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  • 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.
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  • OB/GYN EMERGENCIES Elyse Watkins, Dhsc, PA-C, DFAAPA DISCLOSURES
    OB/GYN EMERGENCIES Elyse Watkins, DHSc, PA-C, DFAAPA DISCLOSURES I have no financial relationships to disclose. TOPICS Ovarian torsion Postpartum hemorrhage Ruptured ectopic Acute uterine inversion pregnancy Amniotic fluid embolism Acute menorrhagia Placental abruption OVARIAN TORSION OVARIAN TORSION .Tumors (benign and malignant) are implicated in 50-60% of cases of torsion .20% occur during pregnancy (corpus luteum cyst) .Unilateral or bilateral abdominal-pelvic pain, usually sudden onset .Exercise or movement exacerbates pain .Nausea and vomiting 70% .Pathophys: reduced venous return, stromal edema, internal hemorrhage, and infarction → necrosis OVARIAN TORSION .Physical exam variable .Ultrasonography with color Doppler .Surgical referral RUPTURED ECTOPIC PREGNANCY RUPTURED ECTOPIC PREGNANCY .All patients of reproductive age with a hx of missed menses and pelvic pain should be considered to have an ectopic pregnancy until proven otherwise. .A patient with missed menses, irregular vaginal bleeding, pelvic pain, syncope, abdominal pain, and/or dizziness should be managed as a ruptured ectopic pregnancy until proven otherwise. RUPTURED ECTOPIC PREGNANCY .Physical exam of pts with a ruptured ectopic can reveal pelvic tenderness, an adnexal mass, and evidence of hemodynamic compromise. .A transvaginal ultrasound will often show an adnexal mass and/or fluid in the pouch of Douglas. .The serum qualitative βHCG will be > 5 mIu/mL. RUPTURED ECTOPIC PREGNANCY HTTPS://YOUTU.BE/TNN1FPWHOXS RUPTURED ECTOPIC PREGNANCY .Immediately order an H/H, type and cross, and place large bore IV access for fluid support. .Laparotomy is performed when patients are hemodynamically unstable or if visualization during laparoscopy was difficult. .Patients with a ruptured ectopic pregnancy must be managed emergently and surgically! ACUTE MENORRHAGIA ACUTE MENORRHAGIA .Abnormal uterine bleeding (AUB) can result in acute blood loss that causes hemodynamic compromise so prompt evaluation of vital signs is important.
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  • Heterotopic Cervical Pregnancy
    Elmer ress Case Report J Clin Gynecol Obstet. 2015;4(4):307-311 Heterotopic Cervical Pregnancy Mathangi Thangavelua, b, Ravinder Kalkata Abstract tenderness or cervical excitation. Initial hormonal investiga- tions showed BHCG levels were raised to 17,276 IU and ini- We report a rare case of heterotopic cervical pregnancy, which posed tial ultrasound was suggestive of minimal retained products diagnostic challenge. With increasing IVF treatment and raising ce- of conception (Fig. 1). However, a repeat BHCG showed an sarean section rate, there is increasing incidence for non-tubal hetero- increasing trend reaching up to 29,971 IU in 96 h. A repeat topic pregnancy. We have discussed the clinical course of our case, transvaginal scan showed the endometrial cavity had mixed diagnosis and management of cervical pregnancy and some good echoes and multiple cystic spaces, largest measuring 6 × 7 × medical practices to avoid missing atypical presentations of ectopic 8 mm with color flow suggesting a possible molar pregnancy pregnancy. (Fig. 2). Bilateral ovarian cysts were present in both adnexa. Laparoscopy and dilatation and curettage were arranged Keywords: Cervical pregnancy; Heterotopic; Ectopic in view of high BHCG levels and no clear evidence of intrau- terine pregnancy. Laparoscopy was negative for tubal ectopic pregnancy and dilatation and curettage was performed. Post- operatively BHCG levels were monitored to ensure its levels were declining. The levels initially dropped to 2,611 IU from Introduction 29,971 IU in a week after D&C. However, the subsequent BHCG levels doubled to 4,207 IU 2 weeks after D&C. With We report an extremely rare case of spontaneous heterotopic the knowledge of earlier scan findings, raising BHCG levels cervical pregnancy who needed multiple investigations before raised the concern of persistent trophoblastic disease.
