Cause of Pertussis
Whooping cough is caused by a bacteria called Bordatella pertussis.
Bordetella pertussis is viewed as the most important species belonging to the genus Bordetella because it infects only humans and causes the most severe symptoms.[3] Bordetella pertussis is a fastidious gram-negative aerobic coccobacillus that is found microscopically alone or in pairs. It is a nonmotile organism that is transferred from host to host through aerosolized droplets generated from the coughing of infected individuals.
Once its presence is established in the host, B. pertussis initiates destruction of airway tissue through a four-step process of attachment, avoidance of host defense, cellular destruction, and systemic effects.
Bordetella pertussis produces a number of toxins and biologically active substances that influence its pathogenicity. Pertussis toxin is viewed as the most virulent factor due to its mitogenic activity. Pertussis toxin affects the circulation of lymphocytes and serves as an adhesion site for bacterial binding to respiratory ciliated cells. Although the role of pertussis toxin in the pathogenesis of pertussis is not fully understood, it has been shown to cause lymphocytosis, hyperinsulinemia, and possibly encephalopathy.
On the outer surface of the cell, B. pertussis contains filamentous hemag-glutinin, pertactin, and fimbriae. The primary pathogenic role of these substances is to aid adherence to epithelial cells within the respiratory tract.
Bordetella pertussis produces several other toxins that enhance its pathogenicity. These toxins include adenylate cyclase toxin, which impairs host immune cell function, and tracheal cytotoxin, which causes respiratory epithelial damage.
Tuesday, April 28, 2009
Signs Symptoms and Complications
What is whooping cough?
Whooping cough (pertussis) is an acute, highly contagious respiratory infection that is caused by a bacterium. The first outbreaks of pertussis were described in the 16th century. The bacterium responsible for the infection, Bordetella pertussis, was not isolated until 1906. The incidence of pertussis has been steadily increasing since the 1980s. According to the U.S. Centers for Disease Control and Prevention (CDC), a total of 25,827 cases of pertussis were reported in 2004 in the U.S.
What are the stages, symptoms, and signs of whooping cough?
The first stage of whooping cough is known as the catarrhal stage. In the catarrhal stage, which typically lasts from one to two weeks, an infected person has symptoms characteristic of an upper respiratory infection, including
- runny nose,
- sneezing,
- low-grade fever, or a
- mild, occasional cough, similar to the common cold.
The cough gradually becomes more severe, and after one to two weeks, the second stage begins. It is during the second stage (the paroxysmal stage) that the diagnosis of whooping cough usually is suspected. The second stage is characterized by
- Bursts (paroxysms) of coughing, or numerous rapid coughs, are apparently due to difficulty expelling thick mucus from the airways in the lungs. Bursts of coughing increase in frequency during the first one to two weeks, remain constant for two to three weeks, and then gradually begin to decrease in frequency.
- At the end of the bursts of rapid coughs, a long inspiratory effort (breathing in) is usually accompanied by a characteristic high-pitched "whoop."
- During an attack, the individual may become cyanotic (turn blue) from lack of oxygen.
- Children and young infants appear especially ill and distressed.
- Vomiting (referred to by doctors as posttussive vomiting) and exhaustion commonly follow the episodes of coughing.
- The person usually appears normal between episodes.
- Paroxysmal attacks occur more frequently at night, with an average of 15-24 attacks per 24 hours.
- The paroxysmal stage usually lasts from one to six weeks but may persist for up to 10 weeks.
- Infants under 6 months of age may not have the strength to have a whoop, but they do have paroxysms of coughing.
The third stage of whooping cough is the recovery or convalescent stage. In the convalescent stage, recovery is gradual. The cough becomes less paroxysmal and usually disappears over two to three weeks; however, paroxysms often recur with subsequent respiratory infections for many months.
Complications of whooping cough (pertussis)
The most common complication and the cause of most pertussis-related deaths is secondary bacterial pneumonia. (Secondary bacterial pneumonia is bacterial pneumonia that follows another infection of the lung, be it viral or bacterial. Secondary pneumonia is caused by a different virus or bacterium than the original infection.) Young infants are at highest risk for whooping cough and also for pertussis-associated complications, including secondary pneumonia. Data from 2001-2003 indicate that secondary pneumonia occurred among 4.9% of all reported pertussis cases.
Pertussis can cause serious illness and even death in young children; 13 children died from the infection in 2003. From 2004-2005, 66 deaths due to whooping cough were reported to the CDC, and 56 of these were children under 3 months of age. Most of the pertussis-related deaths have occurred in children who have not been vaccinated or who are too young to have received the vaccine.
Other possible complications of pertussis include seizures, encephalopathy (abnormal function of the brain due to decreased oxygen delivery to the brain), reactive airway disease (asthma), dehydration, and malnutrition.
http://www.medicinenet.com/pertussis/page3.htm
you can get more info from this site
http://www.medscape.com/viewarticle/552159_5
Pathophysiology of pertussis
Pertussis :
-Commonly known as whooping cough.
-Respiratory tract infection
-Characterized by paroxysmal cough
-Caused by the bacterium Bordetella pertussis
-Typically attacks children
-3 stages :
*Catarrhal
*Paroxysmal
*convalescent
Pathophysiology :
-Bordetella pertussis attaches to and multiplies on the respiratory epithelium.
*damages ciliated respiratory epithelium.
-starting in the nasopharynx and ending primarily in the bronchi and bronchioles
-Cilia attacked by bacteria
*Accumulate debris in the respiratory tract
*Mucus production
~Body can’t get rid of the mucus in the airways
*Coughing
*Inhalation comes with a whistling or whooping sound
~Breathing difficulty.
Whistling/whooping sound :
-Narrowing of the lower respiratory tract
*Caused by mucus
-air moves through the narrowed space, it sounds like whistling or whoosing.
-often comes from the small breathing tubes (bronchial tubes) deep in the chest
-Commonly known as whooping cough.
-Respiratory tract infection
-Characterized by paroxysmal cough
-Caused by the bacterium Bordetella pertussis
-Typically attacks children
-3 stages :
*Catarrhal
*Paroxysmal
*convalescent
Pathophysiology :
-Bordetella pertussis attaches to and multiplies on the respiratory epithelium.
*damages ciliated respiratory epithelium.
-starting in the nasopharynx and ending primarily in the bronchi and bronchioles
-Cilia attacked by bacteria
*Accumulate debris in the respiratory tract
*Mucus production
~Body can’t get rid of the mucus in the airways
*Coughing
*Inhalation comes with a whistling or whooping sound
~Breathing difficulty.
Whistling/whooping sound :
-Narrowing of the lower respiratory tract
*Caused by mucus
-air moves through the narrowed space, it sounds like whistling or whoosing.
-often comes from the small breathing tubes (bronchial tubes) deep in the chest
Treatment and Management of Pertussis
Medical care
The mainstay of therapy in patients with active pertussis infections is supportive. The goals of therapy include limiting the number of paroxysms, observing the severity of cough, providing assistance when necessary, and maximizing nutrition, rest, and recovery.
• Although antimicrobial agents initiated during the paroxysmal stage do not affect the duration and severity of illness, they can hasten the eradication of Bordetella pertussis in the respiratory tract and help prevent spread.
• For patients aged 1 month or older, macrolide antibiotics such as erythromycin, clarithromycin, and azithromycin, are the preferred agents.
• Erythromycin and clarithromycin are not recommended in infants younger than 1 month because their use has been associated with increased risk for infantile hypertrophic pyloric stenosis (IHPS).
• Azithromycin, which also carries some risk for IHPS, is the recommended agent in the youngest patients. Patients who are aged 2 months or older with hypersensitivity to macrolides may be treated with trimethoprim-sulfamethoxazole.
• Hospitalization should be strongly considered for patients at risk of severe disease and complications, including infants younger than 3 months; infants aged 3-6 months, unless observed paroxysms are not severe; premature young infants; and infants or children with underlying pulmonary, cardiac, or neuromuscular disease.
o For the hospitalized patient, in addition to standard precautions, droplet precautions are recommended for 5 days after initiation of effective therapy or until 3 weeks after the onset of paroxysms if appropriate antimicrobial therapy is not given.
o Monitor heart rate, respiratory rate, and oxygen saturation of hospitalized patients continuously, especially in relation to coughing paroxysms. Coughing, feeding, vomiting, and weight changes should be recorded.
o Pay attention to the young infant's hydration and nutritional status.
o Patients who are severely ill may require treatment in an ICU.
Medication
Antimicrobial agents given during the catarrhal phase may ameliorate the disease. Once cough is established, antimicrobial agents may not alter the course of the illness but are still recommended to limit the spread of disease.
Pertussis-specific immune globulin is an investigational product that may be effective in decreasing paroxysms of cough but requires further evaluation.
The use of corticosteroids, albuterol, and other beta2-adrenergic agents for the treatment of pertussis is not supported by controlled, prospective data.
Antibiotics
The Committee on Infectious Diseases of the American Academy of Pediatrics (Red Book Committee) currently recommends promptly treating all household and other close contacts (eg, children and staff at daycare centers) with erythromycin to limit secondary transmission.12 This is regardless of the age or immunization status of contacts. A 14-day course of oral (PO) erythromycin is the antimicrobial therapy of choice for patients with pertussis and for close contacts. Typical dosing schedule is 40-50 mg/kg/d (not to exceed 2 g/d) in 4 divided doses. Some experts prefer the estolate preparation in young infants because of more effective absorption, which may lead to decreased dosing and less frequent dosing intervals.
In infants younger than 2 weeks, an association between orally administered erythromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported. Because pertussis can be life threatening in neonates and the efficacy of alternative therapies has not been well studied, the American Academy of Pediatrics continues to recommend the use of erythromycin for treatment of and prophylaxis for pertussis. Parents and caregivers need to be informed about the risks and signs of IHPS.
Click
http://emedicine.medscape.com/article/967268-treatment
and
http://www.nlm.nih.gov/medlineplus/ency/article/001561.htm#Treatment
for more information.
