The document discusses antiphospholipid antibody syndrome (APAS) and its management during pregnancy. APAS is an autoimmune condition characterized by the presence of antiphospholipid antibodies in the circulation, leading to clinical manifestations. It is associated with an increased risk of thrombosis and adverse obstetric outcomes like recurrent pregnancy loss, preeclampsia, and intrauterine growth restriction. Precise diagnostic criteria include at least one clinical feature and one positive laboratory test confirmed at least 12 weeks apart. Treatment aims to prevent complications and involves low-dose aspirin and low molecular weight heparin throughout pregnancy and postpartum. Close fetal surveillance is also recommended due to the risk of intrauterine growth restriction.
This document provides an overview of current issues in perinatology and preterm birth. It discusses definitions and common causes of preterm birth such as spontaneous preterm labor and preterm premature rupture of membranes. Risk factors for preterm birth include multiple gestations, preeclampsia, and maternal medical conditions. Complications of prematurity are also reviewed such as respiratory distress syndrome and intraventricular hemorrhage. Current tocolytic medications for inhibiting preterm labor are described including beta-agonists, calcium channel blockers, nitric oxide donors, and oxytocin receptor antagonists. The efficacy, maternal and fetal effects, dosing, and contraindications of specific medications like ritodrin and nifed
This document discusses recurrent pregnancy loss and its relationship to thrombophilia and antiphospholipid syndrome. It notes that thrombophilia and antiphospholipid syndrome may account for 10-20% of recurrent pregnancy losses. The antiphospholipid syndrome is an autoimmune condition associated with antibodies that cause clinical complications including venous and arterial thrombosis, preeclampsia, fetal growth restriction, preterm birth and recurrent pregnancy loss. Low molecular weight heparin is recommended for treatment and prevention of complications during pregnancy for those with antiphospholipid syndrome, with dosage depending on whether it is being used prophylactically or therapeutically.
This document discusses non-criteria obstetric antiphospholipid syndrome (APS). It begins by defining antiphospholipid antibodies and the diagnostic criteria for APS. It then examines non-criteria obstetric APS, which includes additional clinical manifestations like recurrent miscarriages or preeclampsia. While these do not meet international diagnostic criteria, treatment with low molecular weight heparin and low-dose aspirin can still yield good pregnancy outcomes. The document also reviews seronegative APS, asymptomatic APL carriers, and concludes that accurate diagnosis of obstetric APS is important and treatment should still be given for non-criteria cases.
This document provides an overview of current issues in perinatology and preterm birth. It discusses definitions and common causes of preterm birth such as spontaneous preterm labor and preterm premature rupture of membranes. Risk factors for preterm birth include multiple gestations, preeclampsia, and maternal medical conditions. Complications of prematurity are also reviewed such as respiratory distress syndrome and intraventricular hemorrhage. Current tocolytic medications for inhibiting preterm labor are described including beta-agonists, calcium channel blockers, nitric oxide donors, and oxytocin receptor antagonists. The efficacy, maternal and fetal effects, dosing, and contraindications of specific medications like ritodrin and nifed
This document discusses recurrent pregnancy loss and its relationship to thrombophilia and antiphospholipid syndrome. It notes that thrombophilia and antiphospholipid syndrome may account for 10-20% of recurrent pregnancy losses. The antiphospholipid syndrome is an autoimmune condition associated with antibodies that cause clinical complications including venous and arterial thrombosis, preeclampsia, fetal growth restriction, preterm birth and recurrent pregnancy loss. Low molecular weight heparin is recommended for treatment and prevention of complications during pregnancy for those with antiphospholipid syndrome, with dosage depending on whether it is being used prophylactically or therapeutically.
This document discusses non-criteria obstetric antiphospholipid syndrome (APS). It begins by defining antiphospholipid antibodies and the diagnostic criteria for APS. It then examines non-criteria obstetric APS, which includes additional clinical manifestations like recurrent miscarriages or preeclampsia. While these do not meet international diagnostic criteria, treatment with low molecular weight heparin and low-dose aspirin can still yield good pregnancy outcomes. The document also reviews seronegative APS, asymptomatic APL carriers, and concludes that accurate diagnosis of obstetric APS is important and treatment should still be given for non-criteria cases.
