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Headache in Pregnancy

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4981. Pre-eclampsia and Eclampsia

Hg in the second half of pregnancy, with ≥1+ proteinuria on reagent stick testing. New hypertension. New and/or significant proteinuria. Features of severe pre-eclampsia include: Severe headache - usually frontal. Sudden swelling of face, hands and feet. Liver tenderness. Visual disturbance (eg, blurring or flashing lights in front of the eyes). Epigastric pain and/or vomiting. Platelet count falling to below 100 x 10 9 /L (a falling platelet count predicts severe disease and these women need (...) Pre-eclampsia and Eclampsia Pre-eclampsia and Eclampsia. Late pregnancy complication | Patient 0.3 g in 24 hours) with or without oedema. Virtually any organ system..."> 0.3 g in 24 hours) with or without oedema. Virtually any organ system..."> TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Pre-eclampsia and Eclampsia Authored by , Reviewed by | Last edited 20 Jan 2016 | Certified by This article is for Medical

2008 Mentor

4982. Pernicious Anaemia and B12 Deficiency

and headache. Vitamin B12 deficiency may present with unexplained neurological symptoms - eg, paraesthesia, numbness, cognitive changes or visual disturbance. Findings on examination may include pallor, heart failure (if anaemia is severe), lemon tinge to the skin, glossitis and oral ulceration. Neuropsychiatric features may include irritability, depression, psychosis and dementia. Neurological features may include subacute combined degeneration of the spinal cord and peripheral neuropathy. Peripheral loss (...) ) may include depression, paranoia (megaloblastic madness), delirium, confusion and . Severely anaemic patients may present with heart failure, often triggered by an infection. Hepatomegaly and splenomegaly may be present. Differential diagnosis [ ] Causes of megaloblastic anaemia - poor diet, goat's milk, gluten-induced enteropathy, tropical sprue, pregnancy, prematurity, chronic haemolytic anaemias (eg, sickle cell anaemia), malignant disease, increased renal loss (congestive cardiac failure

2008 Mentor

4983. Parvovirus Infection

cheek syndrome), a generalised rash illness clinically indistinguishable from rubella, aplastic crises in patients with increased red cell turnover, arthropathy and persistent infection in the immunocompromised. It may also cause fetal loss or fetal hydrops and so detection in pregnancy is important for monitoring and possible treatment. Parvoviruses are among the smallest DNA-containing viruses known to infect mammals (hence the name parvus , which is Latin for small). The only parvovirus known (...) % of infections) or it may present only with nonspecific coryzal symptoms (common). Erythema infectiosum : this is also called 'fifth disease' because it is the fifth of the classic exanthems. Prodromal symptoms usually start around a week following exposure to parvovirus B19. They are usually mild and may include headache, rhinitis, sore throat, low-grade fever and malaise. Less commonly, nausea, diarrhoea, abdominal pain or arthralgia may develop. Following the prodromal phase, patients are usually symptom

2008 Mentor

4984. Pityriasis Rosea

often during the spring and autumn. Presentation Pityriasis rosea on the abdomen Images of the rash of pityriasis rosea are available on the DermNet NZ site. [ ] Clinical features [ ] There may be prodromal symptoms (eg, malaise, nausea, anorexia, fever, joint pain, lymph node swelling and headache) that precede the appearance of the herald patch. Pruritus (may be intense) is thought to occur in about half of cases. The rash begins with a herald patch in 40-76% of cases. The herald patch measures 2 (...) - eg, erythematous plaques and ulcers. Differential diagnosis [ ] . . . . . . . . . . Polymorphic eruption of pregnancy. Secondary . . . Investigations Diagnosis is clinical and usually no investigations are required. Skin biopsy is not usually advised but may be occasionally required to confirm or alter the diagnosis. Other investigations - eg, syphilis serology - may be required to rule out other possible diagnoses. Management [ , ] Pityriasis rosea is a self-limiting disease. Treatment

