Antiphospholipid Antibody Syndrome의 진단 기준

Clinical and Laboratory Criteria for Diagnosis of Antiphospholipid Antibody Syndrome

Clinical and Laboratory Criteria for Diagnosis of Antiphospholipid Antibody Syndrome

Clinical criteria   1.    Three or more consecutive spontaneous abortions before 10 weeks (recurrent pregnancy loss); delivery before 34 weeks; one or more unexplained fetal deaths of a morphologically normal infant; or severe preeclampsia or placental insufficiency necessitating delivery before 34 weeks.   2.    Arterial or vascular thrombosis without an obvious precipitating cause; small-vessel thrombosis in any tissue or organ, without significant evidence of vasculitis. Laboratory criteria   1.    Moderate to high levels of IgG or IgM anticardiolipin antibodies.   2.    Detection of lupus anticoagulant. These tests must be positive on at least two occasions at least 6 weeks apart.

반복 유산의 평가

Evaluation of Couples with Recurrent Pregnancy Loss

Evaluation of Couples with Recurrent Pregnancy Loss

Etiology Diagnostic Evaluation Abnormal Therapy Genetic Karyotype partners 3–5% Genetic counseling, donor gametes Anatomic Hysterosalpingography Hysteroscopy Sonohysterography Magnetic resonance imaging 15–20% Septum transection, myomectomy, adhesiolysis, metroplasty Endocrinologic Midluteal progesterone 8–12% Progesterone   Thyroid-stimulating hormone   Levothyroxine   Prolactin   Dopamine agonists   Fasting insulin:glucose   Metformin Immunologic Lupus anticoagulant, antiphospholipid antibodies 15–20% Heparin + aspirin Microbiologic Cervical cultures 5–10% Antibiotics Thrombophilia Antithrombin III, protein C or S deficiency; factor V Leiden or prothrombin mutation 8–12% Heparin + aspirin, low-molecular-weightheparin   Hyperhomocysteinemia   Folic acid Psychological Interview Questionnaire Varies Support groups, counseling Toxic Tobacco, alcohol use 5% Behavior changes   Exposure to toxins, chemicals   Eliminate exposur

Chromosomal findings in abortion (유산에서 흔한 유전자 문제)

Chromosomal Findings in Abortuses

Incidence in Percent Chromosomal Studies Kajii (1980) Eiben (1990) Simpson (2002) Normal (euploid)         46, XY and 46, XX 46   51   54   Abnormal (aneuploid)         Autosomal trisomy 31   31   22     Monosomy X (45, X) 10 5 19   Triploidy 7 6 8   Tetraploidy 2 4 3   Structural anomaly 2 4 3   Double or triple trisomy 2 0.9 0.7

골반염(PID)의 치료 (CDC 2006 Guideline)

Recommended Oral Outpatient Treatment of Pelvic Inflammatory Disease

Regimen A   Levofloxacin 500 mg once daily for 14 days   or   Ofloxacin 400 mg once daily for 14 days with or without   Metronidazole 500 mg twice daily for 14 days Regimen B   Ceftriaxone 250 mg IM once plus   Doxycycline 100 mg orally twice daily for 14 days with or without   Metronidazole as above   or   Cefoxitin 2 g IM with 1 g oral Probenecid once plus   Doxycycline 100 mg as above with or without   Metronidazole as above   or   Ceftizoxime or cefotaxime 1 gram IM   plus   Doxycycline 100 mg as above with or without   Metronidazole as above

Recommended Parenteral Treatment of Pelvic Inflammatory Disease

Regimen A   Cefotetan 2 g IV every 12 hours   or   Cefoxitin 2 grams IV every 6 hours plus   Doxycycline 100 mg orally or IV every 12 hours Regimen B   Clindamycin 900 mg IV every 8 hours plus   Gentamicin loading dose 2 mg/kg followed by a maintenance dose of 1.5 mg/kg every 8 hours. Single daily dosing at 5 to 7 mg/kg per day may be substituted. Alternative Parenteral Regimens   Levofloxacin 500 mg IV once daily with or without   Metronidazole 500 mg IV every 8 hours   or   Ofloxacin 400 mg IV every 12 hours with or without   Metronidazole 500 mg as above   or   Ampicillin/sulbactam 3 g IV every 6 hours plus   Doxycycline 100 mg orally or IV as above

