Dr amirah zainab binti mamat @muhammad

111303208
manipal melaka medical college

Side effects of labetalol

Excessive tiredness, difficulty

sleeping
Diminished sexual function
Orthostatic hypotension ( due to
alpha receptor blockade)
Hyperkalemia
Hepatotoxicity
Respiratory distrsss ( rare)
Tingling sclap or skin
Dizziness
Lightheadness
Upset stomach
Stuffy nose
Fatigue

Indication labetalol( beta blocker)

Tx pih ass preeclampsia

Tx chronic and acute
hypertension of
pheochromocytoma
Hypertensive crisis
contraindications
Asthma
Congestive heart failure
Any degree of heart block
Bradycardia
Hypotension
Cardiogenic shock

Risk factors of placenta

Womenpraviea
who are younger
Previous placenta previa
(recurrence rate 4-8%),[5]
caesarean delivery,[6]
myomectomy [7]
endometrium damage caused by
D&C.[5]
Alcohol use during pregnancy.[8]
Women who have had previous
pregnancies, especially a large
number of closely spaced
pregnancies, are at higher risk due
to uterine damage.[7]
Smoking during pregnancy ;[1
] cocaine use during pregnancy[9][10]

than 20
and women older than 35.
Women with a large
placentae from twins or
erythroblastosis
Race- Asia and africa
Placental pathology-(
Vellamentous insertion,
succinturiate lobes,
bipartite i.e. bilobed
placenta etc.)[5]
Placenta previa is itself a risk
factor of placenta accreta.

What is cervical cancer

Cervical cancer starts in the cells
lining the cervix -- the lower part
of the uterus (womb). This is
sometimes called theuterine
cervix. The fetus grows in the
body of the uterus (the upper
part). The cervix connects the
body of the uterus to the vagina
(birth canal). The part of the
cervix closest to the body of the
uterus is called the endocervix.
The part next to the vagina is
the exocervix (or ectocervix)..

The 2 main types of cells

covering the cervix
are squamous cells (on the
exocervix) and glandular ce
lls (on the endocervix).
These 2 cell types meet at a
place called
the transformation zone.The
exact location of the
transformation zone changes
as you age and if you give
birth

Tranformation zone
This dysplasia increases the risk of
cancer forming in the transformation
zone, which is the most common area for
cervical cancer to occur.[40] Vaccines
against HPV, such as Gardasil and
Cervarix, reduce the incidence of
cervical cancer, by inoculating against
the viral strains involved in cancer
development.[41]
[41] The colposcope, used in a colposcopy
to visualise the cervix,.
A LEEP procedure using a heated loop
of platinum to excise a patch of cervical
tissue
UK, the Pap test has been superseded
with liquid-based cytology

Potentially precancerous
changes in the cervix can be
detected by
cervical screening, using
methods including a
Pap smear (also called a
cervical smear), in which
epithelial cells are scraped
from the surface of the cervix
examined under a microscop
e
.

Contents of mirena

The intrauterine device (IUD)

with progestogen is a hormonal
intrauterine device classified as a
long-acting reversible
contraceptivemethod. It is one of
the most effective forms of birth
control.[2]
(UK), the IUD with progestogen
is referred to as an intrauterine
system (IUS) or intrauterine
contraceptive (IUC
devices as the hormonal IUD to
distinguish from IUD with copper
. Mirena is one brand available in
the United States and UK.

In addition to birth control,

hormonal IUD are used for
prevention and treatment of:
Menorrhagia (heavy periods)[3]
Endometriosis and
chronic pelvic pain [3][4]
Adenomyosis and
Dysmenorrhea [3][5]
Anemia
In some cases, use of a
hormonal IUD may prevent a
need for a hysterectomy.[7]

 Advantages
Is one of the most effective forms of
reversible birth control[2]
It can be used while breastfeeding[8]
No preparations needed before sex to
ensure it works
Ability to become pregnant returns
quickly when removed
Fewer menstrual cramps
Lighter periods and less blood (some
women stop having periods
completely)
Effective for three-five years
(depending on the IUD)
Less likely to interact with other
medications and safe for women
with medical problems

Disadvantages
Irregular periods and
spotting between
periods often occurs
after insertion, but this
usually improves after
3 to 6 months
Cramping or
backache can occur at
insertion
Mild to moderate
discomfort during
insertion procedure

Effectiveness
After insertion Mirena is effective for 5 -7 years.
Skyla is effective for 3 years.
The hormonal IUD is considered to be a
long-acting reversible contraceptive, among the most effective
forms of birth control.
The first year failure rate for the hormonal IUD is 0.2% and the
five year failure rate is 0.7%.
These rates are comparable to tubal sterilization, but the effects
of the hormonal IUD are reversible.
The hormonal IUD is considered to be more effective than
other common forms of reversible contraception, such as the
birth control pill, because it requires little to no action by the
user after insertion.
The effectiveness of other forms of birth control is mitigated by the users
themselves. If medication regimens for contraception are not followed
precisely, the method becomes less effective. IUDs require no daily, weekly,
or monthly regimen, so their typical use failure rate is therefore the same as

