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As the majority of evidence indicates that reproductive and teratogenic effects of electromagnetic fields are unlikely to occur in women under normal exposure conditions prostate cancer xgeva buy 10 mg uroxatral overnight delivery, such exposures do not require any additional prenatal diagnostic intervention. Only one mother, who had been shot with a Taser (electro-weapon), lost consciousness and sustained injuries and burns (Mehl 1992). Fetal death occurred in 11 (73%) of the pregnancies, possibly due to changes in fetal heart conduction leading to cardiac arrest. Two of the surviving fetuses had oligohydramnios, a clinical sign that is also consistent with impaired cardiac function (Leiberman 1986). In cases of accidental electric shock, the most common sign of adverse fetal effects was immediate cessation of fetal movements. It is possible that there is a reporting bias with these cases, in that only those with the most serious adverse outcomes are more likely to be reported. Nevertheless, these reports do indicate that even an apparently harmless maternal electric shock may cause fetal death. In 1997, the results were published of a small case-control study of 31 women who received electrical shocks during pregnancy, matched with control subjects (Einarson 1997). Of these women, 26 had been exposed to 110 V, 2 to 220 V, 2 to high voltage (from electrified fences), and 1 to 12 V (from a telephone wire). In the exposed group there were 28 normal infants, 1 infant with ventricular septal defect, and 2 miscarriages. The authors reported that in this study the pathway of electric current was only likely to have passed through the uterus in 3 of the 31 women, in contrast with previously published case reports. Adverse effects on the fetus seem more likely to occur when the current is reported to have passed from hand to foot, or electrical burn marks suggest such a route. Eleven case reports of lightning strikes of pregnant women were found (Flannery 1982, Chan 1979, Guha-Ray 1979, Weinstein 1979, Rees 1965). Any work that could expose a pregnant woman to the risk of electrical shock must be avoided during pregnancy. If an electrical shock has occurred, the fetal status should be evaluated immediately. Methodological issues for the assessment of clusters of adverse pregnancy outcomes in the workplace: the case of video display terminal users. Quality of community drinking water and the occurrence of late adverse pregnancy outcomes. Birth defects in the offspring of female workers occupationally exposed to carbon disulfide in China. A model study on the occurrence of adverse pregnancy outcomes in clusters of workers using video display terminals. Organochlorine pesticides and male genital anomalies in the child health and development studies. Organochlorines and heavy metals in pregnant women from the Disko-Bay area in Greenland. Risk of selected birth defects by maternal residence close to power lines during pregnancy. Exposure to electromagnetic fields during pregnancy with emphasis on electrically heated beds: association with birthweight and intrauterine growth retardation. Pregnancy outcome following gestational exposure to organic solvents: a response [Letter to Editor] Teratology. Reproductive and teratologic effects of low-frequency electromagnetic fields: a review of in vivo and in vitro studies using animal models. A review of epidemiological studies of the health effects of living near or working with electricity generation and transmission equipment. Methylmercury and neurodevelopment: longitudinal analysis of the Seychelles child development cohort. Female reproductive health in two lamp factories: effects of exposure to inorganic mercury vapour and stress factors. Lead exposure and the cognitive development of urban pre school children: the Cincinnati lead study cohort at 4 years. The developmental consequences of low to moderate prenatal and postnatal lead exposure: intellectual attainment in the Cincinnati lead study cohort following school entry. Congenital defects and electric bed heating in New York State: a register-based case-control study. Commentary: clustering of anophthalmia and microphthalmia is not supported by the data. The transplacental migration and accumulation in blood of volatile organic constituents. Spontaneous abortion in dry cleaning workers potentially exposed to perchloroethylene. Fetal death and congenital malformation in babies born to nuclear industry employees: report from the nuclear industry family study. Primary infertility in nuclear industry employees: report from the nuclear industry family study. Environmental risk factors and outdoor formaldehyde and risk of congenital heart malformations. Part 5: Mercury in the urine, blood and body organs from amalgam fillings; and Part 6: Possible harmful effects of mercury from dental amalgam. An epidemiological study of work with video screen and pregnancy outcomes: a registry study. Pregnancy outcome in women working as dentists, dental assistants or dental technicians. Low lead level exposure and early pre school periods: intelligence prior to school entry. Association of in utero organochlorine pesticide exposure and fetal growth and fetal length of gestation in agricultural population. Chromosome aberrations and sister-chromatid exchange in workers in chemical laboratories and a rotoprinting factory and in children of women laboratory workers. The risk of miscarriage and birth defects among women who use visual display terminals during pregnancy. New approaches for assessing the etiology and risks of developmental abnormalities from chemical exposure. Work with video display terminal and the risk of reduced birth-weight and preterm birth. Exposure to aerial malathion application and the occurrence of congenital anomalies and low birthweight. Comments on "Amyoplasia congenita-like condition and maternal malathion exposure": is all amyoplasia amyoplasia Aerial spraying of 2,4,5-T and human birth malformations: an epidemiological investigation. Community study of spontaneous abortions: relation to occupation and air pollution by sulfur dioxide, hydrogen sulfide, and carbon disulfide. Spontaneous abortions in hospital staff engaged in sterilizing instruments with chemical agents. Central-nervous-system defects in children born to mothers exposed to organic solvents during pregnancy. Impact of the detention and prevention of developmental abnormalities in human studies. Mercury exposure from dental filling placement during pregnancy and low birth weight risk. An epidemiological study of the incidence of abnormal pregnancy in areas heavily contaminated with methylmercury. Congenital defects and electric bed heating in New York State: a register-based case-control study Letter; comment. Relationships of maternal blood lead and disorders of pregnancy to neonatal birthweight. Pregnancy outcome following exposure to permethrin d use of teratogen information. Maternal contamination with dichlorophenyltrichloroethane and reproductive outcomes in an Australian population. Spontaneous abortions and congenital malformations among women exposed to tetrachloroethylene in dry cleaning. Electric blanket use in relation to the risk of congenital urinary tract anomalies among women with a history of subfertility. Paternal organic solvent exposure and adverse pregnancy ourtcomes: a meta-analysis.

