Cervical Incompetence-Management
Cervical incompetence managed by using cerclage procedures. The 3 types of cerclage that are used are:
1. McDonald’s Cerclage (M/C)
2. Shirodkar Cerclage
3. Abdominal Cerclage -Benson & Durfee Cerclage
Tag: management
Antiphospholipid antibody syndrome-Management
If APLA is diagnosed based on H/O Abortion then aspirin along with low molecular weight heparin has to be given
Aspirin:
• Aspirin low doses= 50-100mg (80mg)
• Started-Urine Pregnancy Test (UPT) +ve
• Continued throughout Pregnancy
• Stopped 4-6 days before labor
Heparin:
Started- Only after confirmation of IU pregnancy
Continued throughout Pregnancy
Stopped at onset of labor
If APLA is diagnosed based on the criteria of Preterm Labor give only Aspirin @ the end of first trimester ;dose- 50-100mg (80mg).
Sickle cell crisis
→ It is characterized by intense bone pain due to intense sequestration of sickled erythrocytes & infarction in various organs.
→ Pregnancy can precipitate sickle cell crisis in both women with sickle cell trait and sickle cell disease.
Management:
→ IV fluids, O2
→ Epidural analgesia
→ Antibiotics
→ Thromboprophylaxis
Note: Red cell transfusion after the onset of pain do not have much benefit but prophylactic transfusions before the crisis, helps in decreasing the pain and shortening the duration of crisis.
Keratoconus-Management
Keratoconus is managed by:
→ Glasses
→ Contact lenses:
- Soft contact lenses should not be used
- Semi soft contact lenses are prescribed
→ Corneal Hydrops:
- Occurs in Keratoconus
- Descemet’s membrane perforates & aqueous humour enters corneal stroma.
- With time hydrops heals with central scarring.
- Rx by Keratoplasty.
→ C3 R (CxR)
- Corneal collagen crosslinking with Riboflavin, new modality of Rx.
- Stops progression, increases strength of cornea with covalent bonding (UV irradiation with riboflavin)
PTSD
- Follow significant traumatic events to self or others
- Symptoms Include
- Intrusion Symptoms – Flashbacks & Nightmares
- Avoidance – Avoids all stimuli which reminds of the trauma
- Arousal Symptoms – Hypervigilance, ↑ Startle response, insomnia, poor concentration
- Other – Emotional numbing, emotional detachment, anhedonia
- Symptoms > 1 month then PTSD, if < 1 Month then ACUTE STRESS SYNDROME
- IF symptoms occur after 6 months then delayed PTSD
- Involved Hippocampus and amygdala
Management:
- SSRIs
- Cognitive behavioral therapy, Psychodynamic therapy and EMDR
- EMDR [Eye movement desensitization and reprocessing]
Adjustment disorders
- Characterized by emotional response to stressful events like financial, medical, relationship problems
- Symptom complex include anxiety and depressive symptoms
- Need to be differentiated from depression. Diagnosis of depression takes precedence
- Management – Psychotherapy [Supportive psychotherapy]
Phobias-Management
- Pharmacotherapy – BDZs, SSRIs
- Psychotherapy – Behavior therapy is the most effective
- Systematic Desensitization – [Exposure / Relaxation] Best Evidence in T/T of Phobias
- Therapeutic graded exposure [Exposure and response prevention]
- Flooding [Implosion]- Exposed in Most severe form
- Modeling [Participant modeling]- Therapist himself makes contact with phobic stimulus
Social Anxiety Disorder [Social Phobia]:
- Fear of social situation including contact with strangers
- Afraid of embarrassing themselves
OCD-Management & prognosis
Management:
Pharmacotherapy:
- First Line – SSRIs and Clomipramine [adverse side effect profile]
- If first line fails then antipsychotics [Haloperidol, quetiapine, risperidone, olanzapine]
- Other Drugs [Venlafaxine, Lithium, valproate and carbamazepine]
Psychotherapy:
- Cognitive Behavior therapy [Exposure & Response prevention]
- Desensitization, thought stopping, flooding and aversive conditioning
Other T/T modalities – ECT, Psychosurgery [Cingulotomy, capsulotomy – Caudate tractotomy]
Prognosis:
Acute Onset – 50%. 20-30% Significant improvement, 40-50% moderate, rest may so deterioration
Panic Disorder-Management
Establishing a Differential Diagnosis:
- MI / Angina / Other Cardiac Conditions
- Asthma / Other Pulmonary conditions
- Hypothyroidism, Hypoglycemia, Carcinoid Syndrome, Pheochromocytoma.
After ruling out all the above-mentioned conditions, the management of panic disorder involves:
- BDZ and SSRIs
- Psychotherapy – Cognitive Behavioral therapy
- Relaxation techniques
Agoraphobia
Fear of places where escape might be difficult
- Fear of being in open spaces / Crowded Spaces
- Fear of enclosed spaces
- Fear of travelling alone or using public transport
Very disabling phobia as patient may become home bound
Management:
- BDZ and SSRIs
- Behavior therapy – Systematic desensitization, flooding, exposure and response prevention
- Relaxation techniques
