Be ready the basics are changing !!!
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This document summarizes changes to guidelines and classifications for preeclampsia and abnormal uterine bleeding. For preeclampsia, proteinuria is no longer required for diagnosis and mild and severe classifications have been eliminated. Treatment indications now include magnesium sulfate for more cases and later termination dates. For abnormal uterine bleeding, a new PALM-COEIN classification system has been adopted that defines bleeding types and replaces older systems. Physicians are encouraged to follow such changes to stay up to date and provide standardized care.
![Protein dipstick grading
Designation
Approx. amount
Concentration[6] Daily[7]
Trace 5–20 mg/dL
1+ 30 mg/dL Less than 0.5 g/day
2+ 100 mg/dL 0.5–1 g/day
3+ 300 mg/dL 1–2 g/day
4+ More than 300 mg/dL More than 2 g/day](https://image.slidesharecdn.com/bereadythebasicsarechanging20-06-141027173355-conversion-gate01/85/Be-ready-the-basics-are-changing-20-320.jpg)
Be ready the basics are changing !!!
- 1. Be ready !!! The basics are changing Dr/ Mahmoud Abdel-Aleem Assistant Professor of Obstetrics and Gynecology
- 3. INTRODUCTION
- 4. • Human mind is always scrutinizing and searching for new information. • Science is always changing and evolving. – Meticulous research is being done. – More new types of research. – Better assessment methods.
- 5. What do we need to discuss? Major changes in our basic practice involving common day-to day problems
- 6. FOR WHOM IS THIS PRESENTATION?
- 7. • For guidelines developers: adopt the recent change to be up-to-date. • For academics: lecture preparation • For specialists: application and standardization of new knowledge and practice. • For postgraduate students: preparation for an exam • For undergraduate students: preparation for an exam • For researchers: for conducting and publishing research.
- 8. IT LOOKS LIKE AN “ORANGE AND PEACHES PRESENTATION”
- 9. Selected Hot Topics • Pregnancy: – Pre-eclampsia. – Diabetes mellitus during pregnancy. • Normal labour – First stage. – Second stage. – Third stage. Common. Practical. Recent Major changes. • Venous Thromboembolism during pregnancy and labour. • Gynecology: Abnormal uterine bleeding.
- 10. Hypertensive disorders during pregnancy
- 11. Increasing incidence Why important? Contribution to prematurity Less than optimal care Contribution to near-miss cases Contribution to maternal mortality
- 12. • ACOG Task Force on Hypertension in Pregnancy. • A 99-page report. • Published on November 2013. • Inclusive of the diagnosis and management of preeclampsia. • Culmination of two years of hard work by the 16-member ACOG task force.
- 13. Classification • Pre-eclampsia / Eclampsia • Chronic HT. • Chronic HT with superimposed PE. • Gestational HT.
- 14. A changing paradigm !!! • The problem is that many patients with preeclampsia don't have enough proteinuria to meet the former criteria, so their diagnosis and treatment are delayed.
- 15. Starting by definition Was Now No longer requires the detection of proteinuria. Persistent HT that develops during pregnancy or during the postpartum period that is associated with: Proteinuria OR New development of thrombocytopenia. hepatic or renal dysfunction. Pulmonary edema. Signs of brain trouble such as seizures and/or visual disturbances. Hypertension Plus Proteinuria
- 16. Next: types Was Now Preeclampsia Preeclampsia with severe features. Mild severe Preeclampsia is a dynamic disease: We don’t know When or at Which rate or in Whom it will change from mild to severe
- 17. IUGR is eliminated. Not a feature of severity
- 18. Hypertension • As it is; no change • 140/90 mmHg or more on 2 readings 6 hours apart at bed rest unless anti-HT drugs were given. • 160/110 mmHg or more on single reading at bed rest unless anti-HT drugs were given.
- 19. Proteinuria • Proteinuria: 300 mg/protein in a 24-hr urine collection. • A protein/creatinine 0.3 • Dipstick is not recommended because of wide variability. It is only to be used if other methods aren’t available. Proteinuria 1+ = diagnosis. • Massive proteinuria > 5gm. Not to be used.
- 20. Protein dipstick grading Designation Approx. amount Concentration[6] Daily[7] Trace 5–20 mg/dL 1+ 30 mg/dL Less than 0.5 g/day 2+ 100 mg/dL 0.5–1 g/day 3+ 300 mg/dL 1–2 g/day 4+ More than 300 mg/dL More than 2 g/day
- 21. Then: treatment Was Now Prophylactic magnesium sulphate is used in: BP 160/110 or more. BP 140/90-159/109 PLUS symptoms. Prophylactic Magnesium sulphate was used in Severe PE with symptoms Termination is at: 37 weeks: no severe features 34 weeks: associated severe features Termination is at: 38 weeks: mild cases 34 weeks: severe cases
- 22. Last of All: Prevention of PE • Vitamin C: no role • Vitamin E: no role. • Calcium: – Normal takers: no role. – Low takers: reduces the severity of PE. • Aspirin: 60-80 mg/day. – Low risk: no value – High risk: slight decrease in PE and adverse perinatal outcome.
- 23. Take home message • Don’t wait proteinuria to diagnose PE. • On diagnosis of new onset HT: do platelet count, liver enzymes, serum creatinine, ask for visual symptoms. • There is no method to predict, to prevent PE. The only way to help women is early diagnosis and early treatment. • Use low dose aspirin only in high risk women.
- 24. Abnormal Uterine Bleeding FIGO classification.
- 25. High incidence Why important? Contribution to anemia Lowering the effective woman load weight in society Contribution Contribution to increasing surgical interventions to low quality of life
- 26. • The Federation Internationale de Gynecologie et d’Obstetrique (FIGO) • Date: November 2010. • The causes of AUB in the reproductive years. • A collaborative, international group consisting of reproductive clinicians, haematologists, basic scientists. • The group had representation from six continents
- 27. Normal values for menstrual flow
- 28. Definitions adopted • Acute AUB: an episode of bleeding in a woman of reproductive age, who is not pregnant, that is of sufficient quantity to require immediate intervention to prevent further blood loss. • Chronic AUB: bleeding from the uterus that is abnormal in frequency, duration and/or volume and has been present for the majority of the previous six months.
- 29. • Inter-menstrual bleeding (IMB): bleeding between clearly defined cyclic and predictable menses and includes random episodes as well as predictable episodes occurring at the same time each month.
- 32. Take home message II • The PALM-COEIN system is readily applicable. • Let us try to use the new classification system for abnormal uterine bleeding as regards the norms, definitions, classification.
- 33. And So !!!
- 34. Do we have to follow the changes ? • We should be in accordance with changes as the scientific society is now “A small village”. • Although the changes may look both few and little, they are of great value in defining, standardizing, diagnosing and treating diseases. • We were already following older recommendations, and once they change, we have to apply the changes especially if these are simple and not sophisticated.