Ppt on recurrent abortion

Human Reproductive Health NURS 330

Drug-Based Methods (cont) Methotrexate –Injection; orally (rarely) Prevents cell division and multiplication Can be used to induce an abortion Effectiveness is increased if used with another drug, Misoprostol (95%) Approved by FDA for treatment of cancer, arthritis and psoriasis Most/ cancer comes back in a person who appeared to be free of the disease after treatment, it is called a recurrence. Survival Rates 5-year localized survival rate Localized cancer is cancer that, at the time of diagnosis, had not /


Topics today Normal puerperium Diseases of puerperium

partly attached and bleeding continues. This abortion must be completed by surgical methods. Missed abortion Recurrent abortion Septic abortion Is the retention of a failed intrauterine pregnancy for a extended period, usually defined as more than two menstrual cycles Recurrent abortion It is a term used when a patient has had two or more consecutive spontaneous abortions Septic abortion Treatment of abortion Incomplete abortion Missed abortion Remove the embryo and placenta as/


Lecture 8 ECTOPIC PREGNANCY. ABORTION Prof. Vlad TICA, MD, PhD.

Identification of chorionic villi in curetting may identify an intrauterine pregnancy DIFFERENTIAL DIAGNOSIS Abortion Acute salpingitis Acute appendicitis Rupture of corpus luteum Torsion of ovarian cyst TREATMENT SURGICAL/RECURRENT ABORTION The patient has had two / more consecutive spontaneous abortions SEPTIC ABORTION TREATMENT INCOMPLETE ABORTION Remove the embryo and placenta as soon as possible Negative pressure suction Embryulcia MISSED ABORTION Notice blood clot function prevent DIC SEPTIC ABORTION/


The Interpregnancy Care Program A pilot evaluation of interpregnancy primary care & social support for African-American women at risk for recurrent very-low-birth.

Program A pilot evaluation of interpregnancy primary care & social support for African-American women at risk for recurrent very-low-birth weight delivery Study Team Principal Investigator: Alfred W. Brann, Jr, MD Co-principal/ 18 months  3/7 (43%) with adverse outcome: - 1 liveborn, intermed. LBW (1500-2499g) - 2 spontaneous abortions (< 20 wks’)  3/7 (43%) liveborn, ≥ 2500 g  1/7 (14%) electively aborted  21/36 (58%) with adverse outcomes: - 7 liveborn, intermed. LBW (1500-2499g) - 3 liveborn, VLBW (


RECURRENT PREGNANCY LOSS

of luteal phase defect Bromocriptine improved SAB rates in patients with elevated prolactin levels Bussen S, S€utterlin M, Steck T. Endocrine abnormalities during the follicular phase in women with recurrent spontaneous abortion. Hum Reprod 1999;14:18–20. Hirahara F, Andoh N, Sawai K, Hirabuki T, Uemura T, Minaguchi H. Hyperprolactinemic/


Low molecular weight heparin and recurrent Implantation failure

2.8%, respectively; p < 0.05). The abortion rate was significantly higher in the placebo-treated group compared to the LMWH group (p < 0.05). Management of 273 cases of recurrent implantation failure: results of a combined evidence-based protocol./ pathology and thromboprophylaxis with daily LMWH from the day of embryo transfer for thrombophilia. Management of 273 cases of recurrent implantation failure: results of a combined evidence-based protocol. Sharif KW, Ghunaim S. Reprod Biomed Online 2010 The/


Preventing recurrent preterm birth The North Carolina 17P Project Kate Berrien, RN, BSN, MS

Preventing recurrent preterm birth The North Carolina 17P Project Kate Berrien, RN, BSN, MS kberrien@unch.unc.edu The Problem: Premature Birth  1/ 2007 & Petrini et al, Obstet Gynecol, 2005. FDA Approval  17P, marketed as Delalutin TM, was approved by the FDA in 1956 for prevention of habitual/recurrent abortion, threatened abortion, and postpartum “afterpains.” Approval was withdrawn in 2000 when Bristol Myers Squibb stopped manufacturing the product (not as a result of safety concerns).  Ther-Rx Company/


Detection of bovine lymphotropic herpesvirus DNA in tissues of a bovine aborted fetus in Québec Donald Tremblay, Ossama Allam, Richard Drolet and Carl.

