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He asked another Pfizer chemist, Willard Welch, to synthesize some previously unexplored tametraline derivatives. Welch then prepared stereoisomers of this compound, which were tested in vivo by animal behavioral scientist Albert Weissman. The objective of this presentation is to highlight a case of Heterotopic Pregnancy – a clinical scenario previously considered rare but recently being encountered more frequently due to an increased use of In Vitro Fertilization Techniques. Heterotopic Pregnancy is defined by the coexistence of intrauterine and extrauterine pregnancies.
A thirty six year old nulliparous lady presented to the Accident and Emergency at five weeks amenorrhoea with a history of fainting episodes and lower abdominal pain. Drug-Based Methods (cont) Methotrexate –Injection; orally (rarely) – Prevents cell division and multiplication – Can be used to induce an abortion Effectiveness is increased if used with another drug, Misoprostol (95%) – Approved by FDA for treatment of cancer, arthritis and psoriasis – Most effective within 7 weeks of fertilization Misoprostol – orally or vaginally – Legal Drug used in conjunction with above drugs – The second drug used to complete the abortion procedure Taken a day or two after administration of the first drug – Causes the uterus to contract and expel its contents – Approved in the US for coating the stomach of people who take stomach- irritating anti-inflammatory drugs.
Abortifacient A method or substance that causes a fertilized egg that has implanted in the uterine wall or fetus to be expelled. Source: Perspectives on Sexual and Reproductive Health Incidence of Abortions Nearly half of pregnancies among American women are unintended, and four in 10 of these are terminated by abortion. Source: Alan Guttmacher Institute California Law California does not have any of the major types of abortion restrictions – such as waiting period, mandated parental involvement or limitations on publicly funded abortions – often found in other states. Cancer (cont) Sometimes cancer cells break away from a tumor and spread to other parts of the body through the blood or lymph system.
Survival Rates 5-year localized survival rate – Localized cancer is cancer that, at the time of diagnosis, had not spread to additional sites within the body. Survival Rates 5-year overall survival rate – The 5-year survival rates represent persons who are living 5 years after diagnosis, whether disease-free, in remission, or under treatment. Breast Changes It is often not possible to tell the difference between benign and cancerous conditions based on symptoms alone – More tests will be needed Some benign breast conditions may not cause any symptoms and may be found during a mammogram or a breast biopsy.
The American Cancer Societys Estimates The American Cancer Society's most recent estimates for breast cancer in the United States are for 2011: About 230,480 new cases of invasive breast cancer will be diagnosed in women. Other Risk Factors Family history of breast cancer – Having a first-degree relative (mother, sister, or daughter) with breast cancer approximately doubles a womans risk.
The American Cancer Societys Screening Recommendations Clinical Breast Exam should be part of a periodic health exam, about every three years for women in their 20s and 30s, and every year for women 40 and older. The American Cancer Societys Screening Recommendations Yearly mammograms are recommended starting at age 40 and continuing for as long as a woman is in good health. Breast Self Exam Beginning in their 20s, women should be told about the benefits and limitations of BSE. Treatment Options Breast conservation surgery* Mastectomy* * In both cases, the lymph nodes under the arm mayalso be removed. RCOG Evidence level II Frequency of monitoring in SGA fetuses with normal Doppler need not generally be more than once every fortnight.
RCOG Evidence level Ia Grade A The biophysical profile has not been shown to improve perinatal outcome but sufficient data do not exist to rule out its value.
Evidence level Ib The absence of benefit from randomised trials and since it is a time-consuming test, So it cannot be recommended for routine monitoring in low risk pregnancies or for primary surveillance in SGA When primary surveillance with umbilical artery Doppler is found to be abnormal, biophysical profile is likely to be useful given its good negative predictive value in high-risk populations.

