Based on available data, rocuronium is not expected to increase risk of congenital anomalies when used for short-term muscle relaxation during pregnancy. However, more data would be needed to fully characterize its safety profile.
Pregnancy Risk Category : C
- Women with bacterial vaginosis (BV) and abnormal vaginal flora are at higher risk of preterm delivery and late miscarriage. Probiotics containing Lactobacillus species have been shown to reduce the risk of recurrent BV and preterm birth by restoring the normal vaginal microbiome.
- Children born preterm face increased risks of mortality and health and developmental problems. Supplementation of probiotics to pregnant mothers has been associated with reduced risks of preterm birth, preeclampsia, and atopic diseases in infants.
- Studies indicate probiotic intake during pregnancy, especially late pregnancy, can help reduce the incidence of preterm birth and pregnancy complications like preeclampsia.
Role of Dydrogesterone in Recurrent Pregnancy Loss Dr Sharda Jain Lifecare Centre
Dydrogesterone is commonly used by Indian gynecologists to treat recurrent pregnancy loss. It has higher bioavailability than natural micronized progesterone when taken orally. Dydrogesterone has an immunomodulatory effect that may help prevent miscarriage by inhibiting pro-inflammatory cytokines and increasing anti-inflammatory cytokines and progesterone-induced blocking factor production. It also increases uterine and endometrial blood flow by stimulating nitric oxide production. Several studies and meta-analyses indicate dydrogesterone may be more effective than natural micronized progesterone for treating recurrent pregnancy loss when taken orally, due to its higher bioavailability and specific affinity for progesterone receptors.
Born too soon the global action report on preterm birthPaul Mark Pilar
The report Born Too Soon analyzes the global problem of preterm birth. It features the first estimates of preterm birth rates by country and is authored by over 45 international experts. The report finds that about 15 million babies are born prematurely each year, which is more than 1 in 10 babies worldwide. Prematurity is the leading cause of newborn death and the second leading cause of death in children under 5 years of age. Many preterm babies who survive face lifelong disabilities. The report highlights proven solutions to save lives of preterm babies and reduce rates of death and disability.
This document discusses emergency contraception options. It provides details about various emergency contraception methods including the Yuzpe method, levonorgestrel pills, mifepristone, and copper IUDs. It summarizes the mechanisms of action, efficacy, side effects, and limitations of each method. The document emphasizes that emergency contraception pills and IUDs are underutilized in India but can significantly reduce unintended pregnancies and abortions if used correctly after unprotected intercourse.
This document discusses preterm labor, which is defined as labor beginning before 37 weeks of gestation. Premature infants are at risk for complications affecting breathing, temperature regulation, feeding, eyesight, intestines and nervous system. While most preterm births have no known cause, risk factors include a previous preterm birth, carrying multiples, cervical/uterine issues, infections, stress, smoking and low weight. Signs of preterm labor include changes in discharge, contractions and pain. Treatments aim to delay delivery long enough for steroid injections to mature the baby's lungs while stopping labor with medications.
This document provides guidelines for the use of electronic fetal monitoring (EFM) during labor and delivery. It was developed by a multidisciplinary group including representatives from several medical organizations and consumer groups. The guidelines aim to evaluate the impact of EFM, develop standards for its use, improve interpretation of EFM readings, and consider medico-legal and resource implications. The guidelines are based on a review and appraisal of available evidence on EFM.
- Women with bacterial vaginosis (BV) and abnormal vaginal flora are at higher risk of preterm delivery and late miscarriage. Probiotics containing Lactobacillus species have been shown to reduce the risk of recurrent BV and preterm birth by restoring the normal vaginal microbiome.
- Children born preterm face increased risks of mortality and health and developmental problems. Supplementation of probiotics to pregnant mothers has been associated with reduced risks of preterm birth, preeclampsia, and atopic diseases in infants.
- Studies indicate probiotic intake during pregnancy, especially late pregnancy, can help reduce the incidence of preterm birth and pregnancy complications like preeclampsia.
Role of Dydrogesterone in Recurrent Pregnancy Loss Dr Sharda Jain Lifecare Centre
Dydrogesterone is commonly used by Indian gynecologists to treat recurrent pregnancy loss. It has higher bioavailability than natural micronized progesterone when taken orally. Dydrogesterone has an immunomodulatory effect that may help prevent miscarriage by inhibiting pro-inflammatory cytokines and increasing anti-inflammatory cytokines and progesterone-induced blocking factor production. It also increases uterine and endometrial blood flow by stimulating nitric oxide production. Several studies and meta-analyses indicate dydrogesterone may be more effective than natural micronized progesterone for treating recurrent pregnancy loss when taken orally, due to its higher bioavailability and specific affinity for progesterone receptors.
Born too soon the global action report on preterm birthPaul Mark Pilar
The report Born Too Soon analyzes the global problem of preterm birth. It features the first estimates of preterm birth rates by country and is authored by over 45 international experts. The report finds that about 15 million babies are born prematurely each year, which is more than 1 in 10 babies worldwide. Prematurity is the leading cause of newborn death and the second leading cause of death in children under 5 years of age. Many preterm babies who survive face lifelong disabilities. The report highlights proven solutions to save lives of preterm babies and reduce rates of death and disability.
This document discusses emergency contraception options. It provides details about various emergency contraception methods including the Yuzpe method, levonorgestrel pills, mifepristone, and copper IUDs. It summarizes the mechanisms of action, efficacy, side effects, and limitations of each method. The document emphasizes that emergency contraception pills and IUDs are underutilized in India but can significantly reduce unintended pregnancies and abortions if used correctly after unprotected intercourse.
This document discusses preterm labor, which is defined as labor beginning before 37 weeks of gestation. Premature infants are at risk for complications affecting breathing, temperature regulation, feeding, eyesight, intestines and nervous system. While most preterm births have no known cause, risk factors include a previous preterm birth, carrying multiples, cervical/uterine issues, infections, stress, smoking and low weight. Signs of preterm labor include changes in discharge, contractions and pain. Treatments aim to delay delivery long enough for steroid injections to mature the baby's lungs while stopping labor with medications.
This document provides guidelines for the use of electronic fetal monitoring (EFM) during labor and delivery. It was developed by a multidisciplinary group including representatives from several medical organizations and consumer groups. The guidelines aim to evaluate the impact of EFM, develop standards for its use, improve interpretation of EFM readings, and consider medico-legal and resource implications. The guidelines are based on a review and appraisal of available evidence on EFM.
