The document describes a multiple-dose methotrexate (MTX) treatment protocol for ectopic pregnancy. On treatment days 1, 3, 5, and 7, patients receive MTX injections if their human chorionic gonadotropin (hCG) levels have declined by less than 15% from the previous measurement. Leucovorin is administered on days 2, 4, 6, and 8. hCG is measured before starting treatment and on each treatment day to assess the decline. If hCG declines by more than 15%, treatment is stopped and surveillance begins. Surveillance involves weekly hCG testing until levels fall below 5 mIU/mL.
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Selective progesterone receptor modulators (SPRMs)
Stimulates growth :
Up regulating epidermal growth factor (EGF)
Down regulating tumour necrosis factor-alpha expression
Inhibits growth :
Downregulating insulin-like growth factor-1 (IGF-1) expression
NO EFFECT ON ESTRADIOL LEVELS
Mifepristone : 5 or 10 mg per day for 1 year
Ulipristal acetate: 5-10mg/day for 13 weeks
Pro apoptotic and anti-proliferative effects on fibroid cells
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Antenatal care is the routine health control of presumed healthy pregnant women without symptoms (screening), in order to diagnose diseases or complicating obstetric conditions without symptoms and to provide information about lifestyle, pregnancy and delivery.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Ectopic pregnancy refers to the pregnancy occurring outside the uterine cavity, predominantly i.e. 90% of them in the fallopian tube. Ectopic pregnancy affects 11 in 1000 pregnancies and is a significant cause of morbidity and at times mortality in the first trimester of pregnancy. In a 20-year longitudinal study on ectopic pregnancy in a defined
population of women aged 15e39 years the rate of ectopic pregnancy per 1000 diagnosed conceptions increased
from 5.8 during 1960e4 to 11.1 during 1975e9. The mean annual incidence of ectopic pregnancy per 1000 women
increased from 0.6 to 1.2 during the same period. The numbers of ectopic pregnancies per 1000 diagnosed
conceptions increased with increasing age of the women and were 4.1 in the teenage group, 6.9 in women aged
20e29 years, and 12.9 in women aged 30e39.
The Accuracy of Diagnostic Colposcopy using IFCPC 2011 TerminologySujoy Dasgupta
This paper was presented in the Annual Conference of Bengal Obstetric and Gynaecological Society (BOGSCON) 2014 held at ITC Sonar, Kolkata- January, 2014
Dindigul district cervical screening study, india acceptability, effectivenes...Asha Reddy
Dindigul district cervical screening study, india acceptability, effectiveness and safety of treatment of cervical precancerous lesions by nurses using cryotherapy
Ectopic Pregnancy has certain risks associated with it. Dr Manavita Mahajan explains the risks, diagnosis and management of Ectopic Pregnancy. She is a renowned Gynaecologist and is known all over the world for her professionalism and experience.
Given the availability of a colposcope and a trained colposcopist this method is an essential tool for effective secondary prevention of female reproductive organ diseases. Colposcopic guided procedures enable a preceise diagnostic and consequent treatments with eventually organ preserving means. This power point presentation highlights the range of opportunities offered by Colposcopy.
Case Report on Invasive Mole. Gestational Trophoblastic Neoplasia (GTN) encom...Niranjan Chavan
Gestational Trophoblastic Neoplasia (GTN) encompasses a suite of rare but significant gynecological malignancies arising from aberrant placental trophoblast cells. As medical professionals and researchers, our comprehension of GTN's complexities is crucial for accurate diagnosis and effective treatment. This introduction serves to illuminate the key features, diagnostic procedures, and treatment protocols associated with GTN, helping to navigate the intricate landscape of this disease.
Discordant noninvasive prenatal testing & cytogenetic results: 109 consecutive cases.
In conclusion, use of conventional cytogenetics as the reference
standard unravels a rather significant discordance with
positive NIPT results. These data should compel us to take a
cautious look at NIPT data sets and their sources. As more
commercial providers advocate this test, or sponsor academic
centers to carry them out, a more diligent comparison of NIPT
results with cytogenetic tests should be undertaken.
