DOCSLIB.ORG

AOGD Bulletin January 2019.Indd

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
AOGD Bulletin January 2019.Indd AAOGDOGD Volume 18; Issue No.9; January 2019 BBULLETINULLETPrice:I ` 30N only AOGD Theme 2018-19 Issue: Current Update Empowering Providers: Obstetric Hemorrhage Enhancing Women’s Health Menstrual Disorders AAOGDOGD SSECRETARIATECRETARIAT Department of Obstetrics and Gynecology Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi-110001 [email protected] Vol. 18, No.9; January, 2019 www.aogd.org 1 AOGD Offi ce-Bearers 2018-19 Dr Abha Singh Dr Manju Puri President Vice President Dr Reena Yadav Dr Kiran Aggarwal Scientifi c Advisor Hon. Secretary Dr Anuradha Singh Dr Nishtha Jaiswal Dr Prabha Lal Dr Shilpi Nain Joint Secretaries Treasurer Co Treasurer Editorial Board Dr Ratna Biswas Dr Manisha Kumar Editor Web Editor Dr Pikee Saxena Dr Sharda Patra Dr Swati Agrawal Dr Vidhi Chaudhary Co-Editors Co-Web Editor Dr Meenakshi Singh Dr Muntaha Dr Amrita Dr Aastha Shrivastava Dr Deepika Meena Dr Aishwarya Kapur Clinical Secretary Public Relations & Hospitality 2 AOGD Bulletin AOGD Executive Committee 2018-19 President Patrons Dr Abha Singh Dr S N Mukherjee Dr Urmil Sharma Vice President Dr Kamal Buckshee AOGD BULLETIN Dr Manju Puri Dr Neera Aggarwal Vol. 18, No.9; January, 2019 Scientifi c Advisor Advisors Dr Reena Yadav Dr Gauri Devi Dr Geeta Radhakrishnan Hony. Secretary Dr Reva Tripathi Contents Dr Kiran Aggarwal Dr S B Khanna Dr Sharda Jain Obstetric Hemorrhage Treasurer Dr Usha Gupta BEST PRACTICES 7 Dr Prabha Lal Ex Offi cio Maternal Safety Bundle for Obstetric Hemorrhage Editor Executive Past Presidents Indu Chawla, Pooja Gupta Dr Ratna Biswas Dr P Chadha (1990-94) RECENT ADVANCES 12 Dr Neera Agarwal (1994-97) Management of Postpartum Hemorrhage Web Editor Dr Maya Sood (1997-99) Shilpi Nain Dr Manisha Kumar Dr D Takkar (1999-2001) Dr Sudha Salhan (2001-03) CONTROVERSY Joint Secretaries 18 Dr Swaraj Batra (2003-05) Morbidly Adherent Placenta: Hysterectomy vs Dr Anuradha Singh Dr N B Vaid (2005-06) Dr Nishtha Jaiswal conservative management Dr S S Trivedi (2006-07) Chandra Mansukhani, Sunita Kumar, Lipika Khurana Co-Treasurer Dr Suneeta Mittal (2007-08) Dr I Ganguli (2008-09) CASE APPROACH Dr Shilpi Nain 21 Dr Shashi Prateek (2009-10) Obstetric Hemorrhage due to Coagulopathy (Abruption Co-Editors Dr U Manaktala (2010-11) and Hepatitis) Dr Pikee Saxena Dr Neerja Goel (2011-12) Abha Sharma, Archana Chaudhary Dr Sharda Patra Dr C Raghunandan (2012-13) Dr Swati Agrawal Dr Alka Kriplani (2013-14) DISTRESS TO DE-STRESS 23 Dr U P Jha (2014-15) The Relation Cure Co-Web Editor Dr Pratima Mittal (2015-16) Mohit D Gupta Dr Vidhi Chaudhary Dr Sudha Prasad (2016-17) CROSSWORD 24 Clinical Secretary Immediate Past President The Maze of Knowledge and Pictorial Quiz Dr Meenakshi Singh (2017-2018) Dr Shalini Rajaram Swati Agrawal Public Relations & Hospitality Immediate Past Secretary Menstrual Disorders Dr Muntaha (2017-2018) Dr Vidhi Chaudhary Dr Abha Sharma STANDARD OF CARE 29 Dr Amrita AUB in Perimenopausal Women Dr Aastha Shrivastava President Elect (2019-2020) Ratna Biswas, Triveni GS Dr Deepika Meena Dr Sunesh Kumar RECENT ADVANCES Dr Aishwarya Kapur Vice President FOGSI 36 Dr Pratima Mittal Diagnosis & Management of Adenomyosis Executive Members J B Sharma, Tanudeep Kaur Dr Achala Batra Chairpersons Dr Amita Suneja AOGD Sub-Committees CASE APPROACH 39 Dr Anjali Tempe Dr Susheela Gupta Clinical Approach to Primary Amenorrhoea Dr Dinesh Kansal Dr Surveen Ghumman Rashmi Dr Indu Chawla Dr Abha Sharma JOURNAL SCAN 46 Dr J B Sharma Dr A G Radhika Ratna Biswas Dr Kanwal Gujral Dr Amita Jain Dr Manju Khemani Dr Shakuntla Kumar Proceedings of AOGD Monthly Clinical Meeting 47 Dr Malavika Sabharwal Dr Ashok Kumar Dr Nirmala Aggarwal Dr Vatsla Dadhwal Dr Pankaj Talwar