PREVENTION OF PRETERM LABOUR - EVIDENCES FOR PROGESTERONE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the role of progesterone in preventing preterm labor and delivery. It provides information on progesterone's mechanisms of action, guidelines and evidence for its use, and summarizes various studies conducted on oral and vaginal progesterone for reducing preterm birth risks in high-risk groups like women with a short cervix or history of prior preterm delivery. The document also compares micronized progesterone to hydroxyprogesterone caproate in terms of indications and side effects.
Recurrent pregnancy losses managing the unexplainedravikantraj55
This document discusses recurrent pregnancy losses and managing unexplained causes. It begins with an introduction to Dr. Manju Gita Mishra who has extensive experience in obstetrics and gynecology. The document then covers definitions of recurrent pregnancy loss, common causes, diagnostic evaluation, and treatment options including progesterone supplementation which some studies have found reduces subsequent miscarriage rates in women with unexplained recurrent miscarriages. It discusses challenges in identifying the cause in about 50% of recurrent pregnancy loss cases and stratifying women into those whose losses are likely due to chance versus an underlying abnormality.
Luteal Phase Support In Art - Dr. Abayomi Ajayiabayomi ajayi
This document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. LPS is required in ART cycles because the luteal phase is abnormal due to ovarian hyperstimulation and disruption of the hypothalamic-pituitary-ovarian axis. Common options for LPS include progesterone, HCG, and GnRH agonists administered through various routes starting on the day of oocyte retrieval and continuing until pregnancy is confirmed or the menstrual period starts. New challenges have emerged with the use of GnRH agonists to trigger final oocyte maturation instead of HCG. Personalized LPS protocols based on ovarian response and risk of ovarian hyperstimulation syndrome show promise for optimizing pregnancy rates while preventing complications.
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
1. Corifollitropin alfa is a recombinant gonadotropin that provides a single dose alternative to multiple daily injections of recombinant FSH for controlled ovarian stimulation.
2. Clinical trials have found corifollitropin alfa to be as effective as daily recombinant FSH with similar outcomes for number of oocytes retrieved, ongoing pregnancy rates, and live birth rates.
3. Safety profiles were also similar between corifollitropin alfa and daily recombinant FSH with no evidence of immunogenicity found.
Unlocking I.V.F Services Redefining the New Normal Dr Sharda Jain Lifecare Centre
1) Frozen embryo transfer (FET) will likely be the treatment of choice after resumption of fertility practice due to its less invasive nature compared to fresh embryo transfer which involves ovarian stimulation.
2) FET cycles are associated with higher success rates than fresh embryo transfers in high responders who produce 15 or more eggs. They also carry lower risks of adverse outcomes like preterm birth and low birth weight.
3) To reduce stress experienced by ART patients during the pandemic, it is recommended to practice digital detox, meditation, interact with support groups, use self-help resources and maintain positive self-talk.
Threatened Miscarriage Verdict is out on Hormonal Treatment Dr Jyoti AgarwalLifecare Centre
- Threatened miscarriage occurs in around 15% of clinically recognized pregnancies and can cause significant emotional and psychological stress for couples.
- Multiple meta-analyses and randomized controlled trials have found that oral administration of dydrogesterone is more effective at reducing the risk of miscarriage in cases of threatened miscarriage compared to vaginal progesterone or no treatment.
- Dydrogesterone has higher bioavailability when taken orally compared to micronized progesterone, requires a lower dose, and may have immunomodulatory properties that further reduce the risk of miscarriage.
Contraception, Hormones, Progestogens: Update : Dr. Jyoti agarwal Dr. Sharda ...Lifecare Centre
This document discusses oral contraceptive pills, specifically those containing progestogens like desogestrel. It provides information on the history and development of oral contraceptives, including how progestogen formulations have evolved to reduce androgenic side effects. Clinical trial results are presented showing that contraceptives containing desogestrel have good cycle control and low rates of side effects. Desogestrel is highlighted as having favorable characteristics like high selectivity and specificity for progesterone receptors over other steroid receptors.
Gastrointestinal Complications in Pregnancy Dr Sharda Jain Lifecare Centre
Nausea and vomiting are common in early pregnancy, affecting 85% of women. Symptoms typically appear between 4-9 weeks and are most severe at 7-12 weeks, subsiding by 12-16 weeks for most. For 15% of women, symptoms continue until 20 weeks. Hyperemesis gravidarum is a more severe form involving weight loss, dehydration and electrolyte imbalance. Treatment involves dietary changes, ginger, vitamin B6, antihistamines and other drugs. For severe cases, hydration and other inpatient management may be needed.
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
This document summarizes a panel discussion on the management of IVF pregnancies conducted by Delhi ISAR, Advance Fertility and Gynaecology Centre, and Madhukar Rainbow Group of Hospitals. The panelists provided expert opinions on topics like the choice of ART treatment, number of embryos to transfer, luteal phase support, anomaly screening, reduction of higher order multiples, antenatal follow-up, prevention of preterm labor, use of antenatal steroids, and delivery timing in twin pregnancies. The document emphasizes that IVF pregnancies require special care and management.
Treatment of RPL myths focuses on debunking common misconceptions around recurrent pregnancy loss (RPL). The document discusses several potential causes of RPL including thrombophilia, genetic factors, anatomical abnormalities, endocrine issues, immune factors, and infections. It provides treatment recommendations for different conditions like administering low-dose aspirin and heparin for antiphospholipid syndrome. The effectiveness of progesterone supplementation is questioned based on recent clinical trial results. Surgical and medical management of conditions like chronic endometritis are outlined. The role of various diagnostic tests and treatments for interpreting RPL causes are also examined.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
Progesterone plays an important role in pregnancy. While progesterone supplementation may reduce miscarriage rates in women with threatened miscarriage or recurrent miscarriage, evidence is still preliminary. The PROMISE trial found no significant difference in live birth rates between progesterone and placebo in women with unexplained recurrent miscarriage. Guidelines provide consensus recommendations but state evidence is still limited. Progesterone appears safe with no significant adverse maternal or fetal effects reported. Further research is still needed to define optimal formulations, doses and durations of progesterone supplementation.
