Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
Thromboprophylaxis in pregnancy and puerperiumManju Puri
This presentation is about thromboprophylaxis in pregnancy and puerperium and describes the risk assessment , indications, drugs to be used, when to start, for how long to continue.
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Lecture by Dr Sujoy Dasgupta in BOGSCON 2015, the Annual Conference of Bengal Obstetric and Gynaecological Society, held at Hotel Novotel, Kolkata in January, 2015; where he had been invited as FACULTY to deliver his lecture
Thromboprophylaxis in pregnancy and puerperiumManju Puri
This presentation is about thromboprophylaxis in pregnancy and puerperium and describes the risk assessment , indications, drugs to be used, when to start, for how long to continue.
THIS WAS PRESENTED AT SAFOG MOGS "SMART CONFERENCE "IN MUMBAI
PREPARED WITH HELP OF DR SUCHITRA PANDIT,DR CN PURANDARE AND DR ALPESH GANDHI.....VIDEOS CAN BE SEEN AT U TUBE
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
The role of uterine artery embolization in gynecology practiceApollo Hospitals
Uterine artery embolization (UAE) is a minimally invasive interventional radiological procedure to occlude the arterial
supply to the uterus. UAE has been very useful for controlling hemorrhage following delivery/abortion, in ectopic or cervical pregnancy, gestational trophoblastic disease or carcinoma cervix. Currently it is being mostly used for treating uterine fibroids. It requires a shorter Hospital stay with early resumption to normal activity. This review briefly summarizes the role of this relatively new technique in gynecologic practice.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
The role of uterine artery embolization in gynecology practiceApollo Hospitals
Uterine artery embolization (UAE) is a minimally invasive interventional radiological procedure to occlude the arterial
supply to the uterus. UAE has been very useful for controlling hemorrhage following delivery/abortion, in ectopic or cervical pregnancy, gestational trophoblastic disease or carcinoma cervix. Currently it is being mostly used for treating uterine fibroids. It requires a shorter Hospital stay with early resumption to normal activity. This review briefly summarizes the role of this relatively new technique in gynecologic practice.
Deep Vein Thrombosis is an important and frequently missed out diagnosis that can often lead to sudden death in post operative patients. Did this powerpoint for an O&G seminar. Mainly focusses on DVT in OBG and its management and prevention. Kindly leave a comment and let me know what you think.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
6. Pregnancy is a risk factor for VTE & is associated
with a10-fold increase
Some women are at even higher risk [they have
one or more additional risk factors].
All women should undergo an assessment of risk
factors in early pregnancy or before pregnancy {why?}
Assessment should be repeated if the woman is
admitted to hospital or develops other intercurrent
problems.
C
ABOUBAKR ELNASHAR
7. Pre-existing
1. Previous VTE
2. Thrombophylia
3. Age above 35
4. Obesity (BMI >30 kg/m2)
5. Parity > 4
6. Gross VV
7. Paraplegia
8. Sickle cell disease
9. Inflammatory bowel disease
10.Nephrotic syndrome
New onset or transient
1. Surgery
2. Hyperemisis
3. Dehydration
4. OHSS
5. Severe infection e.g Pyelonephritis
6. Immobility (>4 d bed rest)
7. PET
8. Excessive Blood loss
9. Long-haul travel
10.Prolonged labor
11.Midcavity instrumental delivery
12.Immobility after delivery
Risk factors for VTE in pregnancy & puerperium
ABOUBAKR ELNASHAR
8. Women with a previous VTE
should have:
1. Careful history
2. Screening for thrombophilia {?}
ideally before pregnancy.
B
ABOUBAKR ELNASHAR
9. Regardless of their risk of VTE,
immobilization should be minimized and
dehydration should be avoided.
Good Practice Point (GPP)
ABOUBAKR ELNASHAR
10. 1. Women with a previous VTE
and no thrombophilia
Antenatal prophylaxis with LMWH
1. Recurrent VTE or
2. Family history of VTE in a first-degree
relative
3. Unusual site (axillary)
• Postnatal prophylaxis with LMWH for 6 w
for all.
C
ABOUBAKR ELNASHAR
11. Antenatal prophylaxis with LMWH and
postnatal for at least 6 w B
2. Women with a previous VTE
who have inherited thrombophilia
ABOUBAKR ELNASHAR
12. {risk of VTE is lower in women with no history of VTE}
Antenatal thromboprophylaxis:
depend on:
type of thrombophilia
presence of other risk factors.
Indicated in:
1. combined defects,
2. homozygous defects
3. antithrombin deficiency.
