Dr Doaa Safwat

*Family history can be used to define women who are at increased risk of ovarian cancer.*

A *_woman is defined as being at high risk of ovarian cancer if*_ she has a first-degree relative (mother,father,sister,brother,
daughter or son) affected by cancer within a family with:

● 2 or more individuals with ovarian cancer, who are first-degree relatives of each other
● 1 individual with ovarian cancer at any age and one with breast cancer diagnosed under age 50 years who are first-degree* relatives of each other
● 1 relative with ovarian cancer at any age and two with breast cancer diagnosed under age 60 years who are connected by first-degree relationships
● 3 or more family members with colon cancer, or two with colon cancer and one with stomach,
ovarian,endometrial,urinary tract or small bowel cancer in two generations.One of these cancers must be diagnosed under age 50 years and affected relatives should be first-degree relatives of each other
● 1 individual with both breast and ovarian cancer.

*Where family history is significant,referring the woman to the Regional Cancer Genetics service should be considered.*

Referrence

**The Management of Ovarian Cysts in PostmenopausalWomen
Green-top Guideline No. 34
July 2016**

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Some Obstetrics
Terms and concepts and numbers

Placenta previa and placenta accreta spectrum
GTG 27a

Vasa previa
Green top guideline 27b

APH summary table

EMQ for chemotherapy adverse effects

Rule of 9 for fetal Bradycardia

Decision-to-delivery time
category 1 and 2 CS (for fetal or maternal compromise ) as quickly as possible particularly for category 1.
category 2 CS in most situations within 75 minutes.
Category 3 CS no maternal or fetal compromise but needs early delivery e.g in the same day .
Category 4 is elective .

Cigarette smoke is a complex, heterogeneous mixture of more than 4000 compounds, including ni****ne, carbon monoxide, carcinogens, and heavy metals ALL are very harmful.

Ni****ne

is an addictive alkaloid derived from to***co and is a potent stimulant. It readily crosses the placenta and has a direct effect on the fetus and the placental in addition to its effect on the maternal circulation.

Ni****ne has been classed as a neuroteratogen and is known to bind nicotinic acetylcholine receptors in the fetal brain, disrupting neurotransmitter function and altering normal brain development. These insults are thought to lead to the cognitive, emotional and behavioral problems seen in children of smokers, such as attention deficit hyperactivity disorder and learning disabilities

Ni****ne replacement therapy NRT seeks to replace cigarette smoking, with its harmful tar, carbon monoxide, and other compounds, with clean ni****ne delivered in a safe manner. The dose of NRT is gradually reduced until a user can stop the therapy without excessive psychological or physiological withdrawal symptoms.

NRT is therefore delivered via mucosal or transdermal routes. Available forms of NRT include transdermal patches, lozenges, chewing gum, oral sprays, micro tabs and inhalers

Transdermal patches deliver ni****ne slowly over the course of a day, in contrast with the other products

NRT use in pregnancy does not influence pregnancy outcomes such as birth weight or preterm labor. Occasional mild adverse effects are encountered with patches, such as skin irritation and headaches, but in general, NRT is well tolerated

The NICE and the RCOGR recommend the use of NRT in pregnancy as an adjunct to a smoking cessation attempt in those who have not quit with a psychosocial intervention alone.