bd8dskin _ pregnancy.ppt

7/25/2019 bd8dSKIN _ pregnancy.ppt

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SKINSKINand PREGNANCYand PREGNANCY

ByBy

Dr M. Y.Abd El-Mawla,MDDr M. Y.Abd El-Mawla,MD

Zagazig Faculty ofZagazig Faculty ofMedicine,Zagazig ,EGYPTMedicine,Zagazig ,EGYPT


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IntroductionIntroduction Changes in the Skin ue toChanges in the Skin ue to

PregnancyPregnancy

Skin Conditions Infun!d b"Skin Conditions Infun!d b"

Pr#nan!"Pr#nan!" Pr#nan!" and I$$un-MdiatdPr#nan!" and I$$un-Mdiatd

DisordrsDisordrs

Skin Conditions S%!i&! toSkin Conditions S%!i&! toPr#nan!"Pr#nan!"

'( )s o* Dru#s *or Dr$atolo#i!'( )s o* Dru#s *or Dr$atolo#i!


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Changes in the Skin ue toChanges in the Skin ue to

PregnancyPregnancy +"%r%i#$ntation+"%r%i#$ntation

1.1. Gnralid or in!ras in %i#$ntGnralid or in!ras in %i#$nt

at s%!i&! aras su!( as t( arola,at s%!i&! aras su!( as t( arola,

#nitals, innr t(i#(s, or ailla#nitals, innr t(i#(s, or ailla

.. Mlas$a / In $ost !ass, t(Mlas$a / In $ost !ass, t(("%r%i#$ntation / %idr$al("%r%i#$ntation / %idr$al

$lanin d%osition du to a$lanin d%osition du to a

!o$bination o* li#(t %osur and!o$bination o* li#(t %osur and

l0atd (or$ons 1stro#n,l0atd (or$ons 1stro#n,

%ro#stron, and $lano!"t-%ro#stron, and $lano!"t-

sti$ulatin# (or$onsti$ulatin# (or$on..


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Mlas$aMlas$a


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PregnancyPregnancy +air2 Nail C(an#s+air2 Nail C(an#s

3.3. +irsutis$ 2 *ronto%arital+irsutis$ 2 *ronto%aritalt(innin# o* $al-%attrn alo%!ia /t(innin# o* $al-%attrn alo%!ia /

in!ras in andro#nsin!ras in andro#ns

.. Post%artu$/ (irsutis$ rsol0sPost%artu$/ (irsutis$ rsol0sand (air $a" ntr t( tlo#nand (air $a" ntr t( tlo#n

%(as, rsultin# in t( di4us%(as, rsultin# in t( di4us

s(ddin# o* tlo#n 5u0iu$s(ddin# o* tlo#n 5u0iu$

6.6. Nail !(an#s / trans0rs #roo0in#,Nail !(an#s / trans0rs #roo0in#,

brittlnss, distal on"!(ol"sis, andbrittlnss, distal on"!(ol"sis, and

subun#ual ("%rkratosissubun#ual ("%rkratosis


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'lo#n 5u0iu$'lo#n 5u0iu$


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Andro#ni! aalo%!iaAndro#ni! aalo%!ia


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7as!ular C(an#s7as!ular C(an#s

in Pr#nan!"in Pr#nan!" Er"t($a 1$ostEr"t($a 1$ost

wo$n8wo$n8

S%idrS%idrtlan#i!tasstlan#i!tass199:8199:8

7a#ina7a#ina1;a!#s

?a!?a!


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7as!ular C(an#s7as!ular C(an#s

in Pr#nan!"in Pr#nan!" 7ari!ositis 1@: o*7ari!ositis 1@: o*

wo$n8wo$n8

Pur%uraPur%ura

7aso$otor7aso$otorinstabilit"instabilit"

Non %ittin# d$aNon %ittin# d$a1B: o* wo$n1B: o* wo$n

P"o#ni! #ranulo$aP"o#ni! #ranulo$a

>#s 2+$orr(oids>#s 2+$orr(oids

>owr tr$itis>owr tr$itis

?a!ial fus(in# ,Pallor?a!ial fus(in# ,Pallor

Cutis $ar$orataCutis $ar$orata

,Ra"naud=s%(no$na,Ra"naud=s%(no$na

?a!,lids 2tr$itis?a!,lids 2tr$itis

Gin#i0a and ot(rGin#i0a and ot(rsitssits


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P"o#ni! #ranulo$aP"o#ni! #ranulo$a


