аборт?
Как мога да открия ако има?
Мерси

по принцип не. всяка лекарствена намеса там е нежелателна, защото може да има катастрофални последици за момичето. най-добре е да се отиде в болницата

Ima neshto novotkrito v Shtatite, vzima se do 4ta sedmica i predizvikva silno kryvotechenie - neshto kato kiurtazh. legalno e samo v niakoi shtati. Predizvika goliam debat, a i pri G. W. Bush 2 edva li shte dobie goliama populiarnost.

Do Evropa ne znam koga shte stigne. Za sega v Bylgaria se opraviyame s tradicionniya abort - nay-dobre 5-6 sedmica.

Da, takova lekarstvo sushtestvuva. Generichnoto naimenovanie e RU 486. Tova e kokteil ot sintetichni hormoni, antagonisti na gonadotropina i se upotrebiava do 9 sedmitsi ot purvia den na poslednata menstruatsia zaedno s pesarii, sudurjasht prostaglandin (koito otvaria shiikata na matkata i ulesniava izhvurlianeto na vutreshnomatochnite produkti). Preporuchvam ti da govorish s ginekolog, koito shte ti obiasni pliusovete i minusite na meditsinskia (s hapche) i hirurgicheski ( s vakuum aspiratia, kiurtaj ili kombinatsia ot dvete) aborti. Osnovnia problem pri aborta s hapche e che poniakoga (pri 1 na 15 jeni) se nalaga kiurtaj poradi nepulno izprazvane na matkata i toi nosi risk ot perforatsia. Preporuchvam vi hirurgicheskia abort s vakuum aspiratsia, pri koito kiurtaj se nalaga mnogo riadko i opasnostta ot sledoperativna infektsia sus vsichkite i nepriatni posleditsi e neznatchitelna. Ako vse pak izberete meditsinskia abort, niama da e zle da vzimate metronidazol (ili pod kakvoto ime se prodava v Bulgaria) kato profilaktika sreshtu gram-otritsatelnite bakterialni infektsii.

Metronidazol za Gram otricatelni infekcii...Bravos... mai ne samo az sym si prospal lekciite po microbiologia... Inache v Bylgaria se prodava po imeto Flagyl i se polzva samo za anaerobni infekcii...karai. Inache sym syglasen s tova koeto si pisala.
Pencho

PS: vsiakakva samodeinost na fronta s abortite e strogo protivopokazana, ei!!!!

Bate Kolio, zavisi si vse pak ot mnogo neshta , vkliuchitelno i ot politikata na bolnicata deto bachka kaka ni Nevenka. Na niakoi mesta sum chuval che izpolzvat Ofloxacin i Metronidazol v kombinacia za vsiakakvi proceduri v malkia taz, vupreki che i az prospah niakoi momenti (ama i ti si si pohurkval, vednaga si priznai chistosurdechno). No za nespecifichni infekcii i osobeno puk v tatkovinata niama da se furlish kato nekoi luv afrikanski na nai-skupata kutiika v aptekata. Dobria star Doxycycline ili eventualno Erythromycin v obichainia kurs shte svurshat rabota.

I ei, samodeeca, da pazish mometo i da ne go plashish s razni bilki. Ne e doshul kraia na sveta! Fashtate se pod ruchichka kato eni dobri deca i se zanasiate pri lelia vi genikolojka v raionnata poliklinika i ot tam natatuk vsichko e lesno! I kolkoto po-skoro , tolkova po-dobre!

Aide i kusmet!

A. Metronidazole is effective in the treatment and prophylaxis of various anaerobic infections, particularly those caused by Bacteroides fragilis. It is considered an alternative to chloramphenicol and clindamycin for this purpose. Metronidazole is effective in the treatment of infections involving gram-negative anaerobes, but it is somewhat unreliable in the treatment of gram-positive anaerobic infections.
Metronidazole is ineffective in treating aerobic infections (Kasten, 1999; Gilman et al, 1985). Metronidazole effectively treats anaerobic intra-abdominal infections, genital infections, respiratory infections, meningitis and brain abscess, osteomyelitis, and oral and dental infections (Kucers & Bennett, 1987). The drug is useful as surgical prophylaxis for obstetric and gynecological, colorectal, and appendectomy
surgeries (de Boer & Thornton, 1989; El-Sefi et al, 1989).

