 possible and atleast above 10gms % in 3rd trimester. Sickle cell anemia and sickle cell crisis does occur in pregnancy and is treated accorduing to standard protocols. Hydoxy urea is contraindicated during pregnancy and patient must use contraception for atleast 6 months after stopping hydroxy urea, before planning a pregnancy. Malaria in pregnancy is very unique situation. Umcomplicated Falciparum malaria is treated with Quinine and clindamycin. But severe Falciparum Malaria must be treated by Parenteral Artesunate [7]. Vivax Malaria can be treated by Chloroquine but Primaquine is contraindicated in pregnancy. World Health Organization recommendfs Intermittent Prophylactc Treatment (IPTp) by Suladoxine/pyremthamine Combination or by by artesesin based combinations in all pregnancies in malaria endemic areas [8].
Thromboembolic disease is another interesting but life threatening disease that can occur during pregnancy or in post partum period. Patient who have a provoked thrombotic phenemenon before pregnancy can wait for pregnancy till they complete the course of anticoaugulants. Direct acting oral anticougulants (DOAC) have not yet been approved during pregnancy. Warfarin is also contraindicated in first trimester of pregnancy and in last trimester. Warfarin embryopathy is a well known phenemonn, so is the foetal bleeding in third trimester. Unfractionated Heparin (UH) and Low Molecular weight Heparin (LMWH) remains the cornor stone of anticoaugulation during pregnancy for any thrombotic disease. Clexane 1 mg per kg twice a day or Daltaprin 100 units per kg twice a day is the standard dose. UH can also be used twice a day and titrated to keep APTT 1.5 to 2.5 times the baseline APTT and it may need to be increased with increase in weight during last trimester. UH is used only if Creatinine clearance in less than 30 ml/min or patient is waiting for labour and might need a rapid reversal of anticoagulation for surgery. In addition, patients with Antiphospholipid antibody syndrome need additionally, Aspirin 150 mg daily during entire pregnancy. Aspirin can be stopped after pregnancy. Sometimes Venous thrombosis occurs for the first time in postpartum period (Phlegma Alba Dolens). This is an emergency and can be limb threatening and life threatenings. It progresses rapidly to cause limb ischemia or even gangrene. It should be treated again with UH infusion or LMWH and may be combined with Thrombolysis, thrombectomy or other surgical methods depending on severity of the thrombosis [9]. Patients with metallic prosthetic heart valves and those who develop Heparin Induced Thrombocytopenia (HIT) must be referred to a haematologist for anticoagulation advice [10,11].
There are many rheumatological disorders that pregnanat patients may come up with. Patients with Systemic Lupus and Rheumatoid artritis patients may need steroids and so may be needed in some resistant Bronchial Asthma patients. There are lot of observational studies on such patients. There is conflicting data regarding the cleft lip with or without cleft palate in patients taking steroids. However there is no data to support that steroids cause any premature delivery, or low birth weight or gestational Diabetes or Gestational hypertension. So pregnant patients must be treated as any nonpregnant patient when it comes to steroids. However the dose and duration of steroids must be kept to minimum required to control the underlying disease. Randomised controlled trials have been seen as unethical on such subject [12].
One of the most challenging disease is seizure disorders. Women with seizure disorders have genuine apprehension of drugs causing major congenital malformation (MCM) and possible risk of seizure, should they stop the drug. Propective registries both in USA and UKA have tried to estimate the frequency of MCM. Highest MCM is seen with Valproic Acid (9.3%, followed by Phenobarbitol (5.5%) Topiramate (4.2%) and Clonazepine (3.0%). These drugs should ideally be avoided in pregnancy. Least MCMs are seen with Levitiracetam (2.4%), Lamotrigine (2.0) and Oxcarbazine (2.2%). These drugs are usually water soluble and have short duration of action. Further the clearance of these drugs increase during pregnancy so levels may fall drastically to ½ to 1/3rd level with advancing pregnancy. So women with seizures may need to be monitored clinically and if possible drug levels must also be monitored more frequently, where possible. None the less,If patients cannot be controlled by other drugs, valproate can be used but the dose must be kept to less than 700mg per day [13].
