Obstructed labor occurs when there is poor or no progress of labor despite strong uterine contractions. It affects 1-2% of deliveries in developing countries and can be caused by issues with the birth canal (e.g. a small pelvis) or the baby (e.g. large size). Diagnosis involves examining the woman and monitoring labor progress with a partograph. Management includes general supportive care, obstetric interventions like assisted delivery or C-section, and treatment to prevent complications for both mother and baby like rupture, infection, asphyxia, or death. Prolonged labor is defined as over 18 hours and can be caused by weak contractions, cervical issues, or structural problems, requiring evaluation
Intrauterine fetal death refers to babies with no signs of life in utero after 24 completed weeks of gestation or weighing over 500g. The document discusses the definition, incidence, impacts, causes, diagnosis, investigations, labour and birth process, complications, lactation, postmortem examination, legal issues, psychological aspects, and follow up considerations for intrauterine fetal death. The overall goal is to provide compassionate care for the health of the mother and support for her and her partner during this difficult time.
Hypertension is a common pregnancy complication and can be pregnancy-induced or pre-existing. Preeclampsia is defined as new hypertension with proteinuria after 20 weeks of gestation. It has various risk factors and causes damage through abnormal placentation. Clinically, it ranges from mild to severe based on blood pressure and can cause maternal organ damage. It is managed through blood pressure control, delivery once stabilized, and monitoring for complications like eclampsia. Preventing measures include calcium, anti-thrombotics and screening high risk women.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The incidence of IUGR is about 3-10% in developed countries. IUGR babies have an increased risk of perinatal mortality and morbidity that progressively increases as birth weight percentile decreases.
3) IUGR can be symmetrical, affecting growth uniformly, or asymmetrical, where the head is larger than the abdomen indicating preferential shunting of nutrients to the brain. Causes include placental insufficiency, infections, and genetic/structural abnormalities.
This document discusses normal amniotic fluid levels at different gestational ages and the causes and effects of oligohydramnios, or low amniotic fluid. It notes that oligohydramnios can be caused by maternal or fetal conditions and presents risks to both mother and fetus. Management involves counseling, serial ultrasounds, amnioinfusion to increase fluid if needed, and close monitoring during labor due to risks of complications from reduced fluid levels like fetal distress, prolonged labor, and infection.
This document discusses breech presentation, which occurs when a fetus is positioned feet or buttocks first in the birth canal rather than head first. It defines breech presentation and classifies the different types. It then covers the etiology, diagnosis, complications, mechanism of labor, and management both antenatally and during delivery. Management may involve external cephalic version, planned cesarean section, or attempted vaginal breech delivery depending on the situation. Close monitoring and potential interventions are needed during a breech delivery to avoid complications for both mother and baby.
Dr. Sourav Chowdhury provides a detailed overview of ectopic pregnancy in 3 pages of text. Some key points:
- An ectopic pregnancy is when a fertilized egg implants outside the uterus, usually in the fallopian tubes.
- Risk factors include previous pelvic inflammatory disease, tubal surgery or infertility treatments. The most common site is the fallopian tube (95-96% of cases).
- Clinical signs can range from asymptomatic to acute abdominal pain and bleeding. Diagnosis involves transvaginal ultrasound, serum hCG levels and laparoscopy.
- Treatment depends on stability but may include expectant management, systemic or local methotrexate, or surgical
This document discusses molar pregnancy, also known as hydatidiform mole. It begins by classifying gestational trophoblastic disease as either benign, premalignant, or malignant. It then discusses the characteristics of complete and partial moles. Complete moles have no fetal tissue and are caused by fertilization of an empty ovum, while partial moles contain some fetal tissue and are usually triploid. Symptoms of a complete mole include vaginal bleeding, hyperemesis gravidarum, and a uterus larger than dates. Diagnosis involves ultrasound showing a "snowstorm" pattern, elevated hCG levels, and pathological examination of tissue. Complications can include theca-lutein cysts, pre
Obstructed labor occurs when there is poor or no progress of labor despite strong uterine contractions. It affects 1-2% of deliveries in developing countries and can be caused by issues with the birth canal (e.g. a small pelvis) or the baby (e.g. large size). Diagnosis involves examining the woman and monitoring labor progress with a partograph. Management includes general supportive care, obstetric interventions like assisted delivery or C-section, and treatment to prevent complications for both mother and baby like rupture, infection, asphyxia, or death. Prolonged labor is defined as over 18 hours and can be caused by weak contractions, cervical issues, or structural problems, requiring evaluation
Intrauterine fetal death refers to babies with no signs of life in utero after 24 completed weeks of gestation or weighing over 500g. The document discusses the definition, incidence, impacts, causes, diagnosis, investigations, labour and birth process, complications, lactation, postmortem examination, legal issues, psychological aspects, and follow up considerations for intrauterine fetal death. The overall goal is to provide compassionate care for the health of the mother and support for her and her partner during this difficult time.
Hypertension is a common pregnancy complication and can be pregnancy-induced or pre-existing. Preeclampsia is defined as new hypertension with proteinuria after 20 weeks of gestation. It has various risk factors and causes damage through abnormal placentation. Clinically, it ranges from mild to severe based on blood pressure and can cause maternal organ damage. It is managed through blood pressure control, delivery once stabilized, and monitoring for complications like eclampsia. Preventing measures include calcium, anti-thrombotics and screening high risk women.
1) Intrauterine growth restriction (IUGR) refers to babies whose birth weight is below the 10th percentile for gestational age. It can affect preterm, term, or post-term babies.
2) The incidence of IUGR is about 3-10% in developed countries. IUGR babies have an increased risk of perinatal mortality and morbidity that progressively increases as birth weight percentile decreases.
3) IUGR can be symmetrical, affecting growth uniformly, or asymmetrical, where the head is larger than the abdomen indicating preferential shunting of nutrients to the brain. Causes include placental insufficiency, infections, and genetic/structural abnormalities.
This document discusses normal amniotic fluid levels at different gestational ages and the causes and effects of oligohydramnios, or low amniotic fluid. It notes that oligohydramnios can be caused by maternal or fetal conditions and presents risks to both mother and fetus. Management involves counseling, serial ultrasounds, amnioinfusion to increase fluid if needed, and close monitoring during labor due to risks of complications from reduced fluid levels like fetal distress, prolonged labor, and infection.
This document discusses breech presentation, which occurs when a fetus is positioned feet or buttocks first in the birth canal rather than head first. It defines breech presentation and classifies the different types. It then covers the etiology, diagnosis, complications, mechanism of labor, and management both antenatally and during delivery. Management may involve external cephalic version, planned cesarean section, or attempted vaginal breech delivery depending on the situation. Close monitoring and potential interventions are needed during a breech delivery to avoid complications for both mother and baby.
Dr. Sourav Chowdhury provides a detailed overview of ectopic pregnancy in 3 pages of text. Some key points:
- An ectopic pregnancy is when a fertilized egg implants outside the uterus, usually in the fallopian tubes.
- Risk factors include previous pelvic inflammatory disease, tubal surgery or infertility treatments. The most common site is the fallopian tube (95-96% of cases).
- Clinical signs can range from asymptomatic to acute abdominal pain and bleeding. Diagnosis involves transvaginal ultrasound, serum hCG levels and laparoscopy.
- Treatment depends on stability but may include expectant management, systemic or local methotrexate, or surgical
This document discusses molar pregnancy, also known as hydatidiform mole. It begins by classifying gestational trophoblastic disease as either benign, premalignant, or malignant. It then discusses the characteristics of complete and partial moles. Complete moles have no fetal tissue and are caused by fertilization of an empty ovum, while partial moles contain some fetal tissue and are usually triploid. Symptoms of a complete mole include vaginal bleeding, hyperemesis gravidarum, and a uterus larger than dates. Diagnosis involves ultrasound showing a "snowstorm" pattern, elevated hCG levels, and pathological examination of tissue. Complications can include theca-lutein cysts, pre
Multiple pregnancies can involve twins, triplets or more. Twin pregnancies are the most common type and can be either dizygotic (fraternal) or monozygotic (identical). Risk factors include advanced maternal age, fertility treatments and genetic factors. Complications of twin pregnancies include preterm birth and low birth weight. Specific complications include twin-twin transfusion syndrome and discordant growth. Care involves monitoring for complications and intervening if needed to improve outcomes for both fetuses.