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Though rare prostate cancer progression buy uroxatral visa, there are some cases of malaria transmission during blood transfusion as well as organ transplantation. At the population level, there are many conditions that increase transmission as well, most of which relate to effects on any of the 30 or so Anopheles species linked to malaria transmission. The rainy season allows for eggs of Anopheles mosquitoes to be laid in water more readily and larvae to develop more easily. Transmission is also higher in regions with longer mosquito lifespans and in areas where humans are the choice blood meal over other animals. In addition, elevation, temperature, and humidity of a region all contribute to transmission efficiency of malaria. Gametocytes enter into the bloodstream where an Anopheles mosquito partakes of a blood meal, ingesting the gametocytes, and then these gametocytes develop into gametes in the mosquito midgut. Male and female gametocytes sexually reproduce to form oocysts, which then grow and release sporozoites. The sporozoites travel to the salivary gland and with a subsequent human bite, complete the transmission cycle. It is worth noting that all Plasmodium species may cause recrudescence, which happens when treatment is suboptimal and parasite clearance incomplete. In these cases, patients may show symptoms of infection months to years after initial infection. Clinical Manifestations the most common presentation of malaria is fever after travel to an endemic area. Fever and chills are the chief complaint in 96% of patients, followed by headaches and muscle aches in 79% and 60%, respectively. Less common, are palpable liver and/or spleen, nausea and vomiting, abdominal pain, and diarrhea. More severe cases can present with jaundice, confusion, orthostatic hypotension, or seizures depending on the type of malaria and severity. Thrombocytopenia will occur in most patients as well, along with elevations in aspartate aminotransferase and alanine transaminase. Infection can quickly lead to severe disease and death if not treated promptly, and so rapid, correct diagnosis can greatly improve survival probability. Sequestration is implicated in severe disease and leads to metabolism of glucose locally, local tissue factor recruitment, edema, and ultimately end organ damage. Sequestration in brain tissues is better described, but it is thought to occur in lung tissue as well. Interestingly cerebral edema is frequently seen in children, but not in adults radiographically. While adult survivors typically do not have lasting neurologic effects, 3% to 15% of children survivors have lasting neurological deficits from P. Cerebral palsy, learning disability, language deficits, and epilepsy are some of the lasting effects in children survivors of P. For instance, the time from initial infection to symptom presentation varies across species. Regardless of species, the life cycle starts when an infected female Anopheles mosquito takes a human blood meal, injecting anywhere from 10 to 100 Plasmodium sporozoites into the host. The sporozoites travel to the liver, invading hepatic cells where they then replicate and each divides forming 10,000 to more than 30,000 merozoites (haploid cells). The species determines how quickly this happens and how many merozoites are formed. During a blood meal, a malaria-infected female Anopheles mosquito inoculates sporozoites 557 into the human host (1). Sporozoites infect liver cells (2) and mature into schizonts (3), which rupture and release merozoites (4). The ring stage trophozoites mature into schizonts, which rupture, releasing merozoites (6). The gametocytes, male (microgametocytes) and female (macrogametocytes), are ingested by an Anopheles mosquito during a blood meal (8). The zygotes in turn become motile and elongated (ookinetes) (10) and invade the midgut wall of the mosquito, where they develop into oocysts (11). Inoculation of the sporozoites (1) into a new human host perpetuates the malaria life cycle. Less common symptoms can include cerebral malaria, pancytopenia, jaundice, splenic rupture, acute renal failure, and shock. Chronic malaria infection, characterized by low-level parasitemia, may lead to a variety of complications. Correctly diagnosing malaria and identifying Plasmodium species quickly is paramount to appropriate timely treatment, and testing should be done whether or not an appropriate chemoprophylaxis regimen was followed. Unfortunately, malaria may mimic many diseases due to its common symptom profile, especially high fevers. The general process of microcopy is described here, but strict protocols should be followed to give reliable and reproducible results. Blood is sampled through finger stick or venipuncture, and the thick smear is air dried and not fixed; therefore, hemolysis occurs. Thick smears are more sensitive at identifying infection, as they concentrate parasites, and may also help estimate parasite concentration. However, hemolysis during preparation makes it difficult to identify species-level characteristics using thick smear microscopy. Negative smears should be repeated every 8 to 12 hours until malaria can be ruled out confidently as symptoms may precede parasitemia. As they do not give information on parasitemia levels and false-negative results are possible, thick and thin smears should still be performed to confirm or rule out diagnosis and determine level of parasitemia. It remains an important research tool detecting drug resistance mutations and offering a secondary means of species confirmation. Antimalarial Medications A variety of malaria chemotherapy treatment and prophylaxis options are available, each with their risks, benefits, and availability issues. Treatment options will be dictated not only by drug availability but also location of disease acquisition, infecting species, resistance patterns, and symptom severity (Table 1). Current antimalarial medications attack the Plasmodium organism at various stages in its life cycle. Those that kill malaria parasites when they have been released into the bloodstream during the asexual, erythrocytic cycle are referred to as blood schizonticides. Meanwhile, tissue schizonticides kill parasites during the exoerythrocytic cycle of infection in the liver and also may prevent relapse in certain species. Chloroquine phosphate (Aralen) is one of the older drugs still used, and along with its sister medication, hydroxychloroquine sulfate (Plaquenil), is used in the prevention and treatment of malaria. These blood schizonticides are active against all Plasmodium species and have gametocidal activity against P. Response to treatment in pregnant women should be monitored closely, especially during second and third trimesters where serum drug concentrations may be lower. Atovaquone/proguanil (Malarone) is a combination drug effective against both blood and tissue schizonts. The combination is indicated for malaria prophylaxis in all areas and may be used for treatment of uncomplicated chloroquine-resistant malarial infections in travelers outside endemic areas or for combination treatment with artesunate10 or primaquine. Rarely, dizziness, oral ulcerations, and elevated liver function study results can occur. It is contraindicated in those with severe renal impairment due to increased pancytopenia risk. Artemisinin derivatives are plant-based compounds derived from the Chinese quinghaosu plant (Artemisia annua) whose components are active against blood schizonts and gametocytes. Artemisinin and its derivatives (artesunate,10 artemether,2 and dihydroartemisinin2) are highly effective at treating uncomplicated and severe P. Although there are minor differences in the oral absorption, bioavailability, and tolerability of the different artemisinin derivatives, there is no evidence that these differences are clinically significant in currently available formulations. For severe malaria, though artemisinin derivatives may be used alone to initiate therapy. Quinine sulfate (Qualaquin) and quinidine gluconate (parenteral form) are blood schizonticides effective at killing erythrocytic stages of all Plasmodium species, and show gametocidal activity against P. More common side effects include symptoms of tinnitus, hearing impairment, nausea, headache, dizziness, dysphoria, and sometimes disturbed vision. More severe issues at higher required doses or increased treatment duration include vertigo, vomiting, diarrhea, and marked auditory and visual loss. An important side effect of quinine seen mostly in children, pregnant women, and the elderly is hyperinsulinemic hypoglycemia.

