Book of Medical Disorders in Pregnancy - Tintash

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When the embolus is small and non fatal, oxygen and a potent analgesic for relief of pain should be given. When' pyrexia develops, as it often does, then indiscriminate use of antibiotics is not indicated: as the pyrexia will settle on its own accord, when the extravasated blood is absorbed. If a pleural effusion has developed, it will resolve spontaneously in the course of a few weeks. Once the acute phase is under control, and pain permits active physiotherapy, ambulation should be started. These measures should be started without further delay and continued till the patient is completely recovered. Deep venous thrombosis: Some prefer to change heparin with one of the oral anticoagulants after 24 to 48 hours especially if treatment is to be continued for several weeks. Embolectomy: When the patient shows no response to resuscitative measures death occurs within 2 hours in two third of the fatal cases, and leaves no time for any form of surgery to be performed. The results of surgery even in the specialized centre are not good. Even successful embolectomy is accompanied with a recurrence of embolism in great majority of cases. The merit of this operation therefore must be weighed against its benefits and success rate. However where facilities and expertise for such measures are present/patient should be given the benefit of this heroic therapy. Inferior Vena Cava may be tied just beyond its origin. This is performed by an extraperitoneal approach to the vessels through a right paramedian muscle- 145 splitting incision. Some prefer partial occlusion of the inferior vena cava and ovarian veins with serrated teflon clips in order to lessen the risk of severe o edema. Anti-coagulant therapy is necessary even when ligation is performed. Indications for surgery are, repeated emboli occurring in a woman for whom anti-coagulant therapy is contra indicated i.e. infective hepatitis, peptic ulcer or hamate. Mesi in the past. Thrombolytic therapy: This form of treatment is as yet in the experimental stage. Powerful fibrinolytic enzyme can cause dissolution of recently formed thrombo plasmin or activators of plasminogen. Streptokinase and urokinase may be used for this purpose. Specially trained physician should only undertake the type of therapy. Amniotic fluid embolism: It is very difficult to assess the exact incidence of this complication, since the diagnosis of this complication is often made by postmortem examination of the lungs or right ventricular blood. It is also possible that some patients recover from minor episodes, and are never diagnosed. Commonly used drugs for thromboembolic disease: and their mechanism of action: antiplatelet drugs: Example: Aspirin, Prevents platelet aggregation /adhesion, Clinical use prevents arterial thrombus: Myocardial infraction (MI), stroke, heart valve replacement and shunts and other antiplatelet drugs are dipyridamole, sulfinpyrazone and Ticlopidine.
Mechanism of action: Aspirin inhibits cyclooxygenase (COX) COX is a key enzyme involved in the synthesis of thromboxanes 2 (prostaglandins) and inhibits platelet aggregation. Prophylactic use of aspirin: Low dose daily. Prevents ischemic attack (minestrones) and MI 335 mg/day reduced the risk of heart attack in patients over 50. More than 1000 mg/ day NO EFFECT: Contraindication - DO NOT give to patients with glucose 6-PO4 dehydrogenase deficiency. Fibrinolysis: Enhance degradation of clots, Activation of endogenous protease, Plasminogen (inactive form) is converted to Plasmin (active form), Plasmin breaks down fibrin clots. Exogenously administered drugs; Streptokinase bacterial product: Continuous use immune reaction, Urokinase human tissue derived no immune response and tissue plasminogen activator (tPA) genetically cloned: no immune reaction and EXPENSIVE. Drug preparations: To reduce clotting: Heparin (generic, Liquaemin sodium), parenteral - 1000 - 40,000 U/ml, Warfarin (generic, Coumadin), oral: 2 - 20 mg tablets and Dipyridamole (Persantine) Oral: 25, 50, 75 mg tablets. Drug preparations: to lyse clots: Alteplase recombinant (TPA, Activase) 146 20, 50 mg Lyophilized powder reconstitute for IV, streptokinase (Kabikinase, Streptase). Parenteral: 250000 - 1.5 million units per vial. Lyophilized powder. Reconstitute for IV Urokinase (Abbokinase). Parenteral: 250000 units per vial. Powder to reconstitute to 5000 u/ml for injection. Drug preparations: clotting deficiencies: Vitamin K (Phytonadione (K1), Mephyton Oral: 5 mg tablets, Plasma fractions for hemophilia Antihemophilic factor (VIII, AHF) Parenteral. Factor IX complex (konyne HT, Proplex T) parenteral: in vials. Drug Preparations: to stop bleeding: Systemic use: aminocaproic acid (Amicar); Tranexamic acid (Cyklokapron), Vitamin K. Local adsorbable drugs, Gelatin sponge (Gelfoam), Gelatin film, Oxidized cellulose (Oxycel) and Microfibrillar collagen (Avitene) Thrombin. REFERENCE: 1. Karlijn J. van Stralen, MSc; Frits R. Rosendaal, MD, PhD; Carine J. M. Doggen, PhD (January 14, 2008). "Minor Injuries as a Risk Factor for Venous Thrombosis". Arch Intern Med 168 No. 1 (1): 21–26. doi:10.1001/archinternmed.2007.5. PMID 18195191. 2. Glynn RJ, Ridker PM, Goldhaber SZ, Zee RY, Buring JE (2007). "Effects of random allocation to vitamin E supplementation on the occurrence of venous thromboembolism: report from the Women's Health Study". Circulation 116 (13): 1497–503. doi:10.1161/CIRCULATIONAHA.107. 716407. PMID 17846285.