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  • Breastfeeding Management in Primary Care-FINAL-Part 2.Pptx
    Breastfeeding Management in Primary Care Pt 2 Heggie, Licari, Turner May 25 '17 5/15/17 Case 3 – Sore nipples • G3P3 mom with sore nipples, baby 5 days old, full term, Breaseeding Management in yellow stools, output normal per BF log, 5 % wt loss. Primary Care - Part 2 • Mother exam: both nipples with erythema, cracked and scabbed at p, areola mildly swollen, breasts engorged and moderately tender, mild diffuse erythema, no mass. • Baby exam: strong but “chompy” suck, thick ght frenulum aached to p of tongue, with restricted tongue movement- poor lateral tracking, unable to extend tongue past gum line or lower lip, minimal tongue elevaon. May 25, 2017, Duluth, MN • Breaseeding observaon: Baby has deep latch, mom Pamela Heggie MD, IBCLC, FAAP, FABM Addie Licari, MD, FAAFP with good posioning, swallows heard and also Lorraine Turner, MD, ABIHM intermient clicking. Mom reports pain during feeding. Sore cracked nipple Type 1 - Ankyloglossia Sore Nipples § “Normal” nipple soreness is very minimal and ok only if: ü Poor latch § Nipple “tugging” brief (< 30 sec) with latch-on then resolves ü LATCH, LATCH, LATCH § No pain throughout feeding or in between feeds ü Skin breakdown/cracks-staph colonizaon § No skin damage ü Engorgement § Some women are told “the latch looks ok”… but they are in pain and curling their toes ü Trauma from pumping ü § It doesn’t maer how it “looks” … if mom is uncomfortable Nipple Shields it’s a problem and baby not geng much milk…set up for low ü Vasospasm milk supply ü Blocked nipple pore/Nipple bleb § Nipple pain is
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  • Olivar C Castejon S. the Histomorphology of Tiny Lobes from the Bilobed Placenta
    Cell & Cellular Life Sciences Journal MEDWIN PUBLISHERS ISSN: 2578-4811 Committed to Create Value for researchers The Histomorphology of Tiny Lobes from the Bilobed Placenta Olivar C Castejon S* Research Article Faculty of Health Sciences, University of Carabobo, Venezuela Volume 5 Issue 1 Received Date: January 24, 2020 *Corresponding author: Olivar C Castejon Moc, Faculty of Health Sciences, Laboratory of Published Date: February 14, 2020 Electron Microscopy, Center for Research and Teaching Analysis of the Aragua Nucleus, CIADANA, DOI: 10.23880/cclsj-16000149 Aragua State, Maracay, Venezuela, Email: [email protected] Abstract Two bilobed placentas were obtained of woman pregnancy at 37 and 38 weeks of gestation with newborns live and examined the villous tree with light microscope. Two small lobes were found in one placenta and other in the second placenta. Two normal placentas were taken as control. Ten histological samples by each lobe were processed with H&E stain. Five biopsies by each normal placenta were taken and three histological slides by biopsy were dyed equally. Degenerative changes at level of vessels of the placental villi were noted in stem villi: stromal lysis, multiple capillarity, congestioned vessels, and increased villi, in immature villi the vessels are near to the syncytium indicating extensive hypoxic villous damage. In this condition a dilatation of vessels. Regions of immature villi, pre- infarcts, deficiency of terminal villi in mature intermediate villi, destroyed diminution of the blood flow or events of thrombosis could to be affecting the growth of these small lobules. Keywords: Tiny Placental Lobes; Degenerative Changes; Bipartite Placenta Abbreviations: VEGF: Vascular Endothelial Growth The origen of the bilobed placenta is unknown.