• Post natal prophylaxis for 6 w in all
3. Women with no history of VTE but
with thrombophylia
C
ABOUBAKR ELNASHAR
13. 4. Women with Antiphospholipid
syndrome {?}
Antenatal LMWH
Low-dose aspirin {improve pregnancy
outcome} for all women.
History of thromboses
Postnatal prophylaxis for 6 w with LMWH.
No history of thrombosis:
Postnatal for 3-5 d
ABOUBAKR ELNASHAR
14. • For diagnosis: 2
1 of 2 clinical criteria (thrombosis or
pregnancy morbidity) &
1 of 2 laboratory criteria (medium to high
titer of aCL or positive LA)
• For treatment: 2
low dose aspirin & heparin starting with
positive pregnancy test till 34 w.
ABOUBAKR ELNASHAR
15. 2 risk factors
Postnatal LMWH for 3-5 d after vaginal delivery.
3 risk factors
Antenatal prophylaxis & postnatal for 3-5 d
An extremely obese woman admitted to the
antenatal ward.
Antenatal prophylaxis with LMWH
Age >35 yrs or BMI >30K/m2 or wt >90 kg with
any other risk factor
Postnatal prophylaxis for 3-5 d
5. Women without previous VTE
or thrombophilia
GPP
ABOUBAKR ELNASHAR
16. 6. Air travelling
Risk factor Short haul flight <4
hours
Long haul flight
>4hours
No added risk Move around cabin
Avoid dehydration
Minimise coffee
The same+
Well fitted below knee elastic
stockings.
Added risk
factors
The same +
Well fitted below knee elastic
stockings.
LMWH pre-flight & the day
after . Or
75 mg Aspirin 3 days before & on
day of travel.
ABOUBAKR ELNASHAR
17. 7. OHSS
Thromboprophylaxis for at least the period
of inpatient stay.
Women with multiple risk factors for VTE and at risk of
OHSS undergoing ovulation induction may also be
considered for thromboprophylaxis.
ABOUBAKR ELNASHAR
19. Antepartum
Antenatal thromboprophylaxis should begin as early
in pregnancy as practical. {VTE during pregnancy has an equal
distribution throughout gestation}
it should continue until delivery unless a specific
risk factor is removed or disappears.
B
ABOUBAKR ELNASHAR
20. Postpartum
Postpartum thromboprophylaxis should be given as
soon as possible after delivery, provided that there is
no postpartum
hge.
Those with postpartum hge should be fitted with
thromboembolic deterrent stockings.
For 6 w in high-risk women.
For 3-5 d in low risk.
B
ABOUBAKR ELNASHAR
21. If the woman has been given regional
analgesia: LMWH should be withheld until 4 hrs
after insertion or removal of the epidural
catheter
(6 hrs if either insertion or removal were
traumatic).
The first postpartum dose can be given after
insertion but before removal of the epidural
catheter.
ABOUBAKR ELNASHAR
22. COC
should not be prescribed during the first 3 months
postpartum for women with other risk factors for
VTE.
ABOUBAKR ELNASHAR
24. LMWH
Antenatal:
Agents of choice {as effective as & safer than
UFH in pregnancy: thrombocytopenia,
osteoporosis & fractures are less}
Postpartum:
Agent of choice for
women who had LMWH antenatally or
those requiring only 3-5 d.
Breast feeding:
Enoxaparin has no adverse effects
B
ABOUBAKR ELNASHAR
25. Monitoring
1. Peak anti-Xa activity is not recommended
except in women
at extremes of B wt (<50 kg or >90 kg) or
with other complicating factors (e.g. renal
impairment or recurrent VTE) putting them at
high risk.
2. Platelet count should not be carried out (unless
UFH has been given).
ABOUBAKR ELNASHAR
26. Low-dose aspirin
Safe in pregnancy, although its use for
thromboprophylaxis has never been assessed
by RCT.
May be appropriate where the risk of VTE is
increased but is not high enough to warrant the
use of LMWH
e.g. previous VTE without thrombophilia.
ABOUBAKR ELNASHAR
27. Warfarin
Should be avoided if possible during
pregnancy, especially between6 & 12 w of
gestation
{Teratogenesis (5%)
Miscarriage,
Fetal and maternal haemorrhage,
Neurological problems in the baby
Stillbirth}.
B
ABOUBAKR ELNASHAR
28. Safe: after delivery & breastfeeding
Requires :
1. Close monitoring,
2. Frequent visits to an anticoagulant clinic
Increased risk of:
1. Postpartum hge
2. Perineal haematoma.
Not appropriate for 3-5 d of postpartum
prophylaxis.
Should be initiated on 2nd or 3rd postnatal day.