The mainstay of therapy in patients with active pertussis infections is supportive. The goals of therapy include limiting the number of paroxysms, observing the severity of cough, providing assistance when necessary, and maximizing nutrition, rest, and recovery.
• Although antimicrobial agents initiated during the paroxysmal stage do not affect the duration and severity of illness, they can hasten the eradication of Bordetella pertussis in the respiratory tract and help prevent spread.
• For patients aged 1 month or older, macrolide antibiotics such as erythromycin, clarithromycin, and azithromycin, are the preferred agents.
• Erythromycin and clarithromycin are not recommended in infants younger than 1 month because their use has been associated with increased risk for infantile hypertrophic pyloric stenosis (IHPS).
• Azithromycin, which also carries some risk for IHPS, is the recommended agent in the youngest patients. Patients who are aged 2 months or older with hypersensitivity to macrolides may be treated with trimethoprim-sulfamethoxazole.
• Hospitalization should be strongly considered for patients at risk of severe disease and complications, including infants younger than 3 months; infants aged 3-6 months, unless observed paroxysms are not severe; premature young infants; and infants or children with underlying pulmonary, cardiac, or neuromuscular disease.
o For the hospitalized patient, in addition to standard precautions, droplet precautions are recommended for 5 days after initiation of effective therapy or until 3 weeks after the onset of paroxysms if appropriate antimicrobial therapy is not given.
o Monitor heart rate, respiratory rate, and oxygen saturation of hospitalized patients continuously, especially in relation to coughing paroxysms. Coughing, feeding, vomiting, and weight changes should be recorded.
o Pay attention to the young infant's hydration and nutritional status.
o Patients who are severely ill may require treatment in an ICU.
Medication
Antimicrobial agents given during the catarrhal phase may ameliorate the disease. Once cough is established, antimicrobial agents may not alter the course of the illness but are still recommended to limit the spread of disease.
Pertussis-specific immune globulin is an investigational product that may be effective in decreasing paroxysms of cough but requires further evaluation.
The use of corticosteroids, albuterol, and other beta2-adrenergic agents for the treatment of pertussis is not supported by controlled, prospective data.
Antibiotics
The Committee on Infectious Diseases of the American Academy of Pediatrics (Red Book Committee) currently recommends promptly treating all household and other close contacts (eg, children and staff at daycare centers) with erythromycin to limit secondary transmission.12 This is regardless of the age or immunization status of contacts. A 14-day course of oral (PO) erythromycin is the antimicrobial therapy of choice for patients with pertussis and for close contacts. Typical dosing schedule is 40-50 mg/kg/d (not to exceed 2 g/d) in 4 divided doses. Some experts prefer the estolate preparation in young infants because of more effective absorption, which may lead to decreased dosing and less frequent dosing intervals.
In infants younger than 2 weeks, an association between orally administered erythromycin and infantile hypertrophic pyloric stenosis (IHPS) has been reported. Because pertussis can be life threatening in neonates and the efficacy of alternative therapies has not been well studied, the American Academy of Pediatrics continues to recommend the use of erythromycin for treatment of and prophylaxis for pertussis. Parents and caregivers need to be informed about the risks and signs of IHPS.
Click
http://emedicine.medscape.com/article/967268-treatment
and
http://www.nlm.nih.gov/medlineplus/ency/article/001561.htm#Treatment
for more information.
Monday, April 27, 2009
Pertussis Fact Sheet
http://health.utah.gov/epi/fact_sheets/Pertussis_Clinician_Fact.pdf
Good link. It has a good summary.
Good link. It has a good summary.
Thursday, April 23, 2009
Syariah Law
Syariah laws is only applied to Muslims. Male and female who are having sexual intercourse outside a legal marriage regardless of age will be sued by the syariah court and if the couple is both unmarried, they are advised to get married as soon as possible. Meanwhile for same sex sexual intercourse it will be VERY ILLEGAL. As Islam strictly against homosexuality.
Laws for sex and RAPE? dont know whether im sposed 2 include that but whatever haha more for u guys 2 rEAD!
Under 16
If you are under 16, no-one is allowed to have sex with you.
Even if you agree to have sex with someone, it is still against the law for that person to have sex with you. They can be charged with a criminal offence.
A person may be able to defend themselves against such a charge where:
Ø you agreed to have sex with them; AND
Ø you were 10 years or older at the time of having sex; AND
Ø they were not more than 2 years older than you
A person may be able to defend themselves against such a charge where:
Ø they “believed on reasonable grounds” that you were 16 or older; OR
Ø they were married to you.
For someone to believe “on reasonable grounds” that you were 16 or over means more than not asking how old you are.
16 and above
Once you are 16, you can legally have sex with any other person who is 16 or over as long as you both agree to it.
If you are 16 or 17 and have sex with someone who has a relationship of "care, supervision or authority" over you (e.g. they are a teacher, step-parent, guardian, foster parent, sports coach, doctor etc), they can be charged with a criminal offence.
A person may be able to defend themselves against such a charge where you agreed to have sex with them; AND
Ø they “believed on reasonable grounds” that you were 18 or older; OR
Ø they are legally married to you.
For someone to believe “on reasonable grounds” that you were 18 or over means more than not asking how old you are.
Under Malaysian law, a man who is said to commit:
1) rape shall be punished for a term which may extend to 20 years, and shall also be liable to whipping, if he has sexual intercourse with a woman under any of the following circumstances:
(a) against her will;
(b) without her consent;
© with her consent when that consent has been obtained by putting her in fear of death or hurt to herself or any other person or obtained under a misconception of fact and the man knows or has reason to believe that the consent was given in consequence of such misconception;
(d) with her consent when the man knows that he is not her husband, and her consent is given because she believes that he is another man to whom she is, or believes herself to be, lawfully married or to whom she would give consent;
(e) with her consent when, at the time of giving such consent, she is unable to understand the nature and consequences of that to which she gives consent;
(f) with her consent, when that consent is obtained by using his position of authority over her or because of a professional relationship or other relationship of trust in relation to her;
(g) with or without her consent, when she is under 16 years of age.
Exception: Sexual intercourse by a man with his own wife in a marriage which is valid is not considered rape.
(References: Sections 375 and 376 of the Penal Code)
2) aggravated rape* is punishable by imprisonment for a term of not less than 5 years and not more than 30 years, and the assailant is also liable to whipping if he commits rape on a woman under any of the following circumstances:
(a) at the time of, or immediately before or after he commits rape, causes hurt to her or to any other person;
(b) at the time of, or immediately before or after he commits rape, puts her in fear of death or hurt to herself or any other person;
© he commits rape in the company of, or in the presence of, any other person;
(d) without her consent, when she is under 16 years of age;
(e) with or without her consent, when she is under 12 years of age;
(f) with her consent, when that consent is obtained by using his position of authority over her or because of a professional relationship or other relationship of trust in relation to her;
(g) at the time of the offence the woman was pregnant.
(Reference: Section 376 of the Penal Code)
3) incestuous rape* shall be punished with imprisonment for a term of not less than 8 years and not more than 30 years, and shall also be punished with whipping of not less than 10 strokes. This is a situation where a man commits rape on a woman whose relationship to him is such that he is not permitted under the law, religion, custom or usage, to marry her.
(Reference: Section 376 of the Penal Code)
4) causing death whilst committing or attempting to commit rape shall be punished with death or imprisonment for a term of not less than 15 years and not more than 30 years, and shall also be punished with whipping of not less than 10 strokes.
(Reference: Section 376 of the Penal Code)
• Note that the terms “aggravated rape” and “incestuous rape” are not expressly used in the Penal Code. They are used here for easy reference.
Additionally,
5) Any husband, who during the subsistence of a valid marriage, causes hurt or fear of death or hurt to his wife or any other person in order to have sexual intercourse with his wife shall be punished with imprisonment for a term which may extend to 5 years.
(Reference: Section 375A of the Penal Code)
6) Any person who has sexual connection with another person by the introduction of any object into the vagina or anus of the other person without the other person’s consent shall be punished with imprisonment up to a maximum of 20 years and shall also be liable to whipping.
Exception: This does not apply where the introduction of any object into the vagina or anus of any other person is carried out for medical or law enforcement purposes.
(Reference: Section 377CA of the Penal Code)
If you are under 16, no-one is allowed to have sex with you.
Even if you agree to have sex with someone, it is still against the law for that person to have sex with you. They can be charged with a criminal offence.
A person may be able to defend themselves against such a charge where:
Ø you agreed to have sex with them; AND
Ø you were 10 years or older at the time of having sex; AND
Ø they were not more than 2 years older than you
A person may be able to defend themselves against such a charge where:
Ø they “believed on reasonable grounds” that you were 16 or older; OR
Ø they were married to you.
For someone to believe “on reasonable grounds” that you were 16 or over means more than not asking how old you are.
16 and above
Once you are 16, you can legally have sex with any other person who is 16 or over as long as you both agree to it.
If you are 16 or 17 and have sex with someone who has a relationship of "care, supervision or authority" over you (e.g. they are a teacher, step-parent, guardian, foster parent, sports coach, doctor etc), they can be charged with a criminal offence.
A person may be able to defend themselves against such a charge where you agreed to have sex with them; AND
Ø they “believed on reasonable grounds” that you were 18 or older; OR
Ø they are legally married to you.
For someone to believe “on reasonable grounds” that you were 18 or over means more than not asking how old you are.
Under Malaysian law, a man who is said to commit:
1) rape shall be punished for a term which may extend to 20 years, and shall also be liable to whipping, if he has sexual intercourse with a woman under any of the following circumstances:
(a) against her will;
(b) without her consent;
© with her consent when that consent has been obtained by putting her in fear of death or hurt to herself or any other person or obtained under a misconception of fact and the man knows or has reason to believe that the consent was given in consequence of such misconception;
(d) with her consent when the man knows that he is not her husband, and her consent is given because she believes that he is another man to whom she is, or believes herself to be, lawfully married or to whom she would give consent;
(e) with her consent when, at the time of giving such consent, she is unable to understand the nature and consequences of that to which she gives consent;
(f) with her consent, when that consent is obtained by using his position of authority over her or because of a professional relationship or other relationship of trust in relation to her;
(g) with or without her consent, when she is under 16 years of age.