MANAGING APLA - AN EVIDENCE BASED PRACTICAL APPROACH BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the diagnosis and management of antiphospholipid syndrome (APS), also known as Hughes syndrome. APS is an autoimmune disorder characterized by blood clots or pregnancy complications in patients who test positive for antiphospholipid antibodies. The document provides details on diagnostic criteria, treatment recommendations including low-dose aspirin and heparin during pregnancy, and antenatal surveillance for successful fetal outcomes in APS patients.
The document discusses various tests used to assess ovarian reserve. It describes anti-Mullerian hormone (AMH) as the most sensitive marker that declines with age and correlates with antral follicle count (AFC). Basal follicle-stimulating hormone (FSH) levels increase with declining reserve but have inter-cycle variability. AFC counts the number of antral follicles and correlates with ovarian response, though cut-offs vary. No single test can reliably predict fertility or treatment response on its own.
Invited Lecture delivered by Dr Sujoy Dasgupta in National Youth Conference, held at Patna in August 2019. This session was sponsored by Bharat Serum and Vaccines
recent evidence of unfractionated heparin and aspirin in recurrent miscarriage Ahmed Rafea
Recurrent miscarriage (RM) occurs in 1-2% of women and is emotionally traumatic. While the cause is often unknown, risk factors include anatomical, immune, and thrombotic issues. Low dose aspirin and unfractionated heparin are used to treat RM caused by antiphospholipid syndrome and inherited thrombophilia. Meta-analyses show that combining aspirin and heparin increases live birth rates for women with RM associated with antiphospholipid antibodies. For unexplained RM, aspirin and heparin combined may potentially increase live birth rates by reducing hypercoagulability, though evidence is mixed. Unfractionated heparin is advocated as an effective and low-cost treatment
This document discusses antiphospholipid antibody syndrome (APS), also known as Hughes syndrome. It is an autoimmune disorder characterized by blood clots and pregnancy complications associated with abnormal antibodies. The syndrome can occur on its own or with lupus. Diagnosis requires certain clinical criteria like blood clots or pregnancy loss along with lab tests showing elevated antibodies on two occasions three months apart. Treatment involves blood thinners like heparin or warfarin to prevent clots. Management of pregnancy in APS patients requires heparin and low-dose aspirin to reduce risks of complications.
Antithrombotic therapy to prevent recurrent pregnancy loss in.pptxpreethikrishna6
1) The document discusses antithrombotic therapy for preventing recurrent pregnancy loss in patients with antiphospholipid syndrome.
2) It reviews 11 randomized control trials including over 1600 women comparing treatments like aspirin, low molecular weight heparin (LMWH), and unfractionated heparin.
3) The trials showed that combinations of aspirin and LMWH may increase live birth rates compared to other treatments, but differences were small and results inconclusive due to variability in how treatments were administered between studies.
This document discusses IVF treatment for polycystic ovary syndrome (PCOS). It begins with an overview of PCOS prevalence, definitions, and diagnostic criteria. IVF is indicated for PCOS patients who fail to conceive after ovulation induction or have other fertility factors. Patient preparation, gonadotropin protocols and monitoring, triggering ovulation, embryo transfer, and luteal phase support are discussed. Outcomes are better with GnRH antagonist protocols for PCOS patients due to lower gonadotropin doses and risk of ovarian hyperstimulation syndrome (OHSS). Primary and secondary prevention of OHSS includes metformin use, coasting, cryopreservation of embryos, and GnRH agonist triggering of ovulation.
The document discusses poor ovarian responders to fertility treatment. It defines poor response based on the Bologna criteria as having two of the following: a previous poor response, abnormal ovarian reserve markers, or age over 40. Predictors of poor response include elevated FSH, low AMH, small antral follicle count, and certain genetic factors. Management options discussed include increasing or adjusting the FSH dose, using a GnRH antagonist or microdose flare protocol, adding LH or adjunctive treatments, and considering natural cycles or gamete intrafallopian transfer.
Poor and hyper responders: biomarkers management, strategies
This document discusses the use of biomarkers such as AMH, AFC, and genetic markers to predict ovarian response and tailor IVF stimulation strategies. Key points:
1. AMH and AFC are effective at predicting poor and hyper ovarian response but not live birth rates. They are useful for choosing protocols.