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Intralesional injection of triamcinolone may be used for individual or focal problematic lesions prostate cancer female best purchase for uroxatral. Results are best if this mouth rinse is used on the first day that the ulcers appear, or when they are in a prodromal stage. Because of their rather profound side effects, immunosuppressive drugs, such as azathioprine and cyclophosphamide, are generally justified only for the treatment of severely affected patients (to permit reduced prednisone dosages). However, when patients are more severely affected, some forms of treatment can provide significant Clobetasol propionate (Temovate) Clobetasol propionate plus "oral adhesive" (50% Temovate ointment plus 50% Orabase) Betamethasone dipropionate (Diprosone) Fluocinonide (Lidex) Betamethasone plus clotrimazole (Lotrisone) Chronic Ulcerative Stomatitis this is a rare debilitating mucocutaneous disorder that produces desquamation and ulceration of the oral mucosa. In contrast to other immune-mediated mucocutaneous diseases, chronic ulcerative stomatitis has been reported to respond less effectively to corticosteroids but shows a good response to hydroxychloroquine. This condition has no relation to gastrointestinal or other autoimmune diseases, nor have systemic manifestations or malignant transformation been noted. Etiology the cause of this noninfectious condition in which vasculitis is a primary feature is poorly understood, although it seems to be related to an immune dysfunction or to an abnormality within the innate immune system. Oral manifestations of this syndrome appear identical to the ulcers of aphthous stomatitis. The ulcers are usually the minor aphthous form and are found in the typical aphthous distribution. Uveitis, conjunctivitis, and retinitis are among the more common inflammatory processes. Genital lesions are ulcerative in nature and may cause significant pain and discomfort. An abnormal immune response to microbial antigen(s) is now regarded as a likely mechanism for the multiple manifestations of this syndrome. Oral lesions have been described in up to 17% of cases as relatively painless aphthous-type ulcers occurring almost anywhere in the mouth. The duration of the disease varies from weeks to months, and recurrences are not uncommon. Diagnosis is dependent on recognition of the various signs and symptoms associated with this syndrome. Immunopathologic support of a vascular target in this condition comes from the demonstration of immunoglobulins and complement within the vessel walls. No specific findings are noted in biopsy tissue, and no supportive laboratory tests are available. Dapsone, cyclosporine, thalidomide, interferon, Diagnosis Diagnosis Treatment Treatment Erythema Multiforme Some evidence suggests that the disease mechanism may be related to antigen-antibody complexes that are targeted for small vessels in the skin or mucosa. Other factors, such as malignancy, vaccination, autoimmune disease, and radiotherapy, are occasionally cited as possible triggers. It consists of concentric erythematous rings separated by rings of nearnormal color. Any area of the mouth may be involved, with the lips, buccal mucosa, palate, and tongue being most frequently affected. Recurrent oral lesions may appear as multiple painful ulcers similar to those of the initial episode or as less symptomatic erythematous patches with limited ulceration. Considerable apprehension may be associated with this condition initially because of occasional explosive onset in some patients. Systemic signs and symptoms of headache, slightly elevated temperature, and lymphadenopathy may accompany more intense disease. Characteristically, the lips show crusting ulceration at the vermilion border that may cause exquisite pain. Ocular inflammation (conjunctivitis and uveitis) may lead to scarring and blindness. Connective tissue changes usually appear as infiltrates of lymphocytes and macrophages in perivascular spaces and in connective tissue papillae. When target, or iris, skin lesions are present, clinical diagnosis is usually straightforward. Ketoconazole Drug Reactions Etiology and Pathogenesis Although the skin is more commonly involved in adverse reactions to drugs, the oral mucosa may occasionally be the target. Virtually any drug has the potential to cause an untoward reaction, but some have a greater ability to do so than others. The pathogenesis of drug reactions may be related to immunologic or nonimmunologic mechanisms (Box 2-12). Immunologic mechanisms are triggered by an antigenic component (hapten) on the drug molecule, resulting in a hyperimmune response, or drug allergy. Mechanisms involved in drug allergy include IgE-mediated reactions, cytotoxic reactions (antibody binds to a drug that is already attached to a cell surface), and circulation of antigen (drug)-antibody complexes. In this type of response, drugs may directly affect mast cells, causing the release of chemical mediators. Acquired angioedema is an IgE-mediated allergic reaction that is precipitated by drugs or foods such as nuts and shellfish. These substances may act as sensitizing agents (antigens) that elicit IgE production. On antigenic rechallenge, mast cells bound with IgE in the skin or mucosa release their contents to cause the clinical picture of angioedema. Individuals who inherit this rare autosomal-dominant trait develop a spontaneous mutation, which results in a deficiency of the inhibitor of the first component of complement C1 esterase. Angioedema, by an acquired or a hereditary pathway, appears as a soft, diffuse, painless swelling, usually of the lips, neck, or face. Antihistamines and, in problematic cases, corticosteroids are used to treat this form of allergy. Oral manifestations of drug reactions may be erythematous, vesicular, or ulcerative. They may also mimic erosive lichen planus, in which case they are known as lichenoid drug reactions (Box 2-13). If rechallenge is performed, minute amounts of the offending drug or a structurally related drug should cause a reaction. Treatment the most important measures in the management of drug reactions are identification and withdrawal of the causative agent. If this is impossible or undesirable, alternative drugs may have to be substituted, or the eruption may have to be dealt with on an empirical basis. Antihistamines and occasionally corticosteroids may be useful in the management of oral and cutaneous eruptions caused by drug reactions. The microscopy of drug reactions includes such nonspecific features as spongiosis, apoptotic keratinocytes, lymphoid infiltrates, eosinophils, and ulceration. Because the clinical and histologic features of drug reactions are highly variable and nonspecific, the diagnosis of drug reaction requires a high index of suspicion and careful history taking. Recent use of a drug is important, although delayed reaction (up to 2 weeks) may occasionally be noted. In the sensitization phase, epithelial Langerhans cells appear to have a major role in the recognition of foreign antigen. Lesions of contact allergy occur directly adjacent to the placement or location of the causative agent. Although contact allergy is frequently seen on the skin, it is relatively uncommon intraorally. Lesions associated with this offender are usually white or even lichenoid, although ulcerative and red lesions may be seen. A related lesion, plasma cell gingivitis, is another form of contact allergy to cinnamon-containing agents such as toothpastes and chewing gums. Initial presentation within the oral cavity is noted in 6% to 13% of cases in the form of painful cobblestone mucosal alterations of the palate and gingiva (hyperplastic, granular alterations) ("strawberry gingivitis"). The clinical differential diagnosis is broad and includes fungal disease, squamous cell carcinoma, lymphoma, infectious granulomatous disease, Langerhans cell disease, peripheral giant cell lesion, pyogenic granuloma, and, when involving the hard palate, necrotizing sialometaplasia. Spongiosis and vesiculation may be seen within the epithelium, and perivascular lymphophagocytic infiltrate is found in the immediate supporting connective tissue.