Dr Rupinder Sekhon Dr Ranjana Sharma Dr Anjali Tempe Dr Renu Misra Dr Renu Misra Dr Sadhna Gupta Dr Nalini Mahajan Disclaimer Dr Sangeeta Gupta The advertisements in this bulletin are not a warranty, endorsement or approval of Dr S N Basu the products or services. The statements and opinions contained in the articles of Dr Suman Lata the AOGD Bulletin are solely those of the individual authors and contributors, and Dr Vijay Kadam do not necessarily refl ect the opinions or recommendations of the publisher. The publisher disclaims responsibility of any injury to persons or property resulting from any ideas or products referred to in the articles or advertisements. Plagiarism Disclaimer Any plagiarism in the articles will be the sole responsibility of the authors, the editorial board or publisher will not be responsible for this. Publisher/Printer/Editor Dr Ratna Biswas on behalf of Association of Obstetricians & Gynecologists of Delhi. Printed at Process & Spot C-112/3, Naraina Industrial Area, Phase-1, New Delhi 110 028 Published from Department of Obstetrics and Gynecology AOGD Secretariat Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi - 110001 Department of Obstetrics and Gynecology Editor Lady Hardinge Medical College & Smt. Sucheta Kriplani Hospital, New Delhi 110001 Dr Ratna Biswas Tel No: 011-23408297; Email: [email protected] Ph. No. 011-23408297; Email: [email protected] www.aogd.org Total number of pages = 52 Vol. 18, No.9; January, 2019 3 PPresident’sresident’s MMessageessage Dear Friends, Greetings! A Very Happy and Prosperous New Year. AOGD begins 2019 with a resolution to generate public awareness on important health issues and organize skill enhancing academic activities for its members. On the same, December chill did not deter us from joining hands with NARCHI to generate awareness on Thalassemia by participating in the walkathon on the morning of 2nd December 2018 at Connaught Place. Continuing with the academic endeavors, AOGD organized a guest lecture on 21/12/18 by Dr Barry Berghmans from Pelvic Care Centre Maastricht Netherlands on “Prevention and nonsurgical management of pelvic fl oor dysfunction” at Lady Hardinge Medical College. The talk provided valuable insights on pelvic fl oor training and rehabilitation. This lecture was well attended and highly appreciated as evidenced by the interaction following it. A Clinical Meeting was held at Sir Gangaram Hospital on 27/12/18 where series of interesting cases, managed laparoscopically were presented. AOGD started January 2019 with a successful “Walk For a Cause: Prevent Female Feticide & Save the Girl Child” in association with FOGSI at Lady Hardinge Medical College on 2nd January 2019. The event started with a skit on prevention of female feticide followed by Zumba dance with very enthusiastic participation by AOGD members, faculty members from other departments, MBBS students and culminated with a walk on Shaheed Bhagat Singh Marg adjacent to Connaught Place where slogans like “save the girl child – Stop female feticide, Beti Bachao – Beti Padhao, Pankh do Parvaz do- Nari ko Aakash do” fi lled the air. More than 250 people participated in the event. This year we pledge to take AOGD to newer heights with our continued efforts on the academic front and for this we bring forth the January issue of AOGD Bulletin with latest scientifi c advances and rich academic content. The present issue focuses on two very important topics, “Obstetrical Hemorrhage” and “Menstrual Disorders”. Obstetrical hemorrhage is a leading cause of maternal mortality and morbidity worldwide. Delayed and improper care can cause mortality within minutes of massive obstetrical hemorrhage. Prenatal identifi cation of at risk women, prompt assessment of blood loss and effective protocol based management is of utmost importance