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Glandular C(an#sGlandular C(an#s

In!rasdIn!rasd E!!rinE!!rin#lands#lands*un!tion/*un!tion/

Miliaria ,+"%r(idrosisMiliaria ,+"%r(idrosis

2D"s(idroti! !$a2D"s(idroti! !$a

D!rasdD!rasdA%o!rinA%o!rin*un!tion/*un!tion/

In!rasd Sba!ous *un!tion inIn!rasd Sba!ous *un!tion in

t(ird tri$str/t(ird tri$str/

A!n 10ariant-%ruriti! *olli!ulitisA!n 10ariant-%ruriti! *olli!ulitis

o* %r#nan!"8 2Sba!ous #landso* %r#nan!"8 2Sba!ous #lands

on t( arola 1Mont#o$r"=son t( arola 1Mont#o$r"=s

#lands8#lands8


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Conn!ti0 'issuConn!ti0 'issu

C(an#s in Pr#nan!"C(an#s in Pr#nan!" Stria distnsaStria distnsa1:8 on t(1:8 on t(

abdo$n, on t( brasts, t(i#(s,abdo$n, on t( brasts, t(i#(s,

and in#uinal aras.and in#uinal aras.

M!(ani!al strt!( 2 in!rasdM!(ani!al strt!( 2 in!rasd

(or$ons 1adrno!orti!al,(or$ons 1adrno!orti!al,

stro#n, and rlain8 ar t(stro#n, and rlain8 ar t($ost si#ni&!ant *a!tors in t($ost si#ni&!ant *a!tors in t(

d0lo%$nt o* stria,d0lo%$nt o* stria,


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Stria distnsaStria distnsa

Ski C di i I f dSki C diti I f d


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Skin Conditions Infun!dSkin Conditions Infun!d

b" Pr#nan!"b" Pr#nan!"

Mlano$as /Mlano$as /no in!rasd risk o*no in!rasd risk o*$lano$a in %r#nan!" .(n$lano$a in %r#nan!" .(ndia#nosd durin# %r#nan!" $a" bdia#nosd durin# %r#nan!" $a" bt(i!kr and t(r*or (a0 a worst(i!kr and t(r*or (a0 a wors%ro#nosis%ro#nosis

N0i/N0i/ $a" d0lo%, nlar#, or$a" d0lo%, nlar#, ordarkn.2 s(ow $ild !"tolo#i! at"%iadarkn.2 s(ow $ild !"tolo#i! at"%ia..

Dr$ato&bro$as >io$"o$as KloidsDr$ato&bro$as >io$"o$as KloidsDr$ato&brosar!o$a/Dr$ato&brosar!o$a/ $a" d0lo%$a" d0lo%or #row ra%idl" in %r#nan!"or #row ra%idl" in %r#nan!"

t t


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t r n on t onsr n on onsInfun!d b" Pr#nan!"Infun!d b" Pr#nan!"

Ato%i! dr$atitisAto%i! dr$atitis

3.3. Mor likl" to worsnMor likl" to worsn

t(an i$%ro0t(an i$%ro0

.. Ma" %rsnt *or t( &rstMa" %rsnt *or t( &rst

ti$ durin# %r#nan!" wit(ti$ durin# %r#nan!" wit(

kratosis %ilariskratosis %ilaris

6.6. Irritant (and dr$atitisIrritant (and dr$atitisdu to was(in# %ost%artu$ 2ni%%ldu to was(in# %ost%artu$ 2ni%%l

dr$atitis du to nursin#dr$atitis du to nursin#


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t(r Skin Conditionst(r Skin Conditions

Infun!d b" Pr#nan!"Infun!d b" Pr#nan!" PsoriasisPsoriasis// Mor likl" to i$%ro0 t(anMor likl" to i$%ro0 t(an

worsnworsn

Psoriati! art(ritis $a" worsnPsoriati! art(ritis $a" worsn I$%ti#o (r%ti*or$isI$%ti#o (r%ti*or$is1#nralid1#nralid

%ustular %soriasis8 /%ustular %soriasis8 / durin# last tri$str,durin# last tri$str,but $a" %rsnt arlir 2%rsists untilbut $a" %rsnt arlir 2%rsists untildli0r" or lon# a*trdli0r" or lon# a*tr

