obgyn watch october 2004 r narayanan october 2004
TRANSCRIPT
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ObGyn Watch October 2004
R Narayanan
OCTOBER 2004
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Nitric Acid (N.O)in
Female Reproduction
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N.O - Major Paracrine Mediator & Regulatory Agent
Menstruation Ovulation Endometrial
receptivity Implantation
Maintenance of Pregnancy
Cervical Ripening
Tocolysis Labour Pains
N.O Donors promote Fertility & Inhibitors facilitate Contraception
Maul H et al Curr Pharm Design Feb 2003
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Effect of N.O on Vasculature N.O Promotes Vasodilatation &
inhibits Platelet Aggregation Low N.O in early II Trimester
impairs vascular formation leading to Placental insufficiency & FGR
High N.O in III Trimester represents compensated Pl perfusion in IUGR
PE develops due to dysfunction of L-arginine – N.O pathway
Tranquilli AL et al J Mat Fet NN Med
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Effect of L-arginine L-arginine infusion decreases BP in
Normo as well as Hypertensive mothers
Reduces BP through release of N.O Improves endothelial function Inhibits Platelet aggregation Prevents Pre eclampsia Potent relaxant - Prolongs pregnancy Better Perinatal outcome
Alfredo et al Rev Chil Ultrasono 2001
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Doppler – USG Evaluation
Lowers Uterine artery vascular resistance
Pathological Doppler waveforms paralleled with N.O production
Accelerated fetal Growth in Rx Group Birth weight improved
Sieroszewski P et al J Mat Fet NN Med June 2004
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Oral0.1G/Kg/Day
X 2 weeksFrom 10th
GestationalWeek
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Moderate intake of Coffee has No effect on Abortion -Coll PN Project 1956-66 - -Klebenoff et al N Eng J Med 1988
Coffee >150G/day increases RR Spontaneous Abortion to 1.36
& LBW to 1.5 Meta analysis of 32 studies
High Coffee intake increases Sudden Infant Death Syndrome
Ob Gyn Surv 1999
Retrospective study 562 Spont Aborters compared with 953 matched controls: Increased coffee consumption increases abortion risk – Coffee not Mutagenic
-Cnattingius S Sweden N Eng J Med 2000
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During PregnancyIt is safe to consume
Less than 150G Coffee/Day
Which is equal to:
1 cup of Brewed2 cups of Instant3-4 cups of Tea2-3 Soft Drinks
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How about Tea?
Study of>1000 women 30 & Older in Taiwan
•Average of 2 cups of Tea >10 years•6.2% greater Bone Density Fluorides,Flavonoids & Phytoestrogens responsible•Tea has >4000 Health-affecting Compounds
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Polycystic Ovaries
Incidence of Abortion in PCOS: 30-50%
Causes:1. Elevated LH2. Hyper insulinemic
Insulin Resistance3. Elevated Androgens4. CL Deficiency
following Dysovulation
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Metformin Insulin Resistance Serum Androgen
Improves Ovulation
Abortion Obesity
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Retrospective Study of Metforminin Pregnancy
Metformin 1-2 G / day throughout Pregnancy
Abortion Rate : 9% in study group
(42% in controls) Lower Free Testosterone levels No IUGR No Fetal Anomalies
Daniela DJ et al J Endocrin Metabol 2002
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Metformin & GDM
Prospective & retrospective Study Incidence of GDM: 3% in Study group (23% in Controls) Safe in Pregnancy Probably acts by decreasing secretory
demands on Pancreatic beta cells
Glueck et al 2001
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L’scopic Ovarian Drilling In CC Resistant PCO: Spont Ovulation 57% Conception 50% Reg Cycles >1 yr 50% Poor Responders: BMI >35Kg/m2 Testosterone >4.5 nMol/L Infertility >3 yrs
Hum Repr 2004
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Farquhar C et al Cochrane Library Issue 3, 2004
•15 Trials of L’scopic Drilling Vs GTH Induction:•Compared 6-12 mths following Drilling with 3-6 cycles of GTH•Cumulative Pregnancy Rate Same•Miscarriage rate same •Multiple pregnancy less with Drilling
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American Men shave 48 sq inches
24 times/monthWomen, 412 sq inches
11 times/month-Gillette
-Westinghouse 1941
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Dysmenorrhoea Pain Relief: Naproxen 59%
Ibuprofen 70% Mefanemic Acid 69% Aspirin 29%
Ibuprofen drug of choice
Coxibs=Naproxen
Metanalysis: Double Blind RCTsZhang WY et al Br J Ob G 1998
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Source BMJ 1999
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Eminence-Based Medicine
‘The more senior the physician, the less important the evidence!’
“Clinical Experience” is defined as ‘Making the same mistakes With increasing confidence
over an impressive number of years’
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Vehemence-Based Medicine
‘Substitution of volumeFor Evidence!’
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Eloquence-Based Medicine
‘Smooth tongue, Sartorial elegance And Verbal eloquence are
Powerful Substitutes’
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Providence-Based Medicine
‘Decision may best be leftIn the hands of Almighty!’
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Diffidence-Based Medicine
‘A sense of DespairMakes the physician feel
helplessAnd do nothing!’
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Nervousness-Based Medicine
‘Fear of Litigation Leads to over investigate
And over treat!’
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Confidence-Based Medicine
(Restricted to Surgeons)
‘He will let his scalpel speak!’
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One-day old TAMARA – 3.75 KgWith Mother 32 year old
Quarda Touriat at BrusselsOn 24 Sep ‘04
Prof Donnez froze Touriat’s ovaries in 1997 before Chemo/Radio Rx for Stage IV Hodgkins Lymphoma.Laparoscopic Ovarian Transplant in 2003Menstruation returned 4 months later.Conceived naturally -Lancet Sept’04
Stop Press!
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