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The diagnostic or therapeutic use of radiopharmaceuticals prostate cancer 34 year old buy uroxatral 10mg fast delivery, mostly technetium or iodine isotopes, should be postponed until breastfeeding has come to an end. With indications that cannot be postponed, breastfeeding should be interrupted depending on the isotope used and its dosage. If the radioactivity of the milk can be measured simply, then a decision regarding the length of time for which pumped milk is required can be made based on the clearance of radiation from the milk and specifics of the case. These compounds are administered intravenously, absorbed orally poorly or not at all, and penetrate peripheral compartments poorly (including in the breast), remaining in extracellular water. Gadolinium compounds peak in the blood immediately, and their half-life values are an hour to an hour and a half. The estimated total dose of drug absorbed from 24 hours of breastfeeding would be less than 1% of intravenous dose (Kubik-Huch 2000, Rofsky 1993). Theoretically, ferristen, from a toxicological viewpoint, is harmless for the breastfed infant. Due to insufficient experience, no risk assessment is possible with the manganese-containing mangafodipir. On the other hand, the advice of the manufacturer to interrupt breastfeeding for 14 days does not seem to make sense. There is no indication to interrupt breastfeeding when gadolinium compounds or ferristen are used. Fluorescein is photosensitive and there is a risk of phototoxicity, especially in neonates who may require phototherapy. There is a case reported of a premature infant who received the compound directly, and had a skin reaction (Kearns 1985). A woman was given 5 ml intravenous dose of a 10% solution for diagnostic angiography shortly after birth, 784 References and had seven milk samples collected between 6 and 76 hours afterwards. Levels were 772 ng/ml at 6 hours and 170 ng/ml at 72 hours (half-life 62 hours) (Maguire 1985). Even when considering the peak values, a weight-adjusted dosage of 1% is calculated for a fully breastfed child, which should not carry a risk of phototoxicity. Corresponding milk samples at 30, 60, and 90 minutes had levels of 20, 22, and 15 ng/ml respectively, suggesting a half-life of 60 minutes and a probable calculated clearance time of 5 hours (Mattern 1990). Allergy injections for diagnostic purposes consist of proteins and carbohydrates from plants and/or animals. It is not anticipated that much would be absorbed from these intradermal injections. Transfer of 131I into human breast milk and transfer coefficients for radiological dose assessments. Breast milk excretion of radiopharmaceuticals: mechanisms, findings, and radiation dosimetry. Vertical transmission after birth mainly occurs via close contact between mother and child. The most likely is a urinary tract infection, an upper respiratory infection or a wound infection. An infection with -hemolytic strep requires aggressive therapy for both mother and infant, interrupting breastfeeding until the mother has received 24 hours of antibiotics. Illness in the infant requires neither interruption of breastfeeding, nor separation of mother and infant. For viral infections, breastfeeding is not interrupted and can be therapeutic, as mother provides her antibodies through the milk to her infant. Even when an abscess has to be surgically drained, breastfeeding should continue unless the incision for drainage is on the areola. An undiagnosed abscess that ruptures spontaneously into a duct would require interruption of breastfeeding on that breast, and the breast would require routine pumping on schedule to hasten the healing. Direct breastfeeding on that breast should resume as soon as drainage stops and antibiotic therapy has been in place at least 24 hours. If streptococcus is suspected by culture or because mastitis is bilateral, the infant should also be treated vigorously. Plugged ducts can be relieved with warm compresses and massage to remove the plug. When mastitis is suspected, the mother should be seen immediately, the diagnosis confirmed, and antibiotics initiated. If the mother has hepatitis A at the time of delivery or develops hepatitis A while breastfeeding, the infant should promptly receive immunoglobulin. Since a vaccine is now available, at-risk individuals and all children and adolescents will eventually be vaccinated and the risk of the disease should diminish (Lawrence 2005). No infection via breast milk was observed in the infants of 100 mothers with chronic hepatitis B. The infant should then also receive the first of three doses of hepatitis B vaccine. Contaminated syringes and blood products are the most critical sources of infection, although the latter has become significantly less of a risk factor since 1993 due to mandatory testing of all blood donations. Transmission rates are similar between breastfed and non-breastfed infants; however, many factors are uncontrolled (Zanetti 1995). A risk of infection for infants whose mothers are ill with only hepatitis C has not been observed as yet. In these cases (about 10% of the women studied), the mothers were advised not to breastfeed (Zimmermann 1995). The authors concluded from their findings that there is no contraindication to breastfeeding (Laufs 2000, Polywka 1999). However, seven of the eight infected children had spontaneous clearance of the virus without developing antibodies (Ruiz-Extremera 2000). The available experience does not, in principle, argue against breastfeeding when the mother is infected with hepatitis C. Whether the decision not to breastfeed should be taken when there is a high viral load. At the start of teething, with the possible resulting injury to the nipples, mothers with hepatitis C should not continue breastfeeding. However, parameters were significantly lower compared to maternal blood (Chibber 2004). Some of the infants of mothers with acute infection also developed liver symptoms. The authors concluded that breast feeding is probably safe, but stress the need to confirm their results by other studies, and the possibility that close contact between mother and child may facilitate transmission. There is no evidence yet that breastfeeding should be prohibited in cases of hepatitis E. When lesions are present near the anticipated time of delivery, a cesarian section is performed immediately when labor starts or the membranes rupture, to avoid infection of the infant. This is as would be expected, because the infection in adults is usually a local one that does not involve viremia. All infant deaths that have been reported have been subsequent to suckling at a breast with a herpetic lesion (Sullivan-Bolyai 1983). Lesions on the breast require temporary interruption of breastfeeding until the lesion has completely dried. Illness in the infant usually develops before 10 days of age, and is more severe because of lack of maternal antibodies. The infant can be infected by aerosolized virus from lesions or the maternal respiratory track. Postnatal varicella can develop from non-maternal sources, and is usually mild if the mother has had varicella or the vaccination. If the mother becomes ill after this point, prophylactic measures are not needed and the baby can be breastfed. If the baby becomes ill, varicella infections normally proceed without complications. With herpes zoster, the baby may continue to be breastfed, but direct contact with the affected part of the skin should be avoided. With the readily available vaccine to prevent chickenpox and the approval of the varicella vaccine for adults to prevent zoster, these cases should be greatly reduced.