This document summarizes evidence on the use of progesterone to prevent preterm birth. It finds that progesterone reduces the risk of preterm birth before 37 weeks in women with a prior preterm delivery or short cervix. Progesterone may also reduce complications for infants born preterm to mothers receiving it. However, progesterone does not prevent early preterm birth in twin or triplet pregnancies. No long-term harms were seen in children exposed to progesterone prenatally.
This document discusses new concepts in oral contraceptive intake, specifically the 24/4 regimen. It begins by providing background on different generations of combined oral contraceptives. It then introduces the 24/4 regimen, which contains ethinylestradiol and drospirenone over 24 days followed by 4 hormone-free days. Studies show this regimen more effectively inhibits follicular development compared to the traditional 21/7 regimen. The 24/4 regimen provides 3 extra days of anti-mineralocorticoid and antiandrogenic effects, and may reduce hormone-withdrawal symptoms. A large observational study found the 24/4 regimen with drospirenone, specifically Yaz, had the lowest contraceptive failure rates including in
PREVENTION OF PRETERM LABOUR - EVIDENCES FOR PROGESTERONE BY DR SHASHWAT JANIDR SHASHWAT JANI
This document discusses the role of progesterone in preventing preterm labor and delivery. It provides information on progesterone's mechanisms of action, guidelines and evidence for its use, and summarizes various studies conducted on oral and vaginal progesterone for reducing preterm birth risks in high-risk groups like women with a short cervix or history of prior preterm delivery. The document also compares micronized progesterone to hydroxyprogesterone caproate in terms of indications and side effects.
Recurrent pregnancy losses managing the unexplainedravikantraj55
This document discusses recurrent pregnancy losses and managing unexplained causes. It begins with an introduction to Dr. Manju Gita Mishra who has extensive experience in obstetrics and gynecology. The document then covers definitions of recurrent pregnancy loss, common causes, diagnostic evaluation, and treatment options including progesterone supplementation which some studies have found reduces subsequent miscarriage rates in women with unexplained recurrent miscarriages. It discusses challenges in identifying the cause in about 50% of recurrent pregnancy loss cases and stratifying women into those whose losses are likely due to chance versus an underlying abnormality.
Luteal Phase Support In Art - Dr. Abayomi Ajayiabayomi ajayi
This document discusses luteal phase support (LPS) in assisted reproductive technology (ART) cycles. LPS is required in ART cycles because the luteal phase is abnormal due to ovarian hyperstimulation and disruption of the hypothalamic-pituitary-ovarian axis. Common options for LPS include progesterone, HCG, and GnRH agonists administered through various routes starting on the day of oocyte retrieval and continuing until pregnancy is confirmed or the menstrual period starts. New challenges have emerged with the use of GnRH agonists to trigger final oocyte maturation instead of HCG. Personalized LPS protocols based on ovarian response and risk of ovarian hyperstimulation syndrome show promise for optimizing pregnancy rates while preventing complications.
IUI is a basic but effective form of fertiltiy treatment and can be a viable alternative to the expensive IVF / test tube baby treatment that is normally advised.
This presentation will be very useful for the practising gynecologists, IVF specialists and General practitioners who perform IUI.
Even patients on going through this presentation will be more educated about iui.
Please reach out to me on 9833032120 by whatsapp / Telegram or phone call or email on dalalsj@gmail.com for further details / treatment options.
1. Corifollitropin alfa is a recombinant gonadotropin that provides a single dose alternative to multiple daily injections of recombinant FSH for controlled ovarian stimulation.
2. Clinical trials have found corifollitropin alfa to be as effective as daily recombinant FSH with similar outcomes for number of oocytes retrieved, ongoing pregnancy rates, and live birth rates.
3. Safety profiles were also similar between corifollitropin alfa and daily recombinant FSH with no evidence of immunogenicity found.
Unlocking I.V.F Services Redefining the New Normal Dr Sharda Jain Lifecare Centre
1) Frozen embryo transfer (FET) will likely be the treatment of choice after resumption of fertility practice due to its less invasive nature compared to fresh embryo transfer which involves ovarian stimulation.
2) FET cycles are associated with higher success rates than fresh embryo transfers in high responders who produce 15 or more eggs. They also carry lower risks of adverse outcomes like preterm birth and low birth weight.
3) To reduce stress experienced by ART patients during the pandemic, it is recommended to practice digital detox, meditation, interact with support groups, use self-help resources and maintain positive self-talk.
Threatened Miscarriage Verdict is out on Hormonal Treatment Dr Jyoti AgarwalLifecare Centre
- Threatened miscarriage occurs in around 15% of clinically recognized pregnancies and can cause significant emotional and psychological stress for couples.
- Multiple meta-analyses and randomized controlled trials have found that oral administration of dydrogesterone is more effective at reducing the risk of miscarriage in cases of threatened miscarriage compared to vaginal progesterone or no treatment.
- Dydrogesterone has higher bioavailability when taken orally compared to micronized progesterone, requires a lower dose, and may have immunomodulatory properties that further reduce the risk of miscarriage.
Contraception, Hormones, Progestogens: Update : Dr. Jyoti agarwal Dr. Sharda ...Lifecare Centre
This document discusses oral contraceptive pills, specifically those containing progestogens like desogestrel. It provides information on the history and development of oral contraceptives, including how progestogen formulations have evolved to reduce androgenic side effects. Clinical trial results are presented showing that contraceptives containing desogestrel have good cycle control and low rates of side effects. Desogestrel is highlighted as having favorable characteristics like high selectivity and specificity for progesterone receptors over other steroid receptors.
Gastrointestinal Complications in Pregnancy Dr Sharda Jain Lifecare Centre
Nausea and vomiting are common in early pregnancy, affecting 85% of women. Symptoms typically appear between 4-9 weeks and are most severe at 7-12 weeks, subsiding by 12-16 weeks for most. For 15% of women, symptoms continue until 20 weeks. Hyperemesis gravidarum is a more severe form involving weight loss, dehydration and electrolyte imbalance. Treatment involves dietary changes, ginger, vitamin B6, antihistamines and other drugs. For severe cases, hydration and other inpatient management may be needed.
Progesterone for luteal phase support in IVF cyclesHesham Al-Inany
Luteal phase support is essential for IVF cycles. Progesterone has many forms and modalities: which to use? this talk is an attempt to answer this question
This document summarizes a panel discussion on the management of IVF pregnancies conducted by Delhi ISAR, Advance Fertility and Gynaecology Centre, and Madhukar Rainbow Group of Hospitals. The panelists provided expert opinions on topics like the choice of ART treatment, number of embryos to transfer, luteal phase support, anomaly screening, reduction of higher order multiples, antenatal follow-up, prevention of preterm labor, use of antenatal steroids, and delivery timing in twin pregnancies. The document emphasizes that IVF pregnancies require special care and management.
