Post on 18-Jan-2016
ObGyn Watch October 2004
R Narayanan
OCTOBER 2004
Nitric Acid (N.O)in
Female Reproduction
N.O - Major Paracrine Mediator & Regulatory Agent
Menstruation Ovulation Endometrial
receptivity Implantation
Maintenance of Pregnancy
Cervical Ripening
Tocolysis Labour Pains
N.O Donors promote Fertility & Inhibitors facilitate Contraception
Maul H et al Curr Pharm Design Feb 2003
Effect of N.O on Vasculature N.O Promotes Vasodilatation &
inhibits Platelet Aggregation Low N.O in early II Trimester
impairs vascular formation leading to Placental insufficiency & FGR
High N.O in III Trimester represents compensated Pl perfusion in IUGR
PE develops due to dysfunction of L-arginine – N.O pathway
Tranquilli AL et al J Mat Fet NN Med
Effect of L-arginine L-arginine infusion decreases BP in
Normo as well as Hypertensive mothers
Reduces BP through release of N.O Improves endothelial function Inhibits Platelet aggregation Prevents Pre eclampsia Potent relaxant - Prolongs pregnancy Better Perinatal outcome
Alfredo et al Rev Chil Ultrasono 2001
Doppler – USG Evaluation
Lowers Uterine artery vascular resistance
Pathological Doppler waveforms paralleled with N.O production
Accelerated fetal Growth in Rx Group Birth weight improved
Sieroszewski P et al J Mat Fet NN Med June 2004
Oral0.1G/Kg/Day
X 2 weeksFrom 10th
GestationalWeek
Moderate intake of Coffee has No effect on Abortion -Coll PN Project 1956-66 - -Klebenoff et al N Eng J Med 1988
Coffee >150G/day increases RR Spontaneous Abortion to 1.36
& LBW to 1.5 Meta analysis of 32 studies
High Coffee intake increases Sudden Infant Death Syndrome
Ob Gyn Surv 1999
Retrospective study 562 Spont Aborters compared with 953 matched controls: Increased coffee consumption increases abortion risk – Coffee not Mutagenic
-Cnattingius S Sweden N Eng J Med 2000
During PregnancyIt is safe to consume
Less than 150G Coffee/Day
Which is equal to:
1 cup of Brewed2 cups of Instant3-4 cups of Tea2-3 Soft Drinks
How about Tea?
Study of>1000 women 30 & Older in Taiwan
•Average of 2 cups of Tea >10 years•6.2% greater Bone Density Fluorides,Flavonoids & Phytoestrogens responsible•Tea has >4000 Health-affecting Compounds
Polycystic Ovaries
Incidence of Abortion in PCOS: 30-50%
Causes:1. Elevated LH2. Hyper insulinemic
Insulin Resistance3. Elevated Androgens4. CL Deficiency
following Dysovulation
Metformin Insulin Resistance Serum Androgen
Improves Ovulation
Abortion Obesity
Retrospective Study of Metforminin Pregnancy
Metformin 1-2 G / day throughout Pregnancy
Abortion Rate : 9% in study group
(42% in controls) Lower Free Testosterone levels No IUGR No Fetal Anomalies
Daniela DJ et al J Endocrin Metabol 2002
Metformin & GDM
Prospective & retrospective Study Incidence of GDM: 3% in Study group (23% in Controls) Safe in Pregnancy Probably acts by decreasing secretory
demands on Pancreatic beta cells
Glueck et al 2001
L’scopic Ovarian Drilling In CC Resistant PCO: Spont Ovulation 57% Conception 50% Reg Cycles >1 yr 50% Poor Responders: BMI >35Kg/m2 Testosterone >4.5 nMol/L Infertility >3 yrs
Hum Repr 2004
Farquhar C et al Cochrane Library Issue 3, 2004
•15 Trials of L’scopic Drilling Vs GTH Induction:•Compared 6-12 mths following Drilling with 3-6 cycles of GTH•Cumulative Pregnancy Rate Same•Miscarriage rate same •Multiple pregnancy less with Drilling
American Men shave 48 sq inches
24 times/monthWomen, 412 sq inches
11 times/month-Gillette
-Westinghouse 1941
Dysmenorrhoea Pain Relief: Naproxen 59%
Ibuprofen 70% Mefanemic Acid 69% Aspirin 29%
Ibuprofen drug of choice
Coxibs=Naproxen
Metanalysis: Double Blind RCTsZhang WY et al Br J Ob G 1998
Source BMJ 1999
Eminence-Based Medicine
‘The more senior the physician, the less important the evidence!’
“Clinical Experience” is defined as ‘Making the same mistakes With increasing confidence
over an impressive number of years’
Vehemence-Based Medicine
‘Substitution of volumeFor Evidence!’
Eloquence-Based Medicine
‘Smooth tongue, Sartorial elegance And Verbal eloquence are
Powerful Substitutes’
Providence-Based Medicine
‘Decision may best be leftIn the hands of Almighty!’
Diffidence-Based Medicine
‘A sense of DespairMakes the physician feel
helplessAnd do nothing!’
Nervousness-Based Medicine
‘Fear of Litigation Leads to over investigate
And over treat!’
Confidence-Based Medicine
(Restricted to Surgeons)
‘He will let his scalpel speak!’
One-day old TAMARA – 3.75 KgWith Mother 32 year old
Quarda Touriat at BrusselsOn 24 Sep ‘04
Prof Donnez froze Touriat’s ovaries in 1997 before Chemo/Radio Rx for Stage IV Hodgkins Lymphoma.Laparoscopic Ovarian Transplant in 2003Menstruation returned 4 months later.Conceived naturally -Lancet Sept’04
Stop Press!