Weight gain
Adverse effects
Headache, migraine
Ovarian Cysts: Enlarged follicles
Nausea
(ovarian cysts) have been
diagnosed in about 12% of the
Acne
subjects using a hormonal IUD.
Most of these follicles are
Excessive hairiness
asymptomatic, although some
may be accompanied by pelvic
Lower abdominal or
pain or dyspareunia. In most
back pain
cases the enlarged follicles
disappear spontaneously after
Decreased libido
two to three months. Surgical
intervention is not usually

Itching, redness or
required.
swelling of the
Mental health changes including:
nervousness, depressed mood,
vagina
mood swings

 A "lost coil" occurs when

the thread cannot be felt by
a woman on routine
checking and is not seen on
speculum
examination.Various thread
collector devices or simple
forceps may then be used to
try to grasp the device
through the cervix.
In the rare cases when this
is unsuccessful, an ultrasound
scan may be arranged to check
the position of the coil and
exclude its perforation through
into the abdominal cavity or its
unrecognised previous expulsion.

Pregnancy complications:
Although the risk of pregnancy with
an IUD is very small, if one does
occur there is an increased risk of
serious problems. These include
ectopic pregnancy,
infection
miscarriage
early labor
delivery. As many as half the
pregnancies that occur in Mirena users
may be ectopic. The incidence rate of
ectopic pregnancies is approximately 1
per 1000 users per year.Immediate

removal the IUD is

recommended in the case of
pregnancy.

 Irregular menstrual pattern: irregular

bleeding and spotting is common in the
first 3 to 6 months of use. After that
time periods become shorter and lighter,
and 20% of women stop having periods
after 1 year of use
Cramping and Pain: many women feel
discomfort or pain during and
immediately after insertion. Some
women may have cramping for the first
12 weeks after insertion
Expulsion: Sometimes the IUD can slip
out of the uterus.. Around 5% of IUD
users experience expulsion. If this
happens a woman is not protected from
pregnancy. Expulsion is more common
in younger women, women who have not
had children, and when an IUS is
inserted immediately after childbirth or
abortion

Infection: The insertion of the

IUD does have a small risk of

pelvic inflammatory disease

(PID).
Concurrent infection with
gonorrhea
chlamydia at the time of
insertion increases the risk
of pelvic inflammatory
disease. If PID does occur, it
will most likely happen
within 21 days of insertion.
The device itself does not
increase the risk of
infection.

Perforation: Very rarely, the IUD

can be pushed through the wall of
the uterus during insertion.
Risk of perforation is mostly
determined by the skill of the
practitioner performing the insertion.
For experienced medical
practitioners, the risk of
perforation is 1 per 1,000
insertions or less. With postpartum
insertions, perforation of the uterus
is more likely to occur when uterine
involution is incomplete; involution
usually completes by 46 weeks
postpartum.

Special considerations
apply to women who plan
to breastfeed. If
perforation does occur it
can damage the internal
organs, and in some cases
surgery is needed to
remove the IUD.

Contraindications

A hormonal IUD should not be used

by women who:
Are, or think they may be, pregnant
Have abnormal vaginal bleeding that
has not been explained
Have untreated cervical or uterine
cancer
Have, or may have, breast cancer
Have abnormalities of the cervix or
uterus
Have had
pelvic inflammatory disease within
the past 3 months
Have liver disease or tumor
Have an allergy to levonorgestrel
or any of the inactive ingredients
included in the device

Have had an STI such as

chlamydia or gonorrhea within the
past 3 months
Insertion of an IUD is not
recommended for women having
had a D&E abortion(secondtrimester abortion) within the past
four weeks.
To reduce the risk of infection,
insertion of an IUS is not
recommended for women that have
had a medical abortion but have
not yet had an ultrasound to
confirm that the abortion was
complete, or that have not yet had
their first menstruation following
the medical abortion.

Pre-eclampsia

Preeclampsia is a disorder of pregnancy

characterized by high blood pressure and
large amounts of protein in the urine.
thrombocytopenia)
impaired liver function,
the development of new kidney
dysfunction,
fluid accumulation in the lungs (
pulmonary edema),
and/or new-onset brain or visual
disturbances.
Central to the effects of preeclampsia are
the resulting presence of uteroplacental
hypoxia (inadequate oxygen supply), an
imbalance in angiogenic and antiangiogenic proteins, oxidative stress,
maternal endothelial (lining of blood
vessels) dysfunction, and elevated
systemic inflammation.