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There is no preparation among the well-established hormonal contraceptives which requires an interruption of breastfeeding prostate cancer images buy uroxatral 10 mg with visa. Accidental intake of a single dose does not require an interruption in breastfeeding. The more common daily intake of 2 mg of cyproterone acetate for acne therapy has not yet been studied. Other antiandrogens, such as bicalutamide and flutamide, and antiestrogen-acting substances, such as aminoglutethimide, anastrozole, formestan, raloxifene, and tamoxifen, as well as the sexhormone inhibitors danazol and tibolone, have practically no role during breastfeeding and have also not been studied. There are also no data on clomiphene and the progesterone antagonist mifepristone. In so far as its (accidental) use during breastfeeding happens at all, a toxic effect on the infant should not be expected due to the brief exposure. Accidental intake of a single dose does not require an interruption of breastfeeding. After birth, other pharmaceuticals are used for uterine involution so that therapy during breastfeeding for obstetrical indications is not common. Both milk-promoting and milk-inhibiting effects have been noted with the various prostaglandins. In a study of 20 women with postpartum uterine atony, either 200 g misoprostol or 250 g methylergometrine were administered orally. The maximum misoprostol concentration in milk was reached at 1 hour, with a half-life of 0. Considering the maximum concentration in milk, the relative dose for misoprostol was 0. There is no indication yet of negative effects of prostaglandins in the breastfed infant. Prostaglandins should only be used for compelling treatment indications during breastfeeding. If severe glaucoma requires local treatment with latanoprost, breastfeeding can continue provided there is careful observation of the baby. Single doses of other prostaglandins, such as misoprostol for uterine atony, do not require any limitation of breastfeeding. Thyroid function in breast-fed infants whose mothers take high doses of methimazole. Intellectual development and thyroid function in children who were breast-fed by thyrotoxic mothers taking methimazole. Transfer of drospirenone to breast milk after a single oral administration of 3 mg drospirenone + 30 microg ethinylestradiol to healthy lactating women. Increased recall rate at screening for congenital hypothyroidism in breast fed infants born to iodine overloaded mothers. Methimazole pharmacology in man: studies using a newly developed radioimmunoassay for methimazole. Luteinizing hormone releasing hormone agonist for contraception in breast-feeding women. Growth, motor, and social development in breastand formula-fed infants of metformin-treated women with polycystic ovary syndrome. Breast feeding is a natural contraceptive and prevents disease and death in infants, linking infant mortality and birth rates. Myocardial infarction post-partum in patients taking bromocriptine for the prevention of breast engorgement. Transient hypothyroidism in a breastfed infant after maternal use of iodoform gauze. Thyroid function in wholly breastfeeding infants whose mothers take high doses of propylthiouracil. The treatment of prolactinomas during pregnancy and the lactation period in German. Health and growth of infants breastfed by Norplant contraceptive implants users: a six-year follow-up study. Iodine concentration in the breast milk of mothers of premature infants in German. The quantity of thyroid hormone in human milk is too low to influence plasma thyroid hormone levels in the very preterm infant. Oils, emollients, creams, and beauty lotions generally act locally on the skin, and do not contain active principles. There are, however, skin preparations that contain potent active chemicals, including liniments and treatments for acne, psoriasis, and other skin diseases. It then becomes a matter of dose, including the concentration of the active ingredient, the surface area covered, the thickness of skin in the area treated, and the treatment interval. If treatment involves a large area of the skin over a long period, then the absorption and 4. Hair preparations, cosmetics, and sunscreens can be used with caution while lactating. Here, the advice on systemic use can serve as orientation (see, for instance, iodine and salicylates). When the breast needs to be treated externally, it should be cleaned before the baby is fed. However, hypersensitization as well as toxic symptoms have not been demonstrated as yet. This does not change the obligation to reduce dermal applications to those that are absolutely essential. It is recommended that bleaching, dying, straightening or curling be done by a professional to reduce the exposure of the lactating woman. The scalp is thick and absorbs poorly, so these chemicals can be used carefully if the hair is rinsed thoroughly. No studies have been done to measure the chemicals in the milk, but it is highly unlikely that much is absorbed and that any reaches the milk. Maternal use of sunscreen while lactating is considered safe when mother relies on shading to minimize direct sun exposure as well. Herbal preparations which also contain chrysanthemums can cause allergic reaction in individuals who are allergic to this family of plants (chrysanthemums, ragweed, and Echinacea are all members of the Composite family). In difficult cases which no longer respond to permethrin, a prescription for lindane 1% may be given; this must be rinsed off within 4 minutes. It is highly toxic to the central nervous system and is contraindicated in children weighing under 50 kg. Oral absorption is more rapid than dermal, so application is contraindicated during lactation. It can cause respiratory depression, and should not be used in a child under 2 years of age. Used carefully and following the instructions for rinsing, this should be safe during lactation as long as the mother develops no symptoms (lacrimation, salivation, shortness of breath) and the infant is not exposed directly. Suffocation of lice by application of occlusive agents such as coconut oil, petroleum jelly, olive oil, or full-fat mayonnaise is reported to be successful, and carries no toxicity or risk during lactation. Scabies Medications for scabies include the preparations for lice, but they must be applied over a wide area of skin (usually the entire body). Permethrin cream (5%) is recommended, including during pregnancy and lactation, in spite of the large amount required, but not for use in children under 2 months of age. Benzylbenzoate and allethrin, a synthetic pyrethroid, are also effective and are not absorbed intradermally. Lindane, as mentioned previously, poses a theoretical risk which is amplified when the compound is used for scabies, based on the area exposed (dose). Lindane is found in the environment, and has been found in maternal milk in environmental screenings. This is 60 times greater than the baseline measured from environmental contamination. Lice infestation should be treated with coconut oil or pyrethrum extract/permethrin, and scabies with crotamiton or benzyl benzoate.