This document discusses the management of preterm labor in cases of placenta previa and abruption placentae. It describes placenta previa as when the placenta is located over or near the internal os, and notes four degrees. For placenta previa, the expectant management using Macafee-Johnson's regime aims to continue the pregnancy for lung maturity up to 37 weeks without risking maternal health. For abruption placentae, where the placenta prematurely separates, active management through immediate delivery is usually indicated due to risks of further separation and fetal death. Lower segment c-section is often used for placenta previa, while vaginal delivery may be possible if the
A partogram is a graphical chart used to monitor and record the progress of labor. It allows healthcare providers to monitor factors like cervical dilation, fetal descent, fetal heart rate, uterine contractions and maternal vital signs over time. Recording this information on a partogram helps providers identify delays in labor progression early. It is recommended that a partogram be used to record the progress of all women in labor, whether low or high risk. Proper documentation on the partogram is important for continuity of care, decision making, research, review and defending medical actions if needed.
A molar pregnancy occurs when abnormal placental tissue develops instead of a fetus. There are two types: complete and partial moles. A complete mole shows trophoblastic proliferation throughout the placenta and no fetal tissue, while a partial mole shows slight, focal proliferation and may contain some fetal tissue. Clinical features can include vaginal bleeding, uterine enlargement beyond dates, and very high hCG levels in the case of a complete mole. Diagnosis is made through histopathological examination of tissue.
This document discusses breech presentation, including its definition, types, diagnosis, and management. Some key points:
- Breech presentation is when the buttocks or lower limbs present first. It occurs in 3.5% of term deliveries and up to 25% of preterm deliveries.
- Types include complete breech, frank breech, and footling breech. Diagnosis is made through inspection, palpation, auscultation, and ultrasound.
- Management options are external cephalic version, vaginal delivery for some cases, or caesarean section which is recommended for complicated breeches or large babies. Vaginal delivery carries risks of complications for
Placenta praevia is a condition where the placenta is partially or totally attached to the lower uterine segment. It occurs in around 0.5% of pregnancies and is more common in multiparous women and twin pregnancies. Placenta praevia can cause painless vaginal bleeding and is diagnosed using ultrasound imaging. Treatment depends on gestational age and amount of bleeding, and may involve bed rest, induction of labor, or caesarean section to deliver the baby safely. Complications for both mother and baby can include bleeding, prematurity, and difficulty during labor and delivery.
Cervical incompetence, also called cervical insufficiency, is a condition where the cervix begins to dilate and efface before pregnancy has reached term, often resulting in miscarriage. Risk factors include a history of preterm birth, multiple abortions, cervical procedures, or congenital uterine abnormalities. Diagnosis involves a history of second trimester losses and physical exam findings of cervical shortening or dilatation. Treatment options during pregnancy include bed rest, progesterone supplementation, cerclage procedures to reinforce the cervix, and sometimes pessary devices. The goal is to prevent premature dilation and maintain the pregnancy until full term.
Dr. Rupa Rajshekar presents information on abruptio placentae (AP), or premature separation of the placenta from the uterine wall. AP has an incidence of 1 in 75 to 1 in 225 births and can recur in subsequent pregnancies. Risk factors include increased age, preeclampsia, smoking, and prior AP. AP is classified as revealed, concealed, or mixed based on whether bleeding is visible. Complications for both mother and baby can be severe, including hemorrhage, shock, renal failure, and fetal death. Diagnosis is based on symptoms and ultrasound may show placental separation. Management depends on gestational age and maternal stability, and may involve resuscitation, monitoring, steroids
Uterine inversion occurs when the uterus turns inside out, most commonly during the third stage of labor due to excessive traction on the umbilical cord or fundal pressure. It can be incomplete, with just the fundus inverted, or complete, with the entire uterus emerging from the vagina or outside the body. Symptoms include hemorrhage, abdominal pain, and shock. Treatment involves immediate manual repositioning of the uterus if diagnosed early, or the O'Sullivan hydrostatic method using saline if delayed. Prevention relies on avoiding excessive fundal pressure or cord traction during delivery of the placenta.
This document discusses septic abortion, which occurs when an abortion is complicated by infection in the uterus or its contents. It defines septic abortion and outlines its causes, clinical presentation, investigations, management, and complications. Septic abortion is most commonly associated with illegal or unsafe induced abortions where proper aseptic techniques are not followed. Management involves controlling the infection with antibiotics, removing the source of infection, and providing supportive care. Treatment is based on clinical grading of the infection from Grade I (localized) to Grade III (generalized peritonitis or septic shock), with more aggressive management needed for higher grades.
This document provides information on fibroids including their incidence, etiology, risk factors, symptoms, natural history, degenerative changes, diagnosis, effects on fertility and pregnancy, differential diagnosis, and treatment options. It notes that fibroids are benign tumors of the uterus that affect 5-20% of women during their reproductive years and discusses genetic, hormonal, and growth factors that contribute to their development. Common symptoms include abnormal uterine bleeding and pain. Treatment options include watchful waiting, medical therapy such as NSAIDs and GnRH agonists, and surgical options like myomectomy and uterine artery embolization.
Heart disease occurs in approximately 1% of pregnancies and can be caused by rheumatic heart disease, congenital heart defects, or other conditions like ischemic heart disease. Diagnosis involves taking a medical history and performing a physical exam, chest X-ray, electrocardiogram, and echocardiogram. Pregnancy places additional strain on the heart and can exacerbate existing heart conditions or lead to heart failure. Management involves rest, diet, infection prevention, hospitalization if decompensation occurs, and possibly medical treatments like diuretics, beta blockers, or surgical treatments such as cardiac surgery or therapeutic abortion in severe cases. During labor, vaginal delivery is preferred if possible but induction is not recommended if acute heart
Postpartum hemorrhage (PPH) is excessive bleeding following childbirth. It is a leading cause of maternal mortality, accounting for nearly one quarter of maternal deaths worldwide. The most common cause is uterine atony, or failure of the uterus to contract after delivery. Other causes include retained placenta, trauma during delivery, coagulation disorders, and issues like placenta previa. Risk factors include previous PPH, macrosomia, multiple pregnancy, and uterine overdistention. Prevention focuses on risk assessment and active management of the third stage of labor. Treatment depends on the severity but may include uterine massage, uterotonic drugs, uterine packing, arterial ligation, embolization, compression sutures,
This document discusses the biophysical profile, a technique used to assess fetal well-being through 5 parameters: non-stress test (NST), fetal breathing, fetal movements, muscle tone, and amniotic fluid volume. It describes how each parameter is evaluated and provides details on interpreting results. Abnormal results in the biophysical profile are associated with conditions like IUGR and placental insufficiency and may indicate the need for delivery. The document also reviews other tests used to monitor fetal health like contraction stress tests, acoustic stimulation, and Doppler ultrasound assessments of fetal and placental blood flow.
1) Premature rupture of membrane (PROM) is defined as the rupture of amniotic sac more than 1 hour before the onset of labor.
2) PROM can be classified as preterm (before 37 weeks gestation), prolonged (rupture of membranes for over 24 hours before onset of labor), or pre-viable (before 24 weeks gestation).
3) Causes and risk factors of PROM include infections, smoking, previous preterm labor or PROM, polyhydramnios, multiple gestation, bleeding during pregnancy, invasive procedures, and cervical insufficiency. Diagnosis involves history collection, examination, and tests to assess fetal wellbeing.
