Thrombophilia and Pregnancy: Diagnosis and Management

Thromboembolic disease during pregnancy is a significant cause of maternal morbidity and mortality involving venous or arterial thrombosis and possible clinical manifestations like clinical symptoms of antiphospholipid antibody syndrome and hyperhomocysteinemia. For diminishing the prevalence of thromboembolic disease, the early identification of pregnant women with various risk factors for thrombosis without clinical symptoms is of great importance. However, the optimal management for asymptomatic pregnant women who have inherited thrombophilia is uncertain and recognized only due to pregnancy complications such as recurrent pregnancy loss and preeclampsia. The clinical approach to thromboembolism is the same in pregnant women with or without thrombophilia. Based on family history, clinical symptoms should begin with simple reliable inexpensive laboratory tests like prothrombin time and activated thromboplastin time to test the status. Early diagnosis and appropriate use of thromboprophylaxis lead to increasing better maternal and perinatal outcomes. Conclusively, it is important to recognize these patients in order to prevent all pregnancy complications

Abortions in First Trimester Pregnancy, Management, Treatment

The miscarriages’ investigation should include a familiar history, gynecological examination and a full laboratory testing including hormonal control, as well as karyotype, maternal immune control and thrombophilia testing. If the physician suspects the cause of abortions is chromosomal due to heredity, a special blood test (karyotype) for the pair is recommended. Chromosomal abnormalities are the most common reason for first trimester abortions, and are impossible to be prevented. Based on the above data, abortion and the subsequent possible infertility should not be considered as a personal failure for the woman and the treating physician. Nowadays, medical advancement provides many options combined with psychological support can actually reduce the miscarriages’ risk

Abortions in First Trimester Pregnancy, Management, Treatment

Tujuan dari penelitian: 1. Mendeskripsikan penerepan pendekatan Client Centered dalam mengatasi kepribadian introvert pada siswa kelas XI IPS MA Al Hidayah Kudus Tahun Pelajaran 2016/2017. 2. Mendeskripsikan kepribadian introvert pada konseli siswa kelas XI IPS MA Al Hidayah Kudus setelah diberikan konseling dengan pendekatan Client Centered. Pendekatan client centered adalah pendekatan yang berpusat pada diri klien, yang mana seorang konselor hanya memberikan konseling serta mengawasi klien pada saat mendapatkan pemberian konseling tersebut agar klien dapat berkembang atau keluar dari masalah yang dihadapinya. Introvert merupakan tipe kepribadian individu yang mempunyai kecenderungan menutup diri dari dunia luar. Jenis penelitian yang digunakan adalah peneltian kualitatif studi kasus. Penelitian dilakukan di MA NU Al Hidayah Kudus Tahun Pelajaran 2016/2017, dengan dua subjek penelitian (ABS, DAS). Metode pengumpulan data yang digunakan: 1. Wawancara, 2. Observasi, 3. Dokumentasi dan 4. Home Visit. Analisis data yang digunakan adalah: analisis sistem Bacon. Hasil penelitian: 1. Konseli I (ABS) faktor yang menyebabkan memiliki kepribadian intovert: 1. Tidak percaya diri. ABS yang berusia 16 tahun dan saat ini tengah duduk di kelas XI IPS MA NU Al Hidayah Kudus merasa kurang percaya diri dengan bentuk kaki yang dimiliki membuat ABS menjadi pibadi yang tidak percaya diri dalam pergaulan, sehingga membuat konseli sering mendapatkan perlakuan yang tidak menyenangkan dari siswa-siswi lain. Konseli memang terlahir dengan keadaan yang tidak sempurna karena cacat fisik pada salah satu kakinya atau yang biasa disebut sebagai (Clubfoot) atau kaki pengkor. 2. Perlakuan diskriminasi. Karena bentuk fisik yang dimiliki oleh konseli yang berbeda, konseli mendapatkan perlakuan diskrinasi dari siswa-siswi lain. 2. Konseli II (DAS) faktor yang menyebabkan konseli memiliki kepribadian introvert: 1. Rendahnya kemampuan interaksi konseli. Konseli sering berpindah tempat tinggal sejak usia sekolah dasar membuat kemampuan interaksi DAS kurang. Di sekolah, konseli banyak diperhatikan oleh siswa-siswi di sekolah karena secara fisik DAS merupakan siswa yang berpenampilan menarik. Tetapi kurang interaksi sosial, konseli lebih banyak memilih menyendiri dan tidak terlihat aktif dalam hubungan pertemanan yang sering terjalin pada anak usia sekolah atau remaja awal. 2. Perceraian kedua orang tua konseli. Perceraian yang ditimbulkan karena keuangan keluarga yang memburuk membuat konseli harus bekerja keras untuk membiayai sekolahnya semakin membuat konseli tidak memiliki waktu untuk bersosialisasi dengan teman sebayanya. Setelah pelaksanaan tiga kali konseling client centered terhadap kedua konseli diperoleh keterangan bahwa, konseli I (ABS) telah mampu menerima kekurangan dirinya yang memiliki keterbatasan pada kakinya. ABS telah percaya diri dan mampu bersosialisasi dengan baik. Konseli II (DAS) telah menyadari bahwa kehidupan yang ia alami harus tetap berjalan, dan DAS juga telah memahami bahwa makna kehidupan adalah terus bekerja dan bahagia atas apa yang dimilikinya sekarang. Berdasarkan kesimpulan di atas peneliti dapat memberikan saran: 1. Kepala sekolah: Dalam penelitian ini menunjukkan bahwa konseling individual sangat membantu siswa dalam memberikan mengatasi perilaku introvert siswa. Sehingga diharapkan kepala sekolah dapat mendukung adanya layanan konseling indivual ini dengan memfasilitasi guru pembimbing dalam memberikan layanan konseling individual. 2. Guru bimbingan dan konseling: Diharapkan guru bimbingan dan konseling dapat menjadikan hasil penelitian sebagai acuan dalam memberikan pelayanan konseling individual dengan konseling client centered. 3. Siswa: Diharapkan siswa dapat bergaul dengan baik dan semakin meningkatkan hubungan interpersonal. 4. Penelitian selanjutnya: Diharapkan peneliti selanjutnya dapat mengembangkan penelitian yang sejenis dengan menggunakan layanan konseling yang lebih varatif, sehingga didapatkan komparasi yang berbeda dengan penelitian ini