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  • ABCDE Acronym Blood Transfusion 231 Major Trauma 234 Maternal
    Cambridge University Press 978-0-521-26827-1 - Obstetric and Intrapartum Emergencies: A Practical Guide to Management Edwin Chandraharan and Sir Sabaratnam Arulkumaran Index More information Index ABCDE acronym albumin, blood plasma levels 7 arterial blood gas (ABG) 188 blood transfusion 231 allergic anaphylaxis 229 arterio-venous occlusions 166–167 major trauma 234 maternal collapse 12, 130–131 amiadarone, overdose 178 aspiration 10, 246 newborn infant 241 amniocentesis 234 aspirin 26, 180–181 resuscitation 127–131 amniotic fluid embolism 48–51 assisted reproduction 93 abdomen caesarean section 257 asthma 4, 150, 151, 152, 185 examination after trauma 234 massive haemorrhage 33 pain in pregnancy 154–160, 161 maternal collapse 10, 13, 128 atracurium, drug reactions 231 accreta, placenta 250, 252, 255 anaemia, physiological 1, 7 atrial fibrillation 205 ACE inhibitors, overdose 178 anaerobic metabolism 242 automated external defibrillator (AED) 12 acid–base analysis 104 anaesthesia. See general anaesthesia awareness under anaesthesia 215, 217 acidosis 94, 180–181, 186, 242 anal incontinence 138–139 ACTH levels 210 analgesia 11, 100, 218 barbiturates, overdose 178 activated charcoal 177, 180–181 anaphylaxis 11, 227–228, 229–231 behaviour/beliefs, psychiatric activated partial thromboplastin time antacid prophylaxis 217 emergencies 172 (APTT) 19, 21 antenatal screening, DVT 16 benign intracranial hypertension 166 activated protein C 46 antepartum haemorrhage 33, 93–94. benzodiazepines, overdose 178 Addison’s disease 208–209 See also massive
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  • Ectopic Pregnancy
    Ectopic Pregnancy P atient Information Women’s Health Service What is an Ectopic Pregnancy? Symptoms include one or more of the following; An ectopic pregnancy is where the fertilised egg Pain on one side of the lower abdomen. It implants outside the uterus (womb), most may develop sharply, or may slowly get commonly in the fallopian tube (the tube that worse over several days. It can become connects the ovary to the uterus). severe. Vaginal bleeding often occurs, but not Rarely an ectopic pregnancy can occur in the ovary, always. It is often different to the bleeding cervix or abdominal cavity. It usually occurs in the of a period. For example, the bleeding may first ten weeks of pregnancy. be heavier or lighter than a normal period. About 1 in 100 pregnancies in is ectopic. This figure The blood may look darker. However, you rises to 5 in 100 after assisted conception therapies may think the bleeding is a late period. and to 20-30 in 100 after tubal damage due to Other symptoms may occur such as infection or tubal surgery. diarrhoea, feeling faint, or pain on passing faeces (stools). What are the possible causes of an ectopic Shoulder-tip pain may develop. This is due pregnancy? to some blood leaking into the abdomen The chances of having an ectopic pregnancy can be and irritating the diaphragm (the muscle increased by the following: used to breathe). Tubal damage from pelvic infection, If the fallopian tube ruptures and causes endometriosis or appendicitis internal bleeding, you may develop severe Women who have had previous abdominal pain or ‘collapse’.