B. Oral administration of METRONIDAZOLE is considered the treatment of choice for Trichomoniasis vaginalis infections in both male and female patients (CDC, 1993). METRONIDAZOLE is also an excellent amebicide (Giron & Ozoktay, 1984; Ashford et al, 1984). It is the drug of choice for the treatment of all symptomatic forms of amebiasis. The drug is an agent of choice for the treatment of giardiasis with cure
rates of 90% to 95% (Kyronseppa & Pettersson, 1981; Gupte, 1975; Anon, 1993). Single oral doses of METRONIDAZOLE are useful in treating Gardnerella vaginalis vaginitis (Purdon et al, 1984). The use of METRONIDAZOLE in the treatment of dracunculiasis should be reserved for patients who fail treatment with NIRIDAZOLE.

и т.н. знаете че има и други приложения. Няма да ви изнасям лекция

Prichinata da ne spomena doxycyclina e che toi se izpisva zaduljitelno sled abort, bil aborta meditsinski ili hirurgicheski, dokato metrondazola ne se dava profilaktichno navsiakude , nai veche po finansovi prichini, dori pri abort v naprednala ( 20-24 sedmitsa sled 1 den na posledna menstruatsia). Tochno na gram otritsatelnite bakterii se duljat nai-goliam broi ot post medikamentoznite abortni infektsii s izkliuchitelno nepriatni posleditsi. Ta misulta mi e, che e po-dobre da vzeme metronydazol sled aborta, otkolkoto da prejivee (ili ne) sledvashta izvunmatochna bremennost pri koiato poniakoga i injektsia methotrexat niama da i pomogne. Kato spomenah methotrexat se setih, che toi e po-dobur variant ot RU 486, no poradi visokata mu tsena se sumniavam, che shte bude izpolzuvan za prekratiavane na bremennost po jelanie. Bihte li mi kazali dali se izpolzuva v Bulgaria, a sushto i RU684, kude i kak?
Vupros do Nikolay s povishena trudnost: Bi li mi tsitiral niakolko Gramme otritsatelni AEROBNI bakterii?

Draga mi Nevena,
Eto ti otgovora na vyprosa s "povishena trudnost". Predpolagam za tvoia goliama iznenada, vsichki GRAM NEGATIVNI BAKTERII or grupata na Enterobacteriaceae sa AEROBI:
E. coli
Proteus Mirabilis
Serratia
Klepsiela Aerogenes
Salmonela
Shigella
Yersinia enterocolitica
ZA VSICHKI PO GORNI METRONIDAZOLA NIKAKVA RABOTA NE VYRSHI. Ne kazvam che ne e indiciran pri abort...tova e syvsem drug vypros.

Otvori si malkata knijka koiato sigurno sa ti dali kato si postupila v bolnicata (Guide for Antibiotic Administration of ..... Hospital) i proveri...
Bydi zdrava,
Yours faithfully,
Nikolay

Uvajaemi Nikolay,
Blagodaria za burzia otgovor. Napulno sum suglasna s tebe. V sushnost nie ne sporim, a si cheshem ezitsite, neshto kato ne shia ami vrat ( vupreki che anatomicheski ima razlika). Izbroenite aerobni bacterii (serratiata e fakultativen anaerob) ne sa ot statisticheska znachimost pri abort i zatova ne gi spomenah. Nie veche 10 stranitsi s pisania postnahme, i to povecheto ne svurzani s temata, a avtora ne se i poiavi pone edno merci da kaje. Daje i moje na shega da go e postnal, zashtoto ginekologa shte mu obiasni podrobnostite pri vsichki polojenia. Blagodaria oshte vednuj i bi li mi otgovoril na drugia vupros, koito postavih v gornia si posting, ako imash vuzmojnost. Prosto mi e interesno zashto v Bulgaria medikamentoznia abort ne e populiaren, vupreki che e 5 puti po-evtin ot hirurgicheskia.

Priaten den
Nevena

Draga mi Nevena,
Zashto ne bil populiaren medicamentoznia abort v Bylgaria. Ami znam li - i az kato tebe ako i da sym zavyrshil medicina v Bylgaria, nikoga ne sym bil lekar v rodinata, taka che pitash greshenia chovek.

Podoziram che e tova e svyrzano cialostnoto nihilistichno otnoshenie kym pacienta (edin vid - "kato si se razbolial shte tyrpish"), osobeno shto se otnasia do abortite. Pone syvsem doskoro v edin nash provincialen grad abort se praveshe samo s mestna upoika (ako vyobshte ginekologa si dade trud i neia da napravi)...