Faculty of veterinary medicine of the University of Montreal started a research project to investigate the etiological agents involved in cow abortion in Québec, Canada -Molecular diagnostic (PCR) 4 principal pathogens: -BVDV -Bovine herpesvirus type 1 (IBR) -/in 2008 - Banks et al., The Veterinary Journal 2008 -small-scale investigation of UK dairy herds reporting recurrent episodic or chronic non-responsive post-partum metritis -High prevalence in affected herds (but no control unaffected herds) /


FIRST TRIMESTER BLEEDING

prevalence20-30% vs 1% vs 0.1%, ectopic is most dangerous needs most study Sab usu handles itself, mole is cookbook SPONTANEOUS ABORTION SPONTANEOUS LOSS, PRE-VIABLE <20 WKS, <500 GM 30% PREVALENCE 80% 1ST TRIMESTER-”EARLY” Prevalence varies- recog vs vs very/for 6-12mo Should drop rapidly& be negative < 90 days normal preg usu takes 2-4wk effective contraception during follow-up Persistent/recurrent HCG rise =HCG rise x2 wk, stable x 3wk,+@3mo ?new pregnancy… Worry re GTN/metastatic disease 25%chorioca, 75%/


History Induced abortion Chinese herbs Give birth to a girl by cesarean Tired and inertia Go to see psychological doctors.

History Induced abortion Chinese herbs Give birth to a girl by cesarean Tired and inertia Go to see psychological doctors symptoms On the sixth day of menstruation / widespread and the surgeon requires more room to work in the abdominal cavity. Hysterectomy is not a guarantee for removing endometriosis! Recurrence of endometriosis after surgery There is a 6 times higher risk of recurrence after hysterectomy if the ovaries are not removed. Even in women who have their ovaries removed, there is still a risk /


Dr. Sharda Jain Director: Global Institute of Gynaecoloy at Pushpanjali Crosslay Hospital Secretary general: Delhi Gynaecologist Forum Recurrent Pregnancy.

placentation resulting from poorly vascularized endometrium Acquired Uterine Defects Etiology Infection n No infectious agent has been proven to cause recurrent pregnancy loss u ? Colonization with Ureaplasma urealyticum leading to empiric antibiotics n Certain infections have been associated with / Factors n Natural killer cells u Murine models show activation of NK cells increases the rate of abortion; depletion of NK cells has opposite effect u Human studies show no association of testing and successful/


Migraine Headaches Migraine – Severe, throbbing, vascular headache – Recurrent unilateral head pain – Combined with neurologic and GI disturbances 90%

attacks are still frequent, drug therapy may be indicated Migraine Headaches Prophylactic Therapy Attempts to prevent or reduce recurrence Abortive Therapy – Treats acute migraine attacks – Taken after headache occurs, at first sign of a headache Migraine/Estrogen – NASAIDs – SSRIs – Tricyclic antidepressants –sSsSimple analgesics –NSAIDs –Ergotamine-containing medications –Other drugs Abortive therapy 1. Triptans—Selective 5-HT Receptor Agonists – almotriptan – eletriptan – frovatriptan – naratriptan – /


Evaluation of effectiveness and safety of acyclovir 1gm twice a day for treatment of recurrent genital herpes Kaushal Verma, M Sunane, Somesh Gupta All.

time ♦ Not a fatal disease Why Treat !!! ♦ Lesions on important body sites ♦ Palliation and promotion of healing ♦ Reducing transmission ♦ Suppression of recurrencesAbort or reduce the duration of episodes ♦ Prevention of complications Challenges in management ♦ Lack of cure & unpredictable nature of recurrences ♦ Cost & compliance issue with suppressive therapy ♦ Communication & counseling issues ♦ Significant impact on Quality of life ♦ Grief reaction to diagnosis ♦ Sexual difficulties/


Abortion. Per Year: Approximately 1.37 Million 3,700 a Day.

the Baby Killer - Baltimore Republican | Examiner.com." Welcome to Examiner.com | Examiner.com. Web. 21 Nov. 2011.. "Parental Consent « Autographed Letter Signed." Autographed Letter Signed. Web. 21 Nov. 2011.. "Prevent Recurrent Heart Attack | Healthy Life." Healthy Life | Health Insurance | Acne Treatment | Diabetes. Web. 21 Nov. 2011.. "Survivors - Educate Yourself - First Trimester Abortion Procedures." Survivors of the Abortion Holocaust. Web. 21 Nov. 2011..