B
ABOUBAKR ELNASHAR
29. Dextran
Should not be used
{risk of anaphylaxis, which has killed
fetuses by causing :
1. Massive histamine release &
2. Uterine hypertonus}.
ABOUBAKR ELNASHAR
30. Graduated elastic compression stockings
Class-II below knee:
Previous VTE or thrombophilia:
throughout pregnancy & for 6–12 w after delivery.
Class-I:
Hospital inpatients at increased risk of VTE
Pregnant women traveling by air.
ABOUBAKR ELNASHAR
32. Anticoagulant therapy during labour and delivery
Once she is established in labour or thinks that she is
in labour: no further heparin.
Planned delivery: LMWH should be discontinued 24
hrs before.
Regional anaesthetic or analgesic techniques: should
not be undertaken until at least 24 hrs after the last
dose of therapeutic LMWH.
A thromboprophylactic dose of LMWH: 3 hrs after CS
(>4 hrs after removal of the epidural catheter).
The epidural catheter: should not be removed within
12 hrs of the most recent injection.
GPPABOUBAKR ELNASHAR
33. Women at high risk of hge with risk factors including:
1. Major antepartum hge,
2. Coagulopathy,
3. Progressive wound haematoma,
4. Suspected intraabdominal bleeding
5. Postpartum hge
managed UFH
{shorter half-life than LMWH,
more experience in the use of protamine sulphate to
reverse its activity}.
Excess blood loss & blood transfusion are risk
factors for VTE, so thromboprophylaxis should be
commenced or reinstituted as soon as the immediate
risk of hge is reduced.
ABOUBAKR ELNASHAR
34. LMWHUFH
1000-100003000-30000Mol Wt range
4000-500012000-15000Mo Wt average
2:1-4:11:1AntiXa: antiIIa activity
NoYesaPTT monitoring required
NoYesInactivation by platelet factor 4
YesNoCapable of inactivation of platelet
bound factor Xa
++++++Inhibition of platelet function
NoYesIncrease vascular permeability
+++++Protein binding
-+++Endothelial cell binding
NoYesDose dependent clearance
2-5 times longer50-20 minElimination half life ABOUBAKR ELNASHAR
37. All women should undergo an assessment of risk
factors for VTE in early pregnancy or before
pregnancy. This assessment should be repeated if the
woman is admitted to hospital or develops other
intercurrent problems.
Women with previous VTE should be screened for
inherited and acquired thrombophilia, ideally before
pregnancy.
Regardless of their risk of VTE, immobilization of
women during pregnancy, labour and the puerperium
should be minimized and dehydration should be
avoided.
C
B
GP
PABOUBAKR ELNASHAR
38. Women with previous VTE should be offered
postpartum thromboprophylaxis with LMWH. It may be
reasonable not to use antenatal thromboprophylaxis with
heparin in women with a single previous VTE
associated with a temporary risk factor that has now
resolved
Women with previous recurrent VTE or a previous VTE
and a family history of VTE in a first-degree relative
should be offered thromboprophylaxis with LMWH
antenatally, and for at least 6 w postpartum.
C
ABOUBAKR ELNASHAR
39. C
Women with previous VTE and thrombophilia should be offered
thromboprophylaxis with LMWH antenatally and for at least 6 w
postpartum.
Women with asymptomatic inherited or acquired thrombophilia
may qualify for antenatal or postnatal thromboprophylaxis,
depending on the specific thrombophilia and the presence of other
risk factors.
Women with three or more persisting risk factors should be
considered for thromboprophylaxis with LMWH antenatally and for
3-5 d postpartum.
B
C
ABOUBAKR ELNASHAR
40. Women should be reassessed before or during labour
for risk for VTE. Age over 35 yrs and BMI >30/body
weight greater than 90 kg are important independent
risk factors for postpartum VTE even after vaginal
delivery. The combination of either of risk factors
(Age over 35 years and BMI greater than30/body
weight greater than 90 kg) with any other risk factor for
VTE (PETor immobility) or the presence of 2 other
persisting risk factorsLMWH for 3-5 d postpartum.
Antenatal thromboprophylaxis should begin as early in
pregnancy as practical. Postpartum prophylaxis
should begin as soon as possible after delivery.
B
GPP
ABOUBAKR ELNASHAR
41. LMWHs are agents of choice for antenatal
thromboprophylaxis. They are as effective as and safer
than UFH in pregnancy.
Warfarin should usually be avoided during pregnancy. It is
safe after delivery and during breastfeeding.
Once the woman is in labour or thinks she is in labour,
she should be advised not to inject any further heparin.
She should be reassessed on admission to hospital and
further doses should be prescribed by medical staff.
GPP
B
B
ABOUBAKR ELNASHAR