Takiva neshta. Razbira se ne znam dali vyobshte Mifepristone (RU486) e registriran v Bylgaria. Mislia che Misoprostol-a e. Razbira se ima i Methotrexate koito za dozi ot poriadyka na 50mg/m2 niama da de koi znae kolko skyp (nali ne sa e neobhodimi 7-8g/m2 kakto pri osteosarkom, koeto veche shte sa mnogo pari)...

Kakto se doseshtash vsichko opira ne tolkova do konkretnia lekar, a do sistemata v koiato raboti.
Haide chao
Tvoi - Nikolay

моля ви колеги обяснете ми каква е връзката на метотрексата и аборта
или аз съм тъп или нещо съм изпуснал или нещо не разбирам

въобще дайте малко акъл

Mirage, ti si umno momche i znaesh angliiski, taka che procheti tuk:

Съдържаниет е скрито
Влезте за да го видите

Напълно си прав, че цената на Метотрексата едва ли би била много висока в споменатата дозировка, още повече в България, където този медикамент е почти без пари:). Аз самата също не бях чувала за аборт с метотрексат и благодаря за това, че въобще го споменахте, вероятно е въпрос наистина на школа, а нашата гинекологична (макар и отдавна да не съм имала нищо общо с тях) знам, че не е сред най-напредничавите... за всяко нещо трябва да минат години. Както и да е, едва ли в момента това е тема за обсъждане.
Приятне ден
OLIVIA

много благодаря, намах и представа дори

господи, явно съм проспал тоя момент, иначе RUто не е регистрирано в България

та и аз се разтърсих и намерих това за метотрексата:

MONOTHERAPY:
A study has found single-agent intramuscular methotrexate (50 milligrams/square meter (mg/m(2)) to be effective in the induction of medical termination of early pregnancy. Study subjects (n=40) received an intramuscular (IM) injection of methotrexate 50 mg/m(2); control subjects (n=53) received the same dose of methotrexate plus were instructed to administer 800 micrograms of misoprostol vaginally 3 to 7 days after the methotrexate injection if no bleeding had
occurred. Twenty-eight (70%) of the study patients had a complete abortion within 21 days. However, the median time to the beginning of bleeding and the passing of contraception products was significantly longer for the study group (15.5 days) versus the control group (8.1 days) (p = 0.0003). No significant difference in side effects between the two groups were noted. The authors concluded that methotrexate (50 mg/m(2) IM) as a single-agent was effective in medical termination of early pregnancy; however, the process was accelerated with the addition of misoprostol, which would decrease patient anxiety (Schaff, et al, 1997).

Methotrexate 80 milligrams (mg) intramuscularly successfully terminated a pregnancy within a very thin uterine scar, a rare but possibly life-threatening complication. Plasma beta human chorionic gonadotropin concentration decreased over eight weeks to 20 mIU/mL. No adverse effects were observed (Ravhon et al, 1997).

COMBINATION THERAPY:
The combination of methotrexate and misoprostolis safe and effective for the termination of early pregnancy (Schaff et al, 1997; Creinin et al, 1996). In a study of 300 pregnant women at less than 8 weeks gestation, each subject received an intramuscular dose of methotrexate 50 milligrams/square meter (mg/(2)). Seven days later, 800 micrograms of misoprostol was administered intravaginally by placing four 200 mcg tablets into the vagina with a speculum. If the abortion did not occur, the dose of misoprostol was repeated. If cardiac activity was present on vaginal
ultrasound after five days, vacuum aspiration was performed. Eighty-eight percent of the women had successful medical abortions; 65% experienced an abortion within 24 hours after either the first or second dose of misoprostol. Vaginal bleeding occurred for a mean of 14 days in those women who immediately aborted and for a mean of 11 days in those women whose abortions were delayed. Nausea and vomiting were the most commonly reported side effects, occurring in 19% and 9% of women, respectively (Creinin et al, 1996). Similar results were reported in a trial of 178 women with early pregnancy with a 96% success rate (Hausknecht, 1995).

ORAL methotrexatefollowed by vaginal MISOPROSTOL was effective in termination of pregnancy in a small group of women (n=20) at less than 49 days gestation. Methotrexate was given as a dose of 25 or 50 milligrams;even days later, 800 micrograms of misoprostol was administered intravaginally. If the abortion did not occur, a second dose of methotrexate was given a day later. Eighty percent of women who received the 50 mg methotrexate dose experienced bleeding and termination of the pregnancy within 24 hours of the first or second dose of methotrexate as
compared to 50% of women who received the 25 mg dose. Bleeding and cramping generally occurred approximately 4 hours after misoprostol was administered. Although this was a small sample size, oral methotrexate appears safe and
effective and may minimize the problems potentially encountered with parenteral administration of a chemotherapeutic medication (Creinin, 1996). In a similar trial, 60 milligrams/square meter (mg/m(2)) IM dose was as effective and safe as
50 mg/m(2) dose (Creinin & Krohn, 1997).

