risk
for alcohol-related birth defects and has also been linked to an
increased risk for stillbirth
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 8
9. Anticonvulsant Medications
• Generally
̶ Pragmatically, no anticonvulsant drugs are considered truly “safe”
in pregnancy
̶ Pregnant mothers taking antiepileptic drugs at 2-3x higher risk of
congenital anomalies
̶ Older antiepileptic agents at higher risk
̶ Newer agents lesser risk
• Valproic Acid
̶ orofacial clefts, cardiac malformations,
and neural-tube defects
̶ In 9% of babies, and 4% have NTDs
̶ Lower IQ at 3 years of age
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10. Fetal hydantoin
syndrome:
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 10
Features include:
• Upturned nose,
• Mild midfacial hypoplasia,
• Long upper lip with thin vermilion border
• Distal digital hypoplasia.
• Several older anticonvulsants produce a constellation of malformations similar to
the fetal hydantoin syndrome
11. Antifungal Medications
• Fluconazole
̶ Only antifungal drug studied to be teratogenic
̶ Category D
̶ But single 150 mg dose to treat vulvovaginal candidiasis does not
apear to be teratogenic
̶ Associated with a pattern of congenital malformations resembling the
autosomal recessive Antley-Bixler syndrome
̶ Abnormalities include
• oral clefts,
• abnormal facies, and
• Cardiac (3 fold increased risk of TOF), skull, long-bone, and
• joint abnormalities
̶ Such findings have been reported only with chronic, high-dose
treatment in the first trimester—at doses of 400 to 800 mg daily
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 11
12. Angiotensin-Converting Enzyme Inhibitors
and Angiotensin-Receptor Blocking Drugs
• ACE-I
̶ Normal renal development depends on the fetal renal-angiotensin
system
̶ Fetotoxic
̶ ACE-inhibitor medication causes fetal hypotension and renal
hypoperfusion, with subsequent ischemia and anuria
̶ Reduced perfusion may cause fetal-growth restriction and calvarium
maldevelopment, whereas oligohydramnios may result in pulmonary
hypoplasia and limb contractures
̶ First-trimester ACE-inhibitor exposure was associated with a two- to
threefold increased risk for cardiac and central nervous system
abnormalities
• ARB
̶ Same mechanisim of action to ACE-I
̶ Considered to be Fetotoxic
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 12
13. Antiinflammatory Agents
• Nonsteroidal Antiinflammatory Drugs
̶ This drug class includes both aspirin and traditional “NSAIDs” such as
ibuprofen and indomethacin
̶ They exert their effects by inhibiting prostaglandin synthesis
1. Aspirin
• Avoid use late in pregnancy
2. Indomethacin
• Constriction of the fetal ductus arteriosus, resulting in pulmonary
hypertension when taken after 30 weeks
• Decrease fetal urine production and thereby reduce amnionic fluid
volume
• This is presumed due to an increase in vasopressin levels and
vasopressin responsivenes
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 13
14. 3. Lefluomide
• This is a pyrimidine-synthesis inhibitor used to treat rheumatoid
arthritis
• Contraindicated in pregnancy
• Related with:
1. Hydrocephalus,
2. Eye anomalies,
3. Skeletal abnormalities, and
4. Embryo death
• Women of childbearing potential who discontinue this
medication should consider cholestyramine treatment/washout,
followed by verification that serum levels are undetectable on
two tests performed 14 days apart
• This is also true for males who considering fatherhood
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 14
15. Antimicrobial Drugs
• Medications used to treat infections are among those most
commonly administered during pregnancy
• With a few exceptions cited below, most of the commonly used
antimicrobial agents are considered safe for the embryo/fetus.
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 15
16. • Aminoglycosides
̶ Preterm infants treated with gentamicin or streptomycin have
developed nephrotoxicity and ototoxicity
̶ Despite theoretical concern for potential fetal toxicity, no
adverse effects have been demonstrated, and no congenital
defects resulting from prenatal exposure have been identified.