Vein Thrombosis Risk in Women and Travel

Deep vein thrombosis (DVT) of the lower limbs is a serious condition that can lead to pulmonary embolism (PE) in about 15–24% of cases. If it is not diagnosed/treated timely, nearly 15% of these PE are lethal. The relationship between travel and staying in the same position for a long time is well-known since World War II. Generally, it is more frequent in air flights. It is also associated with the economic downturn in airplanes because passengers have limited space and have greater difficulty of moving. It is estimated that approximately 1–6% of long-haul passengers arrive at their destination with a clot in their veins, but most DVT are asymptomatic

Premature Birth, Management, Complications

In recent years an increase in premature births (PB) rate has been noticed, as this pregnancy complication that still remain an important cause of perinatal morbidity and mortality, is multifactorial and prediction is not easy in many cases. There are many bibliographic data supporting the view that PB have also genetic predisposition. The trend of “recurrence” of PB in women as well as its increased frequency in ethnic groups suggests its association with genetic factors, either as such or as an interaction of genes and environment. Immunomodulatory molecules and receptors as well as polymorphisms of various genes and/or single nucleotides (single nucleotide polymorphisms, SNPs) now allow with advanced methods of Molecular Biology the identification of genes and proteins involved in the pathophysiology of PB. From the history of a pregnant woman, the main prognostic factor is a previous history of prematurity, while an ultrasound assessment of the cervix between 18 and 24 weeks is suggested, both in the developed and the developing world. According to the latest data, an effective method of successful prevention of premature birth has not been found. The main interventions suggested for the prevention of premature birth are the cervical cerclage, the use of cervical pessary, the use of progesterone orally, subcutaneously or transvaginally, and for treatment administration of tocolytic medication as an attempt to inhibit childbirth for at least 48 hours to make corticosteroids more effective. Despite the positive results in reducing mortality and morbidity of premature infants, the need for more research in the field of prevention, investigation of the genital code and the mechanism of initiation of preterm birth is important

Antiphospholipid Syndrome and Pregnancy-Diagnosis, Complications and Management: An Overview

Antiphospholipid syndrome which is also known as APS is an autoimmune disease which represents an acquired form of thrombophilia. The etiology of APS remains unknown. This disorder occurs when the immune system mistakenly attacks some of the normal human proteins and manifests itself as recurrent arterial or venous thrombosis and it could emerge after abortions or in recurrent pregnancy loss. In APS, the body produces the wrong antibodies against phospholipid-binding proteins, that is present in the blood and plays an important role in coagulation. Antibodies are specific proteins that usually target and neutralize the body’s invaders, such as viruses and bacteria. When antibodies attack phospholipid-binding proteins, blood clots abnormally. Specifically, it could cause blood clots in veins or arteries leading to stroke and various pregnancy complications such as: endometrial death, miscarriage, preeclampsia, intrauterine growth restriction and prematurity. APS is divided into primary and secondary, which is associated with autoimmune diseases and more often with systemic lupus erythematosus (SLE), while antibodies against cardiolipin are detected in many other conditions (infections, malignancies, drugs, etc.). The symptoms of APS, in addition to arterial and/or venous thrombosis and pregnancy complications, are multisystemic and the differential diagnosis of the primary APS from the secondary, in the context of SLE, is of particular clinical interest and is subject of this literature review

