Book of Medical Disorders in Pregnancy - Tintash

liver. The abscess may rupture into the
peritoneal, pleural, or pericardia I cavity,
with serious consequences.
Effect on pregnancy:
During pregnancy the infection is
generally increased. Corticosteroids and
progesterone have been reported to
aggravate the severity of amebic
infection.
Management
Diagnosis:
This can be confirmed by finding cysts
or trophozoites of E. histolytica in stool
or in the exudate from the abscess.
Trophozoites may be detected from the
biopsy of the rectal mucosa or vagina.
It is important to isolate E. histolytica
before subjecting the pregnant patient to
a therapeutic agent which may have
teratogenic effect.
There is no justification of delaying
treatment after first trimester has been
completed. In acute and severe form of
the disease the treatment should be
instituted without waiting for completion
of first trimester.
Unnecessary delay may place the life of
the mother in jeopardy. Treatment
during pregnancy will help to prevent a
possible infection of the newborn from
the mother during the neonatal period.
Amebic liver abscess:
This requires combined medical and
surgical treatment. Large abscesses can
be drained by needle aspiration after
chemotherapy has been started.
158
Local amebic lesions: genital lesions
respond to local applications of Vioform
cream.
Drugs: The specific therapeutic drug
and its dosage recommended is as
follows; Patients who have mild
symptoms can be treated by Diodoquin
(Di-lodo-hydroxyquinoline). This drug
does not have significant toxicity and
cure rate is 75 per cent with one course.
Second course can be given if results are
poor. So far there is no reported teratogenic
effect on fetus.
For moderate to severe cases emetine
oride is given subcutaneously in a dose·
of 1 mg/Kgm body weight daily for
three to five days or until clinical
improvement. It is contra indicated in
pregnancy.
Fig12.5: -Shows tablets of
metronidazole.
Metronidazole - This is the drug of
choice for the treatment of intestinal
amebiasis. For invasive intestinal disease
where the subject is susceptible 5 tablets
(2000 mgs) once daily for three days
will suffice. Where the subject is less
susceptible 2 tablets Le. (400 mgs) thrice
daily for five to ten days is usually
required. The later regimen is more
tolerable and acceptable because of less
severe side effects. The dosage of metronidazole
in hepatic disease including
amebic liver abscess and hepatitis and
other forms of extra intestinal amebiasis