to save these lives. This issue discusses the current evidence based management of obstetric hemorrhage, addresses controversies and highlights newer advances in this fi eld which is mandatory knowledge for every obstetrician. Menstrual disorders are the most common cause of gynecological consultation. Menstrual dysfunction results in frequent absence from workplace and schools in adolescents and can have an impact on quality of life and may also be associated with uterine pathology. It is important to diagnose and manage them appropriately. Hope you will benefi t from this current issue. Dr Abha Singh President AOGD (2018-19) 4 AOGD Bulletin SSecretary’secretary’s MMessageessage Greetings from the AOGD Secretariat, LHMC It is great to interact with all of you in a very pleasant and a smiling new year. We hope lot of health and happiness and joy in the New Year for all AOGD members. It was a happening last year for AOGD with lot of activities, CME’s, a great conference and a series of public awareness programmes. New Year started with a Grand National walk for the girl child piloted by Public awareness committee FOGSI and FOGSI President Dr Jaydeep Malhotra. At AOGD with enthusiastic participation of our members, Nursing school with their students, our senior faculty from other departments, residents and undergraduates we had a successful walkathon on 2nd January, 2019 starting from LHMC. Zumba, street play and talks made the event happening and enjoyable. Guest lecture by Dr Bary Berghmans on addressing nonsurgical concerns for pelvic fl oor dysfunction was enlightening and well appreciated. The editorial team brings forth a very important issue addressing Obstetric haemorrhage and Menstrual disorders. Rising adherent placentas in day to day practice is becoming a frequent event. The latest update on the management of these will keep you in tune with the recent evidence based guidelines. The third postgraduate infertility update by the Infertility
Load more

Recommended publications
  • Spectrum of Benign Breast Diseases in Females- a 10 Years Study
    Original Article Spectrum of Benign Breast Diseases in Females- a 10 years study Ahmed S1, Awal A2 Abstract their life time would have had the sign or symptom of benign breast disease2. Both the physical and specially the The study was conducted to determine the frequency of psychological sufferings of those females should not be various benign breast diseases in female patients, to underestimated and must be taken care of. In fact some analyze the percentage of incidence of benign breast benign breast lesions can be a predisposing risk factor for diseases, the age distribution and their different mode of developing malignancy in later part of life2,3. So it is presentation. This is a prospective cohort study of all female patients visiting a female surgeon with benign essential to recognize and study these lesions in detail to breast problems. The study was conducted at Chittagong identify the high risk group of patients and providing regular Metropolitn Hospital and CSCR hospital in Chittagong surveillance can lead to early detection and management. As over a period of 10 years starting from July 2007 to June the study includes a great number of patients, this may 2017. All female patients visiting with breast problems reflect the spectrum of breast diseases among females in were included in the study. Patients with obvious clinical Bangladesh. features of malignancy or those who on work up were Aims and Objectives diagnosed as carcinoma were excluded from the study. The findings were tabulated in excel sheet and analyzed The objective of the study was to determine the frequency of for the frequency of each lesion, their distribution in various breast diseases in female patients and to analyze the various age group.