3.3. Asso!iatd wit( d!rasd !al!iu$Asso!iatd wit( d!rasd !al!iu$andFor 0ita$in DandFor 0ita$in D

.. S0r $alais, *0r, nausa , 0o$itin#,S0r $alais, *0r, nausa , 0o$itin#,ttan", siursttan", siurs

6.6. Grou%dGrou%d %ustuls%ustulsat t( $ar#ins o*at t( $ar#ins o*s"$$tri! r"t($atous %at!(ss"$$tri! r"t($atous %at!(s


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I$%ti#o (r%ti*or$isI$%ti#o (r%ti*or$is


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I$%ti#oI$%ti#o

(r%ti*or$is (r%ti*or$is

P 2A iP 2A t i


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Pr#nan!" 2Autoi$$unPr#nan!" 2Autoi$$un

DisordrsDisordrs

C(an#s in (or$ons in!ludin# t(C(an#s in (or$ons in!ludin# t(in!ras in stro#n a4!t t( !oursin!ras in stro#n a4!t t( !ourso* autoi$$un disass.o* autoi$$un disass.

'( *to%la!ntal unit dir!ts $atrnal'( *to%la!ntal unit dir!ts $atrnali$$unit" towardi$$unit" toward (u$oral(u$oralrs%onss b"rs%onss b"*a0orin# !rtain !"tokins and ot(r*a0orin# !rtain !"tokins and ot(rinfa$$ator" $diatorsinfa$$ator" $diators

En(an!dEn(an!d(u$oral i$$unit" 2(u$oral i$$unit" 2wakndwaknd !llular i$$unit" lad to!llular i$$unit" lad to0ariabl 4!ts t(at ar d%ndnt on0ariabl 4!ts t(at ar d%ndnt ont( s%!i&! disas %ro!ss .t( s%!i&! disas %ro!ss .


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S"st$i! lu%usS"st$i! lu%us

r"t($atosusr"t($atosus S>E $a" worsn and $a" far %ost%artu$.S>E $a" worsn and $a" far %ost%artu$. >u%us %atints ar ad0isd to a0oid tr"in#>u%us %atints ar ad0isd to a0oid tr"in#

to !on!i0 w(n t(ir disas is a!ti0to !on!i0 w(n t(ir disas is a!ti0 )ndrl"in# lu%us rnal disas $a" worsn)ndrl"in# lu%us rnal disas $a" worsn

durin# %r#nan!".durin# %r#nan!". '(r is a si#ni&!ant risk o* !la$%sia'(r is a si#ni&!ant risk o* !la$%sia A!ti0 disas in t( $ot(r, $atrnal usA!ti0 disas in t( $ot(r, $atrnal us

o* %otntiall" trato#ni! $di!ations, ando* %otntiall" trato#ni! $di!ations, and

%at(o#ni! antibodis 1%at(o#ni! antibodis 1anti-Roanti-Ro----))trans$ittd *ro$ t( $ot(r $a" %rsnttrans$ittd *ro$ t( $ot(r $a" %rsntrisks to t( *tus.risks to t( *tus.


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Ro1SS-A8 2?otal riskRo1SS-A8 2?otal risk

Nonatal lu%us in $ot(rsNonatal lu%us in $ot(rs

wit( !ir!ulatin# anti-Ro1SS-wit( !ir!ulatin# anti-Ro1SS-

A8 antibodisA8 antibodis In!rasd risk o* %r$aturit"In!rasd risk o* %r$aturit"

and s%ontanous abortionand s%ontanous abortion

Con#nital (art blo!kCon#nital (art blo!k


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Nonatal lu%usNonatal lu%us

! ti h h li id!nt

i"hos"holi"id


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!nti"hos"holi"id!nti"hos"holi"id

syndro#e$syndro#e$aP>s8in %r#nantaP>s8in %r#nant

wit( S>Ewit( S>EA%%roi$atl" on t(ird o* %atintsA%%roi$atl" on t(ird o* %atintsw(o (a0 S>E also (a0 aP>s..w(o (a0 S>E also (a0 aP>s.. aP>s / (tro#nous #rou% o*aP>s / (tro#nous #rou% o*

autoantibodis t(at bindautoantibodis t(at bind%(os%(oli%ids, %rotins, or a%(os%(oli%ids, %rotins, or a%(os%(oli%idH%rotin !o$%l on%(os%(oli%idH%rotin !o$%l on%latlts and or 0as!ular ndot(liu$.%latlts and or 0as!ular ndot(liu$.