2. Genetic markers of FSH and LH receptors can help explain hypo-sensitivity to FSH in some patients.
3. An integrated approach combining hormonal, functional and genetic biomarkers is needed to select the optimal treatment protocol for each patient.
4. Individualized treatment based on biomarkers can reduce cancellations, OHSS
Poor and hyper responders: biomarkers management, strategies
This document discusses the use of biomarkers such as AMH, AFC, and genetic markers to predict ovarian response and tailor IVF stimulation strategies. Key points:
1. AMH and AFC are effective at predicting poor and hyper ovarian response but not sufficient for live birth counseling.
2. Biomarkers can help choose protocols, such as using GnRH antagonists for normal responders and agonists to avoid OHSS in high responders.
3. An integrated approach considering hormonal, functional, and genetic biomarkers is needed to determine the optimal treatment strategy for each patient. FSH dose and potential LH supplementation should account for genetic
This document discusses obesity, systemic lupus erythematosus (SLE), thyroid disease, and in vitro fertilization (IVF). It summarizes that obesity is associated with lower clinical pregnancy and live birth rates after IVF due to factors like insulin resistance and inflammation. For SLE patients undergoing IVF, aggressive ovarian stimulation should be avoided to prevent thrombosis, and immunosuppressants may be increased. Thyroid disorders must be controlled before conception, and levothyroxine doses may need adjustment during ovarian stimulation due to changes in hormone levels. Screening for thyroid disease is recommended for those with risk factors prior to IVF to optimize treatment.
Antiphospholipid antibody syndrome (APAS) is caused by antibodies that target phospholipids or phospholipid-binding proteins, activating coagulation and inhibiting natural anticoagulants. This can cause blood clots, recurrent pregnancy loss, or complications like preeclampsia. Two criteria are needed for diagnosis: clinical evidence of blood clots or pregnancy morbidity, and laboratory tests positive for lupus anticoagulant, anticardiolipin antibodies or anti-β2 glycoprotein I. Treatment involves low-dose aspirin and prophylactic heparin during pregnancy. Women with a history of clots may require therapeutic anticoagulation to prevent complications like further clotting events or late fetal loss.
This document summarizes guidelines for treating hypertension during pregnancy. It discusses various antihypertensive medications and their indications and contraindications. For acute severe hypertension, labetalol and hydralazine are recommended. For chronic or gestational hypertension, treatment is usually initiated when blood pressure reaches 150/100 mmHg, with a target lower than 160/110 mmHg. Postpartum, methyldopa is to be avoided due to risk of depression. International guidelines have similar but not identical recommendations for evaluating and managing hypertension in pregnancy.
Aflibercept in combination with fluorouracil, leucovorin, and irinotecan in t...Mary Ondinee Manalo Igot
The document describes a study examining the safety and efficacy of aflibercept in combination with FOLFIRI chemotherapy for Asian patients with metastatic colorectal cancer who had progressed after prior oxaliplatin-based chemotherapy. The study was a retrospective, single-center analysis of 19 Asian patients treated at the National Cancer Centre Singapore. The analysis found that the combination of aflibercept and FOLFIRI resulted in an acceptable safety profile, with the most common adverse events being diarrhea, fatigue, neuropathy and hematologic toxicities. The objective response rate was 21%, comparable to results seen in other studies.
prevention of Preeclampsia: An evidence based approach, 2015Aboubakr Elnashar
This document discusses approaches to preventing preeclampsia. It begins by defining preeclampsia and outlining its pathogenesis. It then describes different types and levels of prevention evidence before examining various methods of prevention, including pharmacological interventions like low-dose aspirin, dietary supplements like calcium, and lifestyle changes. While some methods like low-dose aspirin for high-risk women and calcium supplementation are supported, evidence for other interventions is limited or they provide little benefit in preventing preeclampsia.
Similar to Gebelikte Antifosfolipid Antikor Sendromu ve Yönetimi (20)
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.