    [Show full text]
  • Breastfeeding and Women's Mental Health
    BREASTFEEDING AND WOMEN’S MENTAL HEALTH Julie Demetree, MD University of Arizona Department of Psychiatry Disclosures ◦ Nothing to disclose, currently paid by Banner University Medical Center, and on faculty at University of Arizona. Goals and Objectives ◦ Review the basic physiology involved in breastfeeding ◦ Learn about literature available regarding mood, sleep and breastfeeding ◦ Know the resources available to refer to regarding pharmacology and breast feeding ◦ Understand principles of psychopharmacology involved in breastfeeding, including learning about some specific medications, to be able to counsel a woman and obtain informed consent ◦ Be aware of syndrome described as Dysphoric Milk Ejection Reflex Lactation Physiology https://courses.lumenlearning.com/boundless-ap/chapter/lactation/ AAP Material on Breastfeeding AAP: Breastfeeding Your Baby 2015 AAP Material on Breastfeeding AAP: Breastfeeding Your Baby 2015 A Few Numbers ◦ About 80% of US women breastfeed ◦ 10-15% of women suffer from post partum depression or anxiety ◦ 1-2/1000 suffer from post partum psychosis Depression and Infant Care ◦ Depressed mothers are: ◦ More likely to misread infant cues 64 ◦ Less likely to read to infant ◦ Less likely to follow proper safety measures ◦ Less likely to follow preventative care advice 65 Depression is Associated with Decreased Chance of Breastfeeding ◦ A review of 75 articles found “women with depressive symptomatology in the early postpartum period may be at increased risk for negative infant-feeding outcomes including decreased breastfeeding duration, increased breastfeeding difficulties, and decreased levels of breastfeeding self-efficacy.” 1 Depressive Symptoms and Risk of Formula Feeding ◦ An Italian study with 592 mothers participating by completing the Edinburgh Postnatal Depression Scale immediately after delivery and then feeding was assessed at 12-14 weeks where asked if breast, formula or combo feeding.
    [Show full text]
  • Unilateral Galactorrhea Associated with Low-Dose Escitalopram
    Case Report Unilateral Galactorrhea Associated with Low-dose Escitalopram P. Bangalore Ravi, K. G. Guruprasad1, Chittaranjan Andrade2 ABSTRACT Galactorrhea is a rare adverse effect of selective serotonin reuptake inhibitor treatment. We report a 27-year-old woman who developed unilateral breast engorgement with galactorrhea 18 days after initiation of escitalopram (10 mg/day). The symptom remitted 7 days after withdrawal of escitalopram and did not subsequently recur during maintenance therapy with agomelatine (25 mg/day). Key words: Agomelatine, escitalopram, galactorrhea, prolactin, selective serotonin reuptake inhibitor, unilateral breast engorgement INTRODUCTION about the future, low self-confidence, diminished interest in daily activities, and diminished interest in social life, Galactorrhea refers to the discharge of milk from the poor appetite, and poor sleep. These symptoms were breast, unassociated with recent childbirth or nursing. exacerbated by domestic stress and absence of social Galactorrhea occurs when serum prolactin levels are support. A diagnosis of moderate depression with raised for reasons ranging from pituitary tumors to drug somatic symptoms was made, and she was started on treatments. A number of drugs, including psychotropic escitalopram 5 mg/day along with clonazepam 0.75 mg/day. She was instructed to increase the dose of drugs, cause hyperprolactinemia, some doing so consistently escitalopram to 10 mg/day after 4 days and taper and (e.g., certain antipsychotics), and some, rarely (e.g., certain withdraw the clonazepam at the rate of 0.25 mg/week. antidepressants).[1,2] We herein report an unusual case of galactorrhea resulting from escitalopram use. After about 18 days of treatment, she developed painless engorgement of her left breast associated with CASE REPORT galactorrhea.
    [Show full text]
  • Breast Concerns
    Section 12.0: Preventive Health Services for Women Clinical Protocol Manual 12.2 BREAST CONCERNS TITLE DESCRIPTION DEFINITION: Breast concerns in women of all ages are often the source of significant fear and anxiety. These concerns can take the form of palpable masses or changes in breast contours, skin or nipple changes, congenital malformation, nipple discharge, or breast pain (cyclical and non-cyclical). 1. Palpable breast masses may represent cysts, fibroadenomas or cancer. a. Cysts are fluid-filled masses that can be found in women of all ages, and frequently develop due to hormonal fluctuation. They often change in relation to the menstrual cycle. b. Fibroadenomas are benign sold tumors that are caused by abnormal growth of the fibrous and ductal tissue of the breast. More common in adolescence or early twenties but can occur at any age. A fibroadenoma may grow progressively, remain the same, or regress. c. Masses that are due to cancer are generally distinct solid masses. They may also be merely thickened areas of the breast or exaggerated lumpiness or nodularity. It is impossible to diagnose the etiology of a breast mass based on physical exam alone. Failure to diagnose breast cancer in a timely manner is the most common reason for malpractice litigation in the U.S. Skin or nipple changes may be visible signs of an underlying breast cancer. These are danger signs and require MD referral. 2. Non-spontaneous or physiological discharge is fluid that may be expressed from the breast and is not unusual in healthy women. 3. Galactorrhea is a spontaneous, multiple duct, milky discharge most commonly found in non-lactating women during childbearing years.