Treatment of RPL myths focuses on debunking common misconceptions around recurrent pregnancy loss (RPL). The document discusses several potential causes of RPL including thrombophilia, genetic factors, anatomical abnormalities, endocrine issues, immune factors, and infections. It provides treatment recommendations for different conditions like administering low-dose aspirin and heparin for antiphospholipid syndrome. The effectiveness of progesterone supplementation is questioned based on recent clinical trial results. Surgical and medical management of conditions like chronic endometritis are outlined. The role of various diagnostic tests and treatments for interpreting RPL causes are also examined.
Role of Dydrogesterone in Threatened Abortion Dr Sharda Jain Lifecare Centre
*EXPERINCE SHARING By EXPERTS*
Dr Uma Rai(DGF *E*)
Dr Sangeetaa Gupta(DGF *E*)
Dr Neerja Varshney(DGF *E*)
Dr Surjeet Kapoor(DGF *E*)
Dr Rupam arora(DGF *E*)
Dr Meenakshi Ahuja(DGF *S* )
Dr.Harsha khullar(DGF *C* )
Dr Mamta mittal(DGF *N*)
Dr Leena Sreedhar(DGF *D*)
Dr.Dipti Nabh(DGF *E*)
Dr. Shama Batra(DGF *E*)
Dr Poonam Paul(DGF *SW*)
PAN DGF ( DELHI GYNAECOLOGIST FORUM) CME ON DYDROGESTERONE ON 3/2 /22
Progesterone plays an important role in pregnancy. While progesterone supplementation may reduce miscarriage rates in women with threatened miscarriage or recurrent miscarriage, evidence is still preliminary. The PROMISE trial found no significant difference in live birth rates between progesterone and placebo in women with unexplained recurrent miscarriage. Guidelines provide consensus recommendations but state evidence is still limited. Progesterone appears safe with no significant adverse maternal or fetal effects reported. Further research is still needed to define optimal formulations, doses and durations of progesterone supplementation.
This document summarizes evidence on the use of progesterone to prevent preterm birth. It finds that progesterone reduces the risk of preterm birth before 37 weeks in women with a prior preterm delivery or short cervix. Progesterone may also reduce complications for infants born preterm to mothers receiving it. However, progesterone does not prevent early preterm birth in twin or triplet pregnancies. No long-term harms were seen in children exposed to progesterone prenatally.
This document discusses new concepts in oral contraceptive intake, specifically the 24/4 regimen. It begins by providing background on different generations of combined oral contraceptives. It then introduces the 24/4 regimen, which contains ethinylestradiol and drospirenone over 24 days followed by 4 hormone-free days. Studies show this regimen more effectively inhibits follicular development compared to the traditional 21/7 regimen. The 24/4 regimen provides 3 extra days of anti-mineralocorticoid and antiandrogenic effects, and may reduce hormone-withdrawal symptoms. A large observational study found the 24/4 regimen with drospirenone, specifically Yaz, had the lowest contraceptive failure rates including in
The document discusses drugs and breastfeeding. It provides information on factors that determine whether and how much of a drug passes into breastmilk, including molecular weight, protein binding, lipid solubility, and oral bioavailability. It notes that most drugs pass into breastmilk in small amounts, usually less than 1% of the maternal dose. The document outlines general principles for counseling nursing mothers on drug use, such as choosing short-acting drugs, administering drugs after feeding, and monitoring infants for side effects. It also categorizes drugs based on their safety profile for breastfeeding according to the AAP.
This document summarizes key findings from several studies on exposures during pregnancy and lactation. The studies found:
- Teratogen information services receive thousands of calls annually regarding exposures to medications, infections, herbs and other substances during pregnancy and breastfeeding. The majority of calls concern analgesics, cold medications, herbs and dietary supplements.
- Most calls are made by exposed individuals themselves, highlighting a need for more education during prenatal care about risks of nonprescription drugs and vaccines.
- While some drugs used to treat autoimmune diseases like methotrexate and leflunomide can cause harm if taken during early pregnancy, others like sulfasalazine, azathioprine and antimalarials are
This document summarizes a study that examined the relationship between the drug domperidone, which is commonly used off-label to stimulate lactation, and the risk of ventricular arrhythmia and mortality during the postpartum period. The study used a retrospective cohort of over 225,000 women in British Columbia between 2002-2011. It found a possible doubling of the risk of hospitalization for ventricular arrhythmia among those exposed to domperidone, though the results were not statistically significant. Larger studies are needed to confirm any association.
Safety of Mebendazole Use During Lactationmothersafe
This case series study evaluated the safety of mebendazole use in 45 lactating women and their infants. Mebendazole was administered using single or repeated doses and was well tolerated by both the mothers and infants, with no adverse effects observed in infants. Mild GI irritability occurred in two treated mothers. This study provides the first evidence that mebendazole is safe for use in breastfeeding.
This document summarizes the principles of teratology and developmental toxicology. It discusses key concepts like critical periods of development, dose-response relationships, mechanisms of action of teratogens, and manifestations of deviant development. Historical cases of thalidomide, Bendectin, and diethylstilbestrol are reviewed. The limitations of animal studies for assessing human teratogenic risk are covered. Methods for evaluating safety and risk of drugs in pregnancy are examined, including FDA classification systems and graphical representations. The roles of teratology information services like the Korean Motherisk Program in counseling on inadvertent exposures are described.
1) The document discusses the principles of teratology, which is the study of abnormal fetal development. Some key principles discussed include that susceptibility to teratogenesis depends on factors like genetics and environment.
2) Several recognized human teratogens are discussed like thalidomide, accutane, and alcohol. Historical cases of adverse drug effects in pregnancy from drugs like thalidomide, bendectin, and diethylstilbestrol are also summarized.