This document discusses uterine rupture, a serious obstetric complication where the wall of the pregnant uterus tears. It has a high risk of maternal and perinatal mortality. Uterine rupture can occur during labor, delivery, or rarely during pregnancy. It has an incidence of 0.05% for all pregnancies, rising to 0.8% for those with a previous cesarean section. Causes include a weak scar from prior uterine surgery, obstructed labor, or uterine overstimulation from medications. Symptoms include abdominal pain, vaginal bleeding, and non-reassuring fetal heart rate. Diagnosis is usually made during emergency surgery, with ultrasound sometimes identifying signs of rupture. Treatment requires intensive resuscitation
This document discusses hyperemesis gravidarum, a severe form of vomiting during pregnancy. It defines hyperemesis gravidarum as excessive vomiting that negatively impacts a pregnant woman's health and daily activities. Risk factors include young or older age, being pregnant with multiples, obesity, and unwanted pregnancy. Treatment involves hospitalization, IV fluids to correct dehydration and electrolyte imbalances, antiemetic drugs, and nutritional supplementation. Nursing care focuses on monitoring for signs of improvement and complications while encouraging small, frequent meals once vomiting is controlled.
Breech presentation refers to when the fetus is in a longitudinal lie with its buttocks as the lowest part. The document discusses the different types of breech presentations as well as their incidence, classifications, positions, etiology, diagnosis, and management both during pregnancy and delivery. Management during pregnancy includes attempting external cephalic version after 36 weeks to convert the fetus to head-first position. Management during delivery depends on factors such as gestational age and fetal/maternal conditions, and may involve vaginal delivery with assistance, total breech extraction, or cesarean section to avoid risks to the mother and fetus.
Intrauterine Fetal Death (IUFD),(Kurdistan)Znar Mzuri
This document provides an overview of intrauterine fetal death (IUFD), also known as stillbirth. It defines IUFD as the death of a baby in the uterus after 20 weeks of gestation. The document discusses the epidemiology, etiology, risk factors, clinical features, diagnosis, treatment and management, and nursing care of IUFD. It also provides references for additional information.
Intrauterine foetal death is defined as the death of a foetus after 28 weeks of gestation but before birth where the foetus remains in the uterus. The causes of intrauterine foetal death are often unknown but can include preeclampsia, antepartum hemorrhage, diabetes, severe anemia, hyperpyrexia, malaria, TORCH infections, congenital malformations, Rh-incompatibility, and chromosomal abnormalities. The diagnosis is made when the foetus is no longer alive but remains in the uterus.
Multiple pregnancies can involve twins, triplets or more. Twin pregnancies are the most common type and can be either dizygotic (fraternal) or monozygotic (identical). Risk factors include advanced maternal age, fertility treatments and genetic factors. Complications of twin pregnancies include preterm birth and low birth weight. Specific complications include twin-twin transfusion syndrome and discordant growth. Care involves monitoring for complications and intervening if needed to improve outcomes for both fetuses.
This document discusses the management of preterm labor in cases of placenta previa and abruption placentae. It describes placenta previa as when the placenta is located over or near the internal os, and notes four degrees. For placenta previa, the expectant management using Macafee-Johnson's regime aims to continue the pregnancy for lung maturity up to 37 weeks without risking maternal health. For abruption placentae, where the placenta prematurely separates, active management through immediate delivery is usually indicated due to risks of further separation and fetal death. Lower segment c-section is often used for placenta previa, while vaginal delivery may be possible if the
A partogram is a graphical chart used to monitor and record the progress of labor. It allows healthcare providers to monitor factors like cervical dilation, fetal descent, fetal heart rate, uterine contractions and maternal vital signs over time. Recording this information on a partogram helps providers identify delays in labor progression early. It is recommended that a partogram be used to record the progress of all women in labor, whether low or high risk. Proper documentation on the partogram is important for continuity of care, decision making, research, review and defending medical actions if needed.
A molar pregnancy occurs when abnormal placental tissue develops instead of a fetus. There are two types: complete and partial moles. A complete mole shows trophoblastic proliferation throughout the placenta and no fetal tissue, while a partial mole shows slight, focal proliferation and may contain some fetal tissue. Clinical features can include vaginal bleeding, uterine enlargement beyond dates, and very high hCG levels in the case of a complete mole. Diagnosis is made through histopathological examination of tissue.
This document discusses breech presentation, including its definition, types, diagnosis, and management. Some key points:
- Breech presentation is when the buttocks or lower limbs present first. It occurs in 3.5% of term deliveries and up to 25% of preterm deliveries.
- Types include complete breech, frank breech, and footling breech. Diagnosis is made through inspection, palpation, auscultation, and ultrasound.
- Management options are external cephalic version, vaginal delivery for some cases, or caesarean section which is recommended for complicated breeches or large babies. Vaginal delivery carries risks of complications for
Placenta praevia is a condition where the placenta is partially or totally attached to the lower uterine segment. It occurs in around 0.5% of pregnancies and is more common in multiparous women and twin pregnancies. Placenta praevia can cause painless vaginal bleeding and is diagnosed using ultrasound imaging. Treatment depends on gestational age and amount of bleeding, and may involve bed rest, induction of labor, or caesarean section to deliver the baby safely. Complications for both mother and baby can include bleeding, prematurity, and difficulty during labor and delivery.
Cervical incompetence, also called cervical insufficiency, is a condition where the cervix begins to dilate and efface before pregnancy has reached term, often resulting in miscarriage. Risk factors include a history of preterm birth, multiple abortions, cervical procedures, or congenital uterine abnormalities. Diagnosis involves a history of second trimester losses and physical exam findings of cervical shortening or dilatation. Treatment options during pregnancy include bed rest, progesterone supplementation, cerclage procedures to reinforce the cervix, and sometimes pessary devices. The goal is to prevent premature dilation and maintain the pregnancy until full term.
Dr. Rupa Rajshekar presents information on abruptio placentae (AP), or premature separation of the placenta from the uterine wall. AP has an incidence of 1 in 75 to 1 in 225 births and can recur in subsequent pregnancies. Risk factors include increased age, preeclampsia, smoking, and prior AP. AP is classified as revealed, concealed, or mixed based on whether bleeding is visible. Complications for both mother and baby can be severe, including hemorrhage, shock, renal failure, and fetal death. Diagnosis is based on symptoms and ultrasound may show placental separation. Management depends on gestational age and maternal stability, and may involve resuscitation, monitoring, steroids
Uterine inversion occurs when the uterus turns inside out, most commonly during the third stage of labor due to excessive traction on the umbilical cord or fundal pressure. It can be incomplete, with just the fundus inverted, or complete, with the entire uterus emerging from the vagina or outside the body. Symptoms include hemorrhage, abdominal pain, and shock. Treatment involves immediate manual repositioning of the uterus if diagnosed early, or the O'Sullivan hydrostatic method using saline if delayed. Prevention relies on avoiding excessive fundal pressure or cord traction during delivery of the placenta.
This document discusses septic abortion, which occurs when an abortion is complicated by infection in the uterus or its contents. It defines septic abortion and outlines its causes, clinical presentation, investigations, management, and complications. Septic abortion is most commonly associated with illegal or unsafe induced abortions where proper aseptic techniques are not followed. Management involves controlling the infection with antibiotics, removing the source of infection, and providing supportive care. Treatment is based on clinical grading of the infection from Grade I (localized) to Grade III (generalized peritonitis or septic shock), with more aggressive management needed for higher grades.
This document provides information on fibroids including their incidence, etiology, risk factors, symptoms, natural history, degenerative changes, diagnosis, effects on fertility and pregnancy, differential diagnosis, and treatment options. It notes that fibroids are benign tumors of the uterus that affect 5-20% of women during their reproductive years and discusses genetic, hormonal, and growth factors that contribute to their development. Common symptoms include abnormal uterine bleeding and pain. Treatment options include watchful waiting, medical therapy such as NSAIDs and GnRH agonists, and surgical options like myomectomy and uterine artery embolization.