2008 Mentor

4985. Pill Questions - What to Ask When Starting the OCP.

consultation. It should include: Discussion and explanation: Mechanism of action. Efficacy. Advantages and disadvantages. Risks. Consideration of alternative forms of contraception. Types of COC pill. Choice of first-line options. Assessment: Establish safety by using UK medical eligibility criteria (UKMEC). History. Examination. Exclude pregnancy. Advice on taking the pill: When/how to start. Missed pill advice. Diarrhoea and vomiting. Drug interactions. Side-effects. Verbal and written information (...) depends on the protection afforded by the technique itself and how consistently and correctly it is used. The failure rate for the COC pill (when used perfectly) is estimated to be only 3 pregnancies per 1,000 women per year. However, the typical failure rate is closer to 90 pregnancies per 1,000 women per year [ ] . The efficacy of the COC pill may be decreased by severe vomiting or diarrhoea and concurrent use of other enzyme-inducing medications. Advantages and disadvantages [ ] Advantages Non

2008 Mentor

4986. Phaeochromocytoma

invariably present: Headache Profuse sweating Palpitations Tremor Nausea Weakness Anxiety Sense of doom Epigastric pain Flank pain Constipation Weight loss Persons with familial phaeochromocytoma may be asymptomatic [ ] . Examination Again, the most common features are in bold: Hypertension but it may be paroxysmal in 50%. Postural hypotension . Tremor . Hypertensive retinopathy. Pallor. Fever. Acute hypertension with a tumour that releases predominantly noradrenaline (norepinephrine) may cause reflex (...) presentation, so long-term follow-up is important [ ] . Phaeochromocytoma and pregnancy Pre-eclampsia is fairly common, whilst phaeochromocytoma is very rare and only a few hundred cases in pregnancy have been reported in the literature. If phaeochromocytoma is diagnosed for the first time in pregnancy, there are special concerns with a maternal and fetal mortality rate of 48% and 55% respectively. If diagnosis precedes pregnancy, the outcome is vastly better. Alpha-adrenergic blockade

2008 Mentor

4987. Obesity in Adults

. Additional contraception may be needed in women experiencing marked gastrointestinal side-effects (eg, diarrhoea). Underlying kidney disease may result in hyperoxaluria and oxalate nephropathy. Contra-indications: chronic malabsorption syndrome, cholestasis, pregnancy and breast-feeding. Interactions: (reduced bioavailability), acarbose (lack of pharmacokinetic data), amiodarone (reduced plasma concentrations), coumarins (enhanced anticoagulant effect due to reduced absorption of fat-soluble vitamin K (...) ), anti-epileptic drugs (decreased absorption), levothyroxine (possible risk of hypothyroidism), antiretroviral therapy (reduces absorption). [ ] Common problems: abdominal discomfort/distension, liquid oily stools, faecal urgency and increased frequency, flatulence - more so if a diet contains 2000 kcal/day and is high in fat. Other common problems include headaches, upper respiratory tract infections and hypoglycaemia. Less frequently, rectal pain, menstrual irregularities, anxiety, and fatigue

2008 Mentor

4988. Normal Menstruation

until , unless interrupted by pregnancy. Hormonal control The menstrual cycle is under the control of three sets of hormones: Gonadotrophin-releasing hormones - luteinising hormone-releasing hormone (LHRH) and follicle-stimulating hormone-releasing hormone (FSHRH). Gonadotrophins - luteinising hormone (LH) and follicle-stimulating hormone (FSH). Ovarian hormones - oestrogen and progesterone. The gonadotrophin hormone-releasing factors from the hypothalamus control the release of the pituitary (...) . The hormonal swings may be associated with changes in mood and libido and with headaches in some women. However, some studies have not demonstrated good evidence for premenstrual mood symptoms. [ , ] The typical changes of the menstrual cycle may help to guide natural family planning, if a woman wishes. Several methods are available, including calendar, temperature and cervical mucus observation, or palpating the cervix. [ ] Range of problems Abnormalities in menstruation may include: Quantity : usually