It may develop after 20 weeks of

gestation, though most commonly
after 32 weeks. Preeclampsia
occurring before 32 weeks is
considered early-onset and is
associated with increased morbidity.[6]
Most cases are diagnosed before the
predicted time typical labor would
begin. Delivery of the fetus and
placenta is the only known treatment
for preeclampsia. Rarely,
preeclampsia may also occur in the
postpartum period.
Untreated, preeclampsia can develop
into eclampsia, the life-threatening
occurrence of seizures during
pregnancy. Preeclampsia is associated
with multiple maternal and fetal
adverse effects.

Diagnostic criteria

Pre-eclampsia is diagnosed when a pregnant

woman develops:
Blood pressure 140 mm Hg systolic or
90 mm Hg diastolic on two separate readings
taken at least four to six hours apart after 20
weeks gestation in an individual with
previously normal blood pressure.
Proteinuria 0.3 grams (300 mg) or more of
protein in a 24-hour urine sample or a SPOT
urinary protein to creatinine ratio 0.3 or a
urine dipstick reading of 1+ or greater (dipstick
reading should only be used if other quantitative
methods are not available).
Suspicion for preeclampsia should be
maintained in any pregnancy complicated by
elevated blood pressure, even in the absence of
proteinuria. Ten percent of individuals with
other signs and symptoms of preeclampsia and
20% of individuals diagnosed with eclampsia
show no evidence of proteinuria.
In the absence of proteinuria, the presence of
new-onset hypertension (elevated blood
pressure) and the new onset of one or more of
the following is suggestive of the diagnosis of
preeclampsia

Evidence of kidney dysfunction (oliguria, elevated

creatinine levels)
Impaired liver function (impaired liver function tests
)
Thrombocytopenia (platelet count
<100,000/microliter)
Pulmonary edema
Ankle edema pitting type
Cerebral or visual disturbances
Preeclampsia is a progressive disorder and these
signs of organ dysfunction are indicative of severe
preeclampsia. A systolic blood pressure 160 or
diastolic blood pressure 110 and/or proteinuria >5g
in a 24-hour period is also indicative of severe
preeclampsia.[7]
Clinically, individuals with severe preeclampsia
may also present epigastric/right upper quadrant
abdominal pain, headaches, and vomiting.[7]
Severe preeclampsia is a significant risk factor for
intrauterine fetal death.
Of note, a rise in baseline blood pressure (BP) of 30
mmHg systolic or 15 mmHg diastolic, while not
meeting the absolute criteria of 140/90, is still
considered important to note, but is not considered
diagnostic.

Risk factors

Nulliparity (never given birth)

Diabetes mellitus
Renal disease
Chronic hypertension
Prior history of preeclampsia
Family history of
preeclampsia
Advanced maternal age (>35
years)
Obesity
Antiphospholipid
antibody syndrome
Multiple gestation

Differential diagnosis

chronic hypertension
chronic renal disease
primary seizure disorders
gallbladder
pancreatic disease
immune or
thrombotic thrombocytopenic
purpura
antiphospholipid syndrome
hemolytic-uremic syndrome.
preexisting disease such as
hypertension
acute fatty liver of pregnancymay
also present with elevated blood
pressure and protein in the urine,
but differs by the extent of liver
damage.

Complication

Eclampsia-Warning symptoms for

eclampsia in an individual with
current preeclampsia may include
headaches, visual disturbances, and
right upper quadrant or epigastric
abdominal pain, with headache being
the most consistent symptom
the development of HELLP syndrome
hemolysis (microangiopathic)
elevated liver enzymes (liver
dysfunction)
low platelets (thrombocytopenia).
This condition may occur in 10-20%
of patients with severe preeclampsia
and eclampsia is associated with
increased maternal and fetal
morbidity and mortality. In 50% of
instances, HELLP syndrome develops
preterm, while 20% of cases develop
in late gestation and 30% during the
post-partum period

hemorrhagic or ischemic stroke

liver damage and dysfunction,
acute kidney injury
(ARDS).
increased frequency of Caesarian section
, preterm delivery, placental abruption.
Furthermore, an elevation in blood
pressure can occur in some individuals in
the first week postpartum attributable to
volume expansion and fluid
mobilization Fetal complicationsIUGR; potentially fetal or perinatal
death.
Long-term, an individual with
preeclampsia is at increased risk for
recurrence of preeclampsia in subsequent
pregnancies. There is also an increased
risk for cardiovascular complications,
including hypertension and ischemic
heart disease, and kidney disease.

Definition: Relationship of presenting part to

maternal pelvis: and based on presentation:

Cephalic presentation-Vertex
presentation with longitudinal lie:
Left occipitoanterior (LOA)the occiput is close
to the vagina (hence known as vertex
presentation) faces anteriorly (forward
with mother standing) and towards left.