Heart disease occurs in approximately 1% of pregnancies and can be caused by rheumatic heart disease, congenital heart defects, or other conditions like ischemic heart disease. Diagnosis involves taking a medical history and performing a physical exam, chest X-ray, electrocardiogram, and echocardiogram. Pregnancy places additional strain on the heart and can exacerbate existing heart conditions or lead to heart failure. Management involves rest, diet, infection prevention, hospitalization if decompensation occurs, and possibly medical treatments like diuretics, beta blockers, or surgical treatments such as cardiac surgery or therapeutic abortion in severe cases. During labor, vaginal delivery is preferred if possible but induction is not recommended if acute heart
Postpartum hemorrhage (PPH) is excessive bleeding following childbirth. It is a leading cause of maternal mortality, accounting for nearly one quarter of maternal deaths worldwide. The most common cause is uterine atony, or failure of the uterus to contract after delivery. Other causes include retained placenta, trauma during delivery, coagulation disorders, and issues like placenta previa. Risk factors include previous PPH, macrosomia, multiple pregnancy, and uterine overdistention. Prevention focuses on risk assessment and active management of the third stage of labor. Treatment depends on the severity but may include uterine massage, uterotonic drugs, uterine packing, arterial ligation, embolization, compression sutures,
This document discusses the biophysical profile, a technique used to assess fetal well-being through 5 parameters: non-stress test (NST), fetal breathing, fetal movements, muscle tone, and amniotic fluid volume. It describes how each parameter is evaluated and provides details on interpreting results. Abnormal results in the biophysical profile are associated with conditions like IUGR and placental insufficiency and may indicate the need for delivery. The document also reviews other tests used to monitor fetal health like contraction stress tests, acoustic stimulation, and Doppler ultrasound assessments of fetal and placental blood flow.
1) Premature rupture of membrane (PROM) is defined as the rupture of amniotic sac more than 1 hour before the onset of labor.
2) PROM can be classified as preterm (before 37 weeks gestation), prolonged (rupture of membranes for over 24 hours before onset of labor), or pre-viable (before 24 weeks gestation).
3) Causes and risk factors of PROM include infections, smoking, previous preterm labor or PROM, polyhydramnios, multiple gestation, bleeding during pregnancy, invasive procedures, and cervical insufficiency. Diagnosis involves history collection, examination, and tests to assess fetal wellbeing.
This document discusses uterine rupture, a serious obstetric complication where the wall of the pregnant uterus tears. It has a high risk of maternal and perinatal mortality. Uterine rupture can occur during labor, delivery, or rarely during pregnancy. It has an incidence of 0.05% for all pregnancies, rising to 0.8% for those with a previous cesarean section. Causes include a weak scar from prior uterine surgery, obstructed labor, or uterine overstimulation from medications. Symptoms include abdominal pain, vaginal bleeding, and non-reassuring fetal heart rate. Diagnosis is usually made during emergency surgery, with ultrasound sometimes identifying signs of rupture. Treatment requires intensive resuscitation
This document discusses hyperemesis gravidarum, a severe form of vomiting during pregnancy. It defines hyperemesis gravidarum as excessive vomiting that negatively impacts a pregnant woman's health and daily activities. Risk factors include young or older age, being pregnant with multiples, obesity, and unwanted pregnancy. Treatment involves hospitalization, IV fluids to correct dehydration and electrolyte imbalances, antiemetic drugs, and nutritional supplementation. Nursing care focuses on monitoring for signs of improvement and complications while encouraging small, frequent meals once vomiting is controlled.
Breech presentation refers to when the fetus is in a longitudinal lie with its buttocks as the lowest part. The document discusses the different types of breech presentations as well as their incidence, classifications, positions, etiology, diagnosis, and management both during pregnancy and delivery. Management during pregnancy includes attempting external cephalic version after 36 weeks to convert the fetus to head-first position. Management during delivery depends on factors such as gestational age and fetal/maternal conditions, and may involve vaginal delivery with assistance, total breech extraction, or cesarean section to avoid risks to the mother and fetus.
Intrauterine Fetal Death (IUFD),(Kurdistan)Znar Mzuri
This document provides an overview of intrauterine fetal death (IUFD), also known as stillbirth. It defines IUFD as the death of a baby in the uterus after 20 weeks of gestation. The document discusses the epidemiology, etiology, risk factors, clinical features, diagnosis, treatment and management, and nursing care of IUFD. It also provides references for additional information.
Intrauterine foetal death is defined as the death of a foetus after 28 weeks of gestation but before birth where the foetus remains in the uterus. The causes of intrauterine foetal death are often unknown but can include preeclampsia, antepartum hemorrhage, diabetes, severe anemia, hyperpyrexia, malaria, TORCH infections, congenital malformations, Rh-incompatibility, and chromosomal abnormalities. The diagnosis is made when the foetus is no longer alive but remains in the uterus.
This document discusses intrauterine fetal death (IUFD), defined as the death of the fetus inside the uterus after 25 weeks of gestation. It notes that missed abortion occurs before 25 weeks. Causes of IUFD include fetal abnormalities, placental insufficiency, maternal conditions like hypertension, and unexplained cases. Diagnosis involves assessing fetal movement, ultrasound to check for heart activity over 30 minutes, and x-rays to check for signs of fetal demise. Management involves confirming the diagnosis, counseling, inducing labor or cesarean delivery, and evaluating the stillborn infant, placenta, and amniotic fluid. Complications can include psychological trauma, coagulation disorders if the fetus is retained too long, and post
- Stillbirth is defined as fetal death occurring after 20 weeks of gestation or a fetal weight of at least 500 grams. The worldwide stillbirth rate is over 3 million per year.
- The causes of stillbirth are often unknown, but may include maternal conditions like diabetes or hypertension, fetal conditions like growth restriction, and placental conditions like abruption. Advanced maternal age, obesity, and multiple gestations are also risk factors.
- Evaluation of stillbirth includes fetal autopsy, placental examination, and genetic testing. However, the optimal testing and management for subsequent pregnancies after an unexplained stillbirth remains uncertain due to lack of evidence.
INTRAUTERINE DEATH CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016, Dr sharda...Lifecare Centre
HOW TO DEFINE
IUD or STILL BORN
fetal death after period of viability ( 28 weeks )
24 weeks in USA
24WEEKS OR >500 Gms by WHO
ACOG refers to IUFD as the demise occurring at or later than 20weeks.
The document discusses intrauterine fetal demise (IUFD), defined as the death of a fetus weighing over 500g or over 24 weeks gestation before the onset of labor. It notes that the cause is unknown in 25-60% of cases. Identifiable causes include maternal conditions like diabetes or hypertension, fetal conditions like birth defects or infections, and placental conditions like abruption or insufficiency. Evaluation of an IUFD involves examining the mother's medical history and current pregnancy, evaluating the stillborn infant, investigating the placenta, and certain laboratory tests. Management depends on factors like gestation, number of fetuses, and the parents' wishes regarding expectant or active management such as labor induction. Complications can
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD, Mob: 7289915430, w...Pradeep Garg
This document discusses post-dated pregnancy and intra-uterine fetal death (IUFD). It defines IUFD as the death of a fetus in the uterus and lists various potential causes including pregnancy complications, fetal issues, and idiopathic causes. The document outlines methods for diagnosing IUFD such as symptoms, signs, investigations including ultrasound and biophysical profile, and management approaches including expectant management, induction of labor, and fetal surveillance. It also discusses post-dated pregnancy risks and recommendations for induction of labor at or beyond 41 weeks gestation.