2008 Mentor

4989. Non-pulmonary Tuberculosis

formation (eg, loin mass or psoas abscess from spinal TB), nerve root compression, isolated bone or joint lesions (monoarthritis). See also the separate article on . Central nervous system : tuberculous meningitis and tuberculomas - initially nonspecific symptoms (headache, vomiting, altered behaviour) followed by diminished consciousness ± focal neurological signs. Gastrointestinal : mainly ileocaecal lesions (abdominal pain, bloating, obstruction and simulating appendicitis) but occasional peritoneal (...) neuropathy which is more likely to occur where there are pre-existing risk factors such as diabetes, alcohol dependence, chronic kidney disease, pregnancy, malnutrition and HIV infection. In these circumstances pyridoxine 10 mg daily should be given prophylactically from the start of treatment. During the first two months ('initial phase') of rifampicin administration transient disturbance of liver function with elevated serum transaminases is common but generally does not require any change of treatment

2008 Mentor

4990. Neurological History and Examination

and remissions? For example, worsening of symptoms with hot environments - eg, sauna, hot bath or hot weather in demyelinating disorders (called Uhthoff's sign). Does anything trigger the symptoms - eg, exercise, sleep, posture or external stimuli such as light or smell? Ask about any associated symptoms (other features of neurological disease): Headache. Numbness, pins and needles, cold or warmth. Weakness, unsteadiness, stiffness or clumsiness. Nausea or vomiting. Visual disturbance. Altered consciousness (...) emboli. There may be vascular problems or recurrent miscarriage to suggest antiphospholipid syndrome. There may be diabetes mellitus. Ask about pregnancy, delivery and neonatal health. Ask about any infections, convulsions or injuries in infancy, childhood or adult life. Particularly ask about head or spinal injury, meningitis or encephalitis. Systematic enquiry The systematic enquiry is very important here. For example: Loss of weight and appetite may suggest malignancy and this may

2008 Mentor

4991. Neurofibromatosis

and a growth of existing lesions at puberty or in pregnancy. Cutaneous neurofibromas rarely appear to undergo malignant transformation. However, they may catch on clothing and/or cause cosmetic embarrassment, stinging or itching. Subcutaneous neurofibromas may be tender to touch and cause tingling in the distribution of the affected nerve. Malignant change occasionally occurs: if rapid growth occurs, refer to a specialist, as removal may result in nerve damage. Plexiform neurofibromas are more diffuse (...) . [ ] Obstetric - there appears to be an increased risk of perinatal complications in NF1, with a higher stillbirth rate, intrauterine growth restriction and caesarean section rate. During pregnancy, neurofibromas may grow in size and number and there is the risk of cord compression if spinal plexiform neurofibromas expand. Obstetricians should also ensure pelvic neurofibromas do not impede delivery of the baby. Investigations NB : baseline brain and spinal MRI scanning and routine imaging of the chest

2008 Mentor

4992. Osler-Weber-Rendu Syndrome

, patients with HHT were investigated using CT scanning. 74% had vascular abnormalities but only 8% were symptomatic. [ ] In the central nervous system, AVMs, cavernous angiomas and aneurysm may result in headache, seizures or epilepsy, intracranial haemorrhage and stroke. Lesions of the skin do not usually develop until the 20s. They affect the hands and wrists in 41% and the face in 33%. [ ] They do not tend to be a serious problem with regard to haemorrhage. Vascular malformations of the urinary tract (...) to stem the flow. Surgical or laser ablation may be required as an emergency or elective procedure. AVMs may need embolisation, ligation of the blood supply or resection. Septoplasty of the nose may be required. Liver transplantation or stereotactic intracranial radiosurgery may be indicated. However, a recently published paper concluded that in adults with unruptured brain AVM, interventional therapy appears to worsen outcomes compared to medical management. [ ] Pregnancy in HHT is associated

