Example,

A pregnant in the 2nd trimester was in significant contact with a child with chicken post 7 days ago. She has never had Varicella zoster infection. A stored blood sample is tested negative for varicella zoster virus IgG. Now, she has no rash.

The best management→ Varicella Zoster Immunoglobulin (VZIG)

If she has never had Chicken pox (she is not immune to it) or if the immunity

status is unknown→Check serum Varicella zoster Ab (IgG)

→If +ve (immune) →Reassure.

→If-ve(not immune) → Give Varicella zoster Immunoglobulins (VZIG).

·VZIG is effective if given within 10 days after exposure.

·If she develops rash → Give oral Acyclovir within 24 hours. (VZIG is useless in

this case as she has already gotten the infection).

·If the serum varicella zoster virus IgG came back Positive(immune)

→the answer would have been: Reassure.

Pregnant with exposure and with no VZ antibodies.

Newborns with peri-partum exposure.

·When to give oral Acyclovir?

V Immunocompromised patients who develop Chicken Pox.

V Pregnant of who develop Chicken Pox

A primiparous diabetic African has just delivered a 4.8 Kg baby. The delivery was done by the aid of forceps. The placenta was removed with continuous cord traction and her uterus is well contracted. However, she continues to bleed excessively.

The likely cause of postpartum hemorrhage →Cervical/Vaginal Trauma.

The most common cause of postpartum hemorrhage in general is Uterine Atony. However, here, the uterus is well contracted.

Big baby in a Diabetic mother are RFs of tear/trauma at delivery.

Postmenopausal symptoms - hot flushes, vaginal dryness, dyspareunia, night sweats, irritability

If there is uterus- GIVE
Combined Hormone Replacement Therapy (HRT) OR give transdermal estradiol and progesterone patches

If NO UTERUS, ( e.g hx of hysterectomy ) or if there is IUS in place.

Oestrogen only hormone replacement therapy - 

progesterone is given with the oestrogen to protect the uterus against endometrial carcinoma. If no,uterus, why give progesterone?

Dyspareunia → difficult or painful sexual intercourse.

More information (For reading)- “Cessation of menstruation” is the time after a woman has her last menstrual period. Because her final periods can be irregular, menopause is confirmed 12 months after her last period.,

Menopause is a natural part of ageing that usually occurs between 45 and 55 years of age, as a woman's oestrogen levels decline. In the UK, the average age for a,woman to reach the menopause is 51.

The time of a woman's life following menopause is called postmenopause.

Women in postmenopause may develop “Postmenopausal Vasomotor symptoms",such as Hot flushes, Night sweats.,

To manage these Vasomotor symptoms GIVE Hormone Replacement Therapy (HRT),after evaluating pros and cons.,

If she has had hysterectomy (No uterus), or if there is Intrauterine,system "IUS" in situ→Oestrogen-only HRT.

Otherwise→Combined HRT.,

Note,if a postmenopausal lady is a smoker, the HRT is given “Transdermal" as the,oral route has a higher risk for Venous Thromboembolism (VTE).,

Note,Combined HRT has 2 types:,- Sequential “Cyclical” combined HRT →used in the first 12 months of menopause or in perimenopause “still menstruating". Oestrogen is taken daily,while Progesterone is taken Cyclically “for the last 14 days of a menstrual,cycle".,- Continuous combined HRT → used in menopausal women (women who have,had their last menstrual cycle 12 months ago). Both Oestrogen and,Progesterone are taken daily.,