Gout. The term gout describes a disease spectrum including – hyperuricemia, – recurrent attacks of acute arthritis associated with monosodium urate crystals.

or renal insufficiency, and obviously should not be exposed to overload with alkalinizing sodium salts or unlimited fluid intake. Prophylaxis Recurrences of acute gouty arthritis may be prevented with continuous low-dose daily oral colchicine or by uric acid–lowering therapy with either/of an acute attack, they should increase the dose to 1 mg every 2 hours; in most instances the attack will abort after 1 or 2 mg of colchicine. If the serum urate concentration is within the normal range and the patient has /


Florida West International Airways, Inc.

Florida West International Airways, Inc. Normal Procedures and Recurrent Simulator Training Aid Revision #5 (06/30/10) Introduction The following information is only a suggested /Auto Flight Engine Engine Fuel System Reverse Thrust Flight Controls Navigation GPWS Look Ahead Alerting Crew Rest Module Recall Items (Non-Normal Checklists) Aborted Engine Start Airspeed Unreliable Cabin Altitude or Rapid Depressurization Dual Engine Failure Engine Fire or Severe Damage or Separation Engine Limit or Surge or/


Intrauterine Infection. Intrauterine infection Abortion/stillbirth Congenital Malformation IUGR Prematurity Acute neonatal disease/delayed neonatal disease.

Intrauterine Infection Intrauterine infection Abortion/stillbirth Congenital Malformation IUGR Prematurity Acute neonatal disease/delayed neonatal disease Asymptomatic/17-21 wk Prevention!!! HSV Specific antiviral therapy Nonspecific antiviral therapy Passive immunization Active immunization HSV Primary Non-primary first infection Recurrent symptomatic and asymptomatic Only in humans Direct mucocutaneous contact Any anatomic site Predisposition Incidence of Neonatal HSV Infection and Other Congenital /


Gout & hyperuricemia.

of intracellular crystals of monosodium urate monohydrate in synovial fluid leukocytes. Desired outcome terminate the acute attack, prevent recurrent attacks, and prevent complications associated with chronic deposition of urate crystals in tissues. Therapy Acute gout Non-pharmacological /of an acute attack should increase the dose to 1 mg every 2 hours; in most instances, the attack aborts after 1 or 2 mg. Discontinuation of prophylaxis may be attempted if the serum urate concentration remains normal and/


Neurology.

in behavior and work. The most characteristic neurologic sign is mild clonus. Multiple sclerosis is characteristically marked by recurrent attacks of demyelinization. The clinical picture is pleomorphic, but there are usually sufficient typical features of incoordination, / have improvement of symptoms in pregnancy and many have complete remission. Most medications used for prophylaxis and abortive treatment of migraines in the nonpregnant patient can also be used in pregnant patients. Most beta-blockers and/


The Female Genital Tract. Infections Lower genital tract HSV- latent, recurrence, transmission to offspring, painful ulcers, multinucleated giant cells.

The Female Genital Tract Infections Lower genital tract HSV- latent, recurrence, transmission to offspring, painful ulcers, multinucleated giant cells Molluscum contagiosum –pox virus, umblicated /Anovulatory Cycle Menopausal changes Atrophy Inflammation Acute endometritis Retained products of conception Chronic endometritis Chronic PID Postpartum or post-abortion IUDs TB Non-specific Endometrium Endometriosis Presence of endometrial tissue outside the uterus Infertility Dysmenorrhea Pelvic pain Metastatic /


M. Tvorko. The Herpesviruses All members show latency and cause recurrent infection – more severe with advancing age, cancer chemotherapy, or other.

groin – clusters of sensitive vesicles on the genitalia, perineum, and buttocks – urethritis, painful urination Recurrent bouts usually less severe – triggered by menstruation, stress, and concurrent bacterial infection Herpes of the /seropositivity) special affinity to red blood cells (haematological changes) severe situation in chronic anaemia in pregnancy: spontaneous abortion, malformations Papillomavirus papilloma – benign, squamous epithelial growth, wart or verruca caused by 100 different strains of /


Epilepsy Dr. Shreedhar Paudel May, 2009. Epilepsy… Recurrent, paroxysmal, involuntary clinical events associated with abnormal electrical activity from.