This document discusses the investigation and assessment of stillbirths. It defines stillbirth as fetal loss after 20 weeks of gestation or a birth weight over 500g. Stillbirths can be antepartum (before labor) or intrapartum (during labor). The prevalence of stillbirth globally is discussed, with rates being much higher in developing countries. Common risk factors for stillbirth include maternal age, obesity, medical conditions like diabetes and hypertension, thrombophilias, infection, and multiple pregnancies. An algorithm is presented for the etiologic investigation of stillborn infants, beginning with maternal and family history, physical examination of the stillborn infant, examination of the umbilical cord, and examination of the placent
1. Intrauterine growth restriction (IUGR) refers to fetuses that are small for gestational age and display signs of chronic hypoxia or failure to thrive. It occurs in approximately 3-5% of pregnancies.
2. IUGR can be classified as symmetrical/intrinsic or asymmetrical based on whether growth restriction affects all parameters equally or causes brain sparing. The causes include placental insufficiency, infections, genetic and structural fetal anomalies, and various maternal medical conditions and lifestyle factors.
3. Complications of IUGR include perinatal mortality and morbidity as well as long term risks of metabolic and cardiovascular diseases. Diagnosis involves identifying high risk mothers, accurate dating by ultrasound,
Anticipatory grieving related to pregnancy loss ncpIda Hui-Ming
This document outlines nursing interventions for clients experiencing grief and loss from abortion, pregnancy loss, or perinatal death. It includes assessing the client's emotional state and coping skills, encouraging expression of feelings, identifying support systems, monitoring for suicidal ideation, ensuring comfort, and recognizing individual differences in grieving processes. Nursing goals are to facilitate healthy grieving and coping. Risks like complicated grieving, hemorrhage, disseminated intravascular coagulation, and infection require monitoring and evidence-based interventions.
This document discusses amniotic fluid disorders including polyhydramnious and oligohydramnious. It describes how normal amniotic fluid levels change throughout pregnancy, peaking at 38 weeks. The two main abnormalities are defined as polyhydramnious (excess amniotic fluid over 2000ml) and oligohydramnious (less than 300-500ml at term). Causes, signs/symptoms, complications and management are described for each condition. Preeclampsia, premature rupture of membranes, intrauterine growth restriction, intrauterine fetal death, and preterm labor are also summarized.
The document discusses various classification systems for stillbirths and neonatal deaths. It describes the ReCoDe classification system which categorizes stillbirths into 9 groups based on the relevant condition at death, including groups for fetal conditions, umbilical cord issues, placental problems, amniotic fluid abnormalities, uterine factors, maternal health conditions, intrapartum complications, trauma, and unclassified cases. It then outlines several other classification approaches including the Wigglesworth, Nordic-Baltic, and Aberdeen systems which categorize stillbirths and neonatal deaths based on factors like congenital anomalies, gestational age, infection, maternal conditions, and unexplained cases.
The document provides definitions and discusses the incidence, types, risk factors, evaluation, and causes of stillbirth. It examines maternal, fetal, and placental conditions that can lead to stillbirth and evaluates diagnostic tools like autopsy, placental examination, karyotyping, and infection screening. Recommendations are made for antepartum surveillance in subsequent pregnancies after an unexplained stillbirth.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy and accounts for 90% of cases of diabetes in pregnancy. Risk factors include age over 25, BMI over 25, family history of diabetes, and certain ethnic backgrounds. GDM is caused by insulin resistance during pregnancy and can lead to complications for both mother and baby if not well-controlled such as preeclampsia, macrosomia, and neonatal hypoglycemia. Diagnosis involves screening all pregnant women between 24-28 weeks gestation with a glucose challenge test followed by a 3-hour 100g oral glucose tolerance test for those who fail. Management focuses on tight glycemic control through diet, exercise, glucose monitoring, and possibly insulin
The document discusses gestational diabetes mellitus (GDM). It begins with physiological changes in pregnancy that increase insulin resistance and glucose intolerance. It then defines GDM, discusses prevalence, screening methods, diagnosis, medical and obstetric management, and controversies around screening. Key points include that GDM is associated with adverse maternal and neonatal outcomes. Screening methods include fasting blood glucose and glucose challenge tests. Treatment involves diet, exercise, and potentially insulin or oral hypoglycemic drugs. The goal of management is to maintain euglycemia and prevent macrosomia and other complications.
1. The document discusses the clinical management of diabetes during pregnancy, including screening, diagnosis, and treatment of gestational and pregestational diabetes.
2. It outlines the risks of hyperglycemia for both mother and fetus, including fetal macrosomia, complications during delivery, and long-term risks like childhood obesity.
3. The management of diabetes during pregnancy involves tight glycemic control through diet, glucose monitoring, and insulin when needed to improve outcomes for both mother and baby.
A comprehensive guide to the management of hyperglycaemia in pregnancy aimed at the primary care physician and based on latest evidenced based criteria. Includes information from latest studies such as HAPO study and ACHOIS, and involves guidelines from the IADPSG, ADA, WHO and Malaysia.
This document provides information about gestational diabetes mellitus (GDM), a condition where women without a previous history of diabetes experience high blood sugar levels during pregnancy. The key points are:
- GDM occurs in approximately 5% of pregnancies and can cause health issues for both the mother and baby if not treated.
- Risk factors include age over 25, family history of diabetes, and certain ethnic backgrounds.
- Screening usually takes place between 24-28 weeks of pregnancy with a glucose test.
- Treatment involves diet, exercise, and possibly insulin therapy to control blood sugar levels and minimize health risks.
- Both mother and baby must be monitored during and after pregnancy due to risks like developing type 2 diabetes
This document provides an overview of diabetes mellitus in pregnancy. It defines diabetes in pregnancy and gestational diabetes, and discusses their incidence rates. It describes the screening, diagnosis, and management of diabetes in pregnancy. The document outlines the maternal and fetal effects of diabetes during pregnancy and notes increased risks of complications. It emphasizes the importance of glucose monitoring and medical nutrition therapy in managing diabetes in pregnancy.
1. Antenatal care includes regular checkups during pregnancy to monitor the health of the mother and baby, provide supplements and immunizations, educate on warning signs, and plan for delivery.
2. Less than half of women in India receive antenatal care during their first trimester as recommended. Home births are still common which increases risks.
3. Objectives of antenatal care include promoting maternal and infant health, detecting high-risk pregnancies, advising on self-care, preparing for labor and lactation, and reducing anxiety. Regular checkups and tests are done to monitor progress and identify any issues.
The document provides background information on the implementation of maternal, newborn, adolescent and child health care services in Myanmar using a continuum of care approach. It was developed in accordance with the National Health Plan and short term strategic plans for reproductive health, child health development and adolescent health development. The services were initially implemented in 10 townships in 2011 and have since expanded to 200 townships. The services are delivered through family-oriented, population-oriented, and individual-oriented channels and coordinated at the national and sub-national levels.
This document provides an overview of stillbirths including definitions, epidemiology, etiology, approaches to management of stillbirth cases and subsequent pregnancies. It notes that the stillbirth rate in India in 2021 was 12.4 per 1000 births. Investigating the causes of stillbirth involves examining the mother, fetus, placenta and membranes through history, examinations, tests and potentially an autopsy. Managing subsequent pregnancies after a stillbirth includes increased surveillance and optimizing any medical conditions to reduce recurrence risks. The aim is to reduce India's stillbirth rate to 10 per 1000 births by 2030.
This document discusses evaluating and managing bad obstetric history (BOH). BOH refers to previous disappointments in childbearing like miscarriages, stillbirths, preterm births, or other complications. A detailed history and medical record review aims to identify recurrent or non-recurrent causes. Common causes include pre-eclampsia, inherited or acquired thrombophilia, parental genetic disorders, anatomical factors, endocrine issues, and infections. Investigation may include screening tests for these conditions. Management focuses on modifying identified risks in the current pregnancy through treatments like low-dose aspirin for pre-eclampsia risk and close monitoring throughout pregnancy. The goal is to learn from past pregnancies to optimize outcomes in future pregnancies.
A multiple pregnancy is when you are pregnant with twins, triplets or more. Three babies or more is called a 'higher order' pregnancy, and it's rare – occurring in just 1 in 50 multiple pregnancies.