    [Show full text]
  • Management of Prolonged Decelerations ▲
    OBG_1106_Dildy.finalREV 10/24/06 10:05 AM Page 30 OBGMANAGEMENT Gary A. Dildy III, MD OBSTETRIC EMERGENCIES Clinical Professor, Department of Obstetrics and Gynecology, Management of Louisiana State University Health Sciences Center New Orleans prolonged decelerations Director of Site Analysis HCA Perinatal Quality Assurance Some are benign, some are pathologic but reversible, Nashville, Tenn and others are the most feared complications in obstetrics Staff Perinatologist Maternal-Fetal Medicine St. Mark’s Hospital prolonged deceleration may signal ed prolonged decelerations is based on bed- Salt Lake City, Utah danger—or reflect a perfectly nor- side clinical judgment, which inevitably will A mal fetal response to maternal sometimes be imperfect given the unpre- pelvic examination.® BecauseDowden of the Healthwide dictability Media of these decelerations.” range of possibilities, this fetal heart rate pattern justifies close attention. For exam- “Fetal bradycardia” and “prolonged ple,Copyright repetitive Forprolonged personal decelerations use may onlydeceleration” are distinct entities indicate cord compression from oligohy- In general parlance, we often use the terms dramnios. Even more troubling, a pro- “fetal bradycardia” and “prolonged decel- longed deceleration may occur for the first eration” loosely. In practice, we must dif- IN THIS ARTICLE time during the evolution of a profound ferentiate these entities because underlying catastrophe, such as amniotic fluid pathophysiologic mechanisms and clinical 3 FHR patterns: embolism or uterine rupture during vagi- management may differ substantially. What would nal birth after cesarean delivery (VBAC). The problem: Since the introduction In some circumstances, a prolonged decel- of electronic fetal monitoring (EFM) in you do? eration may be the terminus of a progres- the 1960s, numerous descriptions of FHR ❙ Complete heart sion of nonreassuring fetal heart rate patterns have been published, each slight- block (FHR) changes, and becomes the immedi- ly different from the others.
    [Show full text]
  • Evaluation of Nipple Discharge
    New 2016 American College of Radiology ACR Appropriateness Criteria® Evaluation of Nipple Discharge Variant 1: Physiologic nipple discharge. Female of any age. Initial imaging examination. Radiologic Procedure Rating Comments RRL* Mammography diagnostic 1 See references [2,4-7]. ☢☢ Digital breast tomosynthesis diagnostic 1 See references [2,4-7]. ☢☢ US breast 1 See references [2,4-7]. O MRI breast without and with IV contrast 1 See references [2,4-7]. O MRI breast without IV contrast 1 See references [2,4-7]. O FDG-PEM 1 See references [2,4-7]. ☢☢☢☢ Sestamibi MBI 1 See references [2,4-7]. ☢☢☢ Ductography 1 See references [2,4-7]. ☢☢ Image-guided core biopsy breast 1 See references [2,4-7]. Varies Image-guided fine needle aspiration breast 1 Varies *Relative Rating Scale: 1,2,3 Usually not appropriate; 4,5,6 May be appropriate; 7,8,9 Usually appropriate Radiation Level Variant 2: Pathologic nipple discharge. Male or female 40 years of age or older. Initial imaging examination. Radiologic Procedure Rating Comments RRL* See references [3,6,8,10,13,14,16,25- Mammography diagnostic 9 29,32,34,42-44,71-73]. ☢☢ See references [3,6,8,10,13,14,16,25- Digital breast tomosynthesis diagnostic 9 29,32,34,42-44,71-73]. ☢☢ US is usually complementary to mammography. It can be an alternative to mammography if the patient had a recent US breast 9 mammogram or is pregnant. See O references [3,5,10,12,13,16,25,30,31,45- 49]. MRI breast without and with IV contrast 1 See references [3,8,23,24,35,46,51-55].