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MEDICAL DISORDERS IN PREGNANCY M. S
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PREFACE Almost all medical disorder
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Dedication This manuscript is dedic
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Uri. Elkayam MD Professor of Cardio
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Chapter No: 1 Anaemia in pregnancy:
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performance. Tiredness, listlessnes
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pregnancy and labour. The monthly b
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Fig 1.3: Shows developmental stages
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Prophylactic this includes routine
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granulocytes and thrombocyte is als
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or because the hemoglobin A is repl
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iron. Decrease in the number of gra
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Labor/delivery: Expedite for normal
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Risk factors: The risk of GDM incre
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to a large extent on the measure of
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vomiting, or through intercurrent i
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largely related to the problems of
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femoral epiphyses can help in asses
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in a randomized design the efficacy
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of the previous day’s dose of ins
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women with vascular disease are awa
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Chapter No 3 THYROID DISEASE IN PRE
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such as phenobarbitone 30 mg given
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REFERENCES: 1. Hawe, P. and Francis
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Incidence - Its incidence varies ac
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cerning the disturbance in the Reni
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Renal function: In normal pregnant
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severe pre eclampsia and eclampsia
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Epipastic pain: It is also a late s
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arely occurs. However, if pregnancy
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differentiating between chronic hyp
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fetuses. Recent studies indicate th
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to procrastinate all available meth
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cases are said to occur up to 1 wee
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has been carried out. There can be
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intensive care room for the next 48
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Severe pre eclampsia at or remote f
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Chapter No: 5 HEART DISEASE IN PREG
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pregnancy. The increase in volume i
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Fourth Heart sound - This is rarely
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Class III - With cardiac disease pr
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differentiate from hemodynamically
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dominant). Jervell + Lange Nielson
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striking of which is stippling seen
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increase venous pressure and burden
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determine whether she will be safe
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supplemental 02. Fetal surveillance
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11. Percutaneous transluminal angio
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ureter at the pelvic brim may play
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Fig6.3: Shows location of kidney in
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A clear cut history of streptococca
Page 104 and 105: (a) Polycystic renal disease - Fort
Page 106 and 107: with patients in this category. In
Page 108 and 109: 2. Beard, R.W.and Roberts, A.P. (19
Page 110 and 111: increases slightly. Arterial blood
Page 112 and 113: scan, 0.004 Gy; pulmonary angiograp
Page 114 and 115: CD4 + cell count (200/ml) should re
Page 116 and 117: embark upon a pregnancy. Severe air
Page 118 and 119: Chapter No: 8 LIVER DISEASE IN PREG
Page 120 and 121: owel, but conjugated bilirubin is n
Page 122 and 123: Hepatic causes - Viral hepatitis bo
Page 124 and 125: Immunoprophylaxis at birth followed
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Page 128 and 129: curs in 60 to 70 percent of subsequ
Page 130 and 131: Chronic liver disease: An increased
Page 132 and 133: 22. Riely CA. Hepatic disease in pr
Page 134 and 135: ilirubin is transported across the
Page 136 and 137: when the titre is greater than 1: 3
Page 138 and 139: Induction of labour: When screening
Page 140 and 141: Blood brain barrier and bilirubin e
Page 142 and 143: place if the infant develops jaundi
Page 144 and 145: REFERENCES 1. UpToDate a. “Pathog
Page 146 and 147: of embolus formation is far less in
Page 148 and 149: Unfortunately this faculty is not a
Page 150 and 151: hours. The maximal effect takes 36
Page 152 and 153: may complain of constricting type o
Page 156 and 157: 3. Sukal S, Geronemus R. "Deep Veno
Page 158 and 159: damage specific cells in the tissue
Page 160 and 161: is capable of breaking off and deve
Page 162 and 163: Chapter No: 12 PARASITIC INFECTIONS
Page 164 and 165: sporozoite stage. The main characte
Page 166 and 167: insect repellents and insecticide s
Page 168 and 169: is 2 tablets i.e. (400 mgs) thrice
Page 170 and 171: Cardiac failure resulting from seve
Page 172 and 173: dysmenorrhea, dysuria, and even obs
Page 174 and 175: Chapter No: 13 VIRAL DISEASES IN PR
Page 176 and 177: after exposure favors but does not
Page 178 and 179: Fig13.4: shows CMV infection rash o
Page 180 and 181: three quarters of HYH strains isola
Page 182 and 183: where 'T' stands for toxoplasmosis
Page 184 and 185: Chapter No: 14 Introduction: The dr
Page 186 and 187: hexacyanoferrate (II) 2H2O (Prussia
Page 188 and 189: Restricted indications: Anti lepros
Page 190 and 191: potential Teratogen and inhibits ma
Page 192 and 193: placental abruption, and intrauteri
Page 194 and 195: Inhalation of volatile organic comp
Page 196 and 197: Chapter No: 15 Pregnancy is a norma
Page 198 and 199: time periods during the pregnancy f
Page 200 and 201: y the maternal kidney in urine or b
Page 202 and 203: continues after the end of the uter
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Amniography - In this technique rad
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at the cranial end of the neural tu
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least maceration: placenta, lung, a
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fetal hydrops with monosomy X, or T
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cause progressive renal failure as
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9. Papageorgiou, E.A.; Karagrigorio
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position of the head. The student s
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centimeter ruler is placed alongsid
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echoes in B mode. The operator appl
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also affects depth resolution and t
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From twelve week onwards the bipari
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tract. Normal kidneys can easily be
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3.19, 1.29 and 1.30, respectively [
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iodinated contrast during pregnancy
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Only tiny amounts of iodinated or g
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intraperitoneal hemorrhage, or inju
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REFERENCE: 1. Stewart A, Webb J, Gi
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cardiac defects 181, 200 cardiac di
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gestational age 26, 31, 40, 165, 19
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monitoring, invasive 83-6 monosomy
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sensitization 124-5 sepsis 22, 95-6
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