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 16
17. • Chloramphenicol
̶ This antimicrobial is not considered teratogenic and is no
longer routinely used in the United States
̶ More than 50 years ago, a constellation of findings termed
the gray baby syndrome was described in neonates who
received the medication
̶ Preterm infants were unable to conjugate and excrete the
drug and manifested abdominal distention, respiratory
abnormalities, an ashen-gray color, and vascular collapse
̶ Chloramphenicol was subsequently avoided in late
pregnancy due to theoretical concerns.
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 17
18. • Nitrofurantoin
̶ Fourfold increased risk for hypoplastic left heart
syndrome and microphthalmia/anophthalmia
and a twofold increased risk for clefts and atrial
septal defects
̶ For postexposure counseling purposes, the
absolute risk of these defects remains quite low
̶ For example, a fourfold increased incidence of
hypoplastic left heart would result in a
prevalence of less than 1 per 1000 exposed
infants
̶ Nitrofurantoin is a proven first-line treatment of
urinary infections
̶ The American College of Obstetricians and
Gynecologists (2013b) has concluded that first-
trimester nitrofurantoin use is appropriate if no
suitable alternatives are available
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 18
19. • Sulfonamides
̶ These drugs are often combined with trimethoprim and used to treat
various infections during pregnancy
̶ One example is treatment of methicillin-resistant Staphylococcus
aureus (MRSA)
̶ Associated with
• 3x increased risk for anencephaly and left ventricular outflow tract
obstruction,
• 8x increased risk for choanal atresia, and
• 2x increased risk for diaphragmatic hernia
̶ There are also theoretical concerns that because sulfonamides
displace bilirubin from protein binding sites, they may worsen
hyperbilirubinemia if given near the time of preterm delivery
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 19
20. • Tetracyclines
̶ These drugs are no longer commonly used in pregnant women
̶ They are associated with yellowish-brown discoloration of
deciduous teeth when used after 25 weeks, although the risk for
subsequent dental caries does not appear increased
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21. Antineoplastic Agents
• Cancer management in pregnancy includes many
chemotherapeutic agents generally considered to be at least
potentially toxic to the embryo, fetus, or both
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22. • Cyclophosphamide
̶ Alkylating agent inflicts a chemical insult on developing fetal tissues
and leads to cell death and heritable DNA alterations in surviving cells
̶ Pregnancy loss is increased, and reported malformations include
• Skeletal abnormalities,
• Limb defects,
• Cleft palate, and
• Eye abnormalities
̶ Surviving infants may have
• Growth abnormalities and
• Developmental delays
̶ Environmental exposure among health-care workers is associated with
an increased risk for spontaneous abortion
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 22
23. • Methotrexate
̶ This folic-acid antagonist is a potent teratogen
̶ It is used for
• Cancer chemotherapy,
• Immunosuppression in conditions such as autoimmune diseases and psoriasis,
• Nonsurgical treatment of ectopic pregnancy, and finally, as an abortifacient
̶ It is similar in action to aminopterin, which is no longer in clinical use, and can
cause defects known collectively as the fetal methotrexateaminopterin
syndrome
̶ This includes
• Craniosynostosis with “clover-leaf” skull,
• Wide nasal bridge,
• Low-set ears,
• Micrognathia, and
• Limb abnormalities
̶ The critical developmental period of these abnormalities is believed to be 8 to
10 weeks, at a dosage of at least 10 mg/week, although this is not universally
accepted
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 23
24. • Tamoxifen (Category D)
̶ This nonsteroidal selective estrogen-receptor modulator (SERM)
̶ Used as an adjuvant to treat breast cancer
̶ Has not been associated with fetal malformations in humans
̶ It is fetotoxic and carcinogenic in rodents, inducing
malformations similar to those caused by diethylstilbestrol (DES)
exposure.