Twin Pregnancies Labour Modus and Timing

Twin pregnancies are categorized according to three factors, zygosity, chorionicity and amnionicity. Dizygotic twins are always dichorionic and diamniotic, where each twin has its own chorionic and amniotic sac. Monozygotic twins account for 1/3 of twin pregnancies and show higher morbidity and mortality. In monozygotic twins, chorionicity and amnionicity are determined by the time of zygote division. Chorionicity and amnionicity determine the risks of twin pregnancy. Morbitidies are shown notable decreasing tendency depending on improving of high risk obstetric and neonatal care, however is still discussed the optimum labour management in twin pregnancies Vaginal delivery in twin pregnancies is possible when both have cephalic presentation and in the late weeks of pregnancy during which the risks of prematurity are minimized. The aim of this review was the assessment and evaluation the impact of the labour modus and timing of termination of twin pregnancies due to rise of their occurrence based on scientific aspects of the new published literature on perinatal outcome

The Contribution of Uterine Artery Embolization as a Safe Treatment Option for Uterine Fibroids

Uterine fibroids have remarkably heterogeneous clinical characteristics with unknown exact etiology. The treatment of fibroids should be individualized based on their size, location, growth rate, the symptoms that they cause, the desire to have children and the age of the woman. Embolization is currently the most advanced non-surgical technique. The majority of women report satisfactory post-treatment results like shorter hospitalization period and recovery time in comparison to hysterectomy and improvement or complete remission of clinical symptoms. Complications include amenorrhea (in the majority of cases: recurrence after three months) and infections that are generally treated with antibiotics. The results from most clinical studies and our published experience indicate that embolization improves pelvic symptoms related to uterine fibroids. Collaborative efforts between gynecologists and interventional radiologists are necessary in order to optimize the safety and efficacy of this procedure. In the future, embolization could be generally recommended as treatment option for women who desire future fertility/pregnancy

Uterine Embolization as a New Treatment Option in Adenomyosis Uteri

Adenomyosis is characterized by the development of endometrial ectopic glands and tissue in the myometrium layer in depth greater than 2.5 mm from the endometrial surface of the separative area by -myomas well as by hypertrophy and hyperplasia of the smooth muscles of the myometrium. This is filtration, not mere displacement, of the myometrium, from the endometrium. Clinical symptoms include dysmenorrhea and menorrhagia. It is diffuse (adenomyosis) or focal (adenomyoma), asymmetrically affects the uterine wall of premenopausal women (usually the posterior) and often coexists with myomas. The pathogenesis of adenomyosis remains unknown. The treatment options are: drug therapy, invasive treatment of fibroids: myomectomy (open—intra-abdominal, laparoscopic, hysteroscopic), hysterectomy, myolysis—cryocatalysis, microwave or radiofrequency thermal catalysis (RF-ablation), ultrasound focus catalysis (FUS), laser photocatalysis and percutaneous selective uterine artery embolization (UAE). Embolization remains an alternative and not a substitute of hysterectomy. The medical indication is made on a case-by-case basis, depending on age, desire for pregnancy and the clinical symptoms of adenomyosis

Ten Years of Experience in Contraception Options for Teenagers in a Family Planning Center in Thrace and Review of the Literature

Introduction: The goal of our study was to investigate and evaluate the contraceptive behavior in teenagers from our family planning centre that services two different religious and socioeconomic populations living in the Thrace area. Methods: During the last 10 years 115 Christian Orthodox (group A) and 53 Muslim teenagers (group B) were enrolled in our retrospective study. Contraceptive practice attitudes were assessed by a questionnaire. Religion, demographics, socio-economic characteristics were key factors used to discuss contraception and avoid unplanned pregnancy in each group and to compare with the contraceptive method used. Results: The most used contraceptive method—about two times more frequently—among Christian Orthodox participants was the oral contraceptive pill (p = 0.015; OR = 1.81, 95% CI = 1.13–2.90), while in the other group the use of condoms and IUDs was seven and three times more frequent, respectively. Our family planning centre was the main source of information for contraception. Conclusions: During adolescence, the existence of a family planning centre and participation in family planning programs plays a crucial role to help the teenagers to improve their knowledge and choose an effective contraception method