Exception: Sexual intercourse by a man with his own wife in a marriage which is valid is not considered rape.
(References: Sections 375 and 376 of the Penal Code)
2) aggravated rape* is punishable by imprisonment for a term of not less than 5 years and not more than 30 years, and the assailant is also liable to whipping if he commits rape on a woman under any of the following circumstances:
(a) at the time of, or immediately before or after he commits rape, causes hurt to her or to any other person;
(b) at the time of, or immediately before or after he commits rape, puts her in fear of death or hurt to herself or any other person;
© he commits rape in the company of, or in the presence of, any other person;
(d) without her consent, when she is under 16 years of age;
(e) with or without her consent, when she is under 12 years of age;
(f) with her consent, when that consent is obtained by using his position of authority over her or because of a professional relationship or other relationship of trust in relation to her;
(g) at the time of the offence the woman was pregnant.
(Reference: Section 376 of the Penal Code)
3) incestuous rape* shall be punished with imprisonment for a term of not less than 8 years and not more than 30 years, and shall also be punished with whipping of not less than 10 strokes. This is a situation where a man commits rape on a woman whose relationship to him is such that he is not permitted under the law, religion, custom or usage, to marry her.
(Reference: Section 376 of the Penal Code)
4) causing death whilst committing or attempting to commit rape shall be punished with death or imprisonment for a term of not less than 15 years and not more than 30 years, and shall also be punished with whipping of not less than 10 strokes.
(Reference: Section 376 of the Penal Code)
• Note that the terms “aggravated rape” and “incestuous rape” are not expressly used in the Penal Code. They are used here for easy reference.
Additionally,
5) Any husband, who during the subsistence of a valid marriage, causes hurt or fear of death or hurt to his wife or any other person in order to have sexual intercourse with his wife shall be punished with imprisonment for a term which may extend to 5 years.
(Reference: Section 375A of the Penal Code)
6) Any person who has sexual connection with another person by the introduction of any object into the vagina or anus of the other person without the other person’s consent shall be punished with imprisonment up to a maximum of 20 years and shall also be liable to whipping.
Exception: This does not apply where the introduction of any object into the vagina or anus of any other person is carried out for medical or law enforcement purposes.
(Reference: Section 377CA of the Penal Code)
Wednesday, April 22, 2009
Legal and Ethical issues of Abortion
Medical abortion (therapeutic) - termination of pregnancy based on medical indications as listed below:
- To save the life of the pregnant woman
- To preserve the woman's physical or mental health
- To prevent delivery of a fetus detected to have serious defects
Induced abortion - abortion that has been caused by deliberate human action, usually voluntarily due to :
- Desire to delay or end childbearing
- concern over the interruption of work or education
- Issues of financial or relationship stability
- Lack of access or rejection of contraception resulting in unplanned, unwanted pregnancy
Issues related to induced abortion
For years, induced abortion has initiated many public debates and concern from the:
- Ethical
- Moral
- Philosophical
- Biological
- Religious
- Legal aspects
Public opinions on induced abortion are divided into two main groups:
- Pro-choice group, who supports abortion as a mean of allowing women to make their own reproductive decisions
- Pro-life group, who is against abortion and regards it as a cruel form of murdering a fetus which has the right to live
Reminder
Teenagers considering abortion must not proceed without first consulting trusted adults and trained medical personnel.
Abortion is not legalized in Malaysia except for certain medical reasons. Any individual considering abortion must be aware of the legal implications as it is an offence to be involved in induced abortions, not indicated by medical reasons, in the Penal Codes of Malaysian law. (2008 March)
The Penal Code (Amendment) Act 1989 (Act A727), 1989.
In 1989, Malaysia amended its penal code to provide that inducing an abortion is not an offense if the procedure is performed by a registered medical practitioner who has determined that continuation of the pregnancy would risk the life of the woman or damage her mental or physical health. Additional amendments include a legal description of the conditions which constitute the act of rape. Among these conditions is intercourse with or without consent with a woman under the age of 16. Malaysia fails to recognize rape within a marriage unless the woman is protected from her husband by judicial decree or is living separately from her husband according to Muslim custom. Rape is punishable by imprisonment for a term of 5-20 years and by whipping.
DNA Paternity Testing
Type of paternity testing :
Postnatal (after child’s birth) DNA testing
-Blood collection and testing
-Buccal swab (cheek swab) collection and testing
-Umbilical cord collection and testing
-Other sample collection and testing (semen, tissue, hair etc.
Prenatal (before child’s birth) DNA testing
-Amniocentesis
-Chorionic Villus Sampling
Blood Testing :
-Blood-typing system : ABC typing
-Involve the presence of antigens on the red blood cells
-A allele – dominant
-B allele – dominant
-A allele and B allele – codominant
-O allele - recessive
Check out the blood types ABC explained from this website :
http://www.dnatesting.com/resources/aboBloodTypes.php
Buccal Swab :
-Sample for DNA test
-collected using the painless and simple buccal swab
—similar to a cotton-tipped swab rubbed against
*the inside cheek of the test participant, and
*loose cheek cells adhere to the swab.
Amniocentesis :
second trimester
14th-20th weeks of pregnancy
uses ultrasound to guide a thin needle into your uterus, through your abdomen
needle draws out a small amount of amniotic fluid
small chance of harming the baby and miscarriage
side effects may include
Cramping
leaking of amniotic fluid
vaginal bleeding.
Chorionic Villus Sample
10th-13th weeks
consists of a thin needle or tube which a doctor inserts from the vagina, through the cervix
guided by an ultrasound, to obtain chorionic villi.
little finger-like pieces of tissue attached to the wall of the uterus.
chorionic villi and the fetus come from the same fertilized egg
have the same genetic makeup.
Postnatal (after child’s birth) DNA testing
-Blood collection and testing
-Buccal swab (cheek swab) collection and testing
-Umbilical cord collection and testing
-Other sample collection and testing (semen, tissue, hair etc.
Prenatal (before child’s birth) DNA testing
-Amniocentesis
-Chorionic Villus Sampling
Blood Testing :
-Blood-typing system : ABC typing
-Involve the presence of antigens on the red blood cells
-A allele – dominant
-B allele – dominant
-A allele and B allele – codominant
-O allele - recessive
Check out the blood types ABC explained from this website :
http://www.dnatesting.com/resources/aboBloodTypes.php
Buccal Swab :
-Sample for DNA test
-collected using the painless and simple buccal swab
—similar to a cotton-tipped swab rubbed against
*the inside cheek of the test participant, and
*loose cheek cells adhere to the swab.
Amniocentesis :
second trimester
14th-20th weeks of pregnancy
uses ultrasound to guide a thin needle into your uterus, through your abdomen
needle draws out a small amount of amniotic fluid
small chance of harming the baby and miscarriage
side effects may include
Cramping
leaking of amniotic fluid
vaginal bleeding.
Chorionic Villus Sample
10th-13th weeks
consists of a thin needle or tube which a doctor inserts from the vagina, through the cervix
guided by an ultrasound, to obtain chorionic villi.
little finger-like pieces of tissue attached to the wall of the uterus.
chorionic villi and the fetus come from the same fertilized egg
have the same genetic makeup.
Pregnancy Trimesters
Content:
The trimesters
Test and Procedures
Hormone
THE TRIMESTERS
What are the months of the three Trimesters in pregnancy?
First trimester: 0 - 12 weeks (0 - 3 and a half months)
Second trimester: 12 - 24 weeks (3 1/2 months to 6 mths)
Third trimester: 24 - 40 weeks (7 mths to delivery)
First trimester
Size of baby during 1st month = a dime
has eyes, mouth and head and his legs and arms are growing.
heart and lungs have begun to beat - lungs have begun to form.
at the end of this month of pregnancy, about half an inch long.
Most miscarriages occur during this period
Some studies show that mild to moderate sickness is a sign of a good pregnancy, and less risk of miscarriage.
What to expect
Tender breasts.
Increased hormone production – more sensitive. Feel fuller and heavier. Wearing a more supportive bra or a sports bra may help.
Bouts of nausea.
Queasiness, nausea or vomiting - normal hormonal changes. Usually worse in the morning, but it can last all day. To help relieve this symptom, eat small, frequent meals throughout the day. Suck on hard candy. Try ginger ale or ginger tea. Lemon and peppermint sometimes help, too. Avoid foods or smells that make your nausea worse. If you're not able to eat or drink for more than 24 hours, contact your health care provider.
Unusual fatigue.
body prepares to support the pregnancy. Heart will pump faster and harder, and pulse will quicken. To combat fatigue, rest as much as possible. Make enough iron and protein. Include physical activity in your daily routine, such as a brisk walk.
Increased urination.
Enlarging uterus presses on bladder. May cause you to leak urine when sneezing, coughing or laughing. To help prevent urinary tract infections, urinate whenever you feel the need to. If losing sleep due to middle-of-the-night bathroom trips - drink less fluid in the evening. If you're worried about leaking urine - panty liners.
Dizziness.
Due to normal circulation changes. Stress, fatigue and hunger play a role. To prevent mild, occasional dizziness - avoid prolonged standing. Rise slowly after lying or sitting down. If you start to feel dizzy while you're driving, pull over. If you're standing when dizziness hits, sit or lie down.
Seek prompt care if the dizziness is severe and occurs with abdominal pain or vaginal bleeding. This may indicate an ectopic pregnancy — a condition in which the fertilized egg implants itself outside the uterus. To prevent life-threatening complications, the ectopic tissue must be removed.
Second trimester
Size of baby = 3 inches in length
baby's face has a defined nose, chin, and forehead by now.
can even smile due to development of facial muscle.
Fine hair starts growing all over your baby's body.
She has a distinct set of fingerprints.
She now has her own identity and is no longer just a bunch of cells.
What to expect
Larger breasts.