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Again man health bike best uroxatral 10mg, there is a description and discussion of the latest known evidence for these herbs. These are organized into groups according to how they might negatively affect a pregnant woman. It does not include information on ayruvedic preparations, Chinese herbs and/or medicines, or homeopathy, where evidencedbased safety data for the pregnant woman are even more limited. Sections and tables are presented identifying herbs where there is some evidence supporting the safety of their use during pregnancy, but only at the doses and in the preparations mentioned. It should be emphasized that any product can have potential adverse effects, based upon the quantity or doses used. Since manufacturing standards have not been established, it is impossible to be certain of the dosage in many products produced around the world. While manufacturers in developed countries have tried to establish more defined preparations, this still remains an area of concern. In addition, the stability of products and possible contamination of the plant or product grown in other parts of the world may still be an issue because of the lack of regulatory standards. Therefore, it is a requirement for any consumers of these products, and the provider counseling them, to evaluate carefully the stated preparation of each product used, focusing upon the reported concentrations of the ingredients, the country of origin, the manufacturer and its reputation, and any reported incidents of contamination for that type of product. For pregnant or lactating women, or any woman of reproductive age, further caution is necessary because of the potential for enhanced effects of these substances on the mother, the embryo/fetus, and the breastfed baby. With regard to purity and the safety of specific products, there is a valuable and important resource. Herbs should only be recommended by a competent and qualified provider caring for the pregnant woman, and one who is comfortable with and knowledgeable about the efficacy and risk assessment of herbs in pregnancy. It is well worth becoming familiar with Blumenthal (2003), Rotblatt (2002), and ConsumerLab. Different forms of the herbal preparations will have different compounds in the herbal preparations, as well as differing concentrations. How the herb is prepared is very important to the effect and safety of the pregnant woman and fetus. Herbal preparations come in the following forms: teas or infusions (infusions are hot-water extracts of dried herbs) capsules dried extracts tinctures (tinctures are alcohol extracts of dried herbs). The most commonly used herbs in pregnancy are teas or infusions (which are similar to teas). These usually have the lowest concentrations and contain the least amount of the compounds. Capsules and dried extracts are less commonly used; examples include ginger and echinacea. Tinctures should be avoided in pregnancy because of their higher concentrations as well as the use of alcohol as a carrier. In general, there is no pharmaceutical or herb that is absolutely safe in the first trimester, based upon our current knowledge. It is important to be aware that the rapid cellular development in organogenesis can be altered by any compound, and that some herbs may increase uterine tone, increasing the risk of pregnancy loss. Herbs commonly used as food or food additives are usually safe for use during pregnancy, and can be used daily (at the levels generally used as food ingredients) without affecting the pregnant woman or fetus. They should always be used carefully, in a well-diluted form, and should not be ingested. Although there are no clinical trials available, and there is no evidence-based proof in terms of Western medical standards, some herbal teas/infusions have been used for many years without adverse effects, and are considered to be safe. The evidence of their safety comes from their traditional use and from traditional evidence passed down through history by traditional users. Although there are no data to suggest how much is "safe", it is suggested that consumption of herbal teas be limited to two cups per day during pregnancy. Their safety is unknown when used at higher levels, so the use of herbs above these amounts is not recommended. If the quantities consumed are above these recommended levels, no special action is required except stopping usage at high doses. Red raspberry leaf Usage Relief of nausea, increase in milk production, increase in uterine tone, and ease of labor pains; there is some controversy over its use in the first trimester, primarily because of concern of stimulating uterine tone and causing miscarriage (McFarland 1999, Parsons 1999, 2001, Brinker 1997) Nausea, flatulence Form Tea or infusion 2. Peppermint Tea or infusion is the most common; enteric-coated tablets (187 mg) three times a day (maximum), are also used; peppermint may cause gastroesophageal reflux Tea or infusion Tea or infusion 3. Dandelion Gastrointestinal irritation, insomnia, and joint irritation A mild diuretic, and to nourish the liver; dandelion is known for high amounts of vitamins A and C, and elements of iron, calcium, and potassium, as well as trace elements (Continued) 2. Alfalfa Usage General pregnancy tonic; a source of high levels of vitamins A, D, E, and K, minerals, and digestive enzymes; thought to reduce the risk of postpartum hemorrhage in late pregnancy Sources of calcium and magnesium; helps to relieve anxiety, restlessness, insomnia, and irritable skin All-around pregnancy tonic; sources of high amounts of vitamins A, C, K, and calcium, potassium; and iron. Herbs that may stimulate the smooth muscle of the uterus may be risky during pregnancy, as they may cause a pregnancy loss. Alkaloids are a diverse group of chemical plant constituents that have a wide range of pharmacological impacts on the body. In several studies, it is estimated to be safe when used at doses of 250 mg four times a day or less (Blumenthal 2003, Low Dog 2005). Three published placebo-controlled trials have addressed the safety and efficacy of ginger for morning sickness. Vutyavanicah (2001) conducted a randomized double-blind placebo-controlled study of 70 women with nausea of pregnancy with or without vomiting before the seventeenth week. Again, either 250 mg powdered ginger capsules or placebo four times a day was used. Good efficacy was reported, and no adverse effects were noted on pregnancy outcomes. A study in 2003 by Willetts, in a double-blind placebo-controlled trial, randomly assigned 120 women before the twentieth week of gestation who had experienced morning sickness daily for at least a week. These patients received either 125 mg of ginger extract or placebo four times a day. Follow-up of the pregnancies revealed normal ranges of birth weight, gestational age, Apgar scores, and frequencies of congenital abnormalities when the study group infants were compared to the general population of infants born that year. Surprisingly, the German Commission E (Blumenthal 1998) and the American Herbal Products Association (McGaffin 1997) contraindicate the use of ginger during pregnancy. This is definitely not supported by the popular data, popular 492 Herb Usage Form and dosage 1. Ginger Nausea and vomiting, or morning sickness 250 mg four times a day maximum; ginger is also frequently used as a tea or infusion 2. The first is that inhibition of thromboxane synthetase may affect testosterone binding in the fetus, although this usually happens at much higher doses than those practically used or used in the studies (Backon 1991). The second concern is in vitro evidence that gingerol and shogoal, isolated components of ginger, exhibit mutagenic activity in certain salmonella strains (Nagabhushan 1987). However, researchers have also found potential antimutagenic compounds in ginger (Fudler1991). In that regard, however, a study of rats failed to find malformations in the offspring of animals administered 20 g/l or 50 g/l of ginger tea in their drinking water in early pregnancy. Researchers at the Hospital For Sick Children in Toronto, Canada, studied 187 pregnant women who used some form of ginger in the first trimester (Portnoi 2003). In this small study, there were no increased risks in babies with congenital malformations compared to a control group. With the vast number of women taking ginger during pregnancy, it is reasonable to assume that it is safe for women to use small amounts (up to 250 mg four times a day) of ginger during pregnancy. However, it is prudent to use ginger in moderation (Low Dog 2005, Blumenthal 2003, Muller 1991, Fudler 1991). Although there is a long history of the safe use of cranberry during pregnancy there are no studies confirming this. Evening primrose oil Mastalgia, mood swings (Hibbeln 2002) 500 mg daily There are no known restrictions on the use of evening primrose oil during pregnancy (Chen 1999, Brown 1996, Harrobin 1992, 1991). Although there is a long history of safe topical use during pregnancy, there are no studies showing its safety 494 Herb Usage Form and dosage 4. Aloe vera gel Topical use (only), for burns (Low Dog 2005, Blumenthal 2003) Gel 2. Echinacea Prevention and treatment of upper respiratory tract infections, vaginitis, and herpes simplex virus (Gallo 2000, Blumenthal 1998, McGaffin 1997, Mengs 1991) 900 mg of dried root (or equivalent) three times daily Although there is a long history of safe use during pregnancy, there are very few studies (Gallo 2000, Mengs 1991) showing its safety.

