Pregnant women often have an allergic disease. The treatment of allergic diseases in pregnancy does not differ much from the treatment in general population. More important is allergen avoidance and ...health education of pregnant woman. Double blind placebo controlled trials of the treatment of allergic diseases in pregnancy are extremely rare. Use of drugs that have been on the market for longer time is recommended, because there is more information available on the safety of these drugs. Drugs for local use are generally safer than systemic drugs. It is recommended that nasal decongestants should be avoided. Among antihistamines the drugs of choice are cetirizine and loratadine. Among inhaled corticosteroids the drug of choice is budesonide. The treatment of anaphylaxis is the same as in general population.
Background Stress is one of basic risk factors influencing different health states, including reproductive health of women. The study was aimed at measuring the level of stress in different groups of ...women in order to identify high-risk groups for stress and relate them to birth rate dynamics in Slovenia. Methods The data originate from the national health behaviour database in adults aged 25-64. Data collected in 2001 were used. The sample size was 15,379. Among them there were 4,942 women in reproductive age (25-49 years). The response rate of the mailed questionnaire in this group was 68 %, with 3,181 questionnaires being eligible for analysis. Binary multiple logistic regression was used to determine the impact of age, education, type of work, marital status, self-assessed social class, and type of residence community on the prevalence of frequent perception of stress. Results The overall prevalence of frequent perception of stress was 29.7 %. The highest odds ratios (OR) for stress were registered in women in age group 40-44 (OR 40-44 vs 25-29 = 1.35, p = 0.048), with the lowest (OR uncompleted primary vs primary = 1.73, p = 0.038) and the highest education levels (OR college vs primary = 1.76, p = 0.008; OR university vs primary = 1.80, p = 0.006), employed in industry as heavy workers (OR heavy workers in industry vs housekeepers/students = 1.76, p = 0.010), divorced (OR divorced vs consensual union = 1.72, p = 0.013), self-classified in the lowest social classes (OR lower vs upper-middle = 3.25, p < 0.001; OR labour vs upper-middle = 1.57, p = 0.011); and residents of suburban communities (OR suburban vs rural = 1.27, p = 0.029). Conclusions Public health activities to reduce stress burden among women in reproductive age in Slovenia (e.g. changes of legislation, changes of workplace behaviour) should be focused on women with lowest education and of lowest social class, especially working in heavy industry, and on employed women with highest education.
Regarding medical science and profession everybody strives to be updated. We as physicians have never, however, been trained how to train trainees, even though adult education is a continuously ...developing science as well. This science offers to trainers more efficient tools to teach, appraise and assess trainees in a rather short time available. We owe it to ourselves and medicine to train new specialists in such a way that they will be competent in their specialities. As trainers we can positively contribute to higher self-reflection and responsibility of trainees with introductory appraisal-it is so nice when mentor knows the CV of the trainee in advance-and with repeating the appraisal in regular intervals. The importance of solid basic knowledge and continuous assessment of theoretical knowledge, practical skills and, above all, of attitude and behaviour is stressed. The first audit cycle of Training the trainers workshops will not be completed until after some years. But what is already evident is the fact that trainers are offered positive, useful and enjoyable tools.
Idiopathic dilated cardiomyopathy in pregnancy Ko elj, Mirta; Novak-Antoli, iva; No, Marko ...
Acta obstetricia et gynecologica Scandinavica,
2003, Letnik:
82, Številka:
4
Journal Article
The most sensitive and specific first-trimester Down syndrome screening test employs a combination of maternal age, nuchal translucency (NT) thickness, fβhCG, and PAPP-A. First trimester NT ...measurements do not differ significantly between pregnancies resulting from assisted reproductive technology (ART) and those resulting from spontaneous conception, but maternal blood levels of free beta human chorionic gonadotropin (fβhCG) are higher following in vitro fertilization-embryo transfer (IVF-ET), and levels of pregnancy-associated plasma protein-A (PAPP-A) are lower. Whether or not this results in a higher rate of false positive screening test results is controversial. The investigators compared the screen-positive rates of the first trimester Down syndrome screening test in women with singleton ART pregnancies to those of women whose pregnancies resulted from spontaneous conception. Participants included 130 women who were pregnant after IVF-ET (group 1); 54 who conceived after intracytoplasmic sperm injection (ISCI; group 2); and 914 control women who conceived spontaneously. Fetal NT thickness was estimated at 10–14 weeks’ gestation.Women who conceived via ICSI were 2.8 times as more likely to be screen positive than control women. Although ovarian stimulation in group 1 and group 2 women was associated with significantly lower PAPP-A levels than were present in the control group, women who conceived via IVF-ET were not more likely to be screen positive than control women. Levels of PAPP-A declined significantly as the number of retrieved oocytes or transferred embryos increased, but the levels of other markers were not affected. When a single embryo was transferred, or when ART conception occurred without ovarian stimulation, marker levels were similar to those following spontaneous conception.Although ICSI appears to be associated with a higher rate of false positive first trimester screening test results than that in spontaneously conceived pregnancies, women who conceive by other ART methods are not at increased risk.
We report a case of previously healthy woman who suffered cerebral embolism after delivery. Echocardiography with contrast medium confirmed the patent foramen ovale (PFO). PFO may be a mechanism of ...paradoxical embolism causing a transient ischemic attack or stroke.