방광염의 치료

방광염(UTI)의 치료

Treatment of Urinary Tract Infection

Infection Category Antimicrobial Regimen Uncomplicated cystitis Orally 3 days   Local E coli resistance <20% Trimethoprim-sulfamethoxazole DS (160/800 mg) twice daily   Local E coli resistance 20% Ciprofloxacin 250 mg twice daily   or   Norfloxacin 400 mg twice daily   or   Levofloxacin 250 mg daily   or   Gatifloxacin 400 mg daily Complicated/recurrent cystitis Same as above unless culture and sensitivity dictate change   Postcoital Orally once   Trimethoprim-sulfamethoxazole SS (80/400 mg) 0.5 to 1 tablet   or   Ciprofloxacin 250 mg   or   Levofloxacin 250 mg   or   Gatifloxacin 400 mg   Intermittent (begin with onset of symptoms) Same as uncomplicated acute cystitis Mild pyelonephritis Oral 7 to 14 days   Gram-negative Ciprofloxacin 500 mg twice daily   or   Norfloxacin 400 mg twice daily   or   Levofloxacin 250 mg daily   Gram-positive Amoxicillin/clavulanic acid 875/125 mg twice daily Severe pyelonephritis Intravenous until afebrile 24 to 48 hours, then oral to complete 7 to 14 days therapy   Gram-negative Ciprofloxacin 400 mg twice daily   or   Levofloxacin 500 mg daily   or   Gatifloxacin 400 mg daily with or without   Gentamicin 3 to 5 mg/kg/d        OR   Cefoxitin 2 g every 8 hours with or without aminoglycoside        OR   Cefotaxime 1 to 2 g two to four times daily with or without an aminoglycoside   Gram-positive Ampicillin 3 g every 6 hours   or   Piperacillin/tazobactam 3.375 g every 6 hours   or   Ampicillin/sulbactam 3/1.2 g every 6 hours

산모에게 사용할 수 있는 감기약

산모 감기에 추천되는 약에는 증세별로 어떤것들이 있나요?

임신 초기라면 약물 사용에 주의를 기울여야 하겠지만, 그렇지 않다면 일반적인 감기약은 대부분 괜찮습니다.
 
진해거담제로는 acetylcysteine (FDA category B, 호주 ADEC category B2) 제제 약물도 사용 가능하고, 증상이 심한 경우에는  codein phosphate (FDA category C, 호주 ADEC category A) 제제도 사용할 수 있습니다.
 
콧물은 항히스타민제가 포함된 약물을 사용하면 되고, 현재까지 사용되고 있는 거의 모든 항히스타민제는 임신 중 사용 가능합니다. 예를 들자면 loratadine (FDA category B, 호주 ADEC category B1), cetirizine (FDA category B, 호주 ADEC category B2), chlorpheniramine (FDA category C, 호주 ADEC category A), azelastine (FDA category C), pseudoephedrine (FDA category C, 호주 ADEC category B2) 등이 있습니다.
 
Sore throat에는 chlorhexidine gargling (FDA category C, 호주 ADEC category A)이 효과적이며, 진통제로는 acetaminophen (FDA category B, 호주 ADEC category A)이 가장 안전하게 사용될 수 있습니다.
 
결국 잘 아시다시피 risk benefit을 잘 따져보셔서 약물을 선택하시면 되겠고, 가급적 category A나 B에 해당되는 약물을 사용하시는 것이 좋겠지만 필요하다면 C도 사용할 수 있겠습니다.
 
각 성분이 포함된 약물에 대한 정보를 더 자세히 알기 원하신다면 킴스온라인 https://www.kimsonline.co.kr에서 확인하시기 바랍니다.
 