̶ It is recommended that women who become pregnant while
either on therapy or within 2 months of its discontinuation be
apprised of potential long-term risks of a DES-like syndrome
̶ Exposed offspring should be monitored for carcinogenic effects
for up to 20 years
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 24
25. • Trastuzumab
̶ Recombinant monoclonal antibody directed to the human
epidermal growth factor receptor 2 (HER2) protein
̶ It is used to treat breast cancers that over express HER2 protein
̶ Has not been associated with fetal malformations, but cases of
• Oligohydramnios,
• Anhydramnios, and
• Fetal renal failure have been described
̶ Use may result in
• Fetal pulmonary hypoplasia,
• Skeletal abnormalities, and
• Neonatal death
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 25
26. Antiviral Agents
• Ribavirin
̶ Nucleoside analogue
̶ Component of therapy for hepatitis C infection
̶ Reported malformations include skull, palate, eye, skeleton, and
gastrointestinal abnormalities
̶ It is recommended that women use two forms of contraception
while on therapy and delay childbearing for 6 months following
drug discontinuation
• Efavirenz
̶ Nonnucleoside reverse transcriptase inhibitor used to treat HIV
infection
̶ Related with CNS and Occular abnormalities
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 26
27. Sex Hormones
• It is intuitive that exposure of female fetuses to excessive male sex
hormones—and vice versa—might be detrimental.
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 27
28. • Testosterone and Anabolic Steroids
̶ Exposure of a female fetus may cause varying degrees of
virilization
̶ May result in ambiguous genitalia similar to that encountered in
cases of congenital adrenal hyperplasia
̶ Findings may include
• Labioscrotal fusion with first-trimester exposure and
• Phallic enlargement from later fetal exposure
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 28
29. • Danazole
̶ This ethinyl testosterone derivative
has weak androgenic activity
̶ It is used to treat
• Endometriosis,
• Immune thrombocytopenic purpura,
• Migraine headaches,
• Premenstrual syndrome, and
• Fibrocystic breast disease
̶ 40 percent of exposed female fetuses
virilized
̶ A dose-related pattern of clitoromegaly,
fused labia, and urogenital sinus
malformation
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 29
30. • Diethylstilbestrol
̶ Women offsprings may develop
• Vaginal clear-cell adenocarcinoma
• Vaginal and cervical intraepithelial neoplasia
• hypoplastic, T-shaped uterine cavity; cervical collars,
hoods, septa, and coxcombs; and “withered” fallopian
tubes
• Higher rates of earlier menopause and breast cancer
• Men offsprings may develop:
• Epididymal cysts,
• Microphallus,
• Hypospadias,
• Cryptorchidism, and
• Testicular hypoplasia
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 30
31. Immunosuppressant Medications
• Corticosteroids
̶ Increased risk of clefts
• Mycophenolate Mofetil + Mycophenolic Acid
̶ 50% risk of abortion
̶ 1/5th of surviving ➔ Malformed (50% of this have ear
malformations)
• Radioiodine
̶ Irreversible fetal hypothyroidism and
̶ May increase the risk for childhood thyroid cancer
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 31
32. • Lead
̶ Fetal-growth abnormalities
̶ Childhood developmental delay
̶ Behavioral abnormalities
• Mercury
̶ Developmental delay
̶ Microcephaly and
̶ Severe brain damage
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 32
33. Psychiatric Medications
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 33
• Lithium
̶ Ebstein anomaly, a cardiac abnormality characterized by apical
displacement of the tricuspid valve
̶ Neonatal lithium toxicity from exposure near delivery has been well
documented
• Findings typically persist for 1 to 2 weeks and may include
✓Hypothyroidism,
✓Diabetes insipidus,
✓Cardiomegaly,
✓Bradycardia,
✓Electrocardiogram abnormalities,
✓Cyanosis, and