A programme for the prevention of congenital toxoplasmosis in Slovenia involving the screening of pregnant women for Toxoplasma infection is presented. Of 21,270 pregnant women screened for ...toxoplasmosis between, 1996 and the end of 1999, 13,987 (66%) were seronegative, 7,151 (34%) seropositive and 132 had primary infection; ≈ 9/1,000 women were at risk of acquiring the primary infection. One hundred live-born infants of primary infected women were available for follow-up. Nine infected but asymptomatic children were born to mothers who were screened and treated in time and two congenitally infected babies were born to mothers in whom infection was detected too late in pregnancy and who therefore received no adequate treatment. It is suggested that the results obtained in this study outweigh the cost of screening for toxoplasmosis in pregnancy. Pregnant women should always be tested at the beginning of pregnancy and, in cases of seronegativity, should be re-tested in the second and third trimesters of the pregnancy. Toxoplasma primary infected pregnant women and neonates should be treated as soon as possible. However, long-term follow-up of children born to primary infected women would be necessary for an accurate evaluation of the effectiveness of the screening because of the possibility of late onset of symptoms.
Celotno besedilo
Dostopno za:
DOBA, IJS, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Povzetek Izhodisca. Zdrava scitnica se v razmerah ustrezne preskrbe z jodom brez posledic prilagodi spremembam v nosecnosti. Plodova potreba po scitnicnih hormonih je v prvi tretjini nosecnosti ...neposredno povezana s prehajanjem materinih hormonov preko posteljice. Plodova lastna sinteza pa je odvisna od dostopnosti joda v feto-placentarni enoti. Hipoin hipertiroza v nosecnosti predstavljata tveganje za zdravje nosecnice in za normalen razvoj ploda in otroka. Zakljucki. Ob dobro kontrolirani bolezni scitnice v nosecnosti je izid nosecnosti podoben kot v splosni populaciji in ne vodi v slabsi nevroendokrinoloski razvoj otroka. Pri neprepoznani ali nezdravljeni bolezni so pogostejsi zapleti nosecnosti in poroda. Zato je pomembno pravocasno prepoznavati motnje in jih zdraviti z varnimi zdravili ze v nosecnosti, a tudi po porodu.
Summary
Pregnancy is associated with depressed fibrinolysis as judged from the decreased fibrinolytic response to venous occlusion. In order to elucidate if this decreased response is due to an ...increase in plasminogen activator inhibitors 1 and 2 (PAI-1, PAI-2), and/or to decreased release of tissue-type plasminogen activator (t-PA) antigen during venous occlusion, 36 women (18 women with normal pregnancy and 18 with gestational hypertension without proteinuria) were followed during pregnancy and puerperium. In each woman a 20 min venous occlusion was performed in the second and in the third trimester of pregnancy and 3 days after delivery. The increase in t-PA antigen after venous occlusion relative to basal value was in the second trimester of pregnancy on average 3.7 fold, in the third trimester 4.4 fold, and so not reduced compared to non-pregnant women (3.7 fold increase). After delivery the increase in t-PA antigen was significantly enhanced (8.5 fold,
p
<0.005). The fibrinolytic response to venous occlusion measured by euglobulin and t-PA activity was significantly decreased in the third trimester compared to non-pregnant values (both
p
<0.005) and returned to somewhat higher (euglobulin clot lysis) or significantly higher (t-PA activity,
p
<0.01) values 3 days after delivery. Decreased euglobulin and t-PA activity after venous occlusion in the third trimester coincided with significant increases in basal PAI activity, PAI-1 antigen and PAI-2 antigen (2.9, 2.5 and >30 fold increase relative to non-pregnant values, respectively, all
p
<0.001). No significant differences in fibrinolytic variables were observed between nor-motensive and hypertensive pregnant women. It was concluded that t-PA antigen release during venous occlusion is not decreased during pregnancy and puerperium, and that decreased fibrinolytic response measured by global methods should be attributed to increased t-PA inhibitors. Gestational hypertension without proteinuria is not characterized by changes in fibrinolytic responses different from those observed in normal pregnancy.
To find whether fbetahCG, PAPP-A and inhibin-A levels in maternal serum or fetal nuchal translucency (NT) thickness at the first-trimester screening for trisomy 21 (T21) might detect women at high ...risk for adverse pregnancy outcomes.
A retrospective analysis of 1136 women with singleton pregnancy between 10 and 14 weeks. Women with pregnancy complications were allotted to five subgroups: small for gestational age (SGA), large for gestational age (LGA), gestational diabetes (GDM), hypertensive disorders, preterm delivery; women with normal pregnancy represented the control group. NT, maternal serum fbetahCG, PAPP-A and inhibin-A were measured. Mann-Whitney test was used for the comparison of fbetahCG, PAPP-A, inhibin-A and NT between a subgroup of a certain pregnancy complication and the control group. Multivariate logistic regression models were built to explore the relationship among different variables and the occurrence of pregnancy complications.
PAPP-A values were significantly lower in women who delivered SGA babies (n=51, 0.76 MoM; p=0.002) and significantly higher in women who delivered LGA babies (n=120, 1.12 MoM; p=0.036). In women with GDM (n=27), fbetahCG, PAPP-A and inhibin-A were insignificantly lower than in controls, whereas in women with hypertensive disorders (n=56) no significant differences between the groups were found. In women with a preterm delivery (<34 weeks) (n=17), inhibin-A levels were significantly higher (1.25 MoM; p=0.015).
Low PAPP-A level is associated with the delivery of an SGA baby and high PAPP-A with the delivery of an LGA baby. High inhibin-A is associated with preterm delivery before 34 weeks. Feto-placental products in the first trimester do not prove to be useful as a screening tool for predicting pregnancy complications.