2008 Mentor

4993. Pain Relief in Labour

(RCM) for healthy women with uncomplicated pregnancies [ ] . Concerns have been raised, however, that there may be greater harm to women and/or their babies - eg, a perceived risk associated with neonatal inhalation of water and maternal/neonatal infection. A Cochrane review found that water immersion during the first stage of labour reduces the use of analgesia and reported maternal pain, without adverse effects on labour duration, operative delivery or neonatal outcome [ ] . Nitrous oxide (...) headache in 50%. Epidurals are not available in the community and may steer the woman towards a more interventionalist environment than she wants. Ambulatory epidural This is a low-dose epidural that relieves pain, but allows women to walk about during labour [ ] . Staying mobile in the first stage of labour for women with epidural analgesia has not been shown to produce any benefit to delivery outcomes or satisfaction with analgesia, but there are no obvious harms either [ ] . Editor's note November

2008 Mentor

4994. Non-diabetic Retinal Vascular Disease

(clinic blood pressure >180/110 mm Hg): [ ] patients may have headaches and decreased vision. On fundoscopy, you may see hard exudates appear as a 'macular star' (thin white streaks radiating around the macula), disc swelling, cotton wool spots, flame haemorrhages and arterial or venous occlusions. Management Management should be aimed at controlling the hypertension. Accelerated hypertension is a medical emergency. Outcome Hypertensive retinopathy is associated with a two- to three-fold increase (...) as a result of severe head trauma, chest compression injury or other crush injuries involving broken bones or fat emboli. It can be caused by a number of systemic diseases (eg, pancreatic disease, , and and following bone marrow transplantation). It can occur during pregnancy or delivery. The estimated annual incidence is 0.24 cases per million population per year in the UK. Presentation Presents with sudden, severe visual loss which is usually bilateral. Fundoscopy reveals multiple white retinal patches

2008 Mentor

4995. Oral Anticoagulants

surgery with risk of severe bleeding. Within 48 hours postpartum. Pregnancy (first and third trimesters, can cause congenital malformations and fetal death). Drugs where interactions may lead to a significantly increased risk of bleeding - eg, antiplatelet drugs, non-steroidal anti-inflammatory drugs (NSAIDs), selective serotonin reuptake inhibitors (SSRIs), venlafaxine or duloxetine. Uncorrected major bleeding disorder (eg, haemophilia, chronic kidney disease). Potential bleeding lesions - eg, active (...) as a hospital clinic. Patients should be assessed for capability - only patients able to follow the same total quality management procedures as hospitals should undertake NPT ± PSM. Patients should be audited regularly for comparison with laboratory results, proportion of INRs in range and adverse events. Patient advice Patients should be advised to: Take the prescribed dose at the same time, daily. Report any bruising or bleeding immediately. Attend for blood tests as advised. Avoid pregnancy - ensure

2008 Mentor

4996. DOUBLE BLIND EVALUATION OF ANALGESIC AGENTS IN THE POSTPARTUM PATIENT. (Abstract)

OM Analgesics Back Pain Breast Caffeine Carisoprodol Codeine Dextropropoxyphene Double-Blind Method Episiotomy Female Headache Humans Pain Perineum Phenacetin Placebos Postpartum Period Pregnancy Puerperal Disorders Uterus BACKACHE BREAST CAFFEINE CARISOPRODOL CODEINE EPISIOTOMY HEADACHE PAIN PERINEUM PHENACETIN PLACEBOS PREGNANCY PROPOXYPHENE PUERPERAL DISORDERS UTERUS 1963 7 1 1963 7 1 0 1 1963 7 1 0 0 ppublish 14057471

1996 Western journal of surgery, obstetrics, and gynecology Controlled trial quality: uncertain

4997. An open-label, multicenter, noncomparative safety and efficacy study of Mircette, a low-dose estrogen-progestin oral contraceptive. The Mircette Study Group. (Abstract)