'wo bst !(ara!trid / t( lu%us'wo bst !(ara!trid / t( lu%us

anti!oa#ulant 1>A8 and anti!ardioli%inanti!oa#ulant 1>A8 and anti!ardioli%inantibodis 1aC>8antibodis 1aC>8

..


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la%oratory criteria for thela%oratory criteria for the

diagnosis of !PSdiagnosis of !PS Pr#nan!" >ossPr#nan!" >oss R!urrnt s%ontanous abortion 2R!urrnt s%ontanous abortion 2

)n%laind *tal dat()n%laind *tal dat(

'(ro$bosis/ 7nous t(ro$bosis 2'(ro$bosis/ 7nous t(ro$bosis 2Artrial t(ro$bosis, strokArtrial t(ro$bosis, strok Autoi$$un t(ro$bo!"to%nia2Autoi$$un t(ro$bo!"to%nia2

($ol"ti! an$ia($ol"ti! an$ia 'ransint is!($i! atta!ks'ransint is!($i! atta!ks C(ora #ra0idaru$ 2>i0do rti!ularisC(ora #ra0idaru$ 2>i0do rti!ularis &a%oratory criteria&a%oratory criteria

>u%us anti!oa#ulant, Anti!ardioli%in>u%us anti!oa#ulant, Anti!ardioli%in

antibodis , 3BH I#G bindin# units2antibodis , 3BH I#G bindin# units2a!ti0atd %artial t(ro$bo%lastin ti$ .a!ti0atd %artial t(ro$bo%lastin ti$ .


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Conditions S%!i&! toConditions S%!i&! to

Pr#nan!"Pr#nan!" +r%s #stationis 1+G8 1also known+r%s #stationis 1+G8 1also known

as J%$%(i#oid #stationisJ8 .as J%$%(i#oid #stationisJ8 .

Pruriti! and urti!arial %a%uls andPruriti! and urti!arial %a%uls and

%la


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+r%s Gstationis + G+r%s Gstationis + G

1%$%(i#oid #stationis1%$%(i#oid #stationis88

'( in!idn! 3 in B, %r#nan!is'( in!idn! 3 in B, %r#nan!is D0lo%in# durin# t( s!ond or t(irdD0lo%in# durin# t( s!ond or t(ird

tri$str 1$an onst, 3 wks8 2tri$str 1$an onst, 3 wks8 2

r%ortd in t( &rst tri$str.r%ortd in t( &rst tri$str.

Intnsl" %ruriti!, urti!arial lsions onIntnsl" %ruriti!, urti!arial lsions on

t( abdo$n in (al* o* t( !asst( abdo$n in (al* o* t( !ass

s%!iall"s%!iall" %riu$bili!all"%riu$bili!all", wit( a ra%id, wit( a ra%id

%ro#rssion to $ulti%l, #nralid%ro#rssion to $ulti%l, #nralidbulla. ?a!, $u!ous $$brans, %al$s,bulla. ?a!, $u!ous $$brans, %al$s,

and sols /and sols / s%ards%ard..


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I$%ro0in# durin# t( latr %art o*I$%ro0in# durin# t( latr %art o*%r#nan!", onl" to far at dli0r" or%r#nan!", onl" to far at dli0r" or%ost%artu$ in about B: o* %atints%ost%artu$ in about B: o* %atints

+isto%at(olo#"+isto%at(olo#"/ a sub%idr$al 0si!l/ a sub%idr$al 0si!lwit( %ri0as!ular in&ltrationwit( %ri0as!ular in&ltration1l"$%(o!"ts 2 osino%(ils8.1l"$%(o!"ts 2 osino%(ils8.

Dir!t i$$unofuors!n!Dir!t i$$unofuors!n!/C6 wit( or/C6 wit( or

wit(out I#G in a linar band alon# t(wit(out I#G in a linar band alon# t(bas$nt $$bran on 1LM8. '(bas$nt $$bran on 1LM8. '(antibod" lo!alis to t( roo* o* t(antibod" lo!alis to t( roo* o* t(blistr.blistr.

A $is$at!( o* +>A anti#ns btwn t(A $is$at!( o* +>A anti#ns btwn t($ot(r and *at(r, $ani*std b" an$ot(r and *at(r, $ani*std b" ani$$unolo#i! rs%ons a#ainst t(i$$unolo#i! rs%ons a#ainst t(%atrnal !lass II anti#ns at t( %la!ntal%atrnal !lass II anti#ns at t( %la!ntal

LM wit( !ross-ra!tion at t( skin LM.LM wit( !ross-ra!tion at t( skin LM.