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  • Elective Induction of Labor at 39 Weeks in Low-Risk Nulliparous Patients Does Not Increase the Risk of Adverse Perinatal Outcome
    Elective induction of labor at 39 weeks in low-risk nulliparous patients does not increase the risk of adverse perinatal outcomes, according to ARRIVE trial investigators. ILLUSTRATION: KIMBERLY MARTENS FOR OBG MANAGEMENT MARTENS KIMBERLY ILLUSTRATION: 36 OBG Management | January 2019 | Vol. 31 No. 1 mdedge.com/obgyn Obstetrics UPDATE Jaimey M. Pauli, MD Dr. Pauli is Associate Professor and Attending Perinatologist, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania. The author reports no financial relationships relevant to this article. What are the clinical implications of trial results on these 2 delivery-related issues: timing of elective induction of labor and timing of pushing in the second stage? Plus, ACOG’s new recommendations for optimizing postpartum care. he past year was an exciting one in Finally, the American College of Obstetri- obstetrics. The landmark ARRIVE trial cians and Gynecologists (ACOG) placed new T presented at the Society for Mater- emphasis on the oft overlooked but increas- nal-Fetal Medicine’s (SMFM) annual meet- ingly more complicated postpartum period, ing and subsequently published in the New offering guidance to support improving care IN THIS England Journal of Medicine contradicted a for women in this transitional period. ARTICLE long-held belief about the safety of elective Ultimately, this was the year of the labor induction. In a large randomized trial, patient, as research, clinical guidelines, and Labor induction Cahill and colleagues took a controversial education focused on how to achieve the best at 39 weeks but practical clinical question about second- in safety and quality of care for delivery plan- This page stage labor management and answered it for ning, the delivery itself, and the so-called the practicing obstetrician in the trenches.
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  • Cervical Insufficiency
    Cervical Insufficiency Sonia S. Hassan, MD 1,4 , Roberto Romero, MD 1,2,3 , Francesca Gotsch, MD 5, Lorraine Nikita, RN 1, and Tinnakorn Chaiworapongsa, MD 1,4 1Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA; 2Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA; 3Department of Epidemiology, Michigan State University, East Lansing, Michigan, USA., 4Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA, 5Department of Obstetrics and Gynecology Azienda Ospedaliera Universitaria Integrata Verona, Italy 1 Introduction The uterine cervix has a central role in the maintenance of pregnancy and in normal parturition. Preterm cervical ripening may lead to cervical insufficiency or preterm delivery. Moreover, delayed cervical ripening has been implicated in a prolonged latent phase of labor at term. This chapter will review the anatomy and physiology of the uterine cervix during pregnancy and focus on the diagnostic and therapeutic challenges of cervical insufficiency and the role of cerclage in obstetrics. Anatomy The uterus is composed of three parts: corpus, isthmus and cervix. The corpus is the upper segment of the organ and predominantly contains smooth muscle (myometrium). The isthmus lies between the anatomical internal os of the cervix and the histological internal os, and during labor, gives rise to the lower uterine segment. The anatomical internal os refers to the junction between the uterine cavity and the cervical canal, while the histologic internal os is the region where the epithelium changes from endometrial to endocervical.1 The term “fibromuscular junction” was introduced by Danforth, who identified the boundary between the connective tissue of the cervix and the myometrium.
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  • Ask the Experts Amniotic Fluid Embolism Steven L. Clark, MD
    Ask the Experts Questions have been written by: Amniotic Fluid Embolism Angela K. Hardyk, MD Mount Nittany Physician Group Ob/Gyn Steven L. Clark, MD State College, PA (Obstet Gynecol 2014;123:337–48) Responses have been written by: Steven L. Clark, MD Hospital Corporation of America Nashville, TN Question 1: How would you counsel a patient about a future pregnancy if she has been lucky enough to survive an amniotic fl uid embolism (AFE)? Would there be any special precautions she would need to take for her next pregnancy? Response from Dr. Clark: The available data in this area consist only of several very small series and case reports. These data suggest that the risks of recurrence are low. In addition, a pathophysiologic mechanism of disease that hinges on a maternal reaction to a specif- ic set of fetal antigens would suggest that recurrence ought to be uncommon. On the other hand, having dodged one bullet, is it really wise to spin the wheel again? My counseling goes something like this: “Available data suggest that the risk of recurrence is low, and there are a number of reports of successful pregnancy outcome after AFE survival. However, given the potential severity of AFE if it does recur, and a lack of really good data regarding risks, I advise you to undertake another pregnancy only if you are willing to accept a small risk of catastrophic outcome including death.” If a patient chooses to undertake pregnancy, I do not alter my management in any way, other than delivery in a tertiary center.