Methotrexate plus MISOPROSTOL was more effective than misoprostol alone for medical abortion in a study involving 61 women who were 56 days' gestation or less seeking elective abortion. Patients received methotrexate 50 milligrams/square meter (mg/m(2)) followed 3 days later by misoprostol 800 mcg (n=31) vaginally or misoprostol 800 mcg alone (n=30). Complete abortion occurred in 90% of patients receiving both drugs versus 47% of patients receiving misoprostol alone. There were 3 and 16 treatment failures in group 1 (both drugs) and group 2 (misoprostol alone), respectively. The authors conclude that the combination of methotrexate plus misoprostol may represent an alternative to the use of antiprogestin plus prostaglandin for medical abortion (Creinin & Vittinghoff, 1994).

CERVICAL PREGNANCY, traditionally treated with hysterectomy, was conservatively managed with methotrexateand citrovorumand angiographic embolization to control profuse bleeding. Intramuscular methotrexate 1 milligram/kilogram/day was alternated with citrovorum 0.1 milligram/kilogram/day for 4 days. The patient
received a total of 8 doses (2 courses) with 6 days off drug between treatments. Reproductive capability was preserved and the patient delivered a subsequent infant 12 months later (Marston et al, 1996).

Komplimenti za taz kompleksna razrabotka za Methotrexat-a. Dannata e malko starichka, no e interesna!

Pak samo da si kaja , che vsiaka samodeinost na ginekologichnia front e nepreporuchitelna!

Ne znam koy kakvi lekcii e propuskal ama shto nay nakraya ne mu otgovorite kato horata na momcheto ? Eto: "Abe Rosene, ti ne mojesh da zabremeneesh ! Pri mujete ne se poluchava - kakvo mu beresh grijata ?"

mnogo si samonadejan ,Pencho ,no tova e prostimo za studentite na etap mikrobiologija(treti kurs). Kato stanesh stajant i si izkarash staja po AG ,shte znaesh poveche za lekarstvata ,koito se upotrebjavat v Akusherstvoto ,zashtoto ne vsitshko opira do mikrobiologija.

Драги ми AZ,
Не се съмнявам че си изключително компетентен акушегогинеколог, вероятно дори професор по АГ (със сигурност типичен представител на българската АГ-общественост). Аз съм простичко студент в трети курс... Наистина много неща има да уча. Благодаря че ми посочи моята самоувереност в постинга си по-горе.

Изкрено ти пожелавам да чуеш и видиш неща в гинекологията, през някоя друга призма освен тази на българските гинекологични светила (сигурен съм че много неща, ще те учудят). Като например това че метронидазола е ефективен само за анаеробни инфеции (които без съмнение са чести след аборт), а не при тези причинени от Грам-отрицателни аеробни бацили. Както и това че кюретаж след ранен аборт не се прави рутинно или както казваш ти - ЗАДЪЛЖИТЕЛНО. Или това че медикаментозния аборт е най-често правения за ранна бременност отвъд Драгоман (питай Невена).

В никакъв случай не съм искал да насърчавам каквато и да е била самодейност на сгазили лука тинейджъри - това си е междудокторска дискусия (с влючване на някой и друг третокурсник-зубрач).
Твой - Пенчо

az, predi da pravish revizii s kiuretata, idi napravi edna osnovna revizia na po-novite (i ot 1990 g nasam stavat) uchebnitsi po AG. Propuski i neznanie sa prosteni i na studenti, i na asistenti, che i na profesori. Nejelanieto da nauchish neshto poveche i po-novo kogato si spetsialist e neprostimo. Predi da napishesh mnenieto si, bi mogul pone da prochetesh napisanoto ot drugite po temata. Horata ti izpisaha tonove informatsia, che i linkove ti pusnaha za razlichni medikamenti i upotrebata im pri abort, ti pak si znaesh tvoeto. Kazvash, che pri vas ne se upotrebiavat prostaglandinovi preparati pri ranen abort. Samo ne mi kazvai, che predi da navresh liubimata ti kiureta, raztvariash shiikata na matkata samo mehanicheski sus shishove za pletene! Sigurno i bez pulna upoika go pravite! Hubavo e,che imash dostup do internet, porazgledai se i si nameri edin hubav opresnitelen kurs. Mnogo ti e neobhodim!