Stimulated by estrogen and progesterone, the milk-producing - larger. Additional fat - accumulate in your breasts. The result may be 1 pound of extra breast tissue or up to two additional cup sizes. Initial breast tenderness may improve, nipple tenderness may continue throughout the pregnancy. A supportive bra is a must.
Growing belly.
Uterus becomes heavier and expands to make room for the baby- abdomen expands — sometimes rapidly. Expect to gain up to 4 pounds a month until the end of your pregnancy.
Braxton Hicks contractions.
Uterus start contracting to build strength for the big job ahead - Braxton Hicks contractions, in lower abdomen and groin - painless and on-and-off. Contact your health care provider if the contractions become painful or regular. This may be a sign of preterm labor.
Skin changes.
blood circulation increases - certain areas of skin become darker, such as the skin around your nipples, parts of your face and the line that runs from your navel to your pubic bone.
Dizziness.
Blood vessels dilate in response to pregnancy hormones. Until blood volume expands to fill them, you may experience occasional dizziness. Lower blood pressure due to your rapidly expanding circulatory system play a role. Avoid prolonged standing, and rise slowly after lying or sitting down.
Leg cramps.
Pressure from uterus on the veins returning blood from your legs may cause leg cramps, especially at night. Stretch the affected muscle or walk your way through the cramps.
Heartburn and constipation.
Movements pushing swallowed food from esophagus into stomach are slower – stomach takes longer to empty. Slowdown gives nutrients more time to be absorbed into bloodstream and reach baby. May also lead to heartburn and constipation. May help to eat small, frequent meals. To prevent or relieve constipation, include plenty of fiber in diet and drink lots of fluids.
Nasal and gum problems.
Circulation increases - more blood flows through body's mucous membranes - causes the lining of nose and airway to swell - can restrict airflow and lead to snoring, congestion and nosebleeds. Can also soften your gums, which may cause minor bleeding when you brush or floss your teeth.
Shortness of breath.
Lungs - processing up to 40 percent more air than they did before your pregnancy - allows blood to carry more oxygen to placenta and the baby – may cause breathing slightly faster and feeling short of breath.
Vaginal discharge.
May notice a thin, white vaginal discharge (acidic) - thought to help suppress the growth of potentially harmful bacteria or yeast. Wear panty liners for comfort. Contact your health care provider if discharge becomes strong-smelling, green or yellowish or if it's accompanied by redness, itching or irritation. May indicate a vaginal infection.
Bladder and kidney infections.
Hormonal changes slow the flow of urine, expanding uterus — both factors that increase the risk of bladder and kidney infections. Contact your health care provider if you need to urinate more often than usual, you notice a burning sensation when you urinate, or you have a fever, abdominal pain or backache. Left untreated, urinary infections increase the risk of preterm labor.
Third trimester
baby is likely to grow fastest!
-Seventh Month
the head of the baby will appear to be in proportion to the rest of the body and the brain is better developed.
baby can now, bat his eyelids and can actually produce tears.
The weight of the baby will be close to three pounds (1.360777 kilograms) now, though the physical growth takes a lower pace.
-Eigth Month
May not be much room for the growing baby to move around - the mother may not feel much movement within the womb.
Mild discomforts - indigestion, heartburn during pregnancy, shortness of breath and tiredness may be experienced.
The baby - slowly change position - the head faces the bottom. The amniotic fluid will be at its highest now, and the baby may begin taking alternate breaths, thereby getting himself prepared to breathe air.
The sleep pattern of the baby - more regular now.
By the end of the month, the hearing capability of the baby would have developed completely - recommended that parents should talk to their baby as much as they can.
-Ninth Month
Baby’s head descend into the pelvic region - mother may experience more frequent urge for urination – common.
The baby’s head - have hair, the lungs - completely developed by now and the weight - will now be about 7.25 pounds (3.28854468 kilograms )
chances of the mucus plug getting burst, anytime, which is a sure sign of approach of labor.
TEST & PROCEDURES
FIRST TRIMESTER
During the first appointment:
-Basic medical history
Menstrual cycle
Use of contraceptives
Past pregnancies
Allergies
Other medical conditions
-Due date
Counting ahead 40 weeks from the start of last period
Early establishment helps to monitor foetus’s growth as accurately as possible
-Physical exam
Weight
Height
Blood pressure
Heart beat
Overall health
-Pelvic exam
Examine vagina and cervix for any infections or abnormalities
May require pap test to screen for cervical cancer
Changes in the cervix and in the size of uterus can help confirm the stage of pregnancy
-Blood test
Blood type
Rh factor
Syphilis
Measles
Mumps
Rubella
Hepatitis B
HIV
-Urine tests
Bladder or kidney infection
Diabetes
-Lifestyle issues
Discuss importance of nutrition, prenatal vitamins, exercise, and other lifestyle issues
Work environment
-Other appointment
Scheduled every four to six weeks
Check weight and blood pressure
Discuss signs and symptoms
Screening and diagnostic tests for foetal abnormalities
-Ultrasound
-Blood test
-Chorionic villus sampling (CVS)
Between 10 and 12 weeks of pregnancy
The doctor inserts a needle through abdomen or inserts a catheter through cervix in order to reach the placenta. The doctor then takes a sample of cells from the placenta
Look for problems with chromosomes
-Nucchal translucency screening (NTS)
Between 11 and 14 weeks
Uses an ultrasound and blood test to calculate the risk of some birth defects (e.g. down syndrome)
Ultrasound – check the thickness of the back of the foetus’s neck
Blood test – to check the levels of pregnancy-associated plasma protein and human chorionic gonadotropin (hCG)
Second trimester
Once a month
During every visit:
-Check blood pressure and weight
Track your baby’s growth
By measuring the abdomen from the top of uterus to pubic bone
-Listen to your baby’s heartbeat
Using doppler
-Assess foetal movement
-Routine lab tests
Urine test
Sugar or protein
Blood test
Low iron levels
-Gestational diabetes
Prenatal testing
Blood test
Developmental or chromosomal disorders
Ultrasound
Evaluate foetus’s growth and development
Diagnostic test
-Amniocentesis
At least 16 weeks
Inserting a thin needle through your abdomen, into your uterus, and into the amniotic sac to take out a small amount of amniotic fluid for testing.
Look for problems with chromosomes
Miscarriage: 1 in 200
-Maternal serum screening test
Blood test
Between 15 and 20 weeks of pregnancy
Check for birth defects (down syndrome, Edward syndrome)
Done by checking for alpha-phetoprotein (AFP) (made by foetus’s liver), estriol and (hCG)
-Targeted ultrasound
Between 18 and 20 weeks
Look for physical defects
Find out the sex of the baby
Can look for any neural tube defects (e.g. spina bifida)
Third trimester
Weekly checkups during the last month of pregnancy
Continue to monitor blood pressure and weight, foetus’s heartbeat and movement
-Screening for group B streptococcus
Harmless to adults, but not for foetus
Can become critically ill
If positive, be given intravenous antibiotic during labor
-Resuming vaginal exams
Check the foetus’s position
Feeling the foetus’s head in the lower abdomen or at the top of the birth canal
Detect cervical changes
Cervix will begin to soften, open (dilate) and thin (efface)
Help in determining how difficult it would be to induce labor
HORMONES
Human Gonadotropic Hormone (hCG)
produced only during pregnancy.
(First by ovary and later by placenta)
hCG values double every two days or so in the early part of the first trimester.
Keeps estrogen and progesteroneat their appropriate levels until the placenta has developed enough to take over this function.
Estrogen
Regulate the production of progesterone
Assist in the development of foetus
Regulates bone density in a foetus
Maintains the endometrium during pregnancy
Promotes blood flow within the uterus
Maintains, regulates and triggers the production of other hormones
Protects female foetuses from the effects of androgens in the mother's system.
Progesteron (mostly together with estrogen)
Makes the endometrium develop and secrete fluids after being primed by estrogen
Maintains the functions of the placenta and fights off unwanted cells near the womb that could cause damage to the placenta or foetus.
Keeps the endometrium in a thickened condition
Stops the uterus making spontaneous movements
Stimulates the growth of breast tissue
Strengthens the mucus plug covering the cervix to prevent infection.
Strengthens the pelvic walls in preparation for labour.
Stops the uterus from contracting (thus keeping the baby where it is)
Estrogen &Progesterone
control the onset of breast milk
inhibiting the breasts' response to the hormone prolactin.
At the time of delivery,Estrogen and progesterone levels decrease, allowing prolactin to stimulate the breasts' milk flow.
Increased level
Estrogen
Appearance of rashes or red blotches on skin
Progesterone
Constipation
Heartburn
Runny and irritable nose
Eyesight problems (blurring or headaches)
Increased kidney infection risk.
Prolactin
made by the baby’s kidneys
reduced about a week after birth.
remain high within the mother's blood for about two weeks after birth.
important for the regulation of the mother's metabolism during the pregnancy
assists in the stimulation of immune system cell growth.
prepares the breasts for breastfeeding
promotes the growth of the baby.
Oxytocin
Causes uterus to contract so that birth happen rapidly
Stimulates mammary glands to produce milks
High level of progesterone prevent oxytocin effect
The trimesters
Test and Procedures
Hormone
THE TRIMESTERS
What are the months of the three Trimesters in pregnancy?
First trimester: 0 - 12 weeks (0 - 3 and a half months)
Second trimester: 12 - 24 weeks (3 1/2 months to 6 mths)
Third trimester: 24 - 40 weeks (7 mths to delivery)
First trimester
Size of baby during 1st month = a dime
has eyes, mouth and head and his legs and arms are growing.
heart and lungs have begun to beat - lungs have begun to form.
at the end of this month of pregnancy, about half an inch long.
Most miscarriages occur during this period
Some studies show that mild to moderate sickness is a sign of a good pregnancy, and less risk of miscarriage.
What to expect
Tender breasts.
Increased hormone production – more sensitive. Feel fuller and heavier. Wearing a more supportive bra or a sports bra may help.
Bouts of nausea.