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  • Successful Treatment of Cervical Ectopic Pregnancy with Multi Dose
    Case Report iMedPub Journals Gynaecology & Obstetrics Case report 2020 www.imedpub.com ISSN 2471-8165 Vol.6 No.2:14 DOI: 10.36648/2471-8165.6.2.94 Successful Treatment of Cervical Ectopic Iqbal S1*, Iqbal J2, Nowshad N1 and Pregnancy with Multi Dose Methotrexate Mohammad K1 Therapy 1 Department of Obstetrics and Gynecology, Latifa Hospital, Dubai Health Authority Jaddaf, Dubai, UAE 2 Department of Medical Education, Dubai Abstract Medical University, Dubai, UAE Cervical ectopic pregnancies account for less than 1% of all pregnancies. Earlier, it was associated with significant hemorrhage and was treated presumptively with hysterectomy. With the advent of enhanced ultrasound techniques, early *Corresponding author: Iqbal S detection of these pregnancies has led to the development of more effective conservative management. We present a case of a cervical ectopic pregnancy successfully treated with multi-dose Methotrexate therapy. [email protected] A 37-year-old lady, G3P0+2, pregnant for 9 weeks and 4 days, presented with bleeding per vagina, mild lower abdomen and back pain. Serum Beta-hCG done Department of Obstetrics and Gynecology, 5 days ago was 950 mIU/mL. She was diagnosed as ectopic cervical pregnancy Latifa Hospital, Dubai Health Authority by clinical examination which was confirmed by transvaginal ultrasonography Jaddaf, Dubai, UAE. and subsequently managed by Methotrexate (MTX) Hybrid double dose protocol. Due to rising Beta-hCG and continuous bleeding, it was modified to Multi dose Tel: 971569400124 Methotrexate Therapy. Thereafter, the patient was asymptomatic with falling beta-hCG and she was put on a weekly follow up in the clinic. Keywords: Ectopic pregnancy; Cervical pregnancy; Methrotrexate; Gynaecology Citation: Iqbal S, Iqbal J, Nowshad N, Mohammad K (2020) Successful Treatment of Cervical Ectopic Pregnancy with Multi Received: March 31, 2020; Accepted: May 02, 2020; Published: May 06, 2020 Dose Methotrexate Therapy.
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  • OB Care Packet
    You and Your Pregnancy Congratulations You’re Having A Baby! 1 Table of Contents Welcome 3 Your Pregnancy Timeline 4 Financial Breakdown 5 Frequently Asked Questions 6 Warnings: Things to Avoid 9 When to Call Your Doctor 9 Vaccines 9 Traveling while Pregnant 10 Managing Morning Sickness 10 Dental Care in Pregnancy 11 Prenatal Testing Information 11 How Big is Your Baby? 13 Cervical Dilation 13 Postpartum Care 15 Community Resource Line 17 Health and Welfare Child 17 Protection Safe Haven Idaho Law 17 Childcare and Breastfeeding 18 Classes and Support Parenting Classes 18 Family Nurse Partnership 18 2 We are so grateful you chose us to partner with you and your family on this new journey. We hope this Welcome to packet answers some questions you may have on prenatal care how to have a healthy pregnancy. Our promise to you - With integrated medical, dental and behavioral health with Terry Reilly services, our healthcare professionals work together to make sure that you and your health concerns never go unnoticed. We see success when you and your family are healthy and thriving. In order to provide the best care and experience, we strive to ensure that you are informed about services, appointments, financial responsibilities, payment options, and have access to your health information. 3 WEEKS 6-12 Your Pregnancy Timeline • Confirm pregnancy • Lab tests • Optional blood screening tests • Hospital preregistration • First visit with your clinician • Confirm genetic testing • Discuss genetic testing options • Review lab results • Educational
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