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?otal Risk in in +G?otal Risk in in +G

'( nwborn s(ows'( nwborn s(ows

si#ns o* +G in lsssi#ns o* +G in lss

t(an 3: o* !ass.t(an 3: o* !ass.'( *otal risk /'( *otal risk /

%r$aturit" and low%r$aturit" and lowbirt(wi#(tbirt(wi#(t,,


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)rti!arial %la


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Pa%uls and Pla


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Lio%s"Lio%s" :: a s%on#ioti! %idr$is wit( aa s%on#ioti! %idr$is wit( a%ri0as!ular infa$$ator" in&ltrat/%ri0as!ular infa$$ator" in&ltrat/in!rasd nu$brs o* osino%(ils.in!rasd nu$brs o* osino%(ils.

I$$unofuors!n!I$$unofuors!n!/ n#ati0/ n#ati0 Posin# no risk to t( $ot(rPosin# no risk to t( $ot(r

1!%t %ruritus8 or *tus, rsol0in#1!%t %ruritus8 or *tus, rsol0in#

%ost%artu$%ost%artu$.. Atiolo#" /Atiolo#" /

3.3. Abdo$inal distntion/ li!itin# anAbdo$inal distntion/ li!itin# an

infa$$ator" rs%ons b" da$a#in#infa$$ator" rs%ons b" da$a#in#t( !onn!ti0 tissu 2t( !onn!ti0 tissu 2

.. A substan! rlasd *ro$ %la!ntaA substan! rlasd *ro$ %la!ntainto t( $atrnal !ir!ulationinto t( $atrnal !ir!ulation

tri##rs &broblast %roli*rationtri##rs &broblast %roli*ration


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Intra(%ati! C(olstasis o*Intra(%ati! C(olstasis o*

Pr#nan!" 1ICP8Pr#nan!" 1ICP8 In t( t(ird tri$str o* %r#nan!"In t( t(ird tri$str o* %r#nan!"

1$an, 63 wks8 wit( a $ild *or$ o*1$an, 63 wks8 wit( a $ild *or$ o*intra(%ati! bil s!rtor" d"s*un!tion.intra(%ati! bil s!rtor" d"s*un!tion.

?aturs /?aturs /33-#nralid %ruritus wit( or-#nralid %ruritus wit( orwit(out aundi!wit(out aundi! -absn! o* %ri$ar"-absn! o* %ri$ar"skin lsions,skin lsions, 168168bio!($i!albio!($i!alabnor$alitis !onsistnt wit(abnor$alitis !onsistnt wit(!(olstasis,1!(olstasis,1l0atd sru$ bil a!idsl0atd sru$ bil a!ids

1$an, 36@ $u#F3 $>81$an, 36@ $u#F3 $>8 and 1@8and 1@8rsolution a*tr dli0r".rsolution a*tr dli0r". R!urrn! wit( subs


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Pat(o%("siolo#"Pat(o%("siolo#"

Estro#ns intr*r wit( t( di4usion o*Estro#ns intr*r wit( t( di4usion o*

fuid a!ross t( !anali!ular $$branfuid a!ross t( !anali!ular $$bran

o* t( (%ato!"t and subs


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Prurigo of "regnancyPrurigo of "regnancy

$PP$PP88 '( in!idn! / 3 in 6'( in!idn! / 3 in 6

%r#nan!is.%r#nan!is. In all tri$strs o* %r#nan!"In all tri$strs o* %r#nan!"

Er"t($atous %a%uls and nodulsEr"t($atous %a%uls and nodulson t( tnsor sur*a!s o* t(on t( tnsor sur*a!s o* t(tr$itis and o!!asionall" on t(tr$itis and o!!asionall" on t(abdo$nabdo$n

R!urrn! durin# subs


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Pruriti! *olli!ulitis o*Pruriti! *olli!ulitis o*

%r#nan!"%r#nan!"1P?P81P?P8 Gnralid, %ruriti! r"t($atous,Gnralid, %ruriti! r"t($atous,

*olli!ular %a%uls, d0lo%in# *ro$ t(*olli!ular %a%uls, d0lo%in# *ro$ t(*ourt( to t( nint( $ont( o**ourt( to t( nint( $ont( o*#station .#station .