Queasiness, nausea or vomiting - normal hormonal changes. Usually worse in the morning, but it can last all day. To help relieve this symptom, eat small, frequent meals throughout the day. Suck on hard candy. Try ginger ale or ginger tea. Lemon and peppermint sometimes help, too. Avoid foods or smells that make your nausea worse. If you're not able to eat or drink for more than 24 hours, contact your health care provider.
Unusual fatigue.
body prepares to support the pregnancy. Heart will pump faster and harder, and pulse will quicken. To combat fatigue, rest as much as possible. Make enough iron and protein. Include physical activity in your daily routine, such as a brisk walk.
Increased urination.
Enlarging uterus presses on bladder. May cause you to leak urine when sneezing, coughing or laughing. To help prevent urinary tract infections, urinate whenever you feel the need to. If losing sleep due to middle-of-the-night bathroom trips - drink less fluid in the evening. If you're worried about leaking urine - panty liners.
Dizziness.
Due to normal circulation changes. Stress, fatigue and hunger play a role. To prevent mild, occasional dizziness - avoid prolonged standing. Rise slowly after lying or sitting down. If you start to feel dizzy while you're driving, pull over. If you're standing when dizziness hits, sit or lie down.
Seek prompt care if the dizziness is severe and occurs with abdominal pain or vaginal bleeding. This may indicate an ectopic pregnancy — a condition in which the fertilized egg implants itself outside the uterus. To prevent life-threatening complications, the ectopic tissue must be removed.
Second trimester
Size of baby = 3 inches in length
baby's face has a defined nose, chin, and forehead by now.
can even smile due to development of facial muscle.
Fine hair starts growing all over your baby's body.
She has a distinct set of fingerprints.
She now has her own identity and is no longer just a bunch of cells.
What to expect
Larger breasts.
Stimulated by estrogen and progesterone, the milk-producing - larger. Additional fat - accumulate in your breasts. The result may be 1 pound of extra breast tissue or up to two additional cup sizes. Initial breast tenderness may improve, nipple tenderness may continue throughout the pregnancy. A supportive bra is a must.
Growing belly.
Uterus becomes heavier and expands to make room for the baby- abdomen expands — sometimes rapidly. Expect to gain up to 4 pounds a month until the end of your pregnancy.
Braxton Hicks contractions.
Uterus start contracting to build strength for the big job ahead - Braxton Hicks contractions, in lower abdomen and groin - painless and on-and-off. Contact your health care provider if the contractions become painful or regular. This may be a sign of preterm labor.
Skin changes.
blood circulation increases - certain areas of skin become darker, such as the skin around your nipples, parts of your face and the line that runs from your navel to your pubic bone.
Dizziness.
Blood vessels dilate in response to pregnancy hormones. Until blood volume expands to fill them, you may experience occasional dizziness. Lower blood pressure due to your rapidly expanding circulatory system play a role. Avoid prolonged standing, and rise slowly after lying or sitting down.
Leg cramps.
Pressure from uterus on the veins returning blood from your legs may cause leg cramps, especially at night. Stretch the affected muscle or walk your way through the cramps.
Heartburn and constipation.
Movements pushing swallowed food from esophagus into stomach are slower – stomach takes longer to empty. Slowdown gives nutrients more time to be absorbed into bloodstream and reach baby. May also lead to heartburn and constipation. May help to eat small, frequent meals. To prevent or relieve constipation, include plenty of fiber in diet and drink lots of fluids.
Nasal and gum problems.
Circulation increases - more blood flows through body's mucous membranes - causes the lining of nose and airway to swell - can restrict airflow and lead to snoring, congestion and nosebleeds. Can also soften your gums, which may cause minor bleeding when you brush or floss your teeth.
Shortness of breath.
Lungs - processing up to 40 percent more air than they did before your pregnancy - allows blood to carry more oxygen to placenta and the baby – may cause breathing slightly faster and feeling short of breath.
Vaginal discharge.
May notice a thin, white vaginal discharge (acidic) - thought to help suppress the growth of potentially harmful bacteria or yeast. Wear panty liners for comfort. Contact your health care provider if discharge becomes strong-smelling, green or yellowish or if it's accompanied by redness, itching or irritation. May indicate a vaginal infection.
Bladder and kidney infections.
Hormonal changes slow the flow of urine, expanding uterus — both factors that increase the risk of bladder and kidney infections. Contact your health care provider if you need to urinate more often than usual, you notice a burning sensation when you urinate, or you have a fever, abdominal pain or backache. Left untreated, urinary infections increase the risk of preterm labor.
Third trimester
baby is likely to grow fastest!
-Seventh Month
the head of the baby will appear to be in proportion to the rest of the body and the brain is better developed.
baby can now, bat his eyelids and can actually produce tears.
The weight of the baby will be close to three pounds (1.360777 kilograms) now, though the physical growth takes a lower pace.
-Eigth Month
May not be much room for the growing baby to move around - the mother may not feel much movement within the womb.
Mild discomforts - indigestion, heartburn during pregnancy, shortness of breath and tiredness may be experienced.
The baby - slowly change position - the head faces the bottom. The amniotic fluid will be at its highest now, and the baby may begin taking alternate breaths, thereby getting himself prepared to breathe air.
The sleep pattern of the baby - more regular now.
By the end of the month, the hearing capability of the baby would have developed completely - recommended that parents should talk to their baby as much as they can.
-Ninth Month
Baby’s head descend into the pelvic region - mother may experience more frequent urge for urination – common.
The baby’s head - have hair, the lungs - completely developed by now and the weight - will now be about 7.25 pounds (3.28854468 kilograms )
chances of the mucus plug getting burst, anytime, which is a sure sign of approach of labor.
TEST & PROCEDURES
FIRST TRIMESTER
During the first appointment:
-Basic medical history
Menstrual cycle
Use of contraceptives
Past pregnancies
Allergies
Other medical conditions
-Due date
Counting ahead 40 weeks from the start of last period
Early establishment helps to monitor foetus’s growth as accurately as possible
-Physical exam
Weight
Height
Blood pressure
Heart beat
Overall health
-Pelvic exam
Examine vagina and cervix for any infections or abnormalities
May require pap test to screen for cervical cancer
Changes in the cervix and in the size of uterus can help confirm the stage of pregnancy
-Blood test
Blood type
Rh factor
Syphilis
Measles
Mumps
Rubella
Hepatitis B
HIV
-Urine tests
Bladder or kidney infection
Diabetes
-Lifestyle issues
Discuss importance of nutrition, prenatal vitamins, exercise, and other lifestyle issues
Work environment
-Other appointment
Scheduled every four to six weeks
Check weight and blood pressure
Discuss signs and symptoms
Screening and diagnostic tests for foetal abnormalities
-Ultrasound
-Blood test
-Chorionic villus sampling (CVS)
Between 10 and 12 weeks of pregnancy
The doctor inserts a needle through abdomen or inserts a catheter through cervix in order to reach the placenta. The doctor then takes a sample of cells from the placenta
Look for problems with chromosomes
-Nucchal translucency screening (NTS)
Between 11 and 14 weeks
Uses an ultrasound and blood test to calculate the risk of some birth defects (e.g. down syndrome)
Ultrasound – check the thickness of the back of the foetus’s neck
Blood test – to check the levels of pregnancy-associated plasma protein and human chorionic gonadotropin (hCG)
Second trimester
Once a month
During every visit:
-Check blood pressure and weight
Track your baby’s growth
By measuring the abdomen from the top of uterus to pubic bone
-Listen to your baby’s heartbeat
Using doppler
-Assess foetal movement
-Routine lab tests
Urine test
Sugar or protein
Blood test
Low iron levels
-Gestational diabetes
Prenatal testing
Blood test
Developmental or chromosomal disorders
Ultrasound
Evaluate foetus’s growth and development
Diagnostic test
-Amniocentesis
At least 16 weeks
Inserting a thin needle through your abdomen, into your uterus, and into the amniotic sac to take out a small amount of amniotic fluid for testing.
Look for problems with chromosomes
Miscarriage: 1 in 200
-Maternal serum screening test
Blood test
Between 15 and 20 weeks of pregnancy
Check for birth defects (down syndrome, Edward syndrome)
Done by checking for alpha-phetoprotein (AFP) (made by foetus’s liver), estriol and (hCG)
-Targeted ultrasound
Between 18 and 20 weeks
Look for physical defects
Find out the sex of the baby
Can look for any neural tube defects (e.g. spina bifida)
Third trimester
Weekly checkups during the last month of pregnancy
Continue to monitor blood pressure and weight, foetus’s heartbeat and movement
-Screening for group B streptococcus
Harmless to adults, but not for foetus
Can become critically ill
If positive, be given intravenous antibiotic during labor
-Resuming vaginal exams
Check the foetus’s position
Feeling the foetus’s head in the lower abdomen or at the top of the birth canal
Detect cervical changes
Cervix will begin to soften, open (dilate) and thin (efface)
Help in determining how difficult it would be to induce labor
HORMONES
Human Gonadotropic Hormone (hCG)
produced only during pregnancy.
(First by ovary and later by placenta)
hCG values double every two days or so in the early part of the first trimester.
Keeps estrogen and progesteroneat their appropriate levels until the placenta has developed enough to take over this function.
Estrogen
Regulate the production of progesterone
Assist in the development of foetus
Regulates bone density in a foetus
Maintains the endometrium during pregnancy
Promotes blood flow within the uterus
Maintains, regulates and triggers the production of other hormones
Protects female foetuses from the effects of androgens in the mother's system.
Progesteron (mostly together with estrogen)
Makes the endometrium develop and secrete fluids after being primed by estrogen
Maintains the functions of the placenta and fights off unwanted cells near the womb that could cause damage to the placenta or foetus.
Keeps the endometrium in a thickened condition
Stops the uterus making spontaneous movements
Stimulates the growth of breast tissue
Strengthens the mucus plug covering the cervix to prevent infection.
Strengthens the pelvic walls in preparation for labour.