SE is the first episode of seizure Status epilepticus… Pathophysiology:- – Failure of mechanism that aborts the seizure Evaluation in ED:- – Good description of the event, surrounding circumstances, preliminary /EEG Status epilepticus… Management goals:- – Ensure adequate systemic and cerebral oxygen delivery – Terminate seizure activity – Prevent seizure recurrence – Diagnose and treat underlying cause if present Status epilepticus… Management:- – Secure airway – Maintain oxygenation – Maintain blood/


TORCH tests The five categories of organisms whose antib odies are measured by the TORCH te st are grouped together because they can cause abortion for.

humanparvoviru s. R ubella. C ytomegalovirus(CMV). H erpes(HSV) There are several causes for abortion, some of them are related to viral infection from these viruses: 1.Cytomegalovirus ( CMV). 2.Rubella. 3.Herpes. Other non-viral/2 Genital herpes outbreaks are contagious viral infection that affects primarily the genitals of men and women. It is characterized by recurrent clusters of lesions in the genital areas. It is sexually transmitted (STD) Varicella zoster Infection with the varicell virus can/


Treatment for Upper GI bleeding due to PUD. Goals Control upper GI bleeding Provide symptom relief Promote ulcer healing Prevent recurrence and other.

emergency; 300,000 hospital admissions in the US. Predominant among the elderly 80-85% UGI bleeding stops spontaneously 15-20% continues or develops into recurrent bleeding Sung, J(2006).Current Management of Peptic Ulcer Bleeding. Journal on Nature Clinical Practice of Gastroenterology and Hepatology. Ret. http://www.medscape.com/ in the body – Only indicated for prevention of NSAID induced gastric ulcers in high risk patients. – causes spontaneous abortion Side effects diarrhea and crampy abdominal pain


Genetics Lec.3. Chromosomal abnormalities Incidence is 1: 200 newborn, but it is much higher during pregnancy (50% in the first trimester abortions).

46 Euploid is any exact multiple of the haploid number (xn). Polyploid is 3n (triploid=69) & 4n (tetraploid=92) & generally results in a spontaneous abortion. Aneuploid is any number that is not an exact multiple of n. The causes of aneuploidy are: – Non-disjunction – Anaphase lag Aneuploid The chief cause/.  Most of chromosomal disorders result from de novo changes (i.e. parents are normal & the risk of recurrence in siblings is low). An important exception is the translocation form of Down syndrome.


Lupus Anticoagulants Dr.hani. An acquired autoimmune thrombophilia, characterized by: a) vascular thrombosis. b) recurrent pregnancy losses. c) thrombocytopenia.

–One or more unexplained deaths of a morphologically normal fetus at or beyond10 th week of gestation. –Three or more unexplained spontaneous abortions at or prior to 10 th week of gestation. –One or more premature births at or before the 34 th week of /20% of all DVT with or without PE. 1/3 of new strokes in patients < 50 years age. 10-15% women with recurrent pregnancy losses. APS: significant proportion of thromboembolic disease and pregnancy loss in SLE. APL Abs present in 30-40% SLE. One third of/


Epilepsy and convulsion syndromes. Epilepsy is a chronic disorder, which is characterized by the presence of:  Epileptic focus  Recurrent attacks with.

is a chronic disorder, which is characterized by the presence of:  Epileptic focus  Recurrent attacks with various clinical signs  Personality disorders between attacks  Some specific paraclinical signs Epilepsy as/ severe alcohol intoxication and so on). The main clinical features of epileptic reaction are abortive seizures or general tonic – clonic seizures. Epileptic syndrome – is characterized by recurrent epileptic attacks on the background of pathologic focus in brain. The attacks are variable and/


NU124 Substance Abuse Disorders. Criteria: SUBSTANCE ABUSE Must have one or more in the past 12 months: Recurrent use in physically dangerous settings.

SUBSTANCE ABUSE Must have one or more in the past 12 months: Recurrent use in physically dangerous settings Recurrent drug-related legal problems Continued use despite recurring interpersonal problems Continued: / rate Name other stimulants: ____________ Continued: Anorexia but craves high-sugar, restlessness Massive systematic vasoconstriction = MI, CVA, spontaneous abortion Who will be at risk? Aged, pregnant f females Continued: Withdrawal: Overwhelming fatigue Dysphoria and anhedonia Even after drug has/


Epilepsy and convulsion syndromes. Epilepsy is a chronic disorder, which is characterized by the presence of:  Epileptic focus  Recurrent attacks with.

is a chronic disorder, which is characterized by the presence of:  Epileptic focus  Recurrent attacks with various clinical signs  Personality disorders between attacks  Some specific paraclinical signs Epilepsy as/ shock, insulin shock and so on). The main clinical features of epileptic reaction are abortive seizures or general tonic – clonic seizures. Epileptic syndrome – is characterized by recurrent epileptic attacks on the background of pathologic focus in brain. The attacks are variable and/


Familial Mediterranean Fever (FMF). Definition An autosomal recessive disease, characterized by recurrent febrile episodes with serositis involving the.