3) Methods for evaluating the safety and risks of drugs in pregnancy are covered, including studies in animals and humans as well as systems used by organizations like the FDA and KBS to classify risk. The role of teratology information services in drug
This document discusses infertility evaluation and treatment. It begins by outlining factors to consider before trying to conceive and describing methods for timing intercourse. Common causes of infertility include problems with ovulation, male factor issues, and tubal or uterine abnormalities. Treatment options range from lifestyle changes to assisted reproductive technologies like intrauterine insemination, ovulation induction, and in vitro fertilization. While assisted reproduction can help many couples conceive, it may also lead to multiple births and there are still some unknown risks for children conceived through these methods.
Antipsychotics and mood stabilizers in pregnancyMohamed Sedky
Objectives:
Background risk of spontaneous congenital anomalies
The impact of mental illness on pregnancy
The impact of pregnancy on mental illness
The impact Antipsychotics and mood stabilizers on pregnancy outcome
Recommendations for prescribing during pregnancy
What to include in discussions with a pregnant women
1. The document discusses threatened and unexplained recurrent miscarriages. It provides information on the definition, incidence, types, causes, prognosis, and management of threatened and recurrent miscarriages.
2. For threatened miscarriages, the use of progestins is the most promising treatment and can significantly reduce the rate of miscarriage compared to placebo. For unexplained recurrent miscarriages, the prognosis is generally good without intervention, as many cases are due to chromosomal abnormalities rather than underlying maternal issues.
3. Basic investigations should be performed to investigate potential causes of recurrent miscarriage such as anatomical abnormalities, endocrine disorders, infections, thrombophilias, and alloimmune factors. However, for most cases
This document discusses preventing preterm labour. It begins by providing statistics on the incidence of preterm birth in various locations. It then discusses the magnitude of the problem, highlighting the high costs of preterm birth. Several studies on outcomes of extremely preterm infants are summarized. The document is then organized into sections on primary, secondary, and tertiary prevention of preterm labour. Key points are made about various risk factors and diagnostic tools, as well as treatments such as progesterone, cerclage and antibiotics.
Screening for and treatment of asymptomatic bacteriuria in high-risk pregnant women reduces the risk of preterm birth. However, routine screening of all pregnant women in the first trimester with urine culture is not currently recommended due to the low prevalence of asymptomatic bacteriuria in the general pregnant population and the costs of universal screening.
Isotretinoin is a novel treatment for severe, recalcitrant nodular acne sold under the brand names Accutane®, Amnesteem®, Claravis®, and Sotret®. It is the most widely used teratogenic drug in the United States. From a population based perspective, women and men use the drug in near equal proportions but the risks are exponentially greater for women of childbearing years. Serious developmental abnormalities have displayed a high tendency to occur in clusters in fetuses exposed to isotretinoin. This review of medical literature focuses on the public health implications of isotretinoin use and develops a case for continued risk management. Reduction of fetal isotretinoin exposure is contingent upon effective programming and continued adherence to strict standards.
The document summarizes the principles of teratology and developmental toxicology. It discusses seven principles: 1) Genetic and environmental factors influence susceptibility, 2) Susceptibility varies by developmental stage, 3) Teratogens act through specific mechanisms, 4) Access of influences depends on agent characteristics, 5) Effects can include death, malformations, growth issues, or functional deficits, 6) Risk increases with dose, 7) Not all malformations can be caused. It also discusses evaluating drug safety in pregnancy through animal studies, human data, and limitations. Teratology information services provide counseling based on these principles.
The document discusses the balance between risks and benefits of medical imaging during pregnancy. It describes various imaging modalities like X-ray, CT, MRI, and nuclear medicine. While ionizing radiation carries risks like childhood cancer, the risks are very low from typical medical exposures. MRI is generally safe in pregnancy without radiation. The risks of any diagnostic imaging must be weighed against the potential benefits for both mother and baby.
1. Emergency contraception, also known as the "morning after pill", can prevent pregnancy up to 5 days after unprotected sex but is most effective the sooner it is taken.
2. The document discusses various case presentations involving patients seeking emergency contraception and provides guidance on appropriate contraceptive options and counseling points.
3. Key recommendations include no need for physical exam prior to emergency contraception, offering advance prescriptions, and providing the most effective option of copper IUD insertion for emergency contraception when possible.
This 3-sentence summary provides an overview of the key information from the multi-page Korean language document on drug safety during pregnancy:
1) The document discusses several historical cases that demonstrated the teratogenic effects of drugs such as thalidomide, diethylstilbestrol, and bendectin when taken during pregnancy.
2) It then outlines criteria for proving human teratogenicity and lists drugs that are suspected or proven to be human teratogens, along with graphical representations of risk.
3) The document also describes a Korean study that analyzed over 5,000 consultations on drug exposure during pregnancy between 1999-2008 to evaluate approaches for utilizing reproductive toxicity information.
Describes tThe precise dosage and duration of progesterone administration for luteal support in IVF are still topics of ongoing research, which could potentially lead to suboptimal outcomes such as miscarriage or preterm birth if not correctly managed.The efficacy of progesterone in reducing miscarriage and preterm birth rates in IVF, creating uncertainty about the best approach to luteal phase support.
This document discusses various aspects of managing epilepsy in women. It notes that while the fundamental principles of epilepsy management are the same for men and women, managing epilepsy in women requires attention to some special considerations. These include catamenial epilepsy related to the menstrual cycle, increased risk of sexual dysfunction and reduced fertility from some antiepileptic drugs (AEDs), and increased risk of conditions like polycystic ovarian syndrome (PCOS) in women with epilepsy. It provides guidance on counseling women with epilepsy regarding contraception, pregnancy planning, and risks during pregnancy and delivery.
Role of progestogens in obstetrics and gynecologyAhmad Saber
The
different progestogens with their overlapping effects on estrogen, androgen, glucocorticoid,
and mineralocorticoid receptors are described in order to allow the clinician to make the most appropriate choice of progestogen.
Repeat steroids when is it okay review 2012 ron wapnerAsha Reddy
This document discusses the history and efficacy of antenatal corticosteroids in managing preterm birth. It notes that while antenatal corticosteroids have been shown to significantly reduce neonatal mortality and morbidity rates, questions remain about their efficacy in specific patient populations and safety with repeat courses. The history demonstrates how clinical practices can be adopted before sufficient evidence is available and how arbitrary choices can become standardized. Further research is still needed to determine optimal dosing schedules and administration in special cases.