Prenatal care involves regular checkups during pregnancy to monitor the health of the mother and baby. The nurse plays an important role in prenatal care by registering pregnant women, providing clinical assessments and testing, educating mothers on nutrition, rest, hygiene and warning signs, and making referrals for high-risk mothers. The goals of prenatal care are to ensure a healthy pregnancy and delivery for both mother and baby.
This document discusses various types of abortion and miscarriage, including their causes, classification, clinical evaluation, and management. It covers spontaneous abortions like threatened abortion, inevitable abortion, complete abortion, missed abortion, and septic abortion. It also discusses recurrent miscarriages and examines prevention of septic abortion. The types of abortion and miscarriage are clinically evaluated and can be managed either medically using misoprostol or surgically using manual vacuum aspiration, depending on gestational age and presence of infection.
First trimester bleeding is common, occurring in 25% of pregnancies. While often resulting from miscarriage, it can also be caused by ectopic pregnancy, molar pregnancy, or non-obstetric conditions. Miscarriage is the spontaneous loss of pregnancy before 24 weeks gestation or fetal weight under 500 grams. Risk factors for miscarriage include increased maternal age, smoking, alcohol, caffeine, obesity, toxins, radiation, prior miscarriages, uterine defects, and infections. Diagnosis involves pregnancy tests, ultrasound, and bloodwork. Complications can include infection, shock, and anemia. Treatment depends on the type and severity, ranging from observation to medication and surgical evacuation. Follow up care and family planning counseling
This document discusses the history and evolution of antenatal care (ANC), current practices, limitations, and ways to improve ANC. It notes that while ANC has significantly reduced maternal and infant mortality rates, the maternal mortality rate in India remains high. It identifies limitations like low coverage, inadequate home care, and an overreliance on predicting risks rather than detecting current issues. The document recommends strengthening continuity of care, screening for common diseases, universal ultrasound screening, and developing birth preparedness plans to ensure earlier access to emergency care. The goal is to make pregnancy a normal physiological event and further reduce mortality rates.
This document provides guidance on antenatal care during the second trimester of pregnancy. It discusses the goals and aims of antenatal care, the timing and frequency of visits, assessments and screenings to be performed, common discomforts experienced and their management, and counseling of patients. The key aspects covered are initial evaluation if the first visit is in the second trimester, ongoing assessments at follow-up visits, screening tests and their timing, and identifying and managing high-risk pregnancies.
Second Trimester work up and Algorithms by Dr Pratima Mittal NARENDRA C MALHOTRA
The document provides guidance on antenatal care in the second trimester. It recommends ongoing assessments of the health of the mother and fetus between 14 to 28 weeks of gestation, including accurate dating, screening tests, and monitoring for potential complications. Regular visits allow for early detection and treatment of issues. Common discomforts of pregnancy like back pain, nausea, and constipation are also addressed.
monitoring during pregnancy by diabetesasia.orgDiabetes Asia
Diabetesasia.org is your diabetes resource for asking queries, education, relating and distribution your private diabetes experience or those you care for.
Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
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Our aim is to alleviate human suffering related to diabetes and its complications among those least able to withstand the burden of the disease. From 2002 to March 2017, the World Diabetes Foundation provided USD 130 million in funding to 511 projects in 115 countries.
For every dollar spent, the Foundation raises approximately 2 dollars in cash or as in-kind donations from other sources.
monitoring During Pregnancy by diabetesasia.orgDiabetes Asia
Monitoring during pregnancy for women with diabetes includes self-monitoring of blood glucose (SMBG), fetal monitoring, and other assessments. SMBG should ideally occur daily but if resources are limited, testing can begin at once weekly and increase to every 1-2 weeks in the third trimester. Target blood glucose levels are less than 95 mg/dl fasting and less than 140 mg/dl one hour after meals. Fetal movement counting and ultrasounds are used to monitor fetal growth and well-being. Additional assessments include blood pressure, urine tests, and biophysical profiles from 36 weeks onward.
Prenatal care involves regular examinations and advice during pregnancy to monitor the health of the mother and fetus. It aims to screen for high-risk cases, prevent or treat complications early, provide health education, and discuss delivery plans. Preconception counseling identifies risks and optimizes health before pregnancy. Prenatal visits assess health status, growth, and provide preventative care. Postnatal care ensures the rapid recovery of both mother and baby and provides family planning services and education.
This document provides an outline for a lecture on antenatal care. It defines antenatal care, outlines its objectives and goals which include reducing maternal mortality and morbidity. It describes comprehensive maternity care and different models of antenatal care provision, including traditional and focused antenatal care. The document details the process of antenatal care, including history taking, physical examination, and assessment techniques.
Traditional antenatal care involves promoting the health of the mother and baby through education, monitoring for complications, and developing a birth plan. Key aspects of antenatal care include assessing risk factors, providing health screenings and supplements to prevent issues, detecting existing medical conditions, and monitoring the pregnancy for complications. Effective care also involves continuity with a skilled provider, preparation for birth, and health promotion through addressing behaviors, diseases, and their treatment.
Traditional antenatal care involves promoting the health of the mother and baby through education, monitoring for complications, and developing a birth plan. Effective antenatal care includes care from a skilled attendant, preparation for birth and complications, promoting health and preventing disease through screening and treatment, and early detection and management of any complications. At the initial prenatal visit, providers collect medical history, assess risk factors, perform examinations and tests, and provide health education to develop a care strategy.
PREGNANCY LARGE FOR GASTATION AGE-1.pptxyakemichael
- Large for gestational age (LGA) refers to babies who are born weighing more than the 90th percentile for their gestational age. The major causes of LGA are diabetic mothers, genetics, obesity, and overweight during pregnancy. LGA can be diagnosed clinically during antenatal care through physical exams, fundal height measurements, maternal weight gain tracking, ultrasounds, and lab tests. Preventing LGA involves careful management of diabetes, proper weight gain during pregnancy, and regular prenatal care to monitor fetal growth. LGA is a concern in South Sudan due to high rates of obesity and gestational diabetes that can increase the risk of LGA deliveries.
This document discusses morbidly adherant placenta, also known as placenta accreta spectrum (PAS), which is becoming more common due to rising cesarean section rates. PAS occurs when the placenta invades deeply into the uterine wall and does not separate normally during delivery, potentially causing life-threatening hemorrhage. Early diagnosis through ultrasound screening and counseling of patients at high risk, such as those with prior uterine scarring, allows for improved maternal outcomes through preparedness and planned hysterectomy if needed. The key is anticipating PAS, making an accurate prenatal diagnosis, and being prepared to perform an emergency hysterectomy to control bleeding and save the mother's life if manual placental removal fails.
Management of Intraoperative Haemorrhage in Gynaecological Abdominal SurgeriesRajesh Gajbhiye
Massive hemorrhage is a potential complication of gynecological surgeries and prompt action is needed. The document discusses ways to prepare for and manage intraoperative bleeding through careful surgical techniques, understanding of pelvic anatomy, and use of hemostatic measures and ligation of blood vessels if needed. Internal iliac ligation can be a life-saving procedure to control bleeding when other methods have failed.
Dr. Rakhi Gajbhiye is a director of Mauli Women's Hospital in Nagpur, India. She has published 9 papers in journals and contributed a chapter to a book on hysteroscopy. She is a member of several medical organizations and delivers talks at conferences.
The document discusses various surgical interventions for postpartum hemorrhage (PPH) when medical or mechanical methods have failed. It describes compression sutures like the B-Lynch suture and Hayman suture, as well as ligation of the uterine, ovarian, and internal iliac vessels. Hysterectomy is mentioned as a last resort. Complications of compression sutures and the procedures for
Debate on Abortion Limit should be increased to 24 weeks.Rajesh Gajbhiye
This document discusses raising the limit for legal abortions in India from 20 to 24 weeks. Key points include: some fetal anomalies cannot be diagnosed until after 20 weeks; carrying an unwanted pregnancy to term causes mental and physical stress; access to ultrasound technology is limited in India so late diagnoses are common; international medical organizations support later limits; and raising the limit would make abortions safer by preventing illegal procedures. Concerns about eugenics and the rights of the disabled are addressed. Overall a higher limit is argued to be ethical, safe, and beneficial for patients and clinicians.