This is the most common position and lie.

Right occipitoanterior (ROA)the occiput faces

anteriorly and towards right. Less common than

LOA, but not associated with labor
complications.

Left occipitoposterior (LOP)the

occiput faces
posteriorly (behind) and towards left.

Right occipitoposterior (ROP)the occiput faces

posteriorly and towards right.

Occipitoanterior the occiput faces anteriorly

(absolutely straight without any turning

to

any of the sides)

Occipitoposterior the occiput faces posteriorly

(absolutely straight without any turning to

any of the sides)

Face presentation

Lie
Definition: Relationship between
the longitudinal axis of fetus and
mother:
longitudinal, (resulting in either
cephalic or breech presentation)
oskie, (cephalic presentation, fetus
legs straight along frontal axis of
mother)
oblique, (unstable, will eventually
become either transverse or
longitudinal)
transverse (resulting in shoulder
presentation).

 Breech presentation with

longitudinal lie:
Left sacrum anterior (LSA)the
buttocks, as against the occiput of
the vertex presentation, like close
to the vagina (hence known as
breech presentation), which like
anteriorly and towards the left.
Right sacrum anterior (RSA)the
buttocks face anteriorly and
towards the right.
Left sacrum posterior (LSP)the
buttocks face posteriorly and
towards the left.
Right sacrum posterior (RSP)
the buttocks face posteriorly and
towards right.
Sacrum anterior(SA)the
buttocks face anteriorly.
Sacrum posterior (SP)the
buttocks face posteriorly.

Shoulder presentation
with transverse lie are
classified into four
types, based on the
location of the scapula
delivered caesarean
section.
Left scapula-anterior
(LSA)
Right scapula-anterior
(RSA)
Left scapula-posterior
(LSP)
Right scapula-posterior
(RSP)

MGTT

Preparation
The patient is instructed not to
restrict carbohydrate intake in the
days or weeks before the test. The
test should not be done during an
illness, as results may not reflect
the patient's glucose metabolism

when healthy. A full adult dose

should not be given to a person
weighing less 42.6 kg (94 lb), or
exaggerated glucoses may
produce a false positive result.
Usually the OGTT is performed
in the morning as glucose
tolerance can exhibit a diurnal
rhythm with a significant decrease
in the afternoon. The patient is
instructed to fast (water is
allowed) for 812 hours prior to
the tests

ProcedureA zero time (baseline) blood sample

is drawn.
The patient is then given a measured dose
(below) of glucose solution to drink within a 5
minute time frame.
Blood is drawn at intervals for measurement
of glucose (blood sugar), and sometimes
insulin levels. The intervals and number of
samples vary according to the purpose of the
test. For simple diabetes screening, the most
important sample is the 2 hour sample and the
0 and 2 hour samples may be the only ones
collected. A laboratory may continue to collect
blood for up to 6 hours depending on the
protocol requested by the physician.

 Dose of glucose and variations

In Portugal, the standard glucose load
In the US, dosing is by weight, and since
is provided by the clinical laboratory
the late 1970s has been 1.75 grams of
or hospital by 200 ml of a PET bottle.
glucose per kilogram of body weight, to
The most well known brand and used
a maximum dose of 75g. Prior to 1975 a
is TopStar, produced in Portugal. The
dose of 100g was often used.
recommendation is for a 75g oral
The WHO recommendation is for a 75g
dose in all adults and is adjusted for
oral dose in all adults: the dose is
weight in children. However is also
adjusted for weight only in children.[7]
used the concentrations of 50g and
The dose should be drunk within 5
minutes.
100g and usually in 3 flavors and
A variant is often used in pregnancy to
aroma (orange, lemon and cola).
screen for gestational diabetes, with a
Substances measured and variations[
screening test of 50 grams over one hour.
edit]
If elevated, this is followed with a test of
If renal glycosuria (sugar excreted in
100 grams over three hours.
the urine despite normal levels in the
In UK General Practice, the standard
glucose load is provided by 394ml of the
blood) is suspected, urine samples
sports drink Lucozade (original flavour
may also be collected for testing
only), which the patient is asked to
along with the fasting and 2 hour
[8][9]
supply.

blood tests.

Results
Fasting plasma
glucose (measured before the
OGTT begins) should be below
6.1 mmol/L (110 mg/dL).
Fasting levels between 6.1 and
7.0 mmol/L (110 and
125 mg/dL) are borderline ("
impaired fasting glycaemia"),
and fasting levels repeatedly at
or above 7.0 mmol/L
(126 mg/dL) are diagnostic of
diabetes.

