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Genital Organ Diseases Case No.5 Vaginal Discharge-2

আসসালামুআলাইকুম।

আজকে আমরা একটা common topics

Abnormal vaginal discharge during pregnancy নিয়ে আলচোনা করবো।

♦☘️physiological:☘️

increased cervical secretions and vaginal transudate due to increased vascularity and hyperestrogenic state.

Rx-👉 improvement of personal hygiene.

♦️Trichomonas vaginalis:♦️☘️

🗣️Infection not increased during pregnancy.

🗣️symptoms as in non pregnant state

Rx-👉 metronidazole(should be avoided in first trimester)

  • Husband should be treated simultaneously

Tablet 1:-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Indications of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Amodis is indicated in the treatment of following diseases:

  • The prevention of post-operative infections due to anaerobic bacteria (particularly species of bacteroides and anaerobic streptococci).
  • The treatment of septicaemia, bacteraemia, peritonitis, brain abscess, pelvic abscess, pelvic cellulitis and post-operative wound infections caused by anaerobes.
  • In the treatment of urogenital trichomoniasis.
  • Bacterial vaginosis (also known as non-specific vaginitis).
  • All forms of amoebiasis (intestinal, extra-intestinal disease and that of symptomless cyst passers).
  • Giardiasis.
  • Acute ulcerative gingivitis.
  • Anaerobically infected leg ulcers and pressure sores.
  • Acute dental infections due to anaerobic organisms.
  • Antibiotic associated pseudomembranus colitis.

Pharmacology of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metronidazole is a member of the imidazole class of antibacterial drug and is classified therapeutically as an antiprotozoal agent. The 5-nitro group of Metronidazole is reduced by anaerobes metabolically. Studies have demonstrated that the reduced form of this drug interacts with DNA and gives bactericidal action of Metronidazole.

Dosage & Administration of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Tablet and Suspension:

Trichomoniasis (Adults & Children over 10 yrs)-

  • 200 mg tid or 400 mg bid for 7 days
  • 800 mg in the morning and 1-2 gm at night for 2 days
  • 2 gm as a single dose for 1 days

Trichomoniasis (Children)-

  • Children 7-10 yrs: 100 mg tid
  • Children 3-7 yrs: 100 mg bid
  • Children 1-3 yrs: 50 mg tid

Intestinal amoebiasis (Adults & Children over 10 yrs)- 

  • 800 mg tid for 5 days

Intestinal amoebiasis (Children)-

  • Children 7-10 yrs: 400 mg tid
  • Children 3-7 yrs: 200 mg qid
  • Children 1-3 yrs: 200 mg tid

Extra-intestinal & Asymptomatic amoebiasis (Adults & Children over 10 yrs)-

  • 400-800 mg tid for 5-10 days

Extra-intestinal & Asymptomatic amoebiasis (Children)-

  • Children 7-10 yrs: 200-400 mg tid
  • Children 3-7 yrs: 100-200 mg qid
  • Children 1-3 yrs: 100-200 mg tid

Giardiasis (Adults & Children over 10 yrs)-

  • 2 gm once daily for 3 days

Giardiasis (Children)-

  • Children 7-10 yrs: 1 gm once daily
  • Children 3-7 yrs: 600-800 mg once daily
  • Children 1-3 yrs: 500 mg once daily

Acute ulcerative  gingivitis (Adults & Children over 10 yrs)-

  • 200 mg tid for 3 days

Acute ulcerative  gingivitis (Children)-

  • Children 7-10 yrs: 100 mg tid
  • Children 3-7 yrs: 100 mg bid
  • Children 1-3 yrs: 50 mg tid

Acute dental infections (Adults & Children over 10 yrs)-

  • 200 mg tid for 3-7 days

Bacterial Vaginosis (Adults & Children over 10 yrs)-

  • 400 mg bid for 7 days
  • 2 gm as a single dose for 1 days

Leg ulcers and pressure sores (Adults & Children over 10 yrs)-

  • 400 mg tid for 7 days

Anaerobic infections (Adults & Children over 10 yrs)-

  • 800 mg initially and then 400 mg tid for 7 days

Anaerobic infections (Children)-

  • Children 1-10 yrs: 7.5 mg/kg tid

Surgical prophylaxis (Adults & Children over 10 yrs)-

  • 400 mg tid started 24  hours before  surgery for 1 days

Surgical prophylaxis (Children)-

  • Children 1-10 yrs: 7.5 mg/kg tid

Vaginal Gel:

The recommended dose is one applicator full of Metronidazole gel (approximately 5 grams containing approximately 37.5 mg of Metronidazole) intravaginally once or twice a day for 5 days. For once a day dosing, Metronidazole gel should be administered at bedtime.


