LECTURE 1.pd clinic course lecture 1 from 10

LECTURE 1.pdf clinic course

1. ميحرلا نمحرلا الله مسب

2. OB & GYN Clinic Course
Dr. Ahmed Mohamed Abbas
Assistant Professor of OB-GYN
Faculty of Medicine- Assiut University
E-mail: [email protected]

3. Contents
Case no.1 (Missed period)
Diagnosis of Pregnancy
Dealing with pregnancy
Drug Prescription
Drug safety
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4. Case NO.1
Missed Period
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5. Diagnosis of pregnancy
Dr. Ahmed Mohamed Abbas, MD

6. A Case of Missed Period +
(+ve) Pregnancy Test
•Urine pregnancy test
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7. A Case of Missed Period +
(+ve) Pregnancy Test
•False Negative Urine pregnancy test
1-You tested too early
2-The test strips had too low sensitivity
3-The urine is too diluted.
4-You are overweight and the hCG is too low yet
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8. A Case of Missed Period +
(+ve) Pregnancy Test
•False Positive Urine pregnancy test
1-Readingthehomepregnancytestincorrectly
2-IfyoureceivehCGorgonadotropinsforovulation,it'spossibleto
haveapositivetestfor2-3weeksaftertheshot
3-Impropertesting(Expiredtestsorfaultyhomepregnancytests)
4-Miscarriageorafterpregnancy:Veryearlypregnancyloss.
Also,afterapregnancyormiscarriage,thehCGpregnancy
hormonecanstayforweeksinyourbody
5-Certainraremedicalconditions:Gestationaltrophoblastic
disease,pancreasislet-celltumors,adenomyosis,bladder
cancer,lungcancer.
6-Medications:likeMethadone,chlordiazepoxide,or
promethazine
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9. A Case of Missed Period +
(+ve) Pregnancy Test
•Blood pregnancy test
Ifyouarepregnant,bloodtestwillbepositive3-4
daysafterimplantationor9-10daysafterfertilization
andovulation,whichis5-6daysbeforeamissed
period.
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10. CALCUALTION OF
DURATION OF PREGNANCY
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•First day of LMP
SURE
RELIABLE(3 months)
-not lactating
-not using hormonal contraceptives
-regular cycles

11. CALCUALTION OF
DURAITON OF PREGNANCY
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12. ASSESSMENT OF NORMAL
EARLY PREGNANCY BY
ULTRASOUND

13. 1
4
32
5

14. [1] DECIDUAL REACTION
•Thickeningoftheendometriumisrecognizedbefore
theappearanceofgestationsac.
•Itcannotbetakenasdiagnosticofpregnancybecause
thickenedendometriumonimagingmayoccurfora
numberofreasons.
•Corpusluteummaybedetected.

15. Decidual reaction and corpus luteum

16. [2] THE GESTATION SAC
•Theearliestultrasonicconfirmationofapregnancy.
•GSisclearlyvisualizedfrom4.4-4.6weeks(32-34
days)byTVS,whenitmeasures2–3mmin
diameter.

17. Early GS

18. [3] THE YOLK SAC
•Itisthesecondstructuretoappearafterthe
GS.
•Itcanfirstbeidentifiedtransvaginalat35
days(5weeks)whenthesacis8-10mmin
size.

19. Yolk sac
What is its ultrasonographic importance?

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Yolk sac

21. [4] THE EMBRYO
•Theembryocanbevisualizedfromabout37
daysusingthetransvaginalrouteadjacentto
theyolksac(adiamondringsign).
•Theembryogrowsataround1mmperday.
•Theembryoisvisiblewithmeansacdiameter
>18mm

22. A diamond ring sign

23. [5] EMBRYONIC HEART RATE
•Thecardiacactivitystartsasearlyas5-6weeks
byTV/US.
•ThecutoffCRLfordetectingcardiacactivityby
transvaginalprobeis5-7mm.
•Heartrate100-120at5weeksandprogressively
increasesto120to160beats/minuteafter6to
7weeks.