A 2 hour OGTT glucose level below

7.8 mmol/L (140 mg/dL) is normal,
whereas higher glucose levels
indicate hyperglycemia
Blood plasma glucose between
7.8 mmol/L (140 mg/dL) and
11.1 mmol/L (200 mg/dL) indicate "
impaired glucose tolerance ", and
levels above 11.1 mmol/L
(200 mg/dL) at 2 hours confirms a
diagnosis of diabetes.
For the 75g OGTT: Fasting should be
below 5.1 mmol/L; 1 hour should be
below 10.0 mmol/L; 2 hour should
be below 8.5 mmol/L.

Polyhydramnios
an excess of amniotic fluid in the
amniotic sac. It is seen in about 1% of
pregnancies.[1][2][3] It is typically
diagnosed when the amniotic fluid index
(AFI) is greater than 24 cm.
There are two clinical varieties of
polyhydramnios:
Chronic polyhydramnios where excess
amniotic fluid accumulates gradually
Acute polyhydramnios where excess
amniotic fluid collects rapidly
The opposite to polyhydramnios is
oligohydramnios, a deficiency in
amniotic fluid.

gastrointestinal abnormalities
esophageal atresia,
duodenal atresia,
facial cleft,
neck masses
tracheoesophageal fistula
diaphragmatic hernias
An annular pancreas causing
obstruction may also be the
cause

causes
intrauterine infection (TORCH)
rh-isoimmunisation
chorioangioma of the placenta.
In a multiple gestation
pregnancy, the cause of
polyhydramnios usually is
twin-to-twin transfusion syndrom
e
.
Maternal causes include cardiac
problems, kidney problems, and
maternal diabetes mellitus, which
causes fetal hyperglycemia and
resulting polyuria (fetal urine is a
major source of amniotic fluid).

A recent study distinguishes between mild

and severe polyhydramnios and showed
that Apgar score of less than 7, perinatal
death and structural malformations only
occurred in women with severe
polyhydramnios.[6] In another study, all
patients with polyhydramnios, that had a
sonographically normal fetus, showed no
chromosomal anomalies.[4]
Few cases are associated with fetal
anomalies that impair the ability of the
fetus to swallow (the fetus normally
swallows the amniotic fluid), but these
anomalies include:

 Bochdalek's hernia, in which the pleuro-peritoneal membranes (especially the left)

will fail to develop & seal the pericardio- peritoneal canals. This results in the
stomach protrusion up into the thoracic cavity, and the fetus is unable to swallow
sufficient amounts of amniotic fluid.
fetal renal disorders that results in increased urine production during pregnancy,
such as in antenatal Bartter syndrome.[7] Molecular diagnosis is available for these
conditions.[8]
neurological abnormalities such as anencephaly, which impair the swallowing
reflex
chromosomal abnormalities such as Down syndrome and Edwards syndrome
(which is itself often associated with GI abnormalities)
Skeletal dysplasia, or dwarfism. There is a possibility of the chest cavity not being
large enough to house all of the baby's organs causing the trachea and esophagus to
be restricted, not allowing the baby to swallow the appropriate amount of amniotic
fluid.

 Diagnosis[edit]
There are several pathologic conditions
that can predispose a pregnancy to
polyhydramnios. These include a
maternal history of diabetes mellitus,
Rh incompatibility between the fetus
and mother, intrauterine infection, and
multiple pregnancies.
During the pregnancy, certain clinical
signs may suggest polyhydramnios. In
the mother, the physician may observe
increased abdominal size out of
proportion for her weight gain and
gestation age, uterine size that outpaces
gestational age, shiny skin with stria
(seen mostly in severe
polyhydramnios), dyspnea, and chest
heaviness. When examining the fetus,
faint fetal heart sounds are also an
important clinical sign of this
condition.

Associated conditions[edit]
Fetuses with polyhydramnios are at risk
for a number of other problems
including cord prolapse,
placental abruption, premature birth and
perinatal death. At delivery the baby
should be checked for congenital
abnormalities.
Treatment[edit]
Mild asymptomatic polyhydramnios is
managed expectantly. For a woman with
symptomatic polyhydramnios may need
hospital admission. Antacids may be
prescribed to relieve heartburn and
nausea.
No data support dietary restriction of salt
and fluid.[citation needed]
In some cases, amnioreduction, also
known as therapeutic amniocentesis, has
been used in response to
polyhydramnios

 Clinical features[edit]
The common clinical
features are smaller
symphysiofundal height,
fetal malpresentation, undue
prominence of fetal parts
and reduced amount of
amniotic fluid.

