Carcinoma Corpus Uteri Brinsmead子宫内膜癌宾斯么德.ppt

Cases: Drugs in Pregnancy Max Brinsmead PhD FRANZCOG February 2015 Jenny Q - The Problem You discover that your 22-year old patient who has missed two menstrual periods whilst taking Loette is about 12 weeks pregnant… She asks if her ingestion of The Pill will affect her baby Jenny Q - The Problem Loette contains ethinyloestradiol 30 ug and levonorgestrel 150 ug It is a category B3 for ingestion during pregnancy A related oestrogen, stilboestrol, is category D and known to cause malformations Levonorgestrel is a progestin with some androgenic potential and causes masculinisation of the female fetus when given to pregnant animals Jenny Q – what we did Jenny was counselled: That there is no good evidence from large studies in women that oestrogens and progestins in contraceptive doses are teratogenic About the overall risks of fetal malformations (2-4%) An ultrasound scan at 18 weeks revealed normal fetal anatomy Jenny Q - the outcome Jenny delivered a male infant at 38 weeks gestation with a minor degree of hypospadias Samantha J - The Problem A 16-year old girl, who is just confirmed to be about 6 weeks pregnant, reports that she is taking Doxycycline daily for acne Her mother is very worried and asks if the pregnancy should be terminated Samantha J - The Problem Doxycycline (a tetracycline) is Category D for pregnancy It causes inhibition of bone growth and dysplasia and discolouration of teeth Samantha J – what we did The family (including the boyfriend) was counselled about the non teratogenicity of tetracyclines in the first trimester (up to 18 weeks gestation) Options for the pregnancy and the potential baby were explored with the assistance of a social worker Samantha J - the outcome Samantha and her boyfriend elected to continue the pregnancy A normal female infant was delivered at term A very proud grandmother was present at the birth Julie M - The Problem This 34-year old mother of two (and wife of a laboratory immunologist) is pl