, multicenter trial, a total of 1143 of 1250 healthy female subjects contributed to the determination of extent of exposure, for an equivalent of 1080.8 woman-years of use.Absence of withdrawal bleeding occurred in 5.5% of total cycles and intermenstrual bleeding occurred in 12.0% of total cycles. Breakthrough spotting was more common than breakthrough bleeding. The Pearl Index for total pregnancies during treatment was 1.02/100 woman-years. Fewer than 3% of subjects discontinued study participation (...) , primarily because of menstrual problems, indicating that Mircette was an oral contraceptive acceptable to the women studied. Overall 73.6% of all subjects reported one or more adverse events, and a total of 43.9% of subjects reported drug-related adverse events. The most common drug-related adverse events reported included headache (8.5%), breast pain (7.3%), dysmenorrhea (4.2%), and menstrual disorder (4.2%). There were no reports of venous thromboembolic events or of significant changes in blood

1998 American journal of obstetrics and gynecology

4998. Climacteric symptoms and control of the cycle in women aged 35 years or older taking an oral contraceptive with 0.150 mg desogestrel and 0.020 mg ethinylestradiol. (Abstract)

, 6, 9 and 12 cycles. No pregnancies occurred during the study period. Spotting gradually decreased from 29.3% in cycle 1 to 4.2% in cycle 12, while breakthrough bleeding (BTB) disappeared after cycle 7. One case of superficial thrombophlebitis and 3 cases of minor side effects were registered. With regard to the complaints, breast tenderness, headache, and depression gradually decreased during the study (basal vs. 12-month data: 50.9% vs. 31.2%, 48.3% vs. 18.7%, 39.6% vs. 20.8%, respectively

1995 Contraception

4999. Efficacy and safety of a low-dose monophasic combination oral contraceptive containing 100 microg levonorgestrel and 20 microg ethinyl estradiol (Alesse). North american Levonorgestrel Study Group (NALSG). (Abstract)

contraceptive was administered once a day for 21 days, followed by 7 days of placebo for a complete cycle. During 26,554 cycles evaluated for efficacy, 18 pregnancies occurred (Pearl index of 0.88); 6 of these events were attributable to subject noncompliance. After 30 cycles of exposure the cumulative rate of withdrawal as a result of accidental pregnancy was 1.9%. Breakthrough bleeding (with or without spotting) occurred in 12.9% of the cycles and spotting alone occurred in 10.1% of the cycles. The 2 most (...) common adverse events cited as reasons for discontinuation were headache (2% of subjects) and metrorrhagia (2%). One serious event led to withdrawal of a subject. Overall, the results of this study demonstrate that the monophasic regimen of 100 microg levonorgestrel and 20 microg ethinyl estradiol offers effective contraception, acceptable cycle control, and a good tolerability profile.

1999 American journal of obstetrics and gynecology

5000. [Nitroglycerin patch for tocolysis--a prospective randomized comparison with fenoterol by infusion]. (Abstract)

. The primary outcomes were the prolongation of gestation by 48 h, 7 days or up to 37 weeks of gestation as well as the neonatal outcome. The progression of cervical ripening and maternal side effects during tocolysis were assessed as secondary outcome criteria.There was no difference in successful tocolysis for 48 h and 7 days in both groups, whereas significantly more women passed 37 weeks after GTN therapy. So mean duration of pregnancy, birth weight and height were greater, whereas transfer (...) into neonatal care unit was significantly rare after GTN. There were no differences in neonatal outcome and progression of cervical ripening during tocolysis. Maternal side effects during GTN were fewer and weaker compared with fenoterol. Circa 70% of GTN treated women had a headache temporary, whereas more than 90% of the patients with fenoterol suffered from tachycardia and tremor.Tocolytic efficacy of transdermal GTN was at least equivalent to the established beta-mimetic therapy with fenoterol. Because

2001 Zeitschrift für Geburtshilfe und Neonatologie Controlled trial quality: uncertain

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