Suppository:

Anaerobic Infections-

  • Adults: 1 g every 8 hours for 3 days, then 1 g every 12 hours.
  • Children: 5-10 years: 500 mg every 8 hours for 3 days, then every 12 hours, Over 10 years adult dose.

Surgical Prophylaxis-

  • Adults: 1 g 2 hours before surgery; up to 3 further doses of 1 g may be given every 8 hours for high risk procedures.
  • Children: 5-10 years: 500 mg 2 hours before surgery; up to 3 further doses of 500 mg may be given every 8 hours for high risk procedures.


IV Infusion:

Metronidazole intravenous infusion requires no dilution and should not be mixed with any other drugs prior to administration.

  • Adults and children over 12 years: Infuse 500 mg 8 hourly at a rate of 5 ml/minute and a maximum of 4 g should not be exceeded during a 24-hour period. Treatment for 7 days is sufficient for most patients, but treatment can be extended, especially for cases where reinfection is likely. For surgical prophylaxis, administration shortly before surgery should be followed by 8-hourly doses for the next 24 hours.
  • Children under 12 years: 7.5 mg/kg body weight/day every 8 hours at a rate of 5 ml/minute

Contraindications of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metronidazole is contraindicated in patients with a history of hypersensitivity to Metronidazole or other Nitroimidazole derivatives.

Side Effects of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metallic taste, nausea, vomiting, diarrhoea, drowsiness, rashes may be observed during treatment.

Pregnancy & Lactation of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

US FDA Pregnancy Category of Metronidazole is B. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Metronidazole have been shown to be excreted in human milk. So, caution should be exercised when Metronidazole is administered to a nursing woman.

Precautions & Warnings of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

  • If for compelling reasons, Amodis must be administered longer than the usually recommended duration, it is recommended that hematological tests, especially leucocyte count should be carried out regularly and that patients should be monitored for adverse reactions such as peripheral or central neuropathy (such as paresthesia, ataxia, dizziness, convulsive seizures).
  • Amodis should be administered with caution to patients with hepatic encephalopathy.
  • Patients should be warned that Amodis may darken urine.

Use in Special Populations of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Hepatic impairment: Amodis is mainly metabolised by hepatic oxidation. Substantial impairment of Amodis clearance may occur in the presence of advanced hepatic insufficiency. Significant cumulation may occur in patients with hepatic encephalopathy and the resulting high plasma concentrations of Amodis may contribute to the symptoms of the encephalopathy. Amodis should therefore, be administered with caution to patients with hepatic encephalopathy. The daily dosage should be reduced to one third and may be administered once daily. Patients should be warned that Amodis may darken urine.

Renal impairment: The elimination half-life of Amodis remains unchanged in the presence of renal failure. The dosage of Amodis therefore needs no reduction. Such patients however retain the metabolites of Amodis. The clinical significance of this is not known at present. In patients undergoing haemodialysis Amodis and metabolites are efficiently removed during an eight hour period of dialysis. Amodis should therefore be re-administered immediately after haemodialysis. No routine adjustment in the dosage of Amodis need be made in patients with renal failure undergoing intermittent peritoneal dialysis (IDP) or continuous ambulatory peritoneal dialysis (CAPD).

Overdose Effects of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Single oral doses of Amodis, up to 12 g have been reported in suicide attempts and accidental overdoses. Symptoms were limited to vomiting, ataxia and slight disorientation. There is no specific antidote for Amodis overdosages. In case of suspected massive overdosages, a symptomatic and supportive treatment should be instituted.

