Medical complications in pregnancy COMEP

Medical Complications in Pregnancy Dr Gerry McKay Consultant Physician/Honorary Clinical Senior Lecturer CORE MEDICAL TRAINEES meeting April 2010

Outline of talk ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case 1 – Maternal mortality ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case 1 – Maternal Mortality ,[object Object],[object Object],[object Object],[object Object],[object Object]

Case 1 – Maternal Mortality ,[object Object],[object Object],[object Object]

Case 2 – Maternal Morbidity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Case 2 – Maternal Morbidity ,[object Object],[object Object],[object Object],[object Object]

Common causes of morbidity ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Key points to assessing pregnant women for medical problems ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Prescribing in pregnancy Historical perspective Frances Oldham Kelsey 1962

Historical Perspective ,[object Object],[object Object]

Kefauver Harris Amendment ,[object Object],[object Object],[object Object],[object Object]

Historical perspective ,[object Object],[object Object],[object Object],[object Object]

BUT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Historical perspective An example of the gap between the perception of teratogenic risk and evidence-based proof of safety Koren et al NEJM 1998;338:1128--37 withdrawn in 1982 Bendectin

Isotretinoin ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

For most drugs manufacturers advise ,[object Object]

The process of establishing risk or safety of drugs ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Crab-eating Macaque ( Macaca fascicularis )

The process of establishing risk or safety of drugs in pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]

The process of establishing risk or safety of drugs in pregnancy ,[object Object],[object Object],[object Object]

The process of establishing risk or safety of drugs in pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Pharmacodynamics/Pharmacokinetics ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Haemodynamic modifications during pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object]

Physiological changes in pregnancy Drug distribution ,[object Object],[object Object],[object Object]

Physiological changes in pregnancy Drug elimination ,[object Object],[object Object],[object Object],[object Object]

Counselling women about teratogenic risk ,[object Object],[object Object]

Case 3 ,[object Object],[object Object],[object Object],[object Object],[object Object]

Risk of the drugs ,[object Object],[object Object],[object Object],[object Object]

Risk of the drugs ,[object Object],[object Object]

What are the risks? ,[object Object],[object Object],[object Object],[object Object],[object Object],Holmes et al. NEJM 2001;344:1132-38

What are the risks? ,[object Object],[object Object],[object Object],[object Object],Holmes et al. NEJM 2001;344:1132-38

What are the risks? ,[object Object],[object Object],Holmes et al. NEJM 2001;344:1132-38

Management of epilepsy in pregnancy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

Drugs in pregnancy NEJM 1998, 338; 1128-36

Conclusions (1) ,[object Object],[object Object],[object Object]

Conclusions (2) ,[object Object],[object Object],[object Object],[object Object]

Medical complications in pregnancy COMEP

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Medical complications in pregnancy COMEP