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Payment and funding None prostate ultrasound and biopsy 10mg uroxatral with mastercard, except for the case of three or more children where three months of the leave are fully paid by the employer and funded through general taxation. Flexibility in use Leave may be taken at any time up to the time the child turns six years. In cases of separation, divorce, widowhood or birth without marriage, only the parent that cares for the child is entitled to this leave. Parents with a disabled child do not get additional Parental leave, but are eligible for leave for the care of dependants (see 1iie below). The leave is paid by the employer and funded through general taxation, and is granted after Maternity leave. The leave does not constitute a personal entitlement and can be used by either or both parents within the total nine month period. For a parent who is unmarried, widowed, divorced or has a severely disabled child, the leave is extended by one month. Other employment-related measures Adoption leave and pay Adoptive mothers are granted a three- month paid leave during the first six months after the adoption if the child is less than six years of age. Leave for employees with children or spouses with disability: one hour per day, paid. Flexible working Parents are entitled to work two hours less per day if he/she has children of less than two years old and one hour less per day if he/she has children between two and four years old, with full earnings replacement. As mentioned above (1iid) there is an alternative option for this leave which is nine consecutive months off work after Maternity leave. Flexible working does not constitute a personal entitlement and can be used by either or both parents within the total entitlement period. For a parent who is unmarried, widowed, divorced or severely disabled flexible working is extended by six months. In the case of the birth of a fourth child, flexible working is further extended by two years. Adoptive parents of children up to the age of four are entitled to flexible working or alternatively childcare leave (see 1iid). An employee supporting a child or a husband/wife with a serious disability can work one hour less per day, with full payment. Relationship between leave policy and early childhood education and care policy the maximum period of post-natal leave available in Greece is 60 months in the public sector and 20 months in the private sector; but leave paid at a high rate runs for only 6 months in the private sector and 12 months in the public sector. Moreover, the minimum wage has been reduced by 22 per cent (32 per cent in the case of young labour market entrants) and is no more the outcome of collective bargaining but set by state. Regarding parental rights in particular, the lowering of the minimum wage had an impact on benefits that are relate to it, like maternity benefit and the special leave for the protection of maternity. At the same time, leave take-up has been negatively affected by the severe deterioration in employment and working conditions. In the same report, the Ombudsman identifies, however, a tendency on the part of mothers to solve their problems privately with their employers, accepting in effect the violation of their rights for fear of losing their jobs. But even those that complain to the Ombudsman are hesitant to proceed to further action and sometimes they withdraw the complaint. On the positive side of developments, a new law on Parental leave was voted by the Greek Parliament in April 2012 (articles 48-54, Law 4075/12), and immediately implemented. Special leave is introduced to cover the unplanned and serious needs of parents whose children suffer from serious illness needing regular therapy or hospitalisation Another positive development is the extension of maternity benefits to self-employed women for 14 weeks on the grounds of equal treatment of men and women in this occupational sector (Law 4097/12). The Ombudsman reports also other successful interventions to public authorities that referred to the interpretation of certain provisions of the existing legislation or gaps in legislation. Although not directly related to leave policies, an important development in late 2012 (Law 4093/12) concerns the non-contributory family benefits. On the positive side of this development, we record the extension of these benefits to all families with children instead of only families with 3+ or 4+ children as was the case before. However, much stricter meanstesting criteria were introduced, while the quite generous 3rd child benefits were abolished. Take-up of leave There is no information on take-up of the various types of leave. It seems, however, that mothers are overwhelmingly those that make use of leave to which both parents are eligible. But, as said above, it seems likely that due to the economic crisis, high unemployment and the fear of dismissal, take-up rates are adversely affected in the private sector. General overview During this year, research, publications and conferences mainly revolved around issues that were related to the financial crisis and its impact on health, labour relations, inequality and level of poverty. We mention in particular the 2012 Social Portrait of Greece, an annual publication of the National Centre of Social Research that mainly focused on the impact of crisis on labour relations. The Hungarian names for these three leaves (1c and 1d) literally refer only to the payment element, although in practice they cover leave and payment. Maternity leave (szulesi szabadsag) (responsibility of the Ministry of National Resources) Length of leave (before and after birth) Twenty-four weeks: up to four weeks before birth. Payment (terhessegi-gyermekagyi segely) and funding Seventy per cent of average daily earnings, with no ceiling on payments. In this case, payment is made by the Treasury, not the National Health Insurance Fund. Funded from the National Health Insurance Fund, which is financed by contributions from employers, employees and general taxation; employers and employees both pay 6 per cent of gross earnings to the Health Insurance Fund. Flexibility in use the start date can be between four weeks before birth and the birth itself. The father (birth or adoptive) is eligible if the mother dies or is not present in the household due to health-related reasons. Funded from the National Health Insurance Fund, which is financed by contributions from employers and employees. For multiple births, two hundred per cent of this amount is paid in the case of two children, 300 per cent for three children, with similar increases for additional children. Other employment-related measures Adoption leave and pay For adoptive parents the same regulations for Maternity and Parental leave apply as for other parents. For foster parents the same regulations for Parental leave apply as for other parents. Flexible working Mothers are entitled to two one-hour breaks per day for breastfeeding until a child is six months old; and to one one-hour break until a child is nine months old. Relationship between leave policy and early childhood education and care policy the maximum period of paid post-natal leave available in Hungary is 3 years, but the last year is paid at a low flat rate; until 2 years, insured parents taking leave are paid at a high earnings-related level. Maternity leave There are only statistics on the number of women receiving benefit. Paternity leave the total number of fathers taking leave during 2011 was 22,307, using 111,107 days. There is no information on what proportion of parents take leave or how long they take. It is thought, however, that the number of fathers taking parental leave is very small; over the years, the number of male recipients of benefit has been between 1,000 and 3,000. Some indication of leave-taking is provided by data on the age of children entering bolcsde (nurseries taking children under three years of age); most children enter between 18 months and two years of age. Other employment-related measures In 2011, the total number of paid leave days to care for a sick child was 894,000, which represented 3. General overview Work on issues concerning work-life balance in families with children has been flourishing since 2009. The issues covered are comprehensive, ranging from demography to labour force participation, leave policies, cash benefits and childcare.