Stops the uterus from contracting (thus keeping the baby where it is)
Estrogen &Progesterone
control the onset of breast milk
inhibiting the breasts' response to the hormone prolactin.
At the time of delivery,Estrogen and progesterone levels decrease, allowing prolactin to stimulate the breasts' milk flow.
Increased level
Estrogen
Appearance of rashes or red blotches on skin
Progesterone
Constipation
Heartburn
Runny and irritable nose
Eyesight problems (blurring or headaches)
Increased kidney infection risk.
Prolactin
made by the baby’s kidneys
reduced about a week after birth.
remain high within the mother's blood for about two weeks after birth.
important for the regulation of the mother's metabolism during the pregnancy
assists in the stimulation of immune system cell growth.
prepares the breasts for breastfeeding
promotes the growth of the baby.
Oxytocin
Causes uterus to contract so that birth happen rapidly
Stimulates mammary glands to produce milks
High level of progesterone prevent oxytocin effect
Tuesday, April 21, 2009
Mifepristone - Medical Termination of Pregnancy
Medical termination is the recommended procedure for patients with a gestation less than 9 weeks. It is a non-surgical procedure ideal for patients wishing to terminate an early pregnancy without having a surgical operation or anaesthetic or in later pregnancies without experiencing the small risks associated with a surgical termination.
Criteria
Abortion Medication may be an option if you:
• Are less than 8 weeks since your last menstrual period.
• Are willing and able to give informed consent.
• Have the support you need such as access to reliable transportation and ability to communicate with the clinic by telephone.
• Live no more than 2 hours away from emergency medical care (a hospital).
• Are able to come back to the clinic for 1 to 3 follow-up appointments.
• Agree to have a surgical abortion if the misoprostol does not induce termination.
The above points will be discussed with you by the doctor. If any of these conditions apply please inform the doctor or nurse.
Your Health
Due to the risk of serious health problems, mifepristone and misoprostol may not be recommended if you:
• Have had a blood clotting problem or are taking anticoagulant medicine.
• Have severe anemia.
• Have adrenal failure.
• Are taking long-term systemic corticosteroids.
• May have an ectopic pregnancy.
• Have a mass in the tubes or ovaries.
• Have inherited porphyria.
• Have an allergy to mifepristone, misoprostol or other prostaglandin medicine.
• Have severe diarrhea.
How Does it Work?
Mifepristone blocks the hormone progesterone needed to maintain the pregnancy. Because this hormone is blocked, the uterine lining begins to shed, the cervix begins to soften and bleeding may occur. With the later addition of the second medication, misoprostol, the uterus contracts and the pregnancy is usually expelled within 6 to 8 hours. How RU486 works
Mifepristone is typically given with gemeprost (a prostaglandin). Mifepristone sensitises the myometrium (the muscular wall of the uterus) to prostaglandin-induced contractions and it softens and dilates the cervix. Gemeprost stimulates the uterus to contract which leads to the foetus being expelled from the womb. Misoprostol is a prostaglandin E1 analogue approved by the Food and Drug Administration (FDA) for the prevention and treatment of peptic ulcer disease in patients taking non-steroidal anti-inflammatory drugs. It has also become an important drug in obstetric and gynecologic practice because of its uterotonic and cervical ripening activity. Misoprostol is useful in the management of elective medical and surgical abortion, miscarriage, induction of labor, and postpartum hemorrhage. In contrast to other prostaglandin preparations, misoprostol does not require refrigeration or parenteral administration. It is also inexpensive.
Is it Safe?
Many women, world-wide, have used this treatment and it has been proven to have a very good safety record. However, every form of medical treatment has some potential risks or side effects. With this treatment the main risks, though very small, are excessive vaginal bleeding, incomplete abortion and infection. These are usually treated very easily. The nurse caring for you will be happy to explain these in more detail.
You may bring one adult supporter with you if you wish to do so. For late medical terminations your supporter will be asked to wait in the waiting areas. If you have children, please make arrangements for them to be cared for at home when you visit the clinic.
You must be able to attend for 2 or possibly 3 separate visits as advised:
At your first appointment at the clinic, an ultrasound is performed to confirm you are less than 8 weeks pregnant. You then speak with an experienced counselor who explains how mifepristone and misoprostol work and makes sure you get answers to all of your questions. Your health history is carefully reviewed and if you meet the criteria, the doctor will give you the mifepristone to take orally.
Your Second Appointment
8-10 days from the 1st clinic visit, you must return for a 2nd appointment for an ultrasound.
Remember, the abortion is not complete until the ultrasound on your final visit. Even if you bled heavily, cramped, and passed clots, you can still be pregnant! There is no extra charge for this ultrasound or for a surgical procedure in the event of a failed abortion.
What To Expect
Upon taking mifepristone at the clinic you may begin to bleed. As each woman's body is different, bleeding varies from woman to woman. Some may experience light bleeding much like spotting towards the end of a menstrual period. Others have heavier bleeding like their regular menstrual period, or like a heavy period. Some women do not experience any bleeding until taking the misoprostol.
Side Effects
Most of the side effects when using this early abortion option are caused by the second medication, misoprostol. Side-effects may include heavy bleeding, headache, nausea, vomiting, diarrhea, and heavy cramping.
Risks
Vaginal bleeding with medical abortion could be extremely heavy. In rare situations it could require a aspiration abortion and very rarely, a blood transfusion. You will be given our 24-hour hotline number to call if you have any problems. Medical staff are on call at all times to answer your medical questions and concerns.
If pregnancy is continued after taking these medications, there is a high risk of fetal deformities
Criteria
Abortion Medication may be an option if you:
• Are less than 8 weeks since your last menstrual period.
• Are willing and able to give informed consent.
• Have the support you need such as access to reliable transportation and ability to communicate with the clinic by telephone.
• Live no more than 2 hours away from emergency medical care (a hospital).
• Are able to come back to the clinic for 1 to 3 follow-up appointments.
• Agree to have a surgical abortion if the misoprostol does not induce termination.
This treatment may not be suitable for you if any of the following apply :
• High blood pressure
• High cholesterol
• Asthmatics on long term corticosteroid treatment
• Taking any anticoagulant treatment
• Aged over 35 years of age and smoke more than 10 cigarettes per day, or under 35 years and smoke more than 20 cigarettes a day
• High blood pressure
• High cholesterol
• Asthmatics on long term corticosteroid treatment
• Taking any anticoagulant treatment
• Aged over 35 years of age and smoke more than 10 cigarettes per day, or under 35 years and smoke more than 20 cigarettes a day
The above points will be discussed with you by the doctor. If any of these conditions apply please inform the doctor or nurse.
Your Health
Due to the risk of serious health problems, mifepristone and misoprostol may not be recommended if you:
• Have had a blood clotting problem or are taking anticoagulant medicine.
• Have severe anemia.
• Have adrenal failure.
• Are taking long-term systemic corticosteroids.
• May have an ectopic pregnancy.
• Have a mass in the tubes or ovaries.
• Have inherited porphyria.
• Have an allergy to mifepristone, misoprostol or other prostaglandin medicine.
• Have severe diarrhea.
How Does it Work?
Mifepristone blocks the hormone progesterone needed to maintain the pregnancy. Because this hormone is blocked, the uterine lining begins to shed, the cervix begins to soften and bleeding may occur. With the later addition of the second medication, misoprostol, the uterus contracts and the pregnancy is usually expelled within 6 to 8 hours. How RU486 works
Mifepristone is typically given with gemeprost (a prostaglandin). Mifepristone sensitises the myometrium (the muscular wall of the uterus) to prostaglandin-induced contractions and it softens and dilates the cervix. Gemeprost stimulates the uterus to contract which leads to the foetus being expelled from the womb. Misoprostol is a prostaglandin E1 analogue approved by the Food and Drug Administration (FDA) for the prevention and treatment of peptic ulcer disease in patients taking non-steroidal anti-inflammatory drugs. It has also become an important drug in obstetric and gynecologic practice because of its uterotonic and cervical ripening activity. Misoprostol is useful in the management of elective medical and surgical abortion, miscarriage, induction of labor, and postpartum hemorrhage. In contrast to other prostaglandin preparations, misoprostol does not require refrigeration or parenteral administration. It is also inexpensive.
Is it Safe?
Many women, world-wide, have used this treatment and it has been proven to have a very good safety record. However, every form of medical treatment has some potential risks or side effects. With this treatment the main risks, though very small, are excessive vaginal bleeding, incomplete abortion and infection. These are usually treated very easily. The nurse caring for you will be happy to explain these in more detail.
You may bring one adult supporter with you if you wish to do so. For late medical terminations your supporter will be asked to wait in the waiting areas. If you have children, please make arrangements for them to be cared for at home when you visit the clinic.
You must be able to attend for 2 or possibly 3 separate visits as advised:
At your first appointment at the clinic, an ultrasound is performed to confirm you are less than 8 weeks pregnant. You then speak with an experienced counselor who explains how mifepristone and misoprostol work and makes sure you get answers to all of your questions. Your health history is carefully reviewed and if you meet the criteria, the doctor will give you the mifepristone to take orally.
Your Second Appointment
8-10 days from the 1st clinic visit, you must return for a 2nd appointment for an ultrasound.
Remember, the abortion is not complete until the ultrasound on your final visit. Even if you bled heavily, cramped, and passed clots, you can still be pregnant! There is no extra charge for this ultrasound or for a surgical procedure in the event of a failed abortion.
What To Expect
Upon taking mifepristone at the clinic you may begin to bleed. As each woman's body is different, bleeding varies from woman to woman. Some may experience light bleeding much like spotting towards the end of a menstrual period. Others have heavier bleeding like their regular menstrual period, or like a heavy period. Some women do not experience any bleeding until taking the misoprostol.
Side Effects
Most of the side effects when using this early abortion option are caused by the second medication, misoprostol. Side-effects may include heavy bleeding, headache, nausea, vomiting, diarrhea, and heavy cramping.
Risks
Vaginal bleeding with medical abortion could be extremely heavy. In rare situations it could require a aspiration abortion and very rarely, a blood transfusion. You will be given our 24-hour hotline number to call if you have any problems. Medical staff are on call at all times to answer your medical questions and concerns.
