TEALE FENNING Medical Education    FAQ   Search   Memberlist   Usergroups   Register   Profile   Log in to check your private messages   Log in  mrcog courses for doctors Thrombolysis after MI in pregnancy          TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions View previous topic :: View next topic   Author Message vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Sat Feb 03, 2007 6:46 pm    Post subject: Thrombolysis after MI in pregnancy can anybody tell me With reference to myocardial infarction, thrombolysis is contraindicated in pregnancy. T/F Back to top wolverine Century Club Joined: 16 Jan 2007 Posts: 394 Posted: Sat Feb 03, 2007 7:32 pm    Post subject: I'd guess false. I think that thrombolysis generally is to be avoided in pregnancy but in the case of MI I think the benefit outweigh the risk. Mums first Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Feb 03, 2007 8:06 pm    Post subject: Absolutely ... always anticoagulate a pregnant woman if it may save her life. That is what the Confidential Enquiries continually preach. Not so sure about MI as we are talking about streptokinase or equivalent. Sure it is still better to risk it Back to top Nick Raine-Fenning Course Director Joined: 27 May 2006 Posts: 1854 Location: Nottingham Posted: Sat Feb 03, 2007 8:32 pm    Post subject: Here is a nice paper outlining cardiac events in pregnancy. They seem to suggest early coronary angiography with coronary stenting and emergency coronary artery bypass grafting. Anticoagulation with tissue plasminogen activator (TPA) is required in some. Quote: Management of myocardial infarction must involve early coronary angiography. In the immediate postpartum period, spontaneous coronary artery dissection is the most common cause of myocardial infarction. The pathophysiological mechanisms responsible in the coronary arteries are similar to those responsible for aortic dissection, although the exact pathogenesis remains unclear. Seventy-eight per cent of women with peripartum coronary artery dissection have no risk factors for coronary artery disease and 84% of lesions involve the left anterior descending artery. Successful treatments include coronary stenting and emergency coronary artery bypass grafting. Twenty per cent of women with peripartum myocardial infarction have angiographic evidence of atherosclerosis or intracoronary thrombus. Increasing maternal age, prevalence of type II diabetes and the incidence of smoking in young women may cause this figure to rise. Individual cases in this category have been managed successfully by coronary stenting or the administration of tissue plasminogen activator (TPA) 100 mg over 90 min to lyse intracoronary thrombus. TPA has a large molecular weight and theoretically should not cross the placenta, making it eminently suitable for thrombolysis. The use of TPA is contraindicated in the early postpartum period because the risk of haemorrhage outweighs the risk of treatment with angioplasty and stenting. Concomitant or recent use of anticoagulants and antiplatelet drugs will affect the choice of anaesthesia for labour or Caesarean delivery Click here for a nice overview on MI in pregnancy although this does not address treatment. Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sat Feb 03, 2007 9:32 pm    Post subject: I think streptokinase can be given locally if cardiac catheterisation is planned . Systemic streptokinase will safe the mother from Cardiac events but will harm her by developing uncontrolled vaginal bleeding Back to top vani s Century Club Joined: 20 Jan 2007 Posts: 141 Posted: Sun Feb 04, 2007 9:56 am    Post subject: thanks.. nice reference.. In the immediate postpartum period, spontaneous coronary artery dissection is the most common cause of myocardial infarction. thats new.... just like ' h'age is more commonly a cause of stroke in pregnancy than infarct. ' so during pregnacy either TPA or local streptokinase... and ofcourse stenting n bypass postpartum. . Back to top EMAK Century Club Joined: 26 Nov 2006 Posts: 572 Posted: Sun Feb 04, 2007 10:07 am    Post subject: I think the original question asking about streptokinase.... so False Back to top Display posts from previous: All Posts1 Day7 Days2 Weeks1 Month3 Months6 Months1 Year Oldest FirstNewest First         TEALE FENNING Forum Index -> MRCOG Part 2: MCQ & Past Paper questions All times are GMT Page 1 of 1   Jump to: Select a forum Announcements----------------Forum AnnouncementsExam InformationCourse Announcements Examinations----------------MRCOG Part 1: EMCQsMRCOG Part 2: MCQ & Past Paper questionsMRCOG Part 2: EMQs - Extended Matching QuestionsMRCOG Part 2: Short Answer EssaysMRCOG Part 2: Objective Structured Clinical Examination - the OSCEDRCOG: the Diploma ExaminationMFFP: Membership of the Faculty of Family Planning and Reproductive Health Care of the RCOGPLAB: The Professional and Linguistic Assessment Board test General Discussion----------------Open ForumRCOG News & UpdatesThe Study Buddy SchemeKey Facts in O&GGuidelines & ProtocolsRecommended ReadingUseful WebsitesThe Market PlaceHow things work in the UKHow do you say that? Teale Fenning Courses----------------Our UK CoursesOur Overseas CoursesOur Correspondence CourseCourse AdministrationCourse FeedbackAccommodationOther Courses Training & Career Development----------------Basic Speciality Training in O&GSubspeciality Training & Special Skills ModulesAcademic TrainingResearch & AuditThe Curriculum Vitae or CVInterview SkillsMedical EducationPublication & Presentation SkillsTraining Courses, Conferences, & MeetingsThe Job MarketClinical Attachments  You cannot post new topics in this forum You cannot reply to topics in this forum You cannot edit your posts in this forum You cannot delete your posts in this forum You cannot vote in polls in this forum Powered by phpBB © 2001, 2005 phpBB Group