In this introductory remark at workshop on vaginal hysterectomy where Dr Shirish Seth was operating faculty.
I spoke “lets promote and propagate vaginal hysterectomy which is an indigenous surgery in line with PM Modi’s mission of MAKE IN INDIA.
Vaginal hysterectomy is like Aam admi surgery which is in the best interest of patients and has best scientific evidences in its favour."
Let us not be driven by glamour,gadgets and gimmicks."
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
How to have quality of life in Advanced ovarian malignancyRajesh Gajbhiye
This document discusses advanced ovarian malignancy and improving quality of life. It notes that ovarian cancer is a leading cause of cancer death in women and is difficult to diagnose early. While most patients present with advanced disease, improvements in surgery and chemotherapy have increased survival rates to 45% at 5 years. Quality of life factors like physical, psychological, social and sexual issues are important to consider in treatment. Managing side effects, providing social support, and palliative care can help improve patient quality of life.
Treatment and outcome of anatomical factors for abortionsRajesh Gajbhiye
The document discusses various anatomical factors that can contribute to recurrent pregnancy loss, including uterine anomalies like septate uterus, bicornuate uterus, and unicornuate uterus. It describes how these anomalies can increase risks of miscarriage and preterm birth. The document outlines surgical treatments like hysteroscopic septal resection and metroplasty that aim to correct anomalies and improve reproductive outcomes by reducing miscarriage and preterm birth rates. It also discusses cervical insufficiency and the use of cerclage procedures to treat this issue and prolong pregnancy.
Role of hysteroscopy in Infertility, Dr Rajesh GajbhiyeRajesh Gajbhiye
Hysteroscopy plays an important role in the evaluation and treatment of intrauterine abnormalities found in infertile women. Diagnostic hysteroscopy is considered the gold standard for diagnosing conditions like submucous fibroids, uterine septum, intrauterine adhesions, and endometrial polyps that are common in infertile patients. Surgical treatment of these abnormalities by hysteroscopy has been shown to improve pregnancy rates compared to diagnostic hysteroscopy alone. Additionally, performing hysteroscopy before IVF treatment or endometrial scratching prior to a cycle has been associated with higher success rates, though more research is still needed to confirm these findings.
Travel Clinic Cardiff: Health Advice for International TravelersNX Healthcare
Travel Clinic Cardiff offers comprehensive travel health services, including vaccinations, travel advice, and preventive care for international travelers. Our expert team ensures you are well-prepared and protected for your journey, providing personalized consultations tailored to your destination. Conveniently located in Cardiff, we help you travel with confidence and peace of mind. Visit us: www.nxhealthcare.co.uk
Are you looking for a long-lasting solution to your missing tooth?
Dental implants are the most common type of method for replacing the missing tooth. Unlike dentures or bridges, implants are surgically placed in the jawbone. In layman’s terms, a dental implant is similar to the natural root of the tooth. It offers a stable foundation for the artificial tooth giving it the look, feel, and function similar to the natural tooth.
Nutritional deficiency Disorder are problems in india.
It is very important to learn about Indian child's nutritional parameters as well the Disease related to alteration in their Nutrition.
Giloy in Ayurveda - Classical Categorization and SynonymsPlanet Ayurveda
Giloy, also known as Guduchi or Amrita in classical Ayurvedic texts, is a revered herb renowned for its myriad health benefits. It is categorized as a Rasayana, meaning it has rejuvenating properties that enhance vitality and longevity. Giloy is celebrated for its ability to boost the immune system, detoxify the body, and promote overall wellness. Its anti-inflammatory, antipyretic, and antioxidant properties make it a staple in managing conditions like fever, diabetes, and stress. The versatility and efficacy of Giloy in supporting health naturally highlight its importance in Ayurveda. At Planet Ayurveda, we provide a comprehensive range of health services and 100% herbal supplements that harness the power of natural ingredients like Giloy. Our products are globally available and affordable, ensuring that everyone can benefit from the ancient wisdom of Ayurveda. If you or your loved ones are dealing with health issues, contact Planet Ayurveda at 01725214040 to book an online video consultation with our professional doctors. Let us help you achieve optimal health and wellness naturally.
The biomechanics of running involves the study of the mechanical principles underlying running movements. It includes the analysis of the running gait cycle, which consists of the stance phase (foot contact to push-off) and the swing phase (foot lift-off to next contact). Key aspects include kinematics (joint angles and movements, stride length and frequency) and kinetics (forces involved in running, including ground reaction and muscle forces). Understanding these factors helps in improving running performance, optimizing technique, and preventing injuries.
Discover the benefits of homeopathic medicine for irregular periods with our guide on 5 common remedies. Learn how these natural treatments can help regulate menstrual cycles and improve overall menstrual health.
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Travel vaccination in Manchester offers comprehensive immunization services for individuals planning international trips. Expert healthcare providers administer vaccines tailored to your destination, ensuring you stay protected against various diseases. Conveniently located clinics and flexible appointment options make it easy to get the necessary shots before your journey. Stay healthy and travel with confidence by getting vaccinated in Manchester. Visit us: www.nxhealthcare.co.uk
Summer is a time for fun in the sun, but the heat and humidity can also wreak havoc on your skin. From itchy rashes to unwanted pigmentation, several skin conditions become more prevalent during these warmer months.
3. INTRAUTERINE FETAL DEATH (IUFD)
Fetal death before onset of labour or fetus with no
signs of life in utero after 20 weeks of gestation
Definition varies : Gestational age | Birth weight
WHO :
An infant delivered without signs of life after 20 weeks
of gestation or weighing >500 gms when gestation age
is not known
March 9, 2015 3
4. • WHO Definition(MacDorman 2012)-
Fetal death means death prior to complete
expulsion or extraction from the mother of a
fetus irrespective of duration of pregnancy
and which is not an induced termination of
pregnancy.