Therapeutic Class of Tablet :-Amodis 400 mg (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Amoebicides, Anti-diarrhoeal Antiprotozoal

OR

Vaginal Gel 2:-Flamyd –V 1.3% 5gm tube (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Indications of Vaginal Gel :- Flamyd –V 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Amodis is indicated in the treatment of following diseases:

  • The prevention of post-operative infections due to anaerobic bacteria (particularly species of bacteroides and anaerobic streptococci).
  • The treatment of septicaemia, bacteraemia, peritonitis, brain abscess, pelvic abscess, pelvic cellulitis and post-operative wound infections caused by anaerobes.
  • In the treatment of urogenital trichomoniasis.
  • Bacterial vaginosis (also known as non-specific vaginitis).
  • All forms of amoebiasis (intestinal, extra-intestinal disease and that of symptomless cyst passers).
  • Giardiasis.
  • Acute ulcerative gingivitis.
  • Anaerobically infected leg ulcers and pressure sores.
  • Acute dental infections due to anaerobic organisms.
  • Antibiotic associated pseudomembranus colitis.

Pharmacology of Vaginal gel Flamyd –V 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metronidazole is a member of the imidazole class of antibacterial drug and is classified therapeutically as an antiprotozoal agent. The 5-nitro group of Metronidazole is reduced by anaerobes metabolically. Studies have demonstrated that the reduced form of this drug interacts with DNA and gives bactericidal action of Metronidazole.

Dosage & Administration of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Tablet and Suspension:

Trichomoniasis (Adults & Children over 10 yrs)-

  • 200 mg tid or 400 mg bid for 7 days
  • 800 mg in the morning and 1-2 gm at night for 2 days
  • 2 gm as a single dose for 1 days

Trichomoniasis (Children)-

  • Children 7-10 yrs: 100 mg tid
  • Children 3-7 yrs: 100 mg bid
  • Children 1-3 yrs: 50 mg tid

Intestinal amoebiasis (Adults & Children over 10 yrs)- 

  • 800 mg tid for 5 days

Intestinal amoebiasis (Children)-

  • Children 7-10 yrs: 400 mg tid
  • Children 3-7 yrs: 200 mg qid
  • Children 1-3 yrs: 200 mg tid

Extra-intestinal & Asymptomatic amoebiasis (Adults & Children over 10 yrs)-

  • 400-800 mg tid for 5-10 days

Extra-intestinal & Asymptomatic amoebiasis (Children)-

  • Children 7-10 yrs: 200-400 mg tid
  • Children 3-7 yrs: 100-200 mg qid
  • Children 1-3 yrs: 100-200 mg tid

Giardiasis (Adults & Children over 10 yrs)-

  • 2 gm once daily for 3 days

Giardiasis (Children)-

  • Children 7-10 yrs: 1 gm once daily
  • Children 3-7 yrs: 600-800 mg once daily
  • Children 1-3 yrs: 500 mg once daily

Acute ulcerative  gingivitis (Adults & Children over 10 yrs)-

  • 200 mg tid for 3 days

Acute ulcerative  gingivitis (Children)-

  • Children 7-10 yrs: 100 mg tid
  • Children 3-7 yrs: 100 mg bid
  • Children 1-3 yrs: 50 mg tid

Acute dental infections (Adults & Children over 10 yrs)-

  • 200 mg tid for 3-7 days

Bacterial Vaginosis (Adults & Children over 10 yrs)-

  • 400 mg bid for 7 days
  • 2 gm as a single dose for 1 days

Leg ulcers and pressure sores (Adults & Children over 10 yrs)-

  • 400 mg tid for 7 days

Anaerobic infections (Adults & Children over 10 yrs)-

  • 800 mg initially and then 400 mg tid for 7 days

Anaerobic infections (Children)-

  • Children 1-10 yrs: 7.5 mg/kg tid

Surgical prophylaxis (Adults & Children over 10 yrs)-

  • 400 mg tid started 24  hours before  surgery for 1 days

Surgical prophylaxis (Children)-

  • Children 1-10 yrs: 7.5 mg/kg tid

Vaginal Gel:

The recommended dose is one applicator full of Metronidazole gel (approximately 5 grams containing approximately 37.5 mg of Metronidazole) intravaginally once or twice a day for 5 days. For once a day dosing, Metronidazole gel should be administered at bedtime.


Suppository:

Anaerobic Infections-

  • Adults: 1 g every 8 hours for 3 days, then 1 g every 12 hours.
  • Children: 5-10 years: 500 mg every 8 hours for 3 days, then every 12 hours, Over 10 years adult dose.

Surgical Prophylaxis-

  • Adults: 1 g 2 hours before surgery; up to 3 further doses of 1 g may be given every 8 hours for high risk procedures.
  • Children: 5-10 years: 500 mg 2 hours before surgery; up to 3 further doses of 500 mg may be given every 8 hours for high risk procedures.