Dr. Vandana Bansal is a senior gynaecologist and obstetrician who specializes in infertility and IVF. She directs the Arpit Test Tube Baby Centre in Prayagraj, India. The document discusses intrauterine insemination (IUI), providing rationales for its use, details on techniques and protocols, success rates based on factors like age and ovarian stimulation methods, and alternatives when IUI is unsuccessful. It summarizes evidence from clinical studies on optimizing IUI outcomes.
Medical complications in pregnancy cmt april 2010NESSlideShare
This document discusses three cases related to medical complications in pregnancy. Case 1 describes a woman who died of an undiagnosed pulmonary embolism during pregnancy. Case 2 involves a woman admitted with renal problems during pregnancy. The document then discusses prescribing medications during pregnancy, including the risks of certain anti-epileptic drugs. Case 3 presents a woman with epilepsy who is now pregnant.
(마더리스크라운드) Thyroid disease in pregnancy 임신 중 갑상선mothersafe
This study examined pregnancy outcomes for women exposed to antithyroid medications or levothyroxine for thyroid disorders. The study found that infants of mothers treated for hyperthyroidism with antithyroid medications were more likely to be born preterm or with low birth weight. However, treatment of hypothyroidism with levothyroxine did not negatively impact birth outcomes and showed no increased risk of infant mortality. Additionally, the study found no evidence that levothyroxine exposure increased the risk of major congenital anomalies.
Diclectin in NVP, 44th 유럽기형학회보고 / 한정열 교수mothersafe
This document summarizes a presentation on making a difference as concerned scientists in an environmentally contaminated world. It discusses how scientists have identified problems like chemical pollution and investigated effects on human health. It provides examples like Rachel Carson's Silent Spring which brought attention to pesticide impacts and led to regulations. Endocrine disrupting chemicals can alter fetal development with impacts like reduced intelligence only appearing later. The document then summarizes several talks on topics like the impacts of maternal health conditions like diabetes and epilepsy during pregnancy, using the human placenta to test chemical safety, prenatal metal exposure and DNA methylation in the placenta, free fetal hemoglobin as a potential cause and target for preeclampsia, and revising guidelines
Maternal smoking during pregnancy was associated with an increased risk of major malformations in newborns. A study of over 2000 pregnancies found the risk of major malformations was 3.3 times higher for babies exposed to maternal smoking compared to non-exposed babies. Paternal smoking was also high among the smoking mothers, occurring in over 60% of smoking mothers compared to 38% of non-smoking mothers. Exposure to alcohol and lower education levels were also associated with increased risk of maternal smoking during pregnancy.
This document summarizes guidelines and studies on screening and management of subclinical hypothyroidism during pregnancy. Key points include:
- Guidelines from thyroid societies recommend trimester-specific reference ranges for TSH and treatment of SCH with levothyroxine.
- Studies show mixed results on associations between SCH and adverse pregnancy/child outcomes, and limited benefits of levothyroxine treatment.
- Targeted high-risk screening misses a significant percentage of women with thyroid dysfunction compared to universal screening.
- While evidence is still limited, most experts recommend universal screening to detect and treat overt hypothyroidism given potential benefits.
This document provides information about external cephalic version (ECV):
1. ECV is a procedure performed near term to manually turn a breech baby into a head-down position. The success rate of ECV is reported between 35-86%.
2. ECV has been performed since ancient times but was improved in the 1970s by performing it under tocolysis after screening with ultrasound and fetal monitoring. Recent studies show ECV effectively reduces non-cephalic births and C-sections for malpresentation.
3. Guidelines from obstetric organizations recommend offering ECV to women with a breech fetus near term due to evidence it can reduce C-sections. Factors like adequate amni
1. Proper management of diabetes before and during pregnancy is important to reduce risks of complications. Tight glucose control through medical nutrition therapy, exercise, and insulin treatment can decrease risks of fetal anomalies and growth issues.
2. Gestational diabetes is diagnosed through an oral glucose tolerance test and treated with lifestyle changes and possibly insulin to control blood glucose. Women with a history of GDM require follow up after pregnancy to screen for diabetes.
3. Preconception counseling and care is crucial for women with pre-existing diabetes to optimize health before pregnancy in order to lower risks during pregnancy through strict glucose monitoring and management.
This document discusses alcohol intake during pregnancy and fetal alcohol spectrum disorders (FASD). It provides statistics on alcohol use during pregnancy from various studies. It notes that a safe level of alcohol during pregnancy has not been determined, as the effects of alcohol on the fetus are variable depending on factors like the mother's metabolism and drinking patterns. Low to moderate prenatal alcohol exposure has not shown effects in some studies, but other research has found children with FAS even with reported low alcohol intake. The document describes clinical features of FASD including facial abnormalities, growth issues, central nervous system anomalies, and functional impairments. It discusses diagnostic criteria from various organizations and guidelines for diagnosing FASD.
(마더리스크라운드) Radiation in Pregnancy 조연경 교수mothersafe
This document discusses the risks of ionizing radiation exposure during pregnancy. It notes that ionizing radiation is a known teratogen that can cause developmental effects in the fetus including growth restriction, malformations, and increased cancer risk later in life. The critical periods of susceptibility are during organogenesis from 8-15 weeks and in late pregnancy. While low doses below 100 mGy are not considered grounds for termination, above 1000 mGy significantly increases risks. The document provides examples of radiation doses from various medical imaging procedures and natural sources. It recommends shielding and limiting exposure to protect the pregnant woman and fetus.
This document discusses hyperthermia in pregnancy and its potential risks. It defines hyperthermia as an elevated body temperature above normal levels due to failed thermoregulation. Animal studies show that hyperthermia during pregnancy, especially temperatures over 39.5°C, increases the risk of neural tube defects, miscarriage, and other abnormalities in offspring. Human studies also associate maternal fever, particularly during the first trimester, with an increased risk of neural tube defects, spontaneous abortion, and some heart and brain abnormalities. However, some studies found no clear link. Sauna use during pregnancy appears to carry less risk than other heat sources if core temperature remains below 38.9°C.
Vitamin D supplementation during pregnancy: Is it really necessary?
1) There is ongoing debate around the optimal vitamin D levels during pregnancy and definitions of vitamin D deficiency. 2) Studies have shown associations between vitamin D deficiency and adverse pregnancy outcomes like gestational diabetes and preeclampsia. 3) The placenta plays a role in vitamin D metabolism and higher placental activity of the CYP24A1 enzyme is associated with vitamin D deficiency in pregnancies with gestational diabetes. 4) While routine vitamin D screening in all pregnancies is not currently recommended, high-risk women may benefit from screening and supplementation to treat deficiency.
