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
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.
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
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
Shoulder dystocia occurs when the baby's shoulders become stuck after delivery of the head. It has a low incidence rate of 0.2-1% and risk factors include fetal macrosomia, obesity, diabetes and others. Diagnosis is made when normal maneuvers by the midwife fail to deliver the baby. Management involves calling for help, clearing the baby's airways, and performing maneuvers like McRoberts and Rubin's to rotate the shoulders and decrease their diameter in order to allow delivery. More invasive maneuvers like cleidotomy may be needed if these fail to deliver the anterior shoulder.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
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.
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
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.
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
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
Shoulder dystocia occurs when the baby's shoulders become stuck after delivery of the head. It has a low incidence rate of 0.2-1% and risk factors include fetal macrosomia, obesity, diabetes and others. Diagnosis is made when normal maneuvers by the midwife fail to deliver the baby. Management involves calling for help, clearing the baby's airways, and performing maneuvers like McRoberts and Rubin's to rotate the shoulders and decrease their diameter in order to allow delivery. More invasive maneuvers like cleidotomy may be needed if these fail to deliver the anterior shoulder.
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
Gestational diabetes mellitus (GDM) is glucose intolerance that develops during pregnancy. Risk factors include obesity, family history of diabetes, and ethnicity. During pregnancy, hormones cause insulin resistance and the pancreas must produce more insulin to maintain blood glucose levels. Untreated GDM can lead to complications for both mother and baby like preeclampsia, macrosomia, and neonatal hypoglycemia. Screening and tight glucose control are important. Pre-gestational diabetes also requires careful management to reduce risks of birth defects, complications, and future diabetes in the child.
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.
This document discusses hypertension in pregnancy, including gestational hypertension. It defines gestational hypertension as blood pressure of 140/90 or higher after 20 weeks of pregnancy without proteinuria, with blood pressure returning to normal within 12 weeks postpartum. It notes that early onset of gestational hypertension and higher blood pressure are risk factors for progression to preeclampsia. Treatment for gestational hypertension focuses on monitoring and controlling severe high blood pressure, with delivery occurring between 37-38 weeks.
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.
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
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 antepartum haemorrhage (APH), defined as bleeding from or into the genital tract occurring from 22 weeks of pregnancy until birth. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality. The main causes of APH are placenta praevia, abruptio placentae, vasa praevia, and local cervical/vaginal bleeding. Management involves stabilizing the mother, assessing fetal wellbeing, investigating the cause, and planning for delivery depending on gestational age and the condition of the mother and fetus.
Post-term pregnancy is defined as exceeding 40 weeks of gestation. It occurs in 5-10% of pregnancies, often due to inaccurate gestational age calculation. Both mother and baby are at increased risk of complications like dystocia, meconium aspiration, stillbirth. Management includes assessing gestational age accurately, monitoring the fetus, and inducing labor between 41-42 weeks to prevent risks of post-term pregnancy. Intrauterine fetal death is the death of a fetus before delivery. It can result from maternal, fetal or obstetric complications. Evaluation includes detailed history, examinations, and tests to determine the cause to help counsel patients and prevent future recurrence.
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.
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.
This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines PROM as occurring beyond 28 weeks of gestation but before labor, and preterm PROM (PPROM) as occurring between 28-37 weeks.
The document outlines the risk factors, symptoms, diagnosis, and management of PROM depending on gestational age. Evaluation involves history, physical exam including speculum exam, and tests like nitrazine, ferning, fetal fibronectin, and ultrasound. Management often involves expectant monitoring, antibiotics, corticosteroids, and tocolytics to prolong the pregnancy if it is prior to 34 weeks. The goals are
This document discusses hypertensive disorders of pregnancy, including definitions, classifications, signs, symptoms, risk factors, investigations, complications and management of conditions like pre-eclampsia and eclampsia. It defines pre-eclampsia as hypertension with proteinuria developing after 20 weeks in a previously normotensive woman. Eclampsia is defined as pre-eclampsia with seizures. Management involves controlling blood pressure, preventing seizures, monitoring the patient closely, and timely delivery of the baby. Magnesium sulfate is the primary treatment for preventing and treating seizures.
Rh isoimmunization occurs when an Rh-negative mother carries an Rh-positive fetus. During pregnancy or delivery, fetal red blood cells can enter the mother's circulation, stimulating her immune system to produce antibodies against the Rh antigen. These antibodies can then cross the placenta during subsequent pregnancies and destroy fetal red blood cells, causing hemolytic disease of the newborn. Effects range from mild anemia to severe jaundice, hydrops fetalis, or fetal death. Management involves monitoring maternal antibody levels and fetal well-being through amniocentesis and ultrasound. At-risk pregnancies may require intrauterine transfusions or early delivery. Prevention relies on administering Rh immunoglobulin to the mother during
- Dr. Laxmi Shrikhande is a medical director and chairperson of several organizations focused on obstetrics and gynecology in India.