✓Hypotonia
34. • Selective Serotonin- and Norepinephrine-
Reuptake Inhibitors
̶ Paroxetine
• has been associated with increased
risk for cardiac anomalies, particularly
atrial and ventricular septal defects
̶ Others
• Neonatal behavioral syndrome
✓Self limitted
• Persistent pulmonary hypertension of
the newborn
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 34
35. Antipsychotic Medications
• Exposed neonates have manifested abnormal extrapyramidal
muscle movements and withdrawal symptoms, including:
̶ Agitation,
̶ Abnormally increased or decreased muscle tone,
̶ Tremor,
̶ Sleepiness,
̶ Feeding difficulty, and
̶ Respiratory abnormalities
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 35
36. Retinoids
̶ Inhibit neural-crest cell migration during embryogenesis,
̶ Result in a pattern of cranial neural-crest defects—
termed retinoic acid embryopathy—that involve the
central nervous system, face, heart, and thymus
̶ Specific anomalies may include
• Ventriculomegaly,
• Maldevelopment of the facial bones or cranium,
• Microtia or anotia,
• Micrognathia,
• Cleft palate,
• Conotruncal heart defects, and
• Thymic aplasia or hypoplasia
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 36
37. Thalidomide and Lenalidomide
̶ The characteristic malformation is phocomelia—an absence of
one or more long bones, which results in the hands or feet being
attached to the trunk by a small rudimentary bone
̶ Cardiac malformations, gastrointestinal abnormalities, and other
limb reduction defects are also common following thalidomide
exposure.
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 37
38. Warfarin
̶ Exposure between the 6th and 9th weeks may result in warfarin
embryopathy
̶ This is characterized by stippling of the vertebrae and femoral
epiphyses and by nasal hypoplasia with depression of the nasal bridge
̶ Choanal atresia, resulting in respiratory distress
̶ The syndrome is a phenocopy of chondrodysplasia punctata, a group
of genetic diseases thought to be caused by defects in osteocalcin
̶ agenesis of the corpus callosum; cerebellar vermian agenesis, which is
the Dandy-Walker malformation; microphthalmia; and optic atrophy
̶ Affected infants are also at risk for blindness, deafness, and
developmental delays
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 38
39. Recreational Drugs
• Amphetamines
̶ Fetal-growth restriction and with behavioral
abnormalities
• Cocaine
̶ cleft palate, cardiovascular abnormalities,
and urinary tract abnormalities
̶ fetal-growth restriction and preterm delivery
̶ Children exposed as fetuses are at
increased risk for behavioral abnormalities
and cognitive impairment
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 39
40. • Opioids–Narcotics
̶ Spina bifida, gastroschisis, and cardiac
abnormalities
̶ Heroin-addicted pregnant women are
at increased risk for preterm birth,
placental abruption, fetal-growth
restriction, and fetal death—in part
due to the effects of repeated
narcotic withdrawal on the fetus and
placenta
̶ Neonatal narcotic withdrawal, which is
called the neonatal abstinence
syndrome, may manifest in up to 90
percent of exposed infants
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 40
41. Tobacco
• Anomalies associated with Tobacco use:
̶ Poland sequence
̶ Cardiac anomalies
̶ Hydrocephaly,
̶ Microcephaly,
̶ Omphalocele,
̶ Gastroschisis,
̶ Cleft lip and palate, and
̶ Hand abnormalities
Tuesday, April 3, 2018 Hale T., M.D., Resident Physician 41
42. Reference
1. Robert K. Creas, et al., CREASY & RESNIK'S MATERNAL-FETAL
MEDICINE Principles and Practice 7ed2014: Saunders, an imprint of
Elsevier Inc.
2. Gabbe, et al., Obstetrics: Normal and Problem Pregnancies
7ed2017: Elsevier, Inc.
3. CUNNINGHAM, et al., Williams Obstetrics 24 ed2014: McGraw-Hill
Education.
Hale T., M.D., Resident Physician 42
Tuesday, April 3, 2018
43. Thank you for listening!
43
Hale T., M.D., Resident Physician
Tuesday, April 3, 2018