24. Cardiac activity by color Doppler

25. Early pregnancy
measurements
MSD
CRL

26. Multiple pregnancy

27. US Tips and tricks
•Gestational sac = Pregnancy
•N. of Gestational sacs = N. of placentae
•Yolk sac = intrauterine pregnancy
•N. of Yolk sacs = N. of fetuses
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28. Dealing with pregnancy
Dr. Ahmed Mohamed Abbas, MD

29. First Visit
1-Check High risk pregnancy Conditions.
2-Measure BMI, Blood pressure.
3-Dietary and lifestyle modifications.
4-Drug supplementation.
5-Plan for antenatal visits.
6-Ask for Blood group, RH, cbc, Urine.
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Rubella IgG +HBsAg

30. Food to avoid in pregnancy
1-Fish high in Mercury (Tuna-Mackerel)
2-Processed meats (sausage-hotdog-..)(listeria)
3-Unpasteurized cheese (Soft cheese) (listeria)
4-Raw eggs, Cesar dressing & mayonnaise
(salmonella)
5-Food with high amount of salt
6-Large amount of Caffeine (>200 ml)
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33. Immunizations
•Influenza(allpregnantwomeninfluseason)
•Tetanus,diphtheria,pertussis(Tdap)(allpregnant
womenirrespectiveoftheirpriorhistory);tomaximize
thematernalantibodyresponseandpassiveantibody
transfertotheinfant,optimaltimingis27–36weeks
gestation.
•HepatitisB(pre-andpostexposure)
•HepatitisA(pre-andpostexposure)
•COVID-19vaccine
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34. Follow up Visits
1-Check High risk pregnancy Conditions.
2-Measure BMI, Blood pressure.
3-Drug supplementation.
4-Ask for cbc before delivery.
5-Monitor the growth of fetus.
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35. EFW changes in pregnancy
•[8-14 weeks] = 10 gm weekly [100 gm]
•[14-20 weeks] = 50 gm weekly [400 gm]
•[20-28 weeks] = 100 gm weekly [1200 gm]
•[28-40 weeks] = 200 gm weekly [3600 gm]
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36. Drug use in pregnant
women
Prescription
Dr. Ahmed Mohamed Abbas, MD

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•Routine drug
supplementation

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FOLIC
ACID

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•Folic acid 0.5 mg tab
• ةياهن ىتح لمحلا صيخشت نم ءادغلا دعب دحاو صرق
ثلاثلا رهشلا

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•Folicap 0.5 mg caps
•ايموي ءادغلا دعب ةدحاو ةلوسبك

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•Folic acid 5 mg tab
• لاوطو لمحلا لبق نم ايموي ءادغلا دعب دحاو صرق
ىلولاا ةثلاثلا روهشلا.
1.DM
2.History of anencephaly
3.Epileptic

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•Folicap 2.5 mg caps
• لاوطو لمحلا لبق نم ايموي لكلأا دعب نيترم ةلوسبك
ىلولاا ةثلاثلا روهشلا.
1.DM
2.History of anencephaly
3.Epileptic

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•Cobal-f tab
•صرقنيترمايمويدعبلكلأا

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•Methyl folate tab
ايموي ءادغلا دعب دحاو صرق

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•Cobafolic tab
ايموي ءادغلا دعب دحاو صرق

46. 5-MTHF or Folic acid
•Folicacidmustbeconvertedto5-MTHF.
•Once5-MTHFiscreated,canentercellsandcross
overthebloodbrainbarriertohelpnourishour
tissuesandbrains.
•Successfulconversionfromfolicacidto5-MTHFis
dependentuponaconvertingenzymeknownas
MTHFR.
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47. 5-MTHF or Folic acid
•5-MTHFplaysaroleinconvertinghomocysteine
intomethionine,soif5-MTHFislackingduetothe
MTHFRmutation,homocysteinecanbuildupto
dangerouslevels.
•Highhomocysteinelevelsleadstorecurrent
miscarriage,preeclampsia,PTL.
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48. 5-MTHF or Folic acid
•Itisestimatedthatbetween25and60%ofthe
populationhaveavariationinoneoftheirMTHFR
genesthatnegativelyimpactstheirabilityto
convertfolicacid.
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IRON

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51. IRON PREPARATIONS
•Ferrous salts (gluconate-sulphate-fumarate)
•Amino-acid chelated iron
•Ferrous bis glycinate
•Liposomal Iron
•Sucrosomial iron
•Lactoferrin
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•Feroglobin caps
•Ferrotron caps
•Iroxen caps
•Pharaferro-27 caps
•Theragran-H tab
•لمحلا لاوط ايموي لكلأا دعب دحاو صرق وأ ةدحاو ةلوسبك

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•Iroxen syrup
•Feroglobin Syrup
•لمحلا لاوط ايموي لكلأا دعب ةدحاو ةقلعم