There are many more medical conditions that pregnant patients may suffer from and the management of above mentioned disorders may get complicated further. Discussions on thoses aspects will be beyond the scope of this short, concise review. Clinicians must go to relevant resources for more details on these subjects.
Nice Guidelines (2020) Diabetes in Pregnancy: Management from preconception to the postnatal period.
Coustan D, Lowe L, Metzger B, Dyer A (2010) The HAPO study: Paving the way for new diagnostic Criteria For GDM. Am J Obstet Gynecol 202(6): 654-e1-e6.
Blum AK (2016) Insulin Use in Pregnancy: an Update. Diabetes Spectrum 29(2): 92-96.
Sinkey R, Batherjee AN, Bello NA, Christopher WI, Suxzane O, et al. (2020) Prevention, Diagnosis and Management of Hypertensive disorders of Pregnancy: A comparison of International Guidelines. Curr Hypertension Rep 22(9): 66.
Ronald MR (2022) Management of Preclampsia.
Alexander EK, Pearce EN, Gregory AB, Brown RS, Herbert Ch, et al. (2017) 2017 Guidelines of the American Thyroid Association for the diagnosis and management of Thyroid Disease during pregnancy and the post partum. Thyroid 27(3): 315-389.
Stephen R (2017) Management of Malaria in Pregnancy. Indian J Med Research 146(3): 328-333.
Khalid AJ, Khaja AI, Sequeis RP (2021) Drug tretment and prevention of Malaria in Pregnancy. A critical review of Guidelines. Malar J 20(1): 62.
Gardella L, Faulk JB (2022) Phlegma Alba and cerulea Dolens. Stat Pearls Publishing.
Kenneth AB (2022) Use of Anticoagulants during pregnancy and post partum.
American College of Obstetricians and Gynecologists' Committee on Practice Bulletins-Obstetrics. (2018) ACOG Practice Bulletin No. 196: Thromboembolism in Pregnancy. Obstet Gynecol 132 : e1.
Bandoli G, Palmsten K, Chelsy J, Smith F, Chambers C, et al. (2017) A review of Corticosteroids Use in Pregnancy and the risk of Select pregnancy and birth Outcomes. Rheum Dis Clin North Am 43(3): 489-502.
Sima P, Page BP (2016) Management of Epilepsy during Pregnancy: an Update. Ther Adv Neurol Disord 9(2): 118-129.Get clever with your holiday gifts and decor this year by creating these DIY scented ornaments made from socks. My personal favorite is the Christmas Stocking ornament. I show how you can use almost the entire sock, by utilizing the toe portion to make a 2020 SOCKS ornament. We might as well have a little fun with this rough year we've had!
You can watch the full YouTube tutorial HERE.
Find the FREE pattern here.
These are the socks I used, plus one other fun option.
Make sure you check out the store to see all the great holiday socks we have there!
And whatever you do, make sure you find and share joy this season!
Happy socking!
--AnnaWe all deal with some pretty friggin’ petty things at our workplace, but for some reason this just irks me. I’m a contractor, so generally we get the leftovers when it comes to in-house supplies, including computer speakers, phones and.. chairs. So one day last week I come in and my chair is gone, no other desk appears to have a second chair where there wasn’t one the previous night, it’s just gone. So I go to the desk of someone that just left for another job and take theirs, no problem, right. It did happen to be a nicer chair, but hey, ya snooze ya lose! So today my manager tells me that “there’s a problem with your chair.” As someone new is sitting at the desk that I took this one from and “he has no chair to sit in.” Now there are empty desks with available chairs over there as the section they are in has a LOT of turnover, but no. That section’s manager goes to my manager to tell me that I should return the chair. Petty!
As digital learning continues to play a bigger role in education, we know parents like you have questions about how schools are keeping your kids safe and engaged while learning online.
LanSchool is a classroom management software built to help teachers guide learning, communicate with students, and facilitate collaboration among students using devices – both in the classroom and when learning remotely. It also includes features that help schools limit the websites kids can visit so teachers can notify you of red flag behaviors and intervene when needed