If pregnancy is continued after taking these medications, there is a high risk of fetal deformities
.
http://www.hopeclinic.com/WhatToExpectFirstTrimester.htm
http://www.smpclinic.co.uk/mthowsafe.html
http://www.fwhc.org/abortion/medical-ab.htm
http://www.medic8.com/healthguide/articles/ru486.html
http://www.hopeclinic.com/WhatToExpectFirstTrimester.htm
http://www.smpclinic.co.uk/mthowsafe.html
http://www.fwhc.org/abortion/medical-ab.htm
http://www.medic8.com/healthguide/articles/ru486.html
Pregnancy Termination-Surgical
- In the first trimester : surgical abortions like suction and D&C.
- In the second and third trimesters : instillation types, D&E, intracardiac injections and partial birth abortions.
What are the first trimester surgical ones?
There are several types:
- Menstrual extraction:
This is a very early suction abortion, often done before the pregnancy test is positive.
- Suction-aspiration:
In this method, the abortionist must first paralyze the cervical muscle ring (womb opening) and then stretch it open. This is difficult because it is hard and not ready to open. He then inserts a hollow plastic tube, which has a knife-like edge on the tip, into the uterus. The suction tears the baby’s body into pieces. He then cuts the deeply rooted placenta from the inner wall of the uterus. The scraps are sucked out into a bottle. The suction is 29 times more powerful than a home vacuum cleaner.
- Dilatation & Curettage (D&C):
This is similar to the suction procedure except that the abortionist inserts a curette, a loop-shaped steel knife, up into the uterus. With this, he cuts the placenta and baby into pieces and scrapes them out into a basin. Bleeding is usually profuse.
What are second trimester ones?
In the 1970s and ’80s the most common type was saline amniocentesis, or salt poisoning abortions.
These are not used much anymore because of danger to the mother. These are done after the 16th week. A large needle is inserted through the abdominal wall of the mother and into the baby’s amniotic sac. A concentrated salt solution is injected into the amniotic fluid. The baby breathes and swallows it, is poisoned, struggles, and sometimes convulses. It takes over an hour to kill the baby. When successful, the mother goes into labor about one day later and delivers a dead baby.
Is it actually poisoning?
Yes. The mechanism of death is acute hypernatremia or acute salt poisoning, with development of wide-spread vasodilatation, edema, congestion, hemorrhage, shock, and death.
And other methods?
In the ’70s and ’80s, prostaglandin drugs were used to induce violent premature labor and delivery. When used alone, there was: "...a large complication rate (42.6%) is associated with its use. Few risks in obstetrics are more certain than that which occurs to a pregnant woman undergoing abortion after the 14th week of pregnancy." Duenhoelter & Grant, "Complications Following Prostaglandin F-2 Alpha Induced Mid-trimester Abortion." Jour. of OB & GYN, Sept. 1975
Because of these problems, the D&E or Dilatation & Evacuation method was developed and largely replaced the above. It involves the live dismemberment of the baby and piecemeal removal from below . A material made from seaweed (laminaria) is placed in the cervix in order to dilate it. Forceps are then used to remove the fetus, in pieces.
A pliers-like instrument is used because the baby’s bones are calcified, as is the skull. There is no anesthetic for the baby. The abortionist inserts the instrument up into the uterus, seizes a leg or other part of the body, and, with a twisting motion, tears it from the baby’s body. This is repeated again and again. The spine must be snapped, and the skull crushed to remove them. The nurse’s job is to reassemble the body parts to be sure that all are removed.
This sounds dangerous.
It is, but a report from the U.S. Center for Disease Control, Dept. HEW, stated that it is still safer for the mother than the salt-poisoning or Prostaglandin method. "Comparative Risks of Three Methods of Midtrimester Abortion," Morbidity and Mortality Weekly Report, Center for Disease Control, HEW, Nov. 26, 1976
It is reported that every year about 100,000 women are aborted by the D&E method, between 13 and 24 weeks gestation. Of this, 500 have "serious complications." This was still judged to have a "lower risk of morbidity and mortality than the infusion procedures." MacKay et al., "Safety of Local vs General Anesthesia for Second Trimester D&E Abortions" OB-GYN, vol. 66, no. 5, Nov.1985, p. 661
Any new methods?
Yes, intracardiac injections. Since the advent of fertility drugs, multi-fetal pregnancies have become common. "The frequency of triplet and higher pregnancies . . . has increased 200% since the early 1970s."
Since these are usually born prematurely and some have other problems, a new method has been developed. Assisted Repro. Techniques . . . , L. Wilcox, Fertl. & Sterility, vol. 65, #2, Feb. ’96, pg. 361
At about 4 months a needle is inserted through the mother’s abdomen, into the chest and heart of one of the fetal babies and a poison injected to kill him or her. This is "pregnancy reduction." It is done to reduce the number or to kill a handicapped baby, if such is identified. If successful, the dead baby’s body is absorbed.
Sometimes, however, this method results in the loss of all of the babies.
Are there 3rd trimester abortions?
A more recently developed method here is the partial birth abortion, also called "brain suction" or "D&X" methods.
- These are done after 4 or 5 months.
- 80% of babies are normal.
- Most babies are viable.
This is like a breech delivery. The entire infant is delivered except the head. A scissors is jammed into the base of the skull. A tube is inserted into the skull, and the brain is sucked out. The now-dead infant is pulled out. The drawings illustrate this.
But isn’t it the safest?
It is not. Instead today the much safer Cesarean Section is used.
Complications that could arise :
- cause amniotic fluid embolism or placental abruption
- cervical incompetence in subsequent pregnancies caused by three days of forceful dilation of the cervix, and uterine rupture caused by rotating the fetus in the uterus
- could lead to infection causing sterility
- drawing out the baby in breech position is a very dangerous procedure and could tear the uterus. Such a ruptured uterus could cause the mother to bleed to death in ten minutes.".."The puncturing of the child’s skull produces bone shards that could puncture the uterus."
- Hysterotomies: These are almost identical to a Cesarean section. An incision is made in the woman's abdomen and the fetus is removed.
Links:
http://www.abortionfacts.com/online_books/love_them_both/why_cant_we_love_them_both_18.asp
http://www.religioustolerance.org/abo_surg.htm
http://www.americanpregnancy.org/unplannedpregnancy/surgicalabortions.html
Monday, April 20, 2009
Social Implication of Teenage Pregnancies
Social Aspects of Teenage Pregnancies
Implications to Mother
- not being able to complete education
Only 40 percent of teenagers who have children before age 18 go on to graduate from high school, compared to 75 percent of teens from similar social and economic backgrounds who do not give birth until ages 20 or 21
(National Campaign to Prevent Teen Pregnancy. Why It Matters.)
- long term unemployment / poorly paid jobs -- financial pressures
more than 75 percent of all unmarried teen mothers go on welfare within 5 years of the birth of their first child
Ventura, S.J., et al. Estimated Pregnancy Rates by Outcome for the United States, 1990-2004. National Vital Statistics Reports, volume 56, number 15, April 14, 2008.
- low income results in poor housing and being unable to afford adequate healthcare/basic necessity
- alienation from peers and family
-cause great strain on young relationships (60% don’t have a male partner when baby is born)
-stigma in society towards teenage mothers
- affect teenage mother’s view on parenting ability, motherhood and self-esteem.
- higher risk of postnatal depression than older women
Due to lack of support, isolation, family and financial pressures, societal attidues.
Implications to baby
-more likely to perform poorly in school
Maynard, R.A., Ed., 1996. Kids Having Kids: A Robin Hood
Foundation Special Report on the Costs of Adolescent Childbearing, New
York: Robin Hood Foundation.
-greater risk of abuse and neglect.
Due to poverty, inexperienced parenting
(George, R.M., & Lee, B.J. 1997. Abuse and Neglect of Children. In R.A.
Maynard, Ed., Kids Having Kids: Economic Costs and Social
Consequences of Teen Pregnancy, pp. 205-230. Washington, DC: The
Urban Institute Press.)
- The sons of teen mothers are 13 percent more likely to end up in prison,
while teen daughters are 22 percent more likely to become teen mothers
themselves.
(Maynard, R.A., Ed., 1996. Kids Having Kids: A Robin Hood
Foundation Special Report on the Costs of Adolescent Childbearing, New
York: Robin Hood Foundation.)
links
http://www.vahealth.org/teenpregnancyprevention/documents/TeenPregnancyConsequences.pdf
http://www.womhealth.org.au/studentfactsheets/teenagepregnancy.htm
http://www.marchofdimes.com/professionals/14332_1159.asp
Implications to Mother
- not being able to complete education
Only 40 percent of teenagers who have children before age 18 go on to graduate from high school, compared to 75 percent of teens from similar social and economic backgrounds who do not give birth until ages 20 or 21
(National Campaign to Prevent Teen Pregnancy. Why It Matters.)
- long term unemployment / poorly paid jobs -- financial pressures
more than 75 percent of all unmarried teen mothers go on welfare within 5 years of the birth of their first child
Ventura, S.J., et al. Estimated Pregnancy Rates by Outcome for the United States, 1990-2004. National Vital Statistics Reports, volume 56, number 15, April 14, 2008.
- low income results in poor housing and being unable to afford adequate healthcare/basic necessity
- alienation from peers and family
-cause great strain on young relationships (60% don’t have a male partner when baby is born)
-stigma in society towards teenage mothers
- affect teenage mother’s view on parenting ability, motherhood and self-esteem.
- higher risk of postnatal depression than older women
Due to lack of support, isolation, family and financial pressures, societal attidues.
Implications to baby
-more likely to perform poorly in school
Maynard, R.A., Ed., 1996. Kids Having Kids: A Robin Hood
Foundation Special Report on the Costs of Adolescent Childbearing, New
York: Robin Hood Foundation.
-greater risk of abuse and neglect.
Due to poverty, inexperienced parenting
(George, R.M., & Lee, B.J. 1997. Abuse and Neglect of Children. In R.A.