Causes[edit]
The cause is not known but is often
associated with some:
fetal chromosomal anomolies
intra uterine infections
Drugs; PG inhibitors, ACE inhibitors
renal agenesis or obstruction of the urinary
tract (posterior urethral valve in male
fetus)of the fetus preventing micturation
IUGR associated with placental
insufficiency
amnion nodosum; failure of secretion by the
cells of the amnion covering the placenta
postmaturity (dysmaturity)

 Diagnosis[edit]
uterine size is much smaller than the period of
amenorrhoea
less fetal movements,
the uterus "full of fetus" because of scanty liquor,
malpresentation(breech)
evidences of intra uterine growth retardation of
the fetus,
sonographic diagnosis is made when largest
liquor pool is less than 2 cm,
visualization of normal filling and emptying of
fetal bladder essentially rule out urinary tract
abnormality,
Oligohydramnios with fetal symmetric growth
retardation is associated with increased
chromosomal abnormality.

Complications[edit]
Complications may include cord compression,
musculoskeletal abnormalities such as facial
distortion and clubfoot, pulmonary hypoplasia
and intrauterine growth restriction. Amnion
nodosum is frequently also present (nodules
on the fetal surface of the amnion).[1]
The use of oligohydramnios as a predictor of
gestational complications is controversial. [2][3]
Potter syndrome is a condition caused by
oligohydramnios. Affected fetuses develop
pulmonary hypoplasia, limb deformities, and
characteristic facies. Bilateral agenesis of the
fetal kidneys is the most common cause due to
the lack of fetal urine.

 Treatment[edit]
A Cochrane Review concluded that "simple maternal hydration appears
to increase amniotic fluid volume and may be beneficial in the
management of oligohydramnios and prevention of oligohydramnios
during labour or prior to external cephalic version." [4]
In severe cases oligohydramnios may be treated with amnioinfusion
during labor to prevent umbilical cord compression. There is
uncertainty about the procedure's safety and efficacy, and it is
recommended that it should only be performed in centres specialising in
invasive fetal medicine and in the context of a multidisciplinary team.[5]
In case of congenital lower urinary tract obstruction , fetal surgery seems
to improve survival, according to a randomized yet small study

Medical usesMethyldopa (L-Methyl-3,4-dihydroxyphenylalanine;

Aldomet, Aldoril, Dopamet, Dopegyt
, etc.) is an alpha-adrenergic agonist
(selective for 2-adrenergic receptors
) psychoactive drug used as a
sympatholytic or antihypertensive

Methyldopa is used in the

clinical treatment of the
following disorders:
Hypertension (or high blood
pressure)
Gestational hypertension (or
pregnancy-induced
hypertension) and
pre-eclampsia

Side effects[edit]

Methyldopa is capable of
inducing a number of
adverse side effects, which
range from mild to severe.
Nevertheless, they are
generally mild when the
dose is less than 1 gram per
day.[2] Side effects may
include:

Psychological

Depression and/or even

suicidal ideation, as well as
nightmares
Apathy and/or anhedonia, as well as
dysphoria
Anxiety, especially of the
social anxiety variant
Decreased alertness, awareness, and
wakefulness
Impaired attention, focus, and
concentration
Decreased desire, drive, and
motivation

Fatigue or lethargy and/or

malaise or lassitude
Sedation or drowsiness and/or
somnolence or sleepiness
Agitation or restlessness
Cognitive and memory impair
ment
Derealization and/or
depersonalization, as well as
mild psychosis
Sexual dysfunction including
impaired libido, desire, and
drive

Physiological

Dizziness, lightheadedness, or
vertigo
Miosis or pupil constriction
Xerostomia or dry mouth
Gastrointestinal disturbances such
as diarrhea and/or constipation
Headache or migraine
Myalgia or muscle aches,
arthralgia or joint pain, and/or
paresthesia ("pins and needles")
Restless legs syndrome (RLS)
Parkinsonian symptoms such as
muscle tremors, rigidity,
hypokinesia, and/or
balance or postural instability
Akathisia, ataxia, dyskinesia as
well as even tardive dyskinesia,
and/or dystonia

Bell's palsy or facial paralysis

Sexual dysfunction consisting of impaired
erectile dysfunction and/or anorgasmia
Hyperprolactinemia or excess prolactin, gyneco
/breast enlargement in males, and/or amenorrho
absence of menstrual cycles in females
Bradycardia or decreased heart rate
Hypotension or decreased blood pressure (thou
may also be considered a therapeutic benefit)
Orthostatic hypotension (also known as
postural hypotension)
Hepatitis, hepatotoxicity, or liver dysfunction o
Pancreatitis or inflammation of the pancreas
Haemolytic anaemia or deficiency in red blood
(RBCs)
Myelotoxicity or bone marrow suppression, pot
leading to thrombocytopenia or blood platelet d
and/or leukopenia or white blood cell (WBC) d
Hypersensitivity such as lupus erythematosus,
myocarditis, and/or pericarditis
Lichenoid reactions such as skin lesions and/or
Pallor

mechanism of action

Methyldopa has a dual :

It is a competitive inhibitor
of the enzyme
DOPA decarboxylase, also
known as
aromatic L-amino acid deca
rboxylase
, which converts L-DOPA
into dopamine

Dopamine is a precursor for

norepinephrine (noradrenaline) and
subsequently epinephrine (adrenaline).
This inhibition results in reduced
dopaminergic and adrenergic
neurotransmission in theperipheral
nervous system. This effect may lower
blood pressure and cause
central nervous system effects such as
depression, anxiety, apathy, anhedonia,
and parkinsonism. In addition, decreased
dopamine may reduce its inhibitory
effect on prolactin leading to signs and
symptoms of hyperprolactinemia.