IV Infusion:

Metronidazole intravenous infusion requires no dilution and should not be mixed with any other drugs prior to administration.

  • Adults and children over 12 years: Infuse 500 mg 8 hourly at a rate of 5 ml/minute and a maximum of 4 g should not be exceeded during a 24-hour period. Treatment for 7 days is sufficient for most patients, but treatment can be extended, especially for cases where reinfection is likely. For surgical prophylaxis, administration shortly before surgery should be followed by 8-hourly doses for the next 24 hours.
  • Children under 12 years: 7.5 mg/kg body weight/day every 8 hours at a rate of 5 ml/minute

Contraindications of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metronidazole is contraindicated in patients with a history of hypersensitivity to Metronidazole or other Nitroimidazole derivatives.

Side Effects of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Metallic taste, nausea, vomiting, diarrhoea, drowsiness, rashes may be observed during treatment.

Pregnancy & Lactation of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

US FDA Pregnancy Category of Metronidazole is B. There are, however, no adequate and well-controlled studies in pregnant women. Because animal reproduction studies are not always predictive of human response, this drug should be used during pregnancy only if clearly needed. Metronidazole have been shown to be excreted in human milk. So, caution should be exercised when Metronidazole is administered to a nursing woman.

Precautions & Warnings of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

  • If for compelling reasons, Amodis must be administered longer than the usually recommended duration, it is recommended that hematological tests, especially leucocyte count should be carried out regularly and that patients should be monitored for adverse reactions such as peripheral or central neuropathy (such as paresthesia, ataxia, dizziness, convulsive seizures).
  • Amodis should be administered with caution to patients with hepatic encephalopathy.
  • Patients should be warned that Amodis may darken urine.

Use in Special Populations of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Hepatic impairment: Amodis is mainly metabolised by hepatic oxidation. Substantial impairment of Amodis clearance may occur in the presence of advanced hepatic insufficiency. Significant cumulation may occur in patients with hepatic encephalopathy and the resulting high plasma concentrations of Amodis may contribute to the symptoms of the encephalopathy. Amodis should therefore, be administered with caution to patients with hepatic encephalopathy. The daily dosage should be reduced to one third and may be administered once daily. Patients should be warned that Amodis may darken urine.

Renal impairment: The elimination half-life of Amodis remains unchanged in the presence of renal failure. The dosage of Amodis therefore needs no reduction. Such patients however retain the metabolites of Amodis. The clinical significance of this is not known at present. In patients undergoing haemodialysis Amodis and metabolites are efficiently removed during an eight hour period of dialysis. Amodis should therefore be re-administered immediately after haemodialysis. No routine adjustment in the dosage of Amodis need be made in patients with renal failure undergoing intermittent peritoneal dialysis (IDP) or continuous ambulatory peritoneal dialysis (CAPD).

Overdose Effects of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

Single oral doses of Amodis, up to 12 g have been reported in suicide attempts and accidental overdoses. Symptoms were limited to vomiting, ataxia and slight disorientation. There is no specific antidote for Amodis overdosages. In case of suspected massive overdosages, a symptomatic and supportive treatment should be instituted.

Therapeutic Class of vaginal gel:-Flamyd v 1.3% (AS A Metronidazole AS A Amoebicides, Anti-diarrhoeal Antiprotozoal)

  •  

♦️moniliasis:♦️☘️

🗣️More common than trichomonas vaginalis

,🗣️Due to:

🎈high acidic pH of vaginal secretions

🎈Frequent presence of sugar in urine during pregnancy

🎈More prevalent in diabetic pregnancy

Rx-👉 miconazole vaginal cream

Cream 1:-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Indications of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Fenticona vaginal cream is used for the treatment of vulvovaginal candidiasis.

Fenticona vaginal tablet is indicated for:

  • Vulvovaginal candidiasis
  • Trichomoniasis
  • Mixed Vaginal infections caused by Candida Albicans & Trichomonas vaginalis

Pharmacology of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Fenticonazole is a broad-spectrum antimycotic agent with activity against dermatophytes and yeasts. Fenticonazole has also been shown to exhibit antibacterial action, with a spectrum of activity that includes bacteria commonly associated with vaginal infections and antiparasitic action against the protozoan Trichomonas vaginalis. Therefore, Fenticonazole may be an ideal topical alternative to multi-agent treatment of mixed infections involving mycotic, bacterial, dermatophyte and/or Trichomonas spp.