Magnesium sulphate and other anticonvulsants for women with pre-eclampsia Magnesium sulphate more than halves the risk of eclampsia, reduces risk of abruptio placenta and probably reduces the risk of maternal death. Diuretics Diuretics commonly have been given in an attempt to convert the oliguric state to a nonoliguric state.
She had been tested positive for pregnancy following In Vitro Fertilization and a recent ultrasound examination had shown a viable intrauterine pregnancy.She had been treated in the past for Endometriosis, and Pelvic Inflammatory Disease. Clinical examination, serum beta human chorionic gonadotrophin (beta HCG) assay and trans-vaginal scanning as a diagnostic algorithm may at times lead to false assurance. A vigilant approach and actively looking for heterotrophic pregnancy in high risk women will reduce the risk of missing cases.
Abortion Spontaneous abortion – aka miscarriage – Loss of baby before 20 weeks of pregnancy Induced abortion.
Typically, the earlier a cancer is detected and diagnosed, the more successful the treatment, thus enhancing the survival rate.
About 57,650 new cases of carcinoma in situ (CIS) will be diagnosed (CIS is non-invasive and is the earliest form of breast cancer). A mammogram is the best method for detecting breast cancer because often it can identify cancer before physical symptoms develop. Women should know how their breasts normally feel and report any breast change promptly to their health care provider. Women should be aware of how their breasts normally feel and report any new breast changes to a health professional as soon as they are found. Mona Shroff Antihypertensive drug therapy for mild to moderate hypertension during pregnancy. A systematic review with meta- analysis has provided evidence that the use of umbilical artery Doppler to monitor high-risk fetuses reduces perinatal morbidity and mortality. However, there is evidence from uncontrolled observational studies that biophysical profile in high-risk women has good negative predictive value, i.e. This recommendation is further supported by evidence that, in high-risk women, the biophysical profile was rarely abnormal when Doppler findings were normal. Controlled trials are needed to assess the clinical benefits and possible risks of maternal hydration for specific clinical purposes Hofmeyr GJ, Gulmezoglu AM. Until better evidence is available, the choice of antihypertensive should depend on the clinician's experience and familiarity with a particular drug, and on what is known about adverse effects.
There are insufficient data for any reliable recommendation about which policy of care should be used for women with severe early onset pre- eclampsia.
In the majority of ARF studies, dopamine was associated only with an increase in urine output. It is unclear whether low-dose dopamine therapy for pre- eclamptic women with oliguria is worthwhile. Arch Gen Psychiatry -- Early Coadministration of Clonazepam With Sertraline for Panic Disorder, July 2001, Goddard et al.
However,the incidence is much higher when associated with in vitro fertilisation and is about 1:100 (range of 1% to 3%).

The adnexal sac may be mistaken for ovarian cyst or corpus luteal cyst.The diagnosis can lead to extreme anxiety to the family and adequate counselling and support should be provided. Antihypertensive drugs are often used to lower blood pressure in the belief that they will prevent this progression. If unsuccessful –objective is to support the functionally anephric pt till kidneys recover. In the absence of compelling contradictory data from a randomized, blinded clinical trial, the widespread use of diuretics in critically ill patients with acute renal failure should be discouraged.
In addition to her intra-uterine pregnancy Image A and Image BAfter a detailed counselling, she underwent an uneventful laparoscopic salpingectomy the following morning. Surgical removal is the treatment of choice in cases with a viable intrauterine pregnancy and the woman should be adequately counselled regarding small risk of miscarriage following the surgery. Early detection is very important because the cancer can spread if not treated at its earliest stages. Eat a healthy, balanced diet that includes at least five servings of fruits and vegetables every day.
The review of 46 trials, involving 4282 women, found there was not enough evidence to show the benefit of antihypertensive drugs for mild to moderate hypertension during pregnancy.
Useful only in management of fluid-overloaded patients Cantarovich F, Rangoonwala B, Lorenz H, Verho M, Esnault VL. A high index of suspicion is the key to diagnose such pregnancies and to enable timely management.
Image C and Image DA post surgery assessment confirmed a viable intrauterine pregnancy and she was discharged on the second postoperative day.
Laparoscopic treatment is preferred in a haemodynamically stable individual, as it gives a good chance for continuation of the IU pregnancy.Medical management is only an option if both intrauterine and extra-uterine pregnancies are not viable. Each year, about two percent of women aged 15-44 have an abortion; 47% of them have had at least one previous abortion.
Although there are many kinds of cancer, they all have in common this out-of-control growth of cells. Even when cancer has spread to a new place in the body, it is still named after the part of the body where it started. Age Approximately 77% of women with breast cancer are age 50 or older at the time of diagnosis.
High-dose furosemide for established ARF: a prospective, randomized, double-blind, placebo-controlled, multicenter trial. Cochrane Database of Systematic Reviews 2007, Issue 1 Abalos E, Duley L, Steyn DW, Henderson-Smart DJ.. When cancer comes back in a person who appeared to be free of the disease after treatment, it is called a recurrence.

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