Familial Mediterranean Fever (FMF) Definition An autosomal recessive disease, characterized by recurrent febrile episodes with serositis involving the peritoneum, pleura and synovium. Ethnic distribution Turks Armenian Arabs and Druzes Non-Ashkenazi Jews./ pregnancy Colchicine and breast feeding Colchicine and child growth Colchicine and pregnancy (Studied in FMF) Does not increase abortion rate Normal pregnancy length Normal birth weight Normal outcome Amniocentesis ? No need E Ben-Chetrit et al. AC&R 2011


The 30 minute definition It is a prolonged seizure that last more than 30 minutes, or Recurrent seizures during which the patient does not regain consciousness.

minute definition It is a prolonged seizure that last more than 30 minutes, or Recurrent seizures during which the patient does not regain consciousness within a 30 min period. The/ while tapering if seizures persist If seizures recur Individualized therapy Treat the underlying condition; meningitis, or increased intracranial pressure Start AED to abort the electrical activity Benzodiazepine is the first line therapy Routes of administration IV, IM, buccal, nasal, and rectal Lorazepam preferred IV /


DR AHMED JASIM MOHAMMED ASS, PROF Early pregnancy disorder.

If a conceptus is expelled, normal uterine involuation follows, but frequently part of placenta is retained with some blood clots. Clinical varieties of miscarriage (spontaneous abortion):  Threatened abortion  Inevitable abortion:  Incomplete abortion:  Complete abortion:  Missed abortion:  Septic abortion:  Recurrent abortion (Habitual): Threatened abortion symptoms:  1.scanty uterine bleeding preceded by symptoms of pregnancy.  2.pain is usually absent but may be backache or mild lower abdominal/


OBS &GYN EXAM QUESTIONS, CASES AND NOTES

meconium staining? A- amnio infusion B-C/S C-induction D-observation Ans: C med-ed-online Abortion 1-What is wrong about recurrent abortion? A-HSG is the best method to R/O anatomical etiologies B-HSG is recommended several weeks after / D-translocation Ans:A med-ed-online D-empirical treatment of genital mycoplasma Ans:D 20-Which is recommended in recurrent abortions due to infectious reasons? A- cervical culture B-endometrium biopsy C-chlamydia serology D-empirical treatment of genital mycoplasma Ans/


UTERINE CAVITY FINDINGS BY HYSTEROSCOPY IN IVF FAILURE

uterine abnormalities. Hyperplasia Polyps Endometritis Synechiae Our results indicate that repeat hysteroscopic evaluation in cases of recurrent IVF-ET failure is an important adjunctive method for further avaluating and posibly optimizing the IVF-ET/retrived, fertilization rate, number of embrios transferred or first trimester abortion rates among the groups. Effect of treatment of intrauterine pathologies with office histeroscopy inpatients with recurrent IVF failure Demirol A, Gürgan T, Reprod Biomed /


 Defined as proliferation and degeneration of the chorion  A benign neoplasm of the chorion  The embryo fails to develop in most cases  Occurs in.

others ending in loss Incidence :  occurs in about 1% of women of reproductive age. Causes  Idiopathic recurrent abortion, in about 50%, in which no cause can be found.  The known causes include the followings : 1/chromosomal disorders:  Parental karyotyping: Parental balanced translocation.  Fetal karyotyping: Fetal chromosomal anomalies. Management: 3. in idiopathic recurrent abortion. With support and good antenatal care, the chance of successful spontaneous pregnancy is about 60-70%  Support : /


definition A process of expulsion or extraction of embryo / fetus from womb before it reaches to viability period (or less than 500gm in weight), is called.