Dosage of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Fenticonazole vaginal cream:

  • Route of application is intravaginal. For adults, one applicator full (about 5 gm) is to be administered into the vagina in the morning and evening for three days.
  • After each application, clean it carefully with warm water and soap. Do not use water which is hotter than 50°C or solvents. Then wipe the applicator and store in its packet. Always wash your hands with mild soap and warm water afterwards. Fenticonazole is not greasy and can easily be removed with water.

Fenticonazole vaginal tablet:

  • Trichomonas or mixed (Trichomonas and Candida albicans) vaginal infections: One 600 mg VT (followed by a second administration 24 hours later, if necessary).
  • Candida albicans infections: One single 600 mg VT administration in the evening. Should the symptoms persist, a second administration may be repeated after three days.
  • The tablet must be introduced deep into the vagina and pushed well up to the fornix. To avoid re-infection, it is recommended that the partner undergoes concurrent treatment with Fenticonazole Cream or similar Azole Cream.

Administration of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Follow the instructions to use Fenticonazole cream-

  • Screw the applicator onto the tube in place of the cap.
  • Squeeze the tube gently at its lower end, so as to fill the applicator at 5 gm mark. Unless prescribed by the physician, the applicator must be completely filled up to 5 gm.
  • After taking measured amount cream, remove the applicator from the tube, which should be closed immediately with the cap.
  • In a lying down position, with knees raised and spread apart, delicately insert the applicator into the vagina as deeply as possible. Push the piston to penetrate cream completely, then pull out the applicator without touching the piston.

Follow the instructions to use Fenticonazole vaginal tablet:

  • Pull out plunger until it stops. Place a vaginal tablet into the applicator.
  • Insert applicator containing the tablet carefully as deeply as possible into the vagina (best lying on your back).
  • Push plunger until it stops, there by depositing the tablet into the vagina. Remove the applicator.
  • After use, remove plunger completely by pulling it out of the applicator. Then wash it in warm (not boiling) soapy water, rinse & dry carefully.
  • Pregnant woman must follow physician’s instructions.

Interaction of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Not investigated. Since systemic absorption of Fenticona after application is low, interactions with other drugs are unlikely.

Contraindications

Hypersensitivity to Fenticonazole or any component of the formulation.

Side Effects of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

After intravaginal administration slight transient burning (which usually disappears rapidly) may occasionally happen. Prolonged topical application may cause sensitisation reactions. Fenticona is generally well tolerated by the mucous membranes; only exceptionally mild and transient erythematous reactions have been reported. After topical application or intravaginal administration, a slight burning sensation may occur, usually subsiding soon. Should more persistent irritation occur or resistant micro-organism develop, suspend the treatment and seek the doctor’s advice. Due to poor absorption of Fenticona, no systemic effects should occur, provided the above instructions are carefully observed.

Pregnancy & Lactation of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Since there is no data of use during pregnancy or lactation, So Fenticonazole should not be used without physician’s advice.

Precautions & Warnings of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

It should not be used in conjunction with barrier contraceptives. In the event of a hypersensitivity reaction or development of resistant organisms, treatment should be discontinued and take physician consultation.

Use in Special Populations of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

The use of Fenticona vaginal cream in children is not recommended.

Overdose Effects of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Because of the low systemic absorption after vaginal application, overdosage is unlikely.

Therapeutic Class of Cream :-Fenticona 2% w/w 30gm tube (AS A Fenticonazole Nitrate AS A Topical Antifungal preparations).

Topical Antifungal preparations

OR

Cream 2:Micoderm 2% W/W 10gm tube AS A Miconazole Nitrate

♦️Cervical ectopy:♦️☘️

🗣️due to hyperestrogenic state

Rx-👉 sponteneous regression occurs usually 6-8 wks postpartum .

♦️Cervical polyp:♦️☘️

🗣️any pre- existing polyp bleeds due to increased vascularity.

🗣️in early months: confuse with the diagnosis of threatened abortion

🗣️In later months: constitute the extraplacental cause of APH.

Rx👉-polyp should be removed in the non pregnant state and sent for histological examination.

Raiyyan Tahsan Date:22-01-2025 Wednesday Time:4-38-45 PM

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