A *or$ o* stroid a!n, wit( noA *or$ o* stroid a!n, wit( no0idn! o* an" i$$unolo#i! or0idn! o* an" i$$unolo#i! or(or$onal abnor$alitis.(or$onal abnor$alitis.

So$ aut(orsO (a0 su##std t(atSo$ aut(orsO (a0 su##std t(atP?P and PP s(ould b in!ludd wit(inP?P and PP s(ould b in!ludd wit(int( s%!tru$ o*t( s%!tru$ o*JJ%ol"$or%(i! ru%tion%ol"$or%(i! ru%tiono* %r#nan!".o* %r#nan!".


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'( )s o* Dru#s *or'( )s o* Dru#s *or

Dr$atolo#i! ConditionsDr$atolo#i! Conditionsin Pr#nan!"in Pr#nan!"

?DA Pr#nan!" Cat#oris?DA Pr#nan!" Cat#oris


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?DA Pr#nan!" Cat#oris?DA Pr#nan!" Cat#orisAA Controlld studis s(ow no *tal riskControlld studis s(ow no *tal risk LL No risk to (u$an *tus ds%itNo risk to (u$an *tus ds%it

%ossibl ani$al%ossibl ani$alrisk.risk.

CC Risk !annot b ruld out (u$anRisk !annot b ruld out (u$anstudis ar la!kin#.studis ar la!kin#.

DD Positi0 0idn! *or risk to (u$anPositi0 0idn! *or risk to (u$an*tus, but bn&ts $a" outwi#( risks o**tus, but bn&ts $a" outwi#( risks o*

dru#dru#

Contraindi!atd in %r#nan!" t(r isContraindi!atd in %r#nan!" t(r isno rason to risk us o* dru# in %r#nan!"no rason to risk us o* dru# in %r#nan!")ndtr$ind)ndtr$ind No %r#nan!"No %r#nan!"

!at#or" "t assi#nd!at#or" "t assi#nd


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'o%i!al !orti!ostroids'o%i!al !orti!ostroidsdurin#durin#%r#nan!" /wit( a low risk to t(%r#nan!" /wit( a low risk to t(

*tus1*tus1 Cat#or" CCat#or" Crisk8 as t( riskrisk8 as t( risk!annot b ruld out b!aus no (u$an!annot b ruld out b!aus no (u$an

studis (a0 bn don.studis (a0 bn don.

'o%i!al'o%i!al %o0idon-iodin%o0idon-iodinandand

%odo%("llin%odo%("llin%la! a *tus at risk. / not%la! a *tus at risk. / not

r!o$$ndd *or us durin#r!o$$ndd *or us durin#

%r#nan!"%r#nan!"

Anal#si!sAnal#si!s/ asso!iatd wit( $ini$al/ asso!iatd wit( $ini$alrisk to t( *tus or in*ant.risk to t( *tus or in*ant.

Indo$t(a!in//asso!iatd wit(Indo$t(a!in//asso!iatd wit(

%robl$s in in*ants .%robl$s in in*ants .


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RtinoidsRtinoids andand antino%lasti!antino%lasti!//isotrtinoin 1usd to trat a!nisotrtinoin 1usd to trat a!n

0ul#aris8 2 antino%lasti! #0ul#aris8 2 antino%lasti! #$t(otrat/ !at#or" .$t(otrat/ !at#or" .

Anti%ruriti!Anti%ruriti!a#nts. / do%in/a#nts. / do%in/a0oidd durin# %r#nan!" anda0oidd durin# %r#nan!" andla!tation. +"dro"in / risk in t( &rstla!tation. +"dro"in / risk in t( &rsttri$str o* %r#nan!" and istri$str o* %r#nan!" and isasso!iatd wit( a risk o* !on#nitalasso!iatd wit( a risk o* !on#nitalabnor$alit".abnor$alit".

Antibioti!s/Antibioti!s/in!ludin# ttra!"!lin 2in!ludin# ttra!"!lin 2!i%rofoa!in--%os %otntial risks!i%rofoa!in--%os %otntial risksdurin# %r#nan!".. Pni!illins ardurin# %r#nan!".. Pni!illins ar!onsidrd !o$%arati0l" sa* durin#!onsidrd !o$%arati0l" sa* durin#

%r#nan!"%r#nan!"


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T'!()T'!()Y*+Y*+

bd8dskin _ pregnancy.ppt

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