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
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TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Versio
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
TEST BANK For An Introduction to Brain and Behavior, 7th Edition by Bryan Kolb, Ian Q. Whishaw, Verified Chapters 1 - 16, Complete Newest Version
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
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The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
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share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
6. 한정렬 등 대한산부회지 2002
Perceived teratogenic risk after
inadvertently drug exposure
7. 인공임신중절 이유 N=3,384(명) %
건강문제 부모의 건강문제 98 2.9
태아의 건강문제 126 3.7
임신 중 약물복용 427 12.6
가족계획 더 이상 자녀를 원치 않아서 2,368 70.0
터울 조절을 위해서 208 6.2
원하는 태아의 성별이 아니어서 42 1.2
사회경제적 이유 경제적 어려움 591 17.5
미성년자 혹은 혼인상의 문제 68 2.0
기타 141 4.2
(김해중 등. 인공임신중절 실태조사 및 종합대책수립: 보건복지부 2004년)
인공임신중절의 이유
21. Historical case I.
1960’s Anxiolytic and sedative drug
Malformations : 20 percent
Specific time window :
34 to 50 days menstrual age
Upper limb more seriously affected.
Phocomelia formed limb
THALIDOMIDE
27. 1940-1971, 10milion pregnant women to “support” high risk pregnancies.
But no beneficial effects.
Herbst(1971) : 8 cases of vaginal clear cell adenocarcinoma
Incomplete carcinogen:
absolute cancer risk 1 per1000, not related by dose
no relationship between location of tumor & timing
of exposure.
Structural and functional abnormality:
ectropion, adenosis – malignant potential (2 fold increase)
Diethylstilbestrol (DES)
Historical case III.
32. Period of developmental susceptibility
& Deviant development
Germ cell
Development
Organogenesis Fetal period Neonatal period Adolescence
Fertilization Birth Sexual Maturity
Prenatal/Neonatal death
Structural abnormalities
Functional deficits
Altered growth
Carcinogenesis
33. Most teratogens have a confined group
of congenital malformations
• MTX: growth retardation, microsephaly, meningomyelocele,
mental retardation, hydrocephalus
• Coumarine derivatives: nasal hypoplasia, stippling of secondary
epiphysis, IUGR
• Alcohol: Fetal alcohol syndrome
• DES : Clear cell adenocarcinoma, adenosis, genital abnomalities
34. FDA classification
A Controlled Studies show no risk
B No evidence of risk in humans
C Risk cannot be ruled out
D Positive evidence of risk
X Contraindicated in pregnancy
From 1979
35. Nava-Ocampo AA et al 2007
Graphical representation of risk of
drugs in pregnancy
TERIS
41. Reprotox® Quick take: Misoprostol use during early pregnancy has been
associated with abortion and with congenital malformations in surviving infants.
A meta-analysis concluded that misoprostol use in early pregnancy
increases the risk of Moebius sequence and transverse terminal limb
defects.
45. While there is no doubt that misoprostol is a cause of Mebius sequence, the
absolute risk is very minimal, and in our prospective series-not a single case
was found. There is however one case described in the literature.
I believe the advice should mention a very small risk. Some of the features may
be detected by detailed ultrasound.
All the best
gidi
Gideon Koren MD, FRCPC, FACMT
Director, The Motherisk Program
The Hospital for Sick Children,
Professor of Pediatrics,Pharmacology, Pharmacy and Medical Genetics
The University of Toronto,
47. Q : 마취유도제 Pentothal(thiopental sodium),
Propofol 현재 유럽에서 마취유도제로 쓰이지만 미
국에선 FDA 승인이 나지 않은 약물입니다. 따라서,
FDA 미승인 이므로 쓰지 말아야 한다는 의견과 마취
유도제로 별문제 없다는 의견이 있습니다.
또한, 태아에게 안전성이 입증되어 있는지요? 이 부
분에 대해 약물독성학적 입장에서의 의견을 주시면
좋겠습니다.
48. Pentothal(thiopental sodium)
Ultrashort-acting, barbiturate sedative
Used in the induction phase of anesthesia
Pharmacokinetics :
T1/2 : 3-8hours
MW : 264 g/mol
Protein binding 60-96%
Bioavailability : variable
49. Quick take: Based on experimental animal studies and
human experience, thiopental is not anticipated to
increase the risk of congenital anomalies.
Pregnancy Risk Category : C
50. Thiopental did not increase congenital anomalies in
teratology studies in rats and mice
Persaud TVN 1965, Tanimura T et al 1967
The Collaborative Perinatal Project : the frequency of
congenital anomalies was not increased in children of
152 women treated with thiopental during the first 4
lunar months of pregnancy Friedman JM 1988
51. Propofol
frequently used drug to induce anesthesia
sedation for diagnostic & therapeutic procedures
Pharmacokinetics :
T1/2 : 30-60min
MW : 264 g/mol
Vd 60 l/kg
Protein binding 99%
Bioavailability : variable
52. Quick take: Based on experimental animal studies, induction of
anesthesia with propofol during pregnancy is not expected to
increase the risk of congenital malformations.
Pregnancy Risk Category : B
53. Q : Succinylcholine, Rocuronium,
Vecuronium
산과 영역에서 많이 쓰이는 근이완제 임
태아에 미치는 독성은 어떤가요?
54. Succinylcholine
Short-term muscle relaxation in anesthesia
for facilitation of endotracheal intubation
Pharmacokinetics :
T1/2 : unknown
MW : 290 g/mol
Bioavailability : NA
Protein binding : unknown
Excretion : Renal
55. Quick take: Succinylcholine has not been associated with
adverse effects on the fetus.
Pregnancy Risk Category : C
56. No malformations were observed among 26 children
born to women treated with succinylcholine during
the first four lunar months of pregnancy in the
Collaborative Perinatal Project
(Heinonen et al., 1977)
.
No animal teratology studies of succinylcholine
have been published
57. Rocuronium
an muscle relaxant used in modern
anesthesia, to facilitate endotracheal
intubation
Pharmacokinetics :
T1/2 : 66-80min
MW : 557 g/mol
Protein binding : ~30%
Bioavailability : NA
Excretion : bile & urine
58. Quick take: A rat study did not suggest an increase in
congenital anomaly risk with rocuronium. Published
human experience in pregnancy has been restricted to use
for cesarean section.