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Calcium

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•Caltonex tab
•Matrix tab
•Calcid caps
•Calcitron tab

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•Calvit CD sachets
•Vitacal C sachets
•Calcium Cid sachets
• ىلع راوف سيك1\2ءام بوك

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•Extreme chewable pieces
•Dulcada chewable
•لكلأا دعب غضملل بعكم

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Multivitamins

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•Elevit caps
•Pregnacare tab
•لمحلا لاوط ايموي راطفلاا دعب صرق

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Omega 3

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63. Conclusions
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64. Omega 3 fatty acids
•Alpha-linolenic acid (ALA)
•Eicosapentaenoic acid (EPA)
•Docosahexaenoic acid (DHA) [200 mg]
•1000 mg fish oil capsules [120 DHA + 180
EPA]
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66. Drug use in pregnant
women
Safety
Dr. Ahmed Mohamed Abbas, MD

67. Causes of congenital
malformations
Unknown or multifactorial: 70%
Genetic: 20%
Environmental: 10%
Drugs & chemicals: 5%
Infection: 2%
Maternal disorders: 2%
Irradiation: 1%

68. Factors affecting the teratogenic effect of the drug
A. Fetal factors :
I. Developmental stage :
1.Predifferentiation stage (<31 days of gestation): Death or no
effect.
2.Differentiation stage (31-71 days of gestation): Malformation
3.Post differentiation stage (after 71 days of gestation):
Functional defects, Growth retardation
II. Genetic susceptibility :
1. Species differences: Thalidomide is teratogenic in human & not
in animals.
2. Individual differences: difference in maternal or fetal
metabolism of the drug

69. B. Drug factors:
I. The route, dose & duration of administration
II. Access to fetoplacental unit:
Lipid solubility
Molecular weight: > 1000 dalton not cross the placenta
Protein binding
Thickness of the placental membrane

70. Appearance of teratogenic effect:
Immediate:
•Death & abortion
At birth:
•Malformation
•Functional defects (Streptomycin: nephrotoxic &
ototoxic)
Delayed:
•Carcinogenesis: DES
•Mutagenesis:

71. AdministrationHuman RiskAnimal
risk
Category
YesNo riskNo riskA
YesNo studiesNo riskB
If benefits> RiskNo studiesRiskC
If No alternativeRisk< BenefitD
ContraindicatedRisk> Benefit X
FDA classification for drugs used in pregnancy

72. 1.Category A:
•Controlled studies in humans demonstrated no fetal risk.
2. Category B:
•Animal studies indicate no fetal risk & no controlled
studies in humans.
3.Category C:
• Animal studies indicate fetal risk & no human studies.
These drugs are administered only when their benefits
outweighs the potential fetal harm.

73. 4.Category D:
•There is evidence of fetal risk in humans but the
benefits may outweigh the risk.
These drugs are given only in serious disease because no
alternative.
5. Category X:
There is clear human risk that outweigh the benefits.
These drugs are contraindicated.

74. Impact of the problem
2%: Category A drugs
50%: Category B drugs
40%: Category C drugs
4%: Category D drugs
4%: Category X drugs

75. ClassificationCategory
Studies in animals have not shown evidence of
an increased occurrence of fetal damage.
Category
B1
Studies in animals are inadequate or may be
lacking.
Category
B2
Studies in animals have shown evidence of an
increased occurrence of fetal damage
Category
B3
Have caused harmful effects on the human
fetus or neonate without causing
malformations. These effects may be
reversible.
Category C
AU TGA classification for drugs used in
pregnancy

76. How to check the safety of drug
during pregnancy?
•_____ ___ ___ ___ __ ________
_________ ____ ___________ _____
________ ___________ _________
_________ ________ __________
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78. How to check the safety of drug
during pregnancy?
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79. Antibiotics
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80. Antibiotics
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81. Antibiotics
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82. Antibiotics
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83. Antibiotics
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84. Antibiotics
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Recommendations
Before pregnancy:
Be Familiar with teratogenic drugs
Avoid pregnancy if teratogenic drug should be given
In 1st trimester:
Avoid drugs
Exception folic acid & vit C
If absolutely indicated for short time & minimal effective dose
2nd & 3rd trimester:
Beneficial & safe drugs
if indicated for short time & minimal effective dose
Last week:
Avoid drugs that may affect neonates
If needed stop 7-10 days before labor

86. DR. AHMED ABBAS
86
Thanks
for your
attention
AHMED ABBAS
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