3.Blood grouping & Cross matching 4.Antibiotics: 5.Evacuation after controlling infection 6.Haematenics abortion Recurrent miscarriage Other names Habitual abortions Habitual miscarriage Recurrent abortions Recurrent miscarriages. Habitual abortions Habitual miscarriage Recurrent abortions Recurrent miscarriages. Habitual aborter A woman who has history of three or more consecutive abortions causes Genetic Factors Endocrine Factors Anatomic Causes – Congenital anomalies, in competencies Infectious causes/


Hemorrhage Marianne F. Moore.

fetal tissue releases thromboplastin, and DIC can result Bleeding in Early Pregnancy Spontaneous Threatened Imminent/Inevitable Incomplete Complete Missed Recurrent pregnancy loss Consecutively in three or more pregnancies Bleeding in Early Pregnancy Spontaneous Threatened Imminent/Inevitable Incomplete Complete Missed Recurrent pregnancy loss Septic abortion Infection, usually with PPROM, pregnancy with IUD in place, or attempts to terminate a pregnancy by untrained persons Bleeding/


EARLY PREGNANCY COMPLICATIONS.  Loss of a pregnancy during the first 20 weeks of pregnancy, at a time that the fetus cannot survive.  Such a loss may.

others ending in loss Incidence :  occurs in about 1% of women of reproductive age. Causes  Idiopathic recurrent abortion, in about 50%, in which no cause can be found.  The known causes include the followings : 1/chromosomal disorders:  Parental karyotyping: Parental balanced translocation.  Fetal karyotyping: Fetal chromosomal anomalies. Management: 3. in idiopathic recurrent abortion. With support and good antenatal care, the chance of successful spontaneous pregnancy is about 60-70%  Support : /


Appropriate Management of Adult Migraines Dane Shiltz, PharmD, BCPS Clinical Pharmacy Specialist, Methodist Hospital Assistant Professor, Butler University.

Learning #2 Provide consistent, rapid, complete relief Prevent or minimize treatment side effects Utilize a tolerated administration route Employ a cost-effective acute treatment Restore functional capacity Prevent recurrences & minimize need for escalating abortive doses or other agents Treatment Goals Ice packs to head Rest – dark, quiet settings Identify & avoid triggers –Environment, foods, medications Headache diary –Reveal triggers, frequency, severity, duration Relaxation/


Prof. Omnia Amin Nayel & Dr. Ishfaq Bukhari. Differentiate between types of headache regarding their symptoms, signs and pathophysiology. Recognize drugs.

accompanied) by AURA They specifically target pathways of migraine by  meningeal dilatation &  neural activation via 5HT 1 agonism  i.e. stopping headache as it is evolving.  recurrence frequency, severity, duration & / or disability  responsiveness to abortive therapy Abortive medications > effective if taken early, losing effectiveness once the attack has begun So they must be rapidly acting Non-specifically target individual symptoms i.e. alleviating/


A’asem Zeidan Abu-Shtaya

iso immunization: if the anti-D is not given or if the dose is inadequate Psychological trauma Recurrent abortion A recurrent habitual aborter is a woman who has had 3 or more consecutive SAB’s. Types: Primary all pregnancies/… Uterine disorders: submucous fibroids, cervical incompetance, asherman’s syndrome Infections: e.g. CMV Rh isoimmunization Recurrent abortion Diagnosis Hx -Previous abortion -medical hx: DM, thyroid, autoimmune diseases and thrombophilia P/E General: weight. Thyroid and hair /


Differentiate between types of headache regarding their symptoms, signs and pathophysiology. Recognize drugs used to prevent migraine Identify drugs used.

is overused Timing The full effect of preventive therapy needs several weeks to manifest Treatment should continue for six months and can be repeated Antidepressants / Antiepileptics / Antihypertensives ↓ recurrence frequency, severity & /or duration > responsiveness to abortive therapy ↓ disability Antiepileptics; Block Na channel & augment GABA at GABA-A receptors Topiramate; weight loss & dysthesia. Valproic; weight gain, hair loss, polycystic ovary  not given to young/


Thomas Hviid, MD, PhD Dept. of Clinical Biochemistry Roskilde University Hospital Denmark Reproductive Immunology The HLA System in Pregnancy ’Why did.