-자료출처: 대한산부인과학과 홈페이지 Q&A

임신 중 발견된 자궁경부 이형성증(CIN)의 치료

Cervical dysplasia in pregnancy: progression versus regression postpartum, 임신 중 발견된 자궁경부 이형성증의 치료

분만전 자궁경부 이상이 발견된 산모 중 분만후 약 63-76%가 등급이 낮아졌습니다.
그러므로 산모의 자궁경부 이형성증은 conservative하게 치켜보는 것이 최선이라고 하겠습니다.

 단, 침윤성 암이 의심되는 경우 원추절제술을 시행합니다.

Gazala Siddiqui MD, Richard B. Kurzel MD, E. Charles Lampley MD, Hyung S. Kang MD and Josef Blankstein MD

Mount Sinai Hospital, Finch University of the Health Sciences, the Chicago Medical School, Chicago, IL, USA

Abstract

Objective: To study the natural history of cervical dysplasia diagnosed during pregnancy, in terms of progression or regression postpartum, by the severity of the lesion.
Method: A retrospective review of abnormal Pap test results in pregnancy was performed from October 1996 to April 2000. One hundred patients had antepartum Pap tests and colposcopy, as well as colposcopy postpartum, for inclusion in the study. Groups were classified as HGSIL, LGSIL, or ASCUS. The significance of the rate of change of lesion grade was tested using the χ² and Fisher exact tests.
Results: One hundred patients with abnormal Pap test results were confirmed colposcopically to be HGSIL (30%), LGSIL (53%), and ASCUS (17%). Six patients with HGSIL grade lesion: HGSIL (3% to CIS), LGSIL (2%), and ASCUS (6%). No change in the grade of lesion was seen for HGSIL (63%), LGSIL (64%), and ASCUS (76%). Regression rates for patients with HGSIL and LGSIL were statistically significant (P <0.006). No microinvasive or frankly invasive lesions were seen in this study. Of six patients with CIS antepartum, none progressed to invasion, and two regressed to LGSIL.
Conclusion: A low progression rate of cervical dysplasia during pregnancy allows for conservative management with postpartum follow-up. Regression rates postpartum are high (63–76%) for all grades of lesions.

성기 궤양의 원인 및 치료

Genital Ulcer의 원인 및 치료

Recommended Treatment of Chancroid

Azithromycin 1 g orally or Ceftriaxone 250 mg intramuscularly or Ciprofloxacin 500 mg orally twice daily for 3 days or Erythromycin base 500 mg orally three times daily for 7 days

Recommended Treatment of Granuloma Inguinale

Doxycycline 100 mg twice daily for a minimum of 3 weeks and until lesions have completely healed or Azithromycin 1 g orally once a week as above or Ciprofloxacin 750 mg orally twice daily as above or Erythromycin base 500 mg orally four time daily as above or Trimethoprim-sulfamethoxazole DS orally twice daily as above

Recommended Treatment of Syphilis

Primary, secondary, early latent ( <1 year) syphilis Recommended regimen:   Benzathine penicillin G, 2.4 million units IM once Alternative oral regimens (penicillin-allergic, nonpregnant women):   Doxycycline 100 mg orally twice daily for 2 weeks or   Tetracycline 500 mg orally four times daily for 2 weeks Late latent, tertiary, and cardiovascular syphilis Recommended regimen:   Benzathine penicillin G, 2.4 million units IM weekly times 3 doses Alternative oral regimen (penicillin-allergic, nonpregnant women):   Doxycycline 100 mg orally twice daily for 4 weeks

경구피임약과 뇌졸중의 위험도

대상군	발생률 (no. per 100,000/year)
허혈성 뇌졸중
평균	5
나이 < 35 y	1-3
나이 ≥ 35 y	10
출혈성 뇌졸중
평균	6
피임약으로 인한 추가적 발생률
저용량 피임약	2
저용량 피임약, <35 y	1
고용량 피임약	8

35세 미만 여성에서는 뇌졸중의 위험도가 많이 증가하지 않기 때문에 경구피임약을 처방하는데 문제가 없으나, 역시 35세 이상에서는 2배 이상 증가하기 때문에 처방에 주의해야 하며, 특히 혈전증의 가족력이 있는 환자에서는 주의가 요구된다.