- She has received numerous national awards for her work in women's health issues like the Nagpur Ratan Award and the Bharat Excellence Award.
- The document discusses diabetes in pregnancy, including the types of diabetes (pre-existing vs. gestational), prevalence, pathophysiology, screening and diagnostic criteria, management, and monitoring during pregnancy.
- Key aspects of managing gestational diabetes include medical nutrition therapy, exercise, self-monitoring of blood glucose, glycemic targets, fetal monitoring, and insulin treatment if needed to control blood sugar
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
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
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.
A Bartholin's cyst is a fluid-filled sac within the Bartholin's gland of the vagina. Bartholin's cysts typically occur in nulliparous women of child-bearing age and other risk factors include a personal history of Bartholin's cyst, being sexually active, or a history of vulval surgery. Bartholin's cysts can cause vulvar pain, dyspareunia, and may rupture spontaneously, relieving pain. Treatment options include incision and drainage with placement of a Word catheter or marsupialization to prevent reaccumulation of fluid.
This document provides information on gestational diabetes mellitus (GDM), including its definition, causes, physiological changes during pregnancy that can lead to GDM, effects on pregnancy, fetal and neonatal hazards, diagnosis, screening recommendations, treatment including medical nutrition therapy and insulin management, monitoring during labor and delivery, and postpartum care considerations. GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and results from changes in insulin resistance and secretion during pregnancy. Left untreated, GDM can increase risks for the mother and fetus, so proper screening, diagnosis, and treatment are important aspects of prenatal care.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
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
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 hypertension in pregnancy, including gestational hypertension. It defines gestational hypertension as blood pressure of 140/90 or higher after 20 weeks of pregnancy without proteinuria, with blood pressure returning to normal within 12 weeks postpartum. It notes that early onset of gestational hypertension and higher blood pressure are risk factors for progression to preeclampsia. Treatment for gestational hypertension focuses on monitoring and controlling severe high blood pressure, with delivery occurring between 37-38 weeks.
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.
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
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 antepartum haemorrhage (APH), defined as bleeding from or into the genital tract occurring from 22 weeks of pregnancy until birth. APH complicates 3-5% of pregnancies and is a leading cause of perinatal and maternal mortality. The main causes of APH are placenta praevia, abruptio placentae, vasa praevia, and local cervical/vaginal bleeding. Management involves stabilizing the mother, assessing fetal wellbeing, investigating the cause, and planning for delivery depending on gestational age and the condition of the mother and fetus.
Post-term pregnancy is defined as exceeding 40 weeks of gestation. It occurs in 5-10% of pregnancies, often due to inaccurate gestational age calculation. Both mother and baby are at increased risk of complications like dystocia, meconium aspiration, stillbirth. Management includes assessing gestational age accurately, monitoring the fetus, and inducing labor between 41-42 weeks to prevent risks of post-term pregnancy. Intrauterine fetal death is the death of a fetus before delivery. It can result from maternal, fetal or obstetric complications. Evaluation includes detailed history, examinations, and tests to determine the cause to help counsel patients and prevent future recurrence.
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.
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.
This document discusses premature rupture of membranes (PROM), which is the spontaneous rupture of membranes before the onset of labor. It defines PROM as occurring beyond 28 weeks of gestation but before labor, and preterm PROM (PPROM) as occurring between 28-37 weeks.
The document outlines the risk factors, symptoms, diagnosis, and management of PROM depending on gestational age. Evaluation involves history, physical exam including speculum exam, and tests like nitrazine, ferning, fetal fibronectin, and ultrasound. Management often involves expectant monitoring, antibiotics, corticosteroids, and tocolytics to prolong the pregnancy if it is prior to 34 weeks. The goals are
This document discusses hypertensive disorders of pregnancy, including definitions, classifications, signs, symptoms, risk factors, investigations, complications and management of conditions like pre-eclampsia and eclampsia. It defines pre-eclampsia as hypertension with proteinuria developing after 20 weeks in a previously normotensive woman. Eclampsia is defined as pre-eclampsia with seizures. Management involves controlling blood pressure, preventing seizures, monitoring the patient closely, and timely delivery of the baby. Magnesium sulfate is the primary treatment for preventing and treating seizures.
Rh isoimmunization occurs when an Rh-negative mother carries an Rh-positive fetus. During pregnancy or delivery, fetal red blood cells can enter the mother's circulation, stimulating her immune system to produce antibodies against the Rh antigen. These antibodies can then cross the placenta during subsequent pregnancies and destroy fetal red blood cells, causing hemolytic disease of the newborn. Effects range from mild anemia to severe jaundice, hydrops fetalis, or fetal death. Management involves monitoring maternal antibody levels and fetal well-being through amniocentesis and ultrasound. At-risk pregnancies may require intrauterine transfusions or early delivery. Prevention relies on administering