 . It is converted to methylnorepinephrine by
dopamine beta-hydroxylase (DBH).
-methylnorepinephrine is an
agonist of presynaptic central
nervous system 2-adrenergic
receptors. Activation of these
receptors in the brainstem appears
to inhibit
sympathetic nervous system output
and lower blood pressure. This is
also the mechanism of action of
clonidine.

Pharmacokinetics[edit]
Methyldopa exhibits
variable absorption from
the gastrointestinal tract. It
is metabolized in the liver
and intestines and is
excreted in urine.

 Any vaginal bleeding other than

spotting during early pregnancy is
considered a threatened miscarriage
. (A miscarriage may also be
referred to as a spontaneous
abortion.) Vaginal bleeding is
common in early pregnancy. About
one of every four pregnant women
has some bleeding during the first
few months. About half of these
women stop bleeding and have a
normal pregnancy.

The bleeding and pain associated

with threatened miscarriage are
usually mild. In the best case,
the cervical os (mouth of the
womb) is closed. (A health care
professional can determine if the
cervical os is open by
performing a pelvic exam.)
Typically, no tissue has been
passed from the womb. The
womb and Fallopian tubes may
be tender.

 When a miscarriage is inevitable,

the cervical os is open (dilated).
Bleeding is often heavier, and
abdominal pain and cramping
often occur.
If a miscarriage is incomplete, the
cervical os is open, and the
pregnancy is being expelled.
Ultrasound reveals some material
that remains in the womb.
Bleeding is heavy and abdominal
pain is almost always present.

With a complete
miscarriage, bleeding and
abdominal pain have
occurred but have usually
stopped. Products of
conception have been
passed. The early fetus has
been passed and was not
alive. Ultrasound reveals an
empty womb.

Threatened Miscarriage Causes

Although the actual cause of the

miscarriage is frequently unclear,
the most common reasons include
the following:
An abnormal fetus is almost always
the cause of miscarriages during the
first 3 months of pregnancy (first
trimester). Problems in the genes
cause an abnormal fetus and are
found in more than half of
miscarried fetuses. The risk of
defective genes increases with the
woman's age.

Miscarriage during the

fourth through sixth months
of pregnancy (second
trimester) is usually related
to an abnormality in the
mother rather than in the
fetus.

 Chronic illnesses, including

diabetes, severe high blood pressure
, kidney disease, lupus, and
underactive or overactive thyroid
gland, are frequent causes of a
miscarriage. Prenatal care is
important because it screens for
some of these diseases.
Inadequate ovarian hormone
production is one of the most
common causes of a miscarriage.

Acute infections, including German

measles, CMV (cytomegalovirus),
mycoplasma ("walking" pneumonia) and
other unusual germs, and severe emotional
shock, can also cause miscarriage.
Diseases and abnormalities of the internal
female organs can also cause miscarriage.
Some examples are an abnormal womb,
fibroids, poor muscle tone in the mouth of
the womb, abnormal growth of the placenta
(also called the afterbirth), and being
pregnant with multiples.
Other factors, especially certain drugs,
including excessive caffeine, alcohol,
tobacco, and cocaine, may be the cause.

cercavarix
Cervarix is a vaccine against
certain types of cancer-causing
human papillomavirus (HPV).
Cervarix is designed to prevent
infection from HPV types 16
and 18, that cause about 70%
of cervical cancer cases.[1]
These types also cause most
HPV-induced genital and
head and neck cancers

. Vaccination alone, without

continued screening, would
prevent fewer cervical
cancers than regular
screening alone.[7][8]

Indications
HPV is a virus, usually transmitted
sexually, which can cause cervical
cancer in a small percentage of those
women genital infected. Cervarix is a
preventative HPV vaccine, not
therapeutic. HPV immunity is typespecific, so a successful series of
Cervarix shots will not block infection
from cervical cancer-causing HPV
types other than HPV types 16 and 18
and some related types, so experts
continue to recommend routine
cervical Pap smears even for women
who have been vaccinated

Cervarix is indicated for the

prevention of the following
diseases caused by oncogenic
HPV types 16 and 18: cervical
cancer,
cervical intraepithelial neoplas
ia
(CIN) grade 2 or worse and
adenocarcinoma in situ, and
CIN grade 1. Cervarix is
approved for use in females
10 through 25 years of age.[9]

 Administration
Immunization with Cervarix
consists of 3 doses of 0.5-mL
each, by intramuscular injection
according to the following
schedule: 0, 1, and 6 months.The
preferred site of administration
is the deltoid region of the upper
arm.Cervarix is available in 0.5mL single-dose vials and
prefilled TIP-LOK syringes.

