In pregnancy

The primary difficulty with periodic abstinence is the month-to-month variation in the time of ovulation. Whereas the ovum can only be fertilized during the first 12 to 24 hours after its release from the ovary, sperm remain viable longer in the female reproductive tract, able to fertilize an ovum for 5—7 days and perhaps longer. Thus, intercourse several days prior to ovulation can result in pregnancy. 

Beneficial effects have also been attributed to PAF. In reproduction, PAF secreted by the fertilized egg is instrumental in the implantation of the egg in the uterine wall. PAF is produced in significant quantities in the lungs of the fetus late in pregnancy and may stimulate the production of fetal lung surfactant, a protein-lipid complex that prevents collapse of the lungs in a newborn infant. 

The nurse should use cephalosporins cautiously in patients with renal or hepatic impairment and in patients with bleeding disorders. Safety of cephalosporin administration has not been established in pregnancy or lactation these drugs are assigned to Pregnancy Category B. 

The term pasaon flower is used to denote many of the approximately 400 species of the herb. F saon flower has been used in medicine to treat pain, anxiety, and insomnia. Some herbalists use the herb to treat symptoms of parkinsonism. F saon flower is often used in combination with other herbs , such a valerian, chamomile, and hops, for promoting relaxation, rest and sleep. Although no adverse reactions have been reported, large doses may cause CNS depression. The use of passion flower is contraindicated in pregnancy and in patientstaking the monoamine oxidase inhibitors (MAOIs). Fission flower contains coumarin, and the risk of bleeding may be increased when used in patientstaking warfarin and pasaon flower. 

Clinical Particulars (therapeutic indications, administration, contraindications, special warnings and precautions, interaction with other drugs, use in pregnancy or lactation, effects on driving, undesirable effects, overdose)... 

Dantrolene is the mainstay of MH treatment. It has long been available for the treatment of muscle spasm in cerebral palsy and similar diseases. It is a hydantoin derivative that was first synthesized in 1967, and reported to be effective in the treatment of porcine MH in 1975. Also in 1975, dantrolene was shown to be more effective than procainamide in the treatment of human MH, which until that time was the drug of choice. However, the intravenous preparation was not made available until November 1979. It significantly lowered mortality. The half-life of dantrolene is estimated to be 6-8 hr. Dantrolene s primary mode of action is the reduction in calcium release by the sarcoplasmic reticulum. Dantrolene also exerts a primary antiarrhythmic effect by increasing atrial and ventricular refractory periods. Side effects of dentrolene include hepatotoxicity, muscle weakness, ataxia, blurred vision, slurred speech, nausea, and vomiting. Dantrolene is not contraindicated in pregnancy, but it does cross into breast milk and its effect on the neonate is unknown. 

DasheJS, Jackson GL, Olscher DA, etal Opioid detoxification in pregnancy. Obstet Gynecol 92 854-858, 1998... 

Johnson RE, Jones HE, Fischer G Use of buprenorphine in pregnancy patient management and effects on the neonate. Drug Alcohol Depend 20(suppl 2) S87-SlOl, 2003... 

LutyJ, Nikolaou V, Bearn J Is opiate detoxification unsafe in pregnancy J Subst Abuse Treat 24 363-367, 2003... 

Senay EC Methadone maintenance treatment. Int J Addict 20 803—821, 1985 Senay EC, Dorus W, Goldberg F, et al Withdrawal from methadone maintenance rate of withdrawal and expectation. Arch Gen Psychiatry 34 361—367, 1977 Sharpe C, Kuschel C Outcomes of infants born to mothers receiving methadone for pain management in pregnancy. Arch Dis Child Fetal Neonatal Ed 89 F33—F36, 2004... 

Briggs G, Freeman R, Yaffe S Drugs in Pregnancy and Lactation A Reference Guide to Maternal and Fetal Risk. Philadelphia, Lippincott, Williams Wilkins, 2002 Chengappa KN, Kambhampati R, Perkins K, et al Bupropion sustained release as a smoking cessation treatment in remitted depressed patients maintained on neatment with selective serotonin reuptake inhibitor antidepressants. J Clin Psychiatry 62 503—508, 2001... 

Evans RT, O Callaghan J, Norman A. 1988. A longitudinal study of cholinesterase changes in pregnancy. Clin Chem 34 2249-2252. 

The estrogens are a family of hormones synthesized in a variety of tissues. 17P-Estradiol is the primary estrogen of ovarian origin. In some species, estrone, synthesized in numerous tissues, is more abundant. In pregnancy, relatively more estriol is produced, and this comes from the placenta. The general pathway and the subcellular localization of the enzymes involved in the early steps of estradiol synthesis are the same as those involved in androgen biosynthesis. Features unique to the ovary are illustrated in Figure 42-7. 

Attention to iron metabolism is particularly important in women for the reason mentioned above. Additionally, in pregnancy, allowances must be made for the growing fetus. Older people with poor dietary habits ( tea and toasters ) may develop iron deficiency. Iron deficiency anemia due to inadequate intake, inadequate utilization, or excessive loss of iron is one of the most prevalent conditions seen in medical practice. 

Deficiency of folic acid Decreased intake, defective absorption, or increased demand (eg, in pregnancy) for folate... 

Zellweger, H. and Simpson, J. "Is Routine Prenatal Karyotyping Indicated in Pregnancies of Very Young Women "... 

From a therapeutic point of view, it is essential to confirm the presence of bacteriuria (a condition in which there are bacteria in the urine) since symptoms alone are not a reliable method of documenting infection. This applies particularly to bladder infection where the symptoms of burning micturition (dysuria) and frequency can be associated with a variety of non-bacteriuric conditions. Patients with symptomatic bacteriuria should always be treated. However, the necessity to treat asymptomatic bacteriuric patients varies with age and the presence or absence of underlying urinary tract abnormalities. In the pre-school child it is essential to treat all urinary tract infections and maintain the urine in a sterile state so that normal kidney maturation can proceed. Likewise in pregnancy there is a risk of infection ascending from the bladder to involve the kidney. This is a serious complication and may result in premature labour. Other indications for treating asymptomatic bacteriuria include the presence of underlying renal abnormalities such as stones which may be associated with repeated infections caused by Proteus spp. 

Based primarily on the study protocol of the 1995 NINDS rt-PA study.Many centers would also exclude patients with known documented endocarditis or aortic dissection, and those with CT hypoattenuation in more than one third of the middle cerebral artery territory. There are insufficient data to support the use of rt-PA for ischemic stroke in pregnancy or in the pediatric population (age <18 years). 

IV rt-PA has been safely given in patients with cervical arterial dissection There are four reports of IV rt-PA use in pregnancy, with one case complicated by intrauterine hematoma,rt-PA should be used in this setting only after careful assessment of the risks and benefits. There is insufficient data to determine the benefit of rt-PA in the pediatric population, with no randomized trials. 

Sodium nitropmsside hour <1 minute 10-800 meg /minute Cyanide or thiocyanate toxicity, hypotension, headache Can increase ICP, should not be given in pregnancy... 

Central a2-Agonists Methyl dopa Clonidine (Catapres) Guanabenz Guanfacine (Tenex) Guanadrel No recommendations at this time Transient sedation initially First-line in pregnancy (methyldopa)... 

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