March 9, 2015 4
5. Still Birth - no evidence of life after birth
beyond 20 weeks
Still Birth
Fresh
(quality of Intra-
partum care)
Macerated
(retained >12 hrs)
IUD
Early
(20-27 weeks)
Late
(≥28 weeks)
IUFD
March 9, 2015 5
6. IMPACTS
Emotionally challenging for:
• Doctors
• Parents
Increases medicolegal risk
Indicator of country’s health care system
March 9, 2015 6
7. FREQUENCY
Still Birth Rate : no. of SBs / Thousand Births
• Complicates 1 % of pregnancies
• In 50 % of cases cause is unknown
Current Trends
• 4.5 to 6.5(2.95) per thousand births in US
• 22.1 per thousand births in India(2009)
• Worldwide 18.9 / Thousand births (2009)
Rate depends on medical care and reporting
systemMarch 9, 2015 7
8. ETIOLOGY
• Unknown in 50% of cases
• Known causes
S/No Causes %
1. Maternal 5-10
2. Foetal 25-40
3. Placental 20-35
4. Unexplained 15-35
March 9, 2015 8
13. DIAGNOSIS
Symptoms: Absence of foetal movements
Signs: Retrogression of the positive breast changes
Per abdomen
• Gradual retrogression of the height of
the uterus
• Uterine tone is diminished
• Foetal movement are not felt during
palpation
• Foetal heart sound is not audible
March 9, 2015 13
14. INVESTIGATIONS
• USG (100%) + Associated features can be noted
(oligo, hydrops)
• Straight- X-ray abdomen (obsolete)
Robert’s sign : Appearance of gas shadow
(in 12 hours)
Spalding sign: Collapse skull bones
(usually appears 7 days after )
Ball sign : Hyperflexion of the spine
Helix sign : Gas in umbilical arteries
Crowding of the ribs shadow
March 9, 2015 14
15. SYSTEMATIC APPROACH TO EVALUATION
• Varied recommendations based on experts opinion
• Yet, no scientific effective evaluation plan
• Study ongoing by Still Birth Collaborative Research
Network
• Optimal evaluation is must for
• chance of recurrence
• future preconceptional counseling
• Pregnancy management
• plan prenatal diagnostic procedures
• neonatal management
• Obvious cause - No further testing or limited testing
(cord accidents, anencephaly)
March 9, 2015 15
16. I. History
II. Gross examination
• SB infant
• umbilical cord
• placenta
• amniotic fluid
III. Foetal autopsy & karyotyping
IV. Placental investigations
V. Maternal Investigations
March 9, 2015 16
17. Family
• Recurrent abortions
• Congenital anomalies
• Abnormal karyotype
• Hereditary conditions
• Developmental delay
Maternal
• DM
• HPT
• Thrombophilias
• Autoimmune disease
• Severe Anemia
• Epilepsy
• Consanguinity
• Heart disease
Past Obstetrical
• Baby with congenital anomaly /
hereditary condition
• IUGR
• Gestational HPT with adverse
sequele
• Placental abruption
• IUFD
• Recurrent abortions
I. History
March 9, 2015 17
19. • These 2 are important tests in SB evaluation
(Pinar, 2014)
• Crucial for future pregnancy
• Appropriate consent req to take fetal tissue,Autopsy
• Ideally should be done by perinatal pathologist
• If denied, post mortem MRI should be considered
• Radiographs if indicated for skeletal abnormalities
• Photographs
III. Fetal Autopsy & Karyotyping
March 9, 2015 19
20. • Fetal karyotyping (ACOG recom in all cases) esp-
- Dysmorphic fetus, FGR
- Hydropic
- Signs of chromosomal anomaly
Samples-
• Amniocentesis –highest yield
• 3ml fetal blood from umbilical vs and or cardiac
puncture-heparinized bulb
• If blood not obtained ACOG(2012)recommends at least
1 of the foll samples -
1) Pl block 1x1cm
RL 2) cord 1.5cm
3) costocondral junction or patella(skin not
. recommended)
March 9, 2015 20
21. • Parents with multiple pregnancy losses
(second or third trimester)
• For aneuploidy- FISH, For small deletions- CGH
March 9, 2015 21
22. • Chorionicity
• Cord knot, vessels, thrombosis
• Infarcts, thrombosis, abruption
• Vascular malformations
• Signs of infection
• Placental block(1x1 cm) below cord insertion
• Umbilical segment (1.5 cm)
• Placental swabs for infections
• Bacterial cultures for E. Coli, Listeria
IV. Placental Investigations
March 9, 2015 22
23. • CBC
• Hb electrophoresis
• Diabetes testing (HbA1c, FBS)(Silver,2013)
• TFT
• Additional Tests
• Kleihauer Betke (for all women, before birth), in Rh-
D negative second test after antidote
• Serological Tests (TORCH, Syphilis, Parvovirus)
?? in all cases, opinion varies, rarely helpful
If clinical findings suggest intrauterine infection (i.e.,
those with IUGR, microcephaly)
V. Maternal Evaluation
March 9, 2015 23
24. • Antiphospholipid (LA,ACA), Antiplatelet Ab if ICH
detected
• ?? Thrombophilias screening (6 weeks postpartum) -
factor V leiden mutations & deficiencies, antithombin
III, protein C & S
Current ACOG practice bulletin does not recommend
in cases of pregnancy loss
• Bile acids (Cholestasis of preg)- important cause,
recurrence in 80% cases
• High vaginal & cervical swab for C & S
• Urine toxicology screening (cocaine, amphetamines are
associated with abruption)
March 9, 2015 24
25. • Depends on:
• Single or multiple gestation
• Gestation age at death
• Parents wish (varied response)
– Expectant approach
• 80% goes in labour with in 2-3 weeks
• Emotional burden, risk of Chorioamnionitis & DIC
– Active approach
MANAGEMENT
March 9, 2015 25
26. • Fetal death <28weeks
• Mifepristone 200 mg followed by Misoprostol
400 µg 4 - 6 hourly most effective with shortest
I-D interval
• Fetal death >28weeks
• Cervical ripening (mechanical or chemical)
followed by Oxytocin induction
Induction of Labour
March 9, 2015 26
27. • WHO regimen of Misoprostol in IUD cases
• IUFD at term – 25 µg 6 hourly 2doses, if no
response increase to 50 µg 6 hourly, do not
exceed 4 doses.
• Do not use Oxytocin in 8hrs of using
Misoprostol
• Contraindicated in previous CS cases (WHO)
March 9, 2015 27
28. • RCOG & NICE Regimen
• <26 weeks - 100 µg 6hrly (max 4 doses)
• >27 weeks - 25-50 µg 4hrly (max 6 doses)
• Use of PGs is associated with increase risk of
uterine rupture in cases of previous scar
• Membranes should not be ruptured as long as
possible
• Pain management should be offered
• Keep watch on CBC, coagulation profile, signs
of infection
• Active management of III stage of labour
• Keep blood and blood products ready
March 9, 2015 28
30. • Emotional support & Counseling as they r at
increased risk of PPD(Nelson,2013)
• Keep in non maternity ward
• Suppression of lactation (tight breast support,
dopamine agonists, estrogen)
• Counsel for future pregnancy, early ANC visit,
preconceptional testing
• Assurance in cases of non recurring causes
• Contraceptive counseling
Post delivery
March 9, 2015 30
31. Management of future preg(RCOG)
Preconception or initial prenatal visit
• Detailed medical and obstetric history
• Evaluation and workup of previous stillbirth
• Determination of recurrence risk
• Smoking cessation
• Weight loss in obese women (preconception only)
• Genetic counselling if family genetic condition exists
• Medical prob like Diabetes should be managed prior
• Thrombophilia workup: antiolipid antibodies
(only if specifically indicated)
• Risk of recurrence is 7-10 / 1000 birth
• Support and reassuranceMarch 9, 2015 31
32. First trimester
• Dating sonography
• First-tri screen: pregnancy-associated plasma protein A, b
HCG, and nuchal translucency*
• Folic acid
Second trimester
• Fetal ultrasonographic anatomic survey at 18–20wks
• Maternal serum screening (Quadruple) marker
• Blood investigations
March 9, 2015 32
33. Third trimester
• Sonographic screening for fetal growth restriction after
28 weeks of gestation
• Admission at critical period in high risk cases
• Kick counts starting at 28 weeks of gestation
• Antipartum fetal surveillance starting at 32 wks or 1–2
wks earlier than prior stillbirth (ACOG recommends at
32-34 wks in otherwise normal preg)
• Weekly FHR , BPP, Doppler
• Support and reassurance
March 9, 2015 33
34. STRATEGIES FOR PREVENTION
• No sure fire method to prevent
• Loosing weight, life style modifications
• Women should try to optimize their health prior
to pregnancy
• Enough Folic acid before they get pregnant
• Good preconception and prenatal care
• Women with DM –tight control before and during
pregnancy
• Educate women not to delay pregnancy
March 9, 2015 34
35. • Still birth AUDIT COM – comprising of
Obs,neo,geneticists,neo patho.
• According to survey by Goldenberg n
coworkers (2013) most hosp do not audit SB
March 9, 2015 35
36. Unknown etiology in 25-60% IUFD cases
Optimal evaluation for future pregnancy necessary
Evidence based models for evaluation & future m/m
Counseling & support groups should be involved
Allow parents to sit and pray in isolation, take
photographs, footprints, preserve lock of hair and
name the child
Reassure and guide for future pregnancy
March 9, 2015 36
37. “When you loose a person you love so much,
surviving the loss is difficult”
March 9, 2015 37