Maynard, Ed., Kids Having Kids: Economic Costs and Social
Consequences of Teen Pregnancy, pp. 205-230. Washington, DC: The
Urban Institute Press.)
- The sons of teen mothers are 13 percent more likely to end up in prison,
while teen daughters are 22 percent more likely to become teen mothers
themselves.
(Maynard, R.A., Ed., 1996. Kids Having Kids: A Robin Hood
Foundation Special Report on the Costs of Adolescent Childbearing, New
York: Robin Hood Foundation.)
links
http://www.vahealth.org/teenpregnancyprevention/documents/TeenPregnancyConsequences.pdf
http://www.womhealth.org.au/studentfactsheets/teenagepregnancy.htm
http://www.marchofdimes.com/professionals/14332_1159.asp
Signs and Symptoms of Pregnancy
Missed period/Unusual or abnormal period
Nausea and vomitting/Morning Sickness
Backaches
Headaches
Constipation
Darkening of aerola
Soreness of the breasts
Enlargement of breasts
Bleeding Gum(increase in pregnancy hormones-progesterone, gums swollen)
Frequent Urination
Strange Cravings(Mostly food)
Fatigue
Montgomery’s Tubercules
Skin Changes
Stretch Marks
Enlarging Uterus
Palpatation of the fetus
Leg Cramps
Change in sleeping position
Insomnia
http://pregnancy.about.com/od/signssymptoms/a/25signsofpg.htm
http://www.americanpregnancy.org/gettingpregnant/earlypregnancysymptoms.html
http://www.americanpregnancy.org/pregnancyhealth/constipation.html
http://www.americanpregnancy.org/pregnancyhealth/insomnia.html
Friday, April 10, 2009
Social Issues
Impact of Thalassaemia on the author:
Positive Impact:
• Learn to appreciate life
o Intense passion for living and a deep appreciation for health
o To be the best person that he can be
• Inspiration to continue life
• Quality of life of life is more meaningful than quantity.
• Instil determination and strong will
• Strengthens family dynamics
o Having a supportive family
• Able to understand and share the feelings of others (empathetic)
o Treasure loved ones, family and friends.
Negative Impact:
• Frustration
o Have to deal with chronic illness that consumes an exorbitant amount of time
• Financial difficulties
o Expensive insurance coverage.
• Affect Marital relationship
• Doctor’s appointments, medical procedures, and surgeries are a routine part of life
• Heightened awareness of own mortality
Positive Impact:
• Learn to appreciate life
o Intense passion for living and a deep appreciation for health
o To be the best person that he can be
• Inspiration to continue life
• Quality of life of life is more meaningful than quantity.
• Instil determination and strong will
• Strengthens family dynamics
o Having a supportive family
• Able to understand and share the feelings of others (empathetic)
o Treasure loved ones, family and friends.
Negative Impact:
• Frustration
o Have to deal with chronic illness that consumes an exorbitant amount of time
• Financial difficulties
o Expensive insurance coverage.
• Affect Marital relationship
• Doctor’s appointments, medical procedures, and surgeries are a routine part of life
• Heightened awareness of own mortality
MRI TESTING
An MRI (or magnetic resonance imaging) scan is a radiology technique that uses magnetism, radio waves, and a computer to produce images of body structures. The MRI scanner is a tube surrounded by a giant circular magnet. The patient is placed on a moveable bed that is inserted into the magnet. The magnet creates a strong magnetic field that aligns the protons of hydrogen atoms, which are then exposed to a beam of radio waves. This spins the various protons of the body, and they produce a faint signal that is detected by the receiver portion of the MRI scanner. The receiver information is processed by a computer, and an image is produced.
Magnetic resonance imaging (MRI) provides a noninvasive, quantitative method of estimating parenchymal iron levels. In principle, MRI can be used to quantify iron stores wherever they exist in the body. In practice, MRI has been investigated in the assessment of hepatic, cardiac, and anterior pituitary iron stores.
MRI measures tissue iron concentration indirectly via the detection of the paramagnetic influences of storage iron (ferritin and hemosiderin) on the proton resonance behavior of tissue water (1). The longitudinal (R1) and transverse (R2) nuclear magnetic relaxation rates of nearby solvent water protons can then be calculated. Both R1 and R2 rates are increased when interacting with paramagnetic particles such as iron. R2 (or spin-echo imaging) is preferable to R1 for determining LIC, since ferritin enhances the relaxation of both R1 and R2, while hemosiderin only has a strong R2 relaxation accelerating effect. Gradient echo imaging produces images for calculating T2* and R2*, where R2* = 1000/T2*. A T2* of 20 ms is equivalent to an R2* of 50 Hz.
MRI detection of hepatic iron overload
MRI provides a non-invasive alternative to liver biopsy, and may actually be more accurate in patients with heterogeneous liver iron deposition (such as those with cirrhosis) since it measures iron in the whole organ. In addition, the pathologic status of the liver can also be assessed using MRI.
(i couldnt put the picture up)
MRI detection of hepatic iron overload
An MRI image (R2 map, inverse, false color) clearly displays iron-overloading in the liver.
MRI remains the only noninvasive modality in clinical use with the ability to detect cardiac iron deposition. T2* MRI is rapidly becoming the new standard for measuring cardiac iron levels. (cant put the picture)
A cardiac T2* MRI image shows myocardial iron stores. The lighter ventricle walls in the left image indicate heavy iron loading. Used with permission from Anderson, et al (2). © 2001 Oxford University Press. MRI detection of cardiac iron overload.
http://www.irontoxicity.com/hcp/diagnosis/imaging_studies/magnetic.jsp
Imaging Studies
· Skeletal survey and other imaging studies reveal classic changes of the bones that are usually encountered in patients who are not regularly transfused.
·
o The striking expansion of the erythroid marrow widens the marrow spaces, thinning the cortex and causing osteoporosis. These changes, which result from the expanding marrow spaces, usually disappear when marrow activity is halted by regular transfusions. Osteoporosis and osteopenia may cause fractures, even in patients whose conditions are well-controlled.
o In addition to the classic "hair on end" appearance of the skull, which results from widening of the diploic spaces and observed on plain radiographs , the maxilla may overgrow, which results in maxillary overbite, prominence of the upper incisors, and separation of the orbit. These changes contribute to the classic "chipmunk facies observed in patients with thalassemia major.
o Other bony structures, such as ribs, long bones, and flat bones, may also be sites of major deformities. Plain radiographs of the long bones may reveal a lacy trabecular pattern. Changes in the pelvis, skull, and spine become more evident during the second decade of life, when the marrow in the peripheral bones becomes inactive while more activity occurs in the central bones.
o Compression fractures and paravertebral expansion of extramedullary masses, which could behave clinically like tumors, more frequently occur during the second decade of life.
o MRI and CT scanning are usually used in diagnosing such complications.
· Chest radiography is used to evaluate cardiac size and shape.
· MRI and CT scanning can be used as noninvasive means to evaluate the amount of iron in the liver in patients receiving chelation therapy.
· A newer noninvasive procedure involves measuring the cardiac T2 with cardiac magnetic resonance (CMR). This procedure has shown decreased values in cardiac T2 due to iron deposit in the heart. Unlike liver MRI, which usually correlates very well with the iron concentration in the liver measured using percutaneous liver biopsy samples and the serum ferritin level, CMR does not correlate well with the ferritin level, the liver iron level, or echocardiography findings. This suggests that cardiac iron overload cannot be estimated with these surrogate measurements. This is also true in measuring the response to chelation therapy in patients with iron overload. The liver is clear of iron loading much earlier than the heart, which also suggests that deciding when to stop or reduce treatment based on liver iron levels is misleading.
http://www.medrat.com/info/thalassemia/doc019.php
Benefits
- MRI is a noninvasive imaging technique that does not involve exposure to radiation.
- MR images of the soft-tissue structures of the body—such as the heart, liver and many other organs— is more likely to identify and characterize abnormalities and focal lesions than other imaging methods. This detail makes MRI an invaluable tool in early diagnosis and evaluation of many focal lesions and tumors.
- MRI has proven valuable in diagnosing a broad range of conditions, including cancer, heart and vascular disease, and muscular and bone abnormalities.
- MRI enables the detection of abnormalities that might be obscured by bone with other imaging methods.
- MRI allows physicians to assess the biliary system noninvasively and without contrast injection.
- The contrast material used in MRI exams is less likely to produce an allergic reaction than the iodine-based materials used for conventional x-rays and CT scanning.
- MRI provides a fast, noninvasive alternative to x-ray angiography for diagnosing problems of the heart and blood vessels.
Risks
- The MRI examination poses almost no risk to the average patient when appropriate safety guidelines are followed.
- If sedation is used there are risks of excessive sedation. The technologist or nurse monitors your vital signs to minimize this risk.
- Although the strong magnetic field is not harmful in itself, medical devices that contain metal may malfunction or cause problems during an MRI exam.
- There is a very slight risk of an allergic reaction if contrast material is injected. Such reactions usually are mild and easily controlled by medication.
- Nephrogenic systemic fibrosis is currently a recognized, but rare, complication of MRI believed to be caused by the injection of high doses of MRI contrast material in patients with poor kidney function.
What are the limitations of MRI of the Body?
High-quality images are assured only if you are able to remain perfectly still while the images are being recorded. If you are anxious, confused or in severe pain, you may find it difficult to lie still during imaging.
A person who is very large may not fit into the opening of a conventional MRI machine.
The presence of an implant or other metallic object often makes it difficult to obtain clear images and patient movement can have the same effect.
Breathing may cause artifacts, or image distortions, during MRIs of the chest, abdomen and pelvis. Bowel motion is another source of motion artifacts in abdomen and pelvic MRI studies.
Although there is no reason to believe that magnetic resonance imaging harms the fetus, pregnant women usually are advised not to have an MRI exam unless medically necessary.
MRI may not always distinguish between cancer tissue and edema fluid.
MRI typically costs more and may take more time to perform than other imaging modalities
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