/HLA and HLA class Ib –’Classical’ vs ’non-classical’ MHC/HLA genes –Gene structure, polymorphisms, expression, alternative splicing, functions etc  Certain complications of pregnancy in relation to HLA/HLA-G –(Recurrent) spontaneous abortions, IVF, pre-eclampsia  Pregnancy and HLA diversity –Reproductive selection mechanisms (’mating preferences’) and HLA ? The ’semi-allogenic fetus’ Medawar & Billingham, Nature, 1953  Four hypotheses: –The conceptus lacks immunogenicity –Significant/


Pregnancy Complications… DR.WASEEM AHMED ABUJAMEA ER CONSULTANT SBEM,ABEM Program director SBEM ED DEPUTY Chairman.

the internal os but does not reach it Placenta Previa Risk Factors Prior previa Multiparity Multiple gestations Advanced maternal age Previous cesarean delivery Prior induced abortion Smoking Placenta Previa History Vaginal bleeding  Bright red and painless (recurrent)  Occurs on average at 27-32 weeks gestation  Contractions may or may not occur simultaneously with the bleeding Exam Findings Profuse hemorrhage Hypotension Tachycardia Soft/


EARLY PREGNANCY COMPLICATIONS Rukset Attar, MD, PhD Obstetrics and Gynecology Department.

decreases to 20–30% in second-trimester losses and to 5–10% in third-trimester losses Spontaneous Abortion Etiology the first-trimester losses are typically autosomal trisomies or monosomy X, whereas later losses reflect chromosomal abnormalities/ in about 5% of the reproductive population and antiphospholipid syndrome (APS) in 15–17% of women with recurrent pregnancy loss Non-thrombotic pregnancy complications and thrombophilias Maternal thrombophilias are not associated with pregnancy loss prior to 8–/


Valtrex® (valacyclovir HCl) Caplets NDA 20-550 / S-019 Harry W. Haverkos, M.D. Medical Reviewer Fraser Smith, Ph.D. Statistical Reviewer Division of Antiviral.

patients: – –2 healthy infants, – –2 spontaneous abortions 7 placebo-treated source patients: – –3 healthy infants, – –3 spontaneous and 1 elective abortions 1 susceptible partner treated with valacyclovir – –elected abortion 4 other susceptible partners – –outcome data not presented / every sex act, especially oral sex acts, and not to abstain from sex during symptomatic recurrences despite monthly STD counseling Behavioral research to improve STD counseling effectiveness is urgently needed 58 Questions for/


Dr. Eeson Sinthamoney MD (Mal), MRCOG (London), DFFP (UK) Fellowship in Reproductive Medicine (UK/Singapore) Consultant Obstetrician, Gynaecologist & Fertility.

outcome. Obstet Gynecol 2006; 107:845-50 Conclusion: Corpus luteal support with dydrogesterone has been shown to reduce the incidence of pregnancy loss in threatened abortion during the first trimester in women without a history of recurrent abortion.  What role does progesterone play in maintaining a successful pregnancy?  Therefore, based on sound scientific understanding is there adequate justification to give our threatened miscarriage/


Emad R. Sagr, MBBS, FRCSC, FACOG Consultant OB-Gyn and Gynecology Oncology Security Forces Hospital Bleeding in early pregnancy and Ectopic Pregnancy.

fetus is sufficiently developed to survive (before 24 wks) Incidence:15-20% It is convenient to consider the clinical aspect of spontaneous abortion under 5 sub groups: 1.Threatened 4.Missed 2.Inevitable 5.Recurrent abortion 3.Incomplete 6. Septic Abortion Threatened Abortion 25% of pregnancies This refers only to bleeding from placental site which is not yet severe enough to terminate the pregnancy. Serial/


Prof. Omnia Amin Nayel & Dr. Abdul latif Mahesar.

accompanied) by AURA They specifically target pathways of migraine by  meningeal dilatation &  neural activation via 5HT 1 agonism  i.e. stopping headache as it is evolving.  recurrence frequency, severity, duration & / or disability  responsiveness to abortive therapy Abortive medications > effective if taken early, losing effectiveness once the attack has begun So they must be rapidly acting Non-specifically target individual symptoms i.e. alleviating/


Prof. Omnia Amin Nayel & Dr. Ishfaq Bukhari. Differentiate between types of headache regarding their symptoms, signs and pathophysiology. Recognize drugs.

cause tissue microinfarction They specifically target pathways of migraine by  meningeal dilatation &  neural activation via 5HT 1 agonism  i.e. stopping headache as it is evolving.  recurrence frequency, severity, duration & / or disability  responsiveness to abortive therapy Abortive medications > effective if taken early, losing effectiveness once the attack has begun So they must be rapidly acting Non-specifically target individual symptoms i.e. alleviating/


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