Expressed breast milk on refrigerator storageAsha Reddy
In conclusion, we can store mother’s milk at refrigerator temperature of 4ºC for 96 hours without changing its overall integrity in the form of pH, serum albumin, total protein, lipid and lactose content and can use it for feeding neonates and infants.
Human Milk Banking Guidelines -INDIAN ACADEMY OF PEDIATRICSAsha Reddy
Human Milk Banking Guidelines INFANT AND YOUNG CHILD FEEDING CHAPTER, INDIAN ACADEMY OF PEDIATRICS
Absent or insufficient lactation: Mothers with
multiple births, who can not secrete adequate
breastmilk for their neonates initially.
• For babies of non-lactating mothers, who adopt
neonates and if induced lactation is not possible.
• Abandoned neonates and sick neonates.
• Temporary interruption of breastfeeding.
• Infant at health risk from breastmilk of the biological
mother.
• Babies whose mother died in the immediate
postpartum period
1. TABLE 2
Multiple-dose MTX treatment protocol (28, 29).
Treatment day Laboratory evaluation Intervention
Pretreatment hCG, CBC with differential, liver function Rule out spontaneous Ab
tests, creatinine, blood type and Rhogam if Rh negative
antibody screen
1 hCG MTX 1.0 mg/kg IM
2 LEU 0.1 mg/kg IM
3 hCG MTX 1.0 mg/kg IM if <15% decline day
1–day 3
If >15%, stop treatment and start
surveillance
4 LEU 0.1 mg/kg IM
5 hCG MTX 1.0 mg/kg IM if <15% decline day
3–day 5
If >15%, stop treatment and start
surveillance
6 LEU 0.1 mg/kg IM
7 hCG MTX 1.0 mg/kg IM if <15% decline day
5–day 7
If >15%, stop treatment and start
surveillance
8 LEU 0.1 mg/kg IM
Note: Surveillance every 7 days (until hCG <5 mIU/mL).
Screening laboratory studies should be repeated 1 week after the last dose of MTX. LEU ¼ leucovorin; IM ¼ intramuscu-
larly.
ASRM Practice Commitee. Treatment of ectopic pregnancy. Fertil Steril 2008.
In both single- and multiple-dose MTX treatment proto- When the criteria described earlier are fulfilled, treatment
cols, once hCG levels have met the criteria for initial decline, with MTX yields treatment success rates comparable to those
hCG levels are followed serially at weekly intervals to ensure achieved with conservative surgery (2, 30, 31). Numerous
that concentrations decline steadily and become undetect- open-label studies have been published demonstrating the ef-
able. Complete resolution of an ectopic pregnancy usually ficacy of both MTX treatment regimens. One review con-
takes between 2 and 3 weeks but can take as long as 6 to 8 cluded that MTX treatment was successful in 78%–96% of
weeks when pretreatment hCG levels are in higher ranges selected patients. Post-treatment hysterosalpingography
(29, 30, 35). When declining hCG levels again rise, the diag- documented tubal patency in 78% of cases; 65% of patients
nosis of a persistent ectopic pregnancy is made. who attempted subsequent pregnancies succeeded, and the
TABLE 3
Single-dose MTX treatment protocol (33).
Treatment day Laboratory evaluation Intervention
Pretreatment hCG, CBC with differential, Rule out spontaneous Ab
liver function tests, Rhogam if Rh negative
creatinine, blood type
and antibody screen
1 hCG MTX 50 mg/m2 IM
4 hCG
7 hCG MTX 50 mg/m2 IM if b-hCG
decreased <15%
between day 4 and day 7
Note: Surveillance every 7 days (until hCG <5 mIU/mL).
ASRM Practice Commitee. Treatment of ectopic pregnancy. Fertil Steril 2008.
S208 ASRM Practice Commitee Treatment of ectopic pregnancy Vol. 90, Suppl 3, November 2008