    [Show full text]
  • Burns, Hypertrophic Scar and Galactorrhea
    Karimi H et al. Injury & Violence 117 J Inj Violence Res. 2013 Jun; 5(2): 117-119. doi: 10.5249/ jivr.v5i2.314 Case Report Burns, hypertrophic scar and galactorrhea Hamid Karimi a , Samad Nourizad a ,* , Mahnoush Momeni a, Hosein Rahbar a, Mazdak Momeni b, Khosro Farhadi c a Faculty of Medicine, Tehran University of Medical Sciences,Tehran, Iran. b Baylor College of Medicine, Houston, Texas, USA. c Department of Anesthesiology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran. Abstract: An 18-year old woman was admitted to Motahari Burn Center suffering from 30% burns. KEY WORDS Treatment modalities were carried out for the patient and she was discharged after 20 days. Three to four months later she developed hypertrophic scar on her chest and upper limbs. At the same time she developed galactorrhea in both breasts and had a disturbed menstrual cycle four Burns months post-burn. On investigation, we found hyperprolactinemia and no other reasons for the Hypertrophic scar high level of prolactin were detected. Galactorrhea She received treatment for both the hypertrophic scar and the severe itching she was experiencing. After seven months, her prolactin level had decreased but had not returned to the normal level. It seems that refractory hypertrophic scar is related to the high level of prolactin in burns patients. Received 2012-09-28 Accepted 2013-01-23 © 2013 KUMS, All rights reserved *Corresponding Author at: Dr. Samad Nourizad: Department of Anesthesiology, Tehran University of Medical Science, Tehran, Iran, Email: [email protected] (Nourizad S.). © 2013 KUMS, All rights reserved Introduction sis, i.e.
    [Show full text]
  • OBGYN-Study-Guide-1.Pdf
    OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test.
    [Show full text]
  • Nipple Discharge-1
    Nipple Discharge Epworth Healthcare Benign Breast Disease Symposium November 12th 2016 Jane O’Brien Specialist Breast and Oncoplastic Surgeon What is Nipple Discharge? Nipple discharge is the release of fluid from the nipple Based on the characteristics of presentation Nipple Discharge is categorized as: • Physiologic nipple discharge • Normal milk production (lactation) • Pathologic nipple discharge 27-Jun-20 2 • Nipple discharge is the one of the most commonly encountered breast complaints • 5-10% percent of women referred because of symptoms of a breast disorder have nipple discharge • Nipple discharge is the third most common presenting symptom to breast clinics (behind lump/lumpiness and breast pain) • Most nipple discharge is of benign origin 27-Jun-20 3 • Less than 5% of women with breast cancer have nipple discharge, and most of these women have other symptoms, such as a lump or newly inverted nipple, as well as the nipple discharge • Mammography and ultrasound have a low sensitivity and specificity for diagnosing the cause of nipple discharge • Nipple smear cytology has a low sensitivity and positive predictive value • The risk of an underlying malignancy is increased if the nipple discharge is spontaneous and single duct 27-Jun-20 4 Physiological Nipple Discharge • Fluid can be obtained from the nipples of 50–80% of asymptomatic women when massage/squeezing used. • This discharge of fluid from a normal breast is referred to as 'physiological discharge' • It is usually yellow, milky, or green in appearance; does not occur spontaneously;
    [Show full text]
  • Sheehan's Syndrome and Lymphocytic Hypophysitis Fact Sheet for Patients
    1 Sheehan’s Syndrome and Lymphocytic Hypophysitis Fact sheet for patients Sheehan’s Syndrome and Lymphocytic Hypophysitis (LH) can present after childbirth, in similar ways. However, in Sheehan’s there is a history of profound blood loss and imaging of the pituitary will not show a mass lesion. In Lymphocytic Hypophysitis, there is normal delivery and post-partum, and it can be a month or more after delivery that symptoms start. An MRI in this instance may show a pituitary mass and thickened stalk. Management of Sheehan’s is appropriate replacement of hormones, in LH - replacement hormones and in some circumstances, steroids and surgical biopsy. The key of course is being seen by an endocrinologist with expertise in pituitary and not accepting the overwhelming features of hypopituitarism as just ‘normal’. If features of Diabetes Insipidus are present the diagnosis is usually easier, as severe thirst and passing copious amounts of urine will be present. Sheehan’s syndrome Sheehan’s syndrome is a rare condition in which severe bleeding during childbirth causes damage to the pituitary gland. The damage to pituitary tissue may result in pituitary hormone deficiencies (hypopituitarism), which can mean lifelong hormone replacement. What causes Sheehan’s syndrome? During pregnancy, an increased amount of the hormone oestrogen in the body causes an increase in the size of the pituitary gland and the volume of blood flowing through it. This makes the pituitary gland more vulnerable to damage from loss of blood. If heavy bleeding occurs during or immediately after childbirth, there will be a sudden decrease in the blood supply to the already vulnerable pituitary gland.