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The placental perfusion was only improved by sildenafil in those placentas from pregnancies with growth retardation (Wareing 2005) man health and environment uroxatral 10mg fast delivery. Pulmonary hypertension is a life-threatening disease in pregnancy, and therefore interdisciplinary management in specialized centers is mandatory. Most experience in the specific treatment of chronic pulmonary hypertension during pregnancy exists with epoprostenol. The most common type of hypotension is postural hypotension, where symptoms occur after abruptly standing or sitting. Postural hypotension is sometimes an adverse effect of drug treatment (antidepressants), or may be due to illness (diabetes mellitus), or to nerve damage that disrupts the reflexes controlling blood pressure. In the majority of cases, treatment of hypotension depends on the underlying cause. In the 1980s, particular attention was paid to the consequences of chronic hypotension in pregnancy. An increased rate of prematurity of up to 17 percent was attributed to untreated hypotension (Goeschen 1984), and treatment during pregnancy was advocated. Dihydroergotamine was considered to be more effective than the adrenergic substances, and use of this drug in hypotensive pregnant women has been reported in the German literature (Goeschen 1984). However, its use in pregnancy is controversial because of its potential oxytocic effects and adverse pregnancy outcomes associated with vascular injury (Raymond 1995). Embryotoxic effects and stimulation of uterine contractions are not likely to occur after oral therapeutic doses. However, the risk cannot be eliminated in the case of an overdose or after intravenous administration. There was a reduction in fetal weight among the offspring of pregnant guinea pigs treated chronically with dihydroergotamine in doses less than those used in humans. Occasional oral use in low doses for migraine or vascular headaches seems not to have marked teratogenic effects, but idiosyncratic reactions may occur resulting in fetal damage. Dihydroergotamine may be used where severe hypotension has been resistant to other treatment regimens. Amezinium, etilefrine, gepefrin, midodrine, norfenefrine, and pholedrine are also used as antihypotonics. Vasoconstrictor sympathomimetics raise blood pressure transiently by acting at -adrenergic receptors to constrict peripheral vessels. The danger of using vasoconstrictors is that they raise blood pressure at the expense of the perfusion of other vital organs, such as the kidney. In animal studies, adrenergic substances caused a reduction of uterine blood supply (Hohmann 1992). Animals treated with high doses of amezinium by gavage during organogenesis showed no evidence of teratogenicity at the highest doses, despite the presence of severe maternal and fetal toxicity (Satoh 1988A, 1988B). There are limited conflicting data concerning the frequency of congenital anomalies reported in the children of women treated with adrenaline during pregnancy (Czeizel 1998, Heinonen 1977). No reports were found of teratogenic effects within the therapeutic dose range in human pregnancy. When significant symptoms compel drug treatment of hypotension in pregnancy, adrenergic substances may be prescribed. Combination preparations should not be used because of the possibility of drug interaction. It is used in the treatment of atrial fibrillation and in some cases of heart failure. Digoxin is widely distributed and extensively bound in varying degrees to tissues throughout the body, which results in an apparent high volume of distribution. It is excreted primarily through the kidneys, and has a half-life of about 40 hours. Absorption from the gastrointestinal tract is about 80 percent for methyldigoxin and acetyldigoxin. Methyldigoxin is demethylated in the liver, whereas acetyldigoxin is deacetylated in the intestinal mucosa. All digitalis glycosides cross the placenta, resulting in significant fetal levels (Gilstrap 1998). However, the myocardial sensitivity in the fetus appears to be less than it is in adults (Saarikoski 1978). In some instances it has been used to treat fetal tachycardias (Hallak 1991, Rotmensch 1987). There have been no reports linking digitalis glycosides with congenital malformations. They are indicated for some kinds of maternal and fetal tachycardia, and for some instances of chronic cardiac failure. If the pregnant woman needs an antiarrhythmic therapy, a drug is recommended which passes via the placenta in low amounts. On the other hand, if the fetus is the patient, sufficient placental transfer is desirable in order to treat the fetus via the mother. Supraventricular extrasystoles and premature ventricular beats are not harmful, and neither the mother nor the fetus needs medical treatment. Antiarrhythmic therapy of the pregnant woman New onset of tachycardia in otherwise healthy women is seldom seen in pregnancy. If supraventricular tachycardia, atrial flutter, atrial fibrillation or ventricular tachycardia has led to an unstable hemodynamical situation, electrocardioversion is recommended as in ventricular flutter or fibrillation. In the case of a stable hemodynamical situation, a drug-monitored cardioversion should be tried. Another indication for an antiarrhythmic therapy in pregnant women is to prevent a relapse. Bombelli (2003) reported on three cases of successful radiofrequency catheter ablation in drug-refractory maternal supraventricular tachycardia in late pregnancy. If treatment of bradycardia is necessary, a pregnant woman should also be fitted with a pacemaker. Fetal tachycardia is defined as more than 180 beats per minute, and mostly occurs in late pregnancy. If symptoms are persistent, cardiac failure or cardiomyopathy with pleural or pericardial effusion and/or ascites can result and edema. Fetal hydrops is defined as fluid retention in two or more compartments, and can precede intrauterine death. The drug of first choice is digitalis, but in case of hydrops, fetal serum concentration of digitalis might not reach therapeutic levels. This could be the reason why, in cases of fetal hydrops caused by tachycardia, digitalis therapy is often not successful (Oudijk 2002). The drugs of second choice, in combination with or without digitalis, are sotalol and/or flecainide (Doherty 2003, Oudijk 2002). It takes at least 72 hours, sometimes up to 14 days, before flecainide can succeed in converting the rhythm to sinus rhythm (Krapp 2002). Athanssiadis (2004) advocates that verapamil is the drug of second choice, whereas others think that it is contraindicated (Oudijk 2002). There is a case report of a fetus treated via the mother with flecainide, where the fetal heart rate decreased without converting to sinus rhythm. If there is no success prematurely, labor might be induced in order to try electrocardioversion of the newborn. In general, a healthy pregnant woman seldom suffers from adverse effects of the antiarrhythmic therapy of the fetus. Bradycardia as fetal side effect can occur, which is more likely after injection of adenosine into the umbilical vein than after other treatment. All antiarrhythmics can produce arrhythmias, at worst ventricular fibrillation of the fetus, which can lead to intrauterine death. As a vagal antagonist, it can increase the heart rate slightly despite its depressive effect on the pacemaker cells. Quinidine is one of the oldest antiarrhythmics, and is apparently without any noteworthy teratogenic potential.