Limitations of effectiveness
Cervarix does not provide
protection against disease due to
all HPV types, nor against
disease if a woman has
previously been exposed through
sexual activity and protection
may not be obtained by all
recipients.It is therefore
recommended that women
continue to adhere to cervical
cancer screening procedures.

 Adverse effects[edit]
The most common local adverse reactions
in 20% of patients were pain, redness,
and swelling at the injection site.
The most common general adverse events
in 20% of subjects were fatigue,
headache, muscle pain (myalgia),
gastrointestinal symptoms, and joint pain (
arthralgia).[9]
In common with some other prefilled
syringe vaccination products, the tip cap
and the rubber plunger of the needleless
prefilled syringes contain dry natural latex
rubber that may cause
allergic reactions in latex sensitive individu
als
.[10] The vial stopper does not contain latex.

Ingredients[edit]
The active components of the
vaccine are:[9][11]
Human Papillomavirus type 16
L1 protein 20 micrograms
Human Papillomavirus type 18
L1 protein 20 micrograms
AS04 adjuvant, containing: 3-Odesacyl-4'- monophosphoryl lipid
A (MPL) 50 micrograms adsorbed
on aluminium hydroxide ,
hydrated (Al(OH)3) 0.5
milligrams Al 3+ in total

Uterine artery

The uterine artery usually arises

from the anterior division of the
internal iliac artery. It travels to
the uterus, crossing the ureter
anteriorly, reaching the uterus by
traveling in the cardinal ligament.
Uterine artery
It travels through the
parametrium of the inferior
broad ligament of the uterus.
It anastomoses (connects with)
the ovarian artery.
The uterine artery is the major
blood supply to the uterus and
enlarges significantly during
pregnancy.

Branches and organs

supplied
round ligament of the uteru
s
ovary ("Ovarian branches")
uterus (arcuate vessels)
vagina ("Vaginal branches"
- azygos
arteries of the vagina)
uterine tube ("Tubal
branch")

The posterior inferior cerebellar

artery (PICA)
Branches from this artery supply the

COURSE
It winds backward around the upper part
of the medulla oblongata, passing
between the origins of the vagus and
accessory nerves, over the
inferior cerebellar peduncle to the
undersurface of the cerebellum, where it
divides into two branches.
The medial branch continues backward to
the notch between the two hemispheres of
the cerebellum;
the lateral supplies the under surface of
the cerebellum, as far as its lateral border,
where it anastomoses with the
anterior inferior cerebellar and the
superior cerebellar branches of the
basilar artery.

choroid plexus of the fourth ventricle.

Diseases-Infarction of this artery due
to thrombosis or a stroke leads to
lateral medullary syndrome, also known
as PICA syndromeor Wallenberg
syndrome. Severe occlusion

of this or
vertebral arteries could lead to
Horner's Syndrome.
The posterior inferior cerebellar
artery (PICA), the largest branch of
the vertebral artery, is one of the three
main arterialblood supplies for the
cerebellum, part of the brain.
Occlusion of the posterior inferior
cerebellar artery or one of its branches, or
of the vertebral artery leads to
Wallenberg syndrome, also called lateral
medullary syndrome.

Iron
Folic Acid

Baby Benefits: Helps protect against

spinal cord birth defects during the
first 30 days of pregnancy, helps
prevent early miscarriage and
premature delivery.
Your Benefits: Prevents anemia.

Pregnancy RDA: 600 micrograms

(mcg)
Best Food Sources
Lentils, 1 cup cooked -- 358 mcg
Spinach, 1 cup cooked -- 263 mcg
White enriched rice, 1 cup cooked -195 mcg
Enriched spaghetti, 1 cup cooked -172 mcg
Broccoli, 1 cup cooked -- 168 mcg
Orange juice, 1 cup -- 110 mcg
Enriched bread, 2 slices -- 34 mcg

Baby Benefits: Helps prevent premature

delivery.
Your Benefits: Wards off anemia in
pregnant women.
Pregnancy RDA: 27 mg; don't exceed 45
mg
Best Food Sources
Whole Grain Total Cereal, 3/4 cup -- 22
mg
Cheerios, 1 cup -- 10 mg
Enriched rice, 1 cup cooked -- 8 mg
Canned white beans, 1 cup -- 8 mg
Beef, 3 oz cooked -- 3 mg
Lamb, 3 oz cooked -- 2 mg
White meat chicken, 3 oz. cooked -- 1 mg