Pregnancy Risk Category : C
59. a muscle relaxant to facilitate endotracheal intubation
& to provide skeletal muscle relaxation during surgery
Vecuronium
Pharmacokinetics :
T1/2 : 51-80min
MW : 557 g/mol
Bioavailability : 100%(IV)
Protein binding : ? %
Excretion : fecal and renal
60. Quick take: Vecuronium has been used during late human
pregnancy without apparent adverse effects on the
fetus. There are no data on early human pregnancy effects
of this agent.
Pregnancy Risk Category : C
61. No animal teratology studies of vecuronium have been
published.
Vecuronium has been administered directly to the
fetus(17 cases) at 22~35 weeks to facilitate intrauterine
transfusion. No adverse fetal effect of such treatment
was observed. (Leveque et al., 1992)
Use of vecuronium during maternal anesthesia for
cesarean section has not been associated with any
clinically important adverse effect on the newborn infant.
(Hawkins et al., 1990, Iwama et al., 1999)
63. Sugammadex
an agent for reversal of neuromuscular blockade by
rocuronium in general anesthesia
Pharmacokinetics :
T1/2 : 2.2 hours
MW : 2,178 g/mol
Lipophilic core & hydrophilic periphery
Bioavailability : ? %
Protein binding : low %
Excretion : renal
64. Pregnancy risk category : ?
Placental transfer :
< 2-6% in rat and rabbit
No relevant reproductive toxicity
or teratogenicity
Sugammadex
http://www.fda.gov/ohrms/dockets/ac/08/slides/2008-4346s1-01-Schering-Plough-corebackup.pdf
65. Q : 혈압강하제 esmolol, labetalol, nicardipine,
그리고 ACE inhibitor는 태아에 어떤 영향을
줄 수 있나요?
66. Esmolol
a cardioselective beta receptor blocker
Ultra short-acting beta blocker with low lipid solubility
Pharmacokinetics :
T1/2 : 9 min
MW : 295 g/mol
Bioavailability : poor
Protein binding : 60 %
Excretion : renal
67. Quick take: Esmolol is a beta-blocker and may produce
signs of beta blockade in the fetus after treatment of the
mother. Ex) bradycardia
Pregnancy Risk Category : C
69. Quick take: Based on experimental animal studies and
human reports, labetalol therapy does not appear to
increase the risk of congenital anomalies
Pregnancy Risk Category : C
71. Quick take: Nicardipine and other calcium channel blockers may
interfere with embryo development in experimental animal species.
Human pregnancy outcome data after exposure are not adequate
to assess possible risk. Later pregnancy use for tocolysis or
hypertension has sometimes been associated with pulmonary
edema.
Pregnancy Risk Category : C
73. Quick take: Captopril is not used during the second
and third trimester of pregnancy because of
associated fetal oliguria, skull defects, and death.
Pregnancy Risk Category : C in the 1st trimester
D in the 2nd & 3rd trimester
74. Valsartan
a new angiotensin II receptor antagonist
Pharmacokinetics :
T1/2 : 9 hours
MW : 435 g/mol
Bioavailability : 23%
Protein binding : 97%
Excretion : renal and biliary
75. Quick take: Valsartan is believed to have potential for adverse
pregnancy effects consistent with ACE inhibitor embryopathy,
featuring oligohydramnios, abnormal development, and fetal
death.
Pregnancy Risk Category : C in the 1st trimester
D in the 2nd & 3rd trimester
77. Diazepam
a benzodiazepine drug
Pharmacokinetics :
T1/2 : 43 hours
MW : 285 g/mol
Bioavailability : 100%
Protein binding : 99 %
Excretion : renal
78. Quick take: Diazepam increases the incidence of cleft palate in mice. Most
human studies do not show an increase in cleft palate or other
defects in babies exposed during pregnancy. A neonatal
withdrawal syndrome has been described. It may be preferable to use
benzodiazepines that are less likely to accumulate in the fetus and infant
such as lorazepam .
Pregnancy Risk Category : D
80. Quick take: Human experience with alprazolam does not suggest
an increase in congenital anomaly risk. Experimental animal
studies did not show an increase in birth defects except with very high
dose exposure. Withdrawal symptoms may occur after pregnancy or
lactation exposure to benzodiazepines.
Pregnancy Risk Category : D
81. Q : 진통관리에 쓰이는 Ketorolac은 태아 및
모유수유아에 어떤 영향을 줄 수 있나요?
82. Ketorolac
a NSAID for short-term management
of moderate to severe pain
Pharmacokinetics :
T1/2 : 3.5-9.2 hours
MW : 255 g/mol
Bioavailability : 100%
Protein binding : 99 %
Excretion : renal and biliary
83. Quick take: Based on experimental animal studies, ketorolac is
not expected to increase the risk of congenital anomalies.
Nonsteroidal anti-inflammatory drugs are avoided in later
pregnancy due to concerns about constriction of the ductus
arteriosus.
Pregnancy Risk Category : C in the 1st trimester
D in the 2nd & 3rd trimester
Lactation Risk Category : L2 (safer)
84. Q : 임신부에서 비산과적인 복강경수술시 사용하는
CO2 insufflation시 태아에 문제되지 않나요?
86. When given at 6% to pregnant rats, carbon dioxide
induced cardiac malformations in the offspring
(Haring, 1960)
Exposure to 10-13% CO2 was associated with vertebral
defects in rabbits (HSDB , 1997)
Maternal and fetal effects of laparoscopic insufflation in
the gravid baboon : mothers and fetuses had no adverse
effects at an IAP of 10 mm Hg, but may have significant
cardiovascular and respiratory alterations associated with
IAP of 20 mm Hg. (Reedy MB, 1995)
IN ANIMAL
87. Laparoscopic surgery in pregnancy: long-term follow-up
11 laparoscopic cases in pregnancy 16th to 28th week
follow-up of 1 to 8 years
No fetal distress or demise occurred, nor were any tocolytics
used. The resultant children were then monitored, and no
evidence of developmental or physical abnormalities was
detected during the study period.
(Rizzo AG, 2003)
IN HUMAN
88. 정 리
임신부에서 마취 약물 :
대부분의 마취 관련 약물은 기형을 유발하지 않음
기형유발 우려 약물에 노출 시 적절한 상담 필요
[☎ 1588-7309 (한국마더세이프전문상담센터)]