Causes of polyhydramnios
(source: Obstetrics and Gynaecology, An evidence based text for MRCOG)
1. idiopathic
2. maternal diabetes mellitus
3. intestinal obstruction (oesophageal or duodenal atresia)
4. impaired fetal swallowing (anencephaly, aneuploidy, muscular dystrophy)
5. fetal polyuria (twin-twin transfusion syndrome, Barter syndrome)
6. cardiac failure secondary to significantly lowered fetal vascular
resistance or fetal anaemia
7. fetal infection
Sunday, June 30, 2013
Malignant melanoma of the Vulva
Malignant melanoma of the vulva
Malignant melanoma of the vulva is the second most common cancer of
the vulva, but is very rare. It accounts for 5% of all vulva
malignancy. Only 0.1% of all nevi in women are on vulvar skin, the
disproportionate frequency of occurrence of melanoma in this area may
be a result of the fact that nearly all vulvar nevi are of the
junctional variety. These tumours most commonly arise in the region of
labia minora and clitoris. There is a tendency of superficial spread
towards urethra and vagina. A darkly pigmented raised lesion at
mucocutaneous junction is a characteristics finding. However,
non-pigmented lesion may closely resembled to the squamous cell
carcinoma on inspection. The lesion primarily spreads through
lymphatic channels and tends to metastasize early in the course of
disease. It should be managed by wide local excision. Outcomes are not
influenced by inguinal lymph nodes dissection. The management should
be considered as for criteria for other sites of cutaneous melanoma.
Ref: Health.am>Health Centers>Cancer Health Center>Cancer of the Vulva
Malignant melanoma of the vulva is the second most common cancer of
the vulva, but is very rare. It accounts for 5% of all vulva
malignancy. Only 0.1% of all nevi in women are on vulvar skin, the
disproportionate frequency of occurrence of melanoma in this area may
be a result of the fact that nearly all vulvar nevi are of the
junctional variety. These tumours most commonly arise in the region of
labia minora and clitoris. There is a tendency of superficial spread
towards urethra and vagina. A darkly pigmented raised lesion at
mucocutaneous junction is a characteristics finding. However,
non-pigmented lesion may closely resembled to the squamous cell
carcinoma on inspection. The lesion primarily spreads through
lymphatic channels and tends to metastasize early in the course of
disease. It should be managed by wide local excision. Outcomes are not
influenced by inguinal lymph nodes dissection. The management should
be considered as for criteria for other sites of cutaneous melanoma.
Ref: Health.am>Health Centers>Cancer Health Center>Cancer of the Vulva
Indomethacin in the treatment of polyhydramnios
Indomethacin can be used as a medical management for polyhydramnios. It is a prostaglandin synthetase inhibitor. The optimal dose of indomethacin is unknown. A 25mg oral dose can be given 6 hourly.
Fetal echocardiography should be started in the 24hr after the start of the indomethacin and then weekly. Discontinue the drug when there is severe constriction of ductus arteriosus or tricuspid regurgitation. Decrease the dose when there is lesser degree of constriction of ductus arteriosus. Amniotic fluid assessment should be done with USG once or twice weekly. Known side effects of drug are renal failure in neonates, premature ductus arteriosus, increased in perinatal mortality, necrotizing enterocolitis and intracranial haemorrhage.
Fetal echocardiography should be started in the 24hr after the start of the indomethacin and then weekly. Discontinue the drug when there is severe constriction of ductus arteriosus or tricuspid regurgitation. Decrease the dose when there is lesser degree of constriction of ductus arteriosus. Amniotic fluid assessment should be done with USG once or twice weekly. Known side effects of drug are renal failure in neonates, premature ductus arteriosus, increased in perinatal mortality, necrotizing enterocolitis and intracranial haemorrhage.
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