    [Show full text]
  • Effectiveness of Bromocriptine Monotherapy Or Combination
    CURRENT THERAPEUTIC RESEARCH VOLUME 7[, NUMBFR 4, AUGUST 2010 Effectiveness of Bromocriptine Monotherapy or Combination Treatment With Clomiphene for Infertility in Women With Galactorrhea and Normal Prolactin: A Systematic Review and Meta-Analysis Tao Xue, MD; Shang-Wei Li, MD; and Yan Wang, MD Reproductive Medical Center of West China Second Hospital, Sichuan University, Cbengdu, China ABSTRACT BACKGROUND: Among women with unexplained infertility, 28% to 55% of patients with galactorrhea are normoprolactinemic. Bromocriptine, a common treat­ ment for infertile women with hyperprolactinemia, has been used in the treatment of unexplained subfertility in women with galactorrhea and normal prolactin; however, its effectiveness and safety profile have never been determined. OBJECTIVE: The aim of this study was to determine the relative effectiveness and safety profile of bromocriptine monotherapy or as an adjunct to clomiphene cit­ rate in women with galactorrhea and normal prolactin levels. METHODS: We conducted a search of the Cochrane Subferriliry Review Group specialized register of controlled trials (March 2010), CENTRAL (The Cochrane Library, Issue 3, 2010), MEDLINE (1950-March 2010), EMBASE 0980-March 2010), and the China Biological Medicine Database (inception to March 2010) for relevant randomized controlled trials (RCTs) using the following terms: controlled, randomized, blinded, clinical trials,humans, galactorrhea, prolactin, bromocriptine, mfertility, and subfertility. Additionally, reference lim of identified articles were searched for relevant articles. RESULTS: Of the 8 studies identified, 5 were excluded after full-text review for the following reasons: lack of a placebo group (2); difference in cointerventions (1); difference in end points (1); and systematic review (1). Therefore, 3 RCTs were in­ cluded in this review.
    [Show full text]
  • Pretest Obstetrics and Gynecology
    Obstetrics and Gynecology PreTestTM Self-Assessment and Review Notice Medicine is an ever-changing science. As new research and clinical experience broaden our knowledge, changes in treatment and drug therapy are required. The authors and the publisher of this work have checked with sources believed to be reliable in their efforts to provide information that is complete and generally in accord with the standards accepted at the time of publication. However, in view of the possibility of human error or changes in medical sciences, neither the authors nor the publisher nor any other party who has been involved in the preparation or publication of this work warrants that the information contained herein is in every respect accurate or complete, and they disclaim all responsibility for any errors or omissions or for the results obtained from use of the information contained in this work. Readers are encouraged to confirm the information contained herein with other sources. For example and in particular, readers are advised to check the prod- uct information sheet included in the package of each drug they plan to administer to be certain that the information contained in this work is accurate and that changes have not been made in the recommended dose or in the contraindications for administration. This recommendation is of particular importance in connection with new or infrequently used drugs. Obstetrics and Gynecology PreTestTM Self-Assessment and Review Twelfth Edition Karen M. Schneider, MD Associate Professor Department of Obstetrics, Gynecology, and Reproductive Sciences University of Texas Houston Medical School Houston, Texas Stephen K. Patrick, MD Residency Program Director Obstetrics and Gynecology The Methodist Health System Dallas Dallas, Texas New York Chicago San Francisco Lisbon London Madrid Mexico City Milan New Delhi San Juan Seoul Singapore Sydney Toronto Copyright © 2009 by The McGraw-Hill Companies, Inc.
    [Show full text]