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
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.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
Visit Us: https://drdeepikashomeopathy.com/service/irregular-periods-treatment/
5 Effective Homeopathic Medicines for Irregular Periods
Gebelikte Antifosfolipid Antikor Sendromu ve Yönetimi
1. Gebelikte Antifosfolipid Antikor
Sendromu ve Yonetimi
Serdar H. Ural, M.D., F.A.C.O.G.
Director, Division of Maternal Fetal Medicine
Medical Director, Labor and Delivery Unit
Vice Chair, National Thrombosis and Pregnancy Working Group
Associate Professor of Obstetrics and Gynecology
Penn State University College of Medicine
2. Gebelikte Antifosfolipid Antikor Sendromu
Otoimmun hastalik
Dolasimdaki antifosfopilid antikorlar (APA) nedeniyle bulgular
Antifosfopilid antikor sendromu (APAS) %70 kadinlarda
Trombofili grubunda
Klinik komplikasyonlar/bulgular
Laboratuar bulgulari
Tedavi yontemleri
Levine J, Branch D et al. The antiphospholipid syndrome. N Engl J Med 2002, 346; 752-63
Lockshin M. Antiphospholipid antibody. Babies, blood, clots, biology. JAMA 1997; 277;1549-51
6. Assessment of the 2006 Revised
APLS Classification Criteria
200 APAS (+) hasta
1999 orijinal Sapporo kriteri ile yeni 2006 APAS klasifikasyon
kriteri karsilastirma analizi
7. Assessment of the 2006 Revised
APLS Classification Criteria
1999 kriterine uygun hastalardan %59’u 2006 kriterlerine uygun
Laboratuar kriter uygunlugu; %60 2006 kriterine uygun
%50 hasta tromboz risk faktor grubuna girdi, 2006 kriterleri
Selektif kriterler, gercekci yaklasim, gereksiz tedaviyi azaltabilir
Kaul M et al. Assessment of the 2006 Revised APLS Classification Criteria. Ann Rheum Dis 2007, March 2
8. Gebelikte Antifosfolipid Antikor Sendromu
Klinik Bulgular- Yeni 2006 Kriterleri
Obstetrik bulgu:
<10 gebelik haftasi, >2 spontane dusuk
>10 gebelik haftasi, sebebi bilinmeyen intrauterin fetal olum (IUFD)
<34 gebelik haftasi, sebebi bulunamamis preterm dogum, preeklampsi nedeniyle
dogum, intrauterin gelisme geriligi (IUGR)—uteroplasental yetmezlik
Vaskuler tromboz: (%2 APAS)
Sebebi bilinmeyen venoz tromboz (%70)
Sebebi bilinmeyen arteryel tromboz (%30)
Kapiller dahil, herhangi doku veya organ
Wilsin W, Brancg D et al. International consensus statement on preliminary classification criteria for definite antiphospholipid syndrome; report of an international
workshop. Arthritis Rgeum 1999, 42, 1309-11
9. Gebelikte Antifosfolipid Antikor Sendromu
Antifosfolipid Antikorlar
Her ne kadar degisik antikorlar (AB) bulunsa da, sadece 3 tanesi spesifik
olarak APAS ile iliskilidir
Lupus antikoagulan (LA)
Antikardiyolipin antikoru(ACA)
Anti-beta2-glikoprotein1 (AGP)
Alarcon S et al. Preliminary classification criteria for the antiphospholipid syndrome within SLE. Semin Arthritis Rheum 1992, 21; 275-86
Asherson R et al. The primary antiphospholipid syndrome; major clinical and serological features. Medicine (Baltimore) 1989, 68; 366-74
10. Gebelikte Antifosfolipid Antikor Sendromu
Laboratuar Kriterleri
Anti-Beta2-glikoprotein1 antikor:
IgG ya da IgM, %>99 percentile
En azindan 12 hafta arayla 2 defa olcum
2 pozitiflik lazim IgG ya da IgM icin
Antikardiyolipin antikor:
IgG, IgM izotip, (>40 GPL ya da >40 MPL, ya da %>99 percentile)
En azindan 12 hafta arayla 2 defa olcum
2 pozitiflik lazim IgG ya da IgM icin
Lupus antikoagulan;
(+) ya da (-)
En azindan 12 hafta arayla 2 defa olcum, International Society on Thrombosis and
Hemostasis normlarina uygun
2 pozitiflik lazim
Viard J et al. Association of anti beta 2 glycoprotein I antibodies with lupus type circulating anticoagulant and thrombosis in SLE. Am J Med 1992, 93,181-6
2006 APLS Criteria, J Thromb Hemost, 4: 295
11.
12. Gebelikte Antifosfolipid Antikor Sendromu
Tanisi
Kesin APAS tanisi en azindan 1 klinik kriter ve en azindan 1
laboratuar kriter bulunmasiyle gerceklesir
Diger antikorlar bazen APAS ile birlikte bulunsa da kuvvetli
korelasyon su anda mevcut degildir
APAS teshisi icin laboratuar tetkikleri sadece klinik kriter
bulgulari olan kisilere uygulanmalidir
Trombofilier ile birlikte degerlendirmeye alinmalidir
Branch D et al. Outcome of treated pregnancies in women with APLS; an update of the utah experience. Obstet Gynecol 1992,80, 614-20
13. Gebelikte Antifosfolipid Antikor Sendromu
Tanisi
APAS’in laboratuar teshisi acisindan pozitif olmasi icin, LA,
AGP, ve ACA tetkiki en az 12 hafta arayla tekrar edilmeli, ve de
her iki defada da en azindan ya LA ya ACA ya da AGP pozitif
sonuc vermelidir
APAS olmayan hastalarda bazen bu AB’lar bulunabilir, en az 12
hafta arayla testlerin tekrar edilme sebebi budur. Bu yolla yalanci
pozitiflik minimum’a indirgenmektedir
Pierangeli S et al. Are immunoglobulins with lupus antocoagulant activity specific for phospholipids? Br J Hematol 1993; 85; 124-32
14. Gebelikte Antifosfolipid Antikor Sendromu
Tedavi
Kumadin 1st trimestr yan etileri; %5
Embryopati
Mental retardasyon
Optik atrofi
Nasal hipoplazi
Iskelet anomalileri
CNS anomalileri
Fetal hemoraji
Normal heparin subkutan 5000U q 12 saat
Hayes E et al. LMWH, the most cost effective treatment of VTE. Presented at SMFM Meeting, 2006
15. Gebelikte Antifosfolipid Antikor Sendromu
Tedavi
LMWH daha az maternal yan etki, fetus’a gecmez, daha efektif,
faktor Xa inhibisyonu
Proflaktik dozaj icin seviye olcumune luzum yok
Tinzaparin 4500 IU q gun
Enoxaparin 40 mg q gun
Dalteparin 5000 IU bid
Terapotik anti-faktor Xa peak seviye hedefi 0.8-1.2 IU/ml
Tinzaparin 175 IU/kg q gun
Enoxaparin 1 mg/kg bid
Dalteparin 100 IU/kg q bid
16. Gebelikte Antifosfolipid Antikor Sendromu
Tedavi
Eger gebelikte APAS teshisi var ise, ama tromboz hikayesi yoksa
proflaktik doz heparin ya da dusuk molekuler agirlikli heparin (LMW)
ve de 81mg gunluk aspirin tedavisi uygundur. Bu tedavi postpartum
8’ci haftaya kadar devam etmelidir
Eger APAS teshisi ve de tromboz hikayesi mevcut ise o zaman
terapotik doz antikoagulasyon tedavisi gebelik suresince ve de
postpartum 8’ci haftaya kadar uygulanmasi onerilmektedir
APAS’una sahip kadinlar gebelik sonrasi reproduktif senelerinde
estrojen ihtiva eden dogum kontrol yontemlerini kullanmamalidirlar
Chamley L et al. Separation of lupus anticoagulant from anticardiolipin antibodies by ion exchange and gel filtration chromatography. Hemostasis 1991; 21;
25-9
18. Gebelikte Antifosfolipid Antikor Sendromu
Gebelikte Takip
IUGR riski nedeniyle fetus’un ultrason takibi gereklidir
32’ci gebelik haftasindan itibaren diger antenatal tetkikler
APAS’in vaskuler bir etyolojiye sahip olmasindan oturu,
uteroplasental yetmezligin tetkik edilmesi ancak bu yolla
gerceklesebilir.
Passam F et al. Laboratory tests for APLS; current concepts. Pathology 2004, 36;129-38
19. Gebelik ve Postpartum Donemde Tedavi
Tedavi amaci preterm dogum, dusuk, preeklampsi, plasental
yetmezlik, trombozun onlenmesi icindir
APAS (+), tromboz (-), proflaktik doz heparin ya da dusuk
molekuler agirlikli heparin (LMW) ve de 81mg gunluk aspirin
tedavisi dusuk riskini %50 azaltir
LMW tedavisiyle gebelikte DVT/PE riski ortalama %75
azalmaktadir
Yasuda M et al. Prospective studies of the association between anticardiolipin antibody and pregnancy outcome. Obstet Gynecol 1995, 86; 555-9
20. Gebelik ve Postpartum Donemde Tedavi
Gebelik oncesi terapinin yarari kanitlanmis degildir
APAS ve tromboz (+), terapotik doz antikoagulasyon
tedavisi, aspirinin eklenmesi ekstra yarar
saglamamaktadir
Steroid ve IVIG, heparin-LMW + aspirinden daha etkili
oldugu saptanmamistir, data az
21.
22. APAS Icin Kim Test Edilmeli?
Obstetrik bulgu:
<10 gebelik haftasi, >2 spontane dusuk
>10 gebelik haftasi, sebebi bilinmeyen intrauterin fetal olum (IUFD)
<34 gebelik haftasi, sebebi bulunamamis preterm dogum, preeklampsi nedeniyle
dogum, intrauterin gelisme geriligi (IUGR)—uteroplasental yetmezlik
Vaskuler tromboz: (%2 APAS)
Sebebi bilinmeyen venoz tromboz (%70)
Sebebi bilinmeyen arteryel tromboz (%30)
Kapiller dahil, herhangi doku veya organ
Silver R et al. ACA; clinical consequenses of low titers. Obstet gynecol 1996; 87; 494-500
23. APAS Icin Hangi Laboratuar
Kriterleri Gerekir?
Anti-Beta2-glikoprotein1 antikor:
IgG ya da IgM, %>99 percentile
En azindan 12 hafta arayla 2 defa olcum
2 pozitiflik lazim IgG ya da IgM icin
Anticardiyolipin antikor:
IgG, IgM izotip, (>40 GPL ya da >40 MPL, ya da %>99 percentile)
En azindan 12 hafta arayla 2 defa olcum
2 pozitiflik lazim IgG ya da IgM icin
Lupus antikoagulan;
(+) ya da (-)
En azindan 12 hafta arayla 2 defa olcum, International Society on Thrombosis and
Hemostasis normlarina uygun
2 pozitiflik lazim
Coulam C et al. Interlaboratory inconsistencies in detection of ACA. Lancet 1990;335; 865
24. Antifosfolipid Antikor Sendromu
Uzun vadeli tedavi ve takip
3-10 sene icinde %50 tromboz, felc, %10 SLE
Tam olarak nasil tedavi gerektigi, hatta gerekip gerekmedigi
henuz tespit edilmis degildir
Antikoagulan tedavinin riski uzun vadede ne derece azalttigi
tam bilinmemekte
Genelde 8’ci postapartum haftalik peryottan sonra tedavi
durdurulur
Bir daha ki gebelikte ayni yontemler
Rai R et al. APA and beta 2in 500women with recurrent miscarriage; results of a comprehensive screening approach. Hum Reprod 1995, 10, 2001-5
25. Sonuc
APAS icin yapilan laboratuar analizleri sadece klinik kriterlere
uyan kisilerde yapilmali
LMWH normal heparin’e gore, bilhassa yan etki acisindan daha
cok tercih edilmekte; trombositopeni, osteoporoz riski daha azdir
Heparin ile trombositopeni %5
Eger klinik kritere uyulmadan lab analizi yapilmissa, ornegin
trombofili analizi icin, proflaktik LMWH ya da aspirin
Tedavi ile %70-80 saglikli dogum
26. Referanslar
Duhl A, Paidas M, Ural SH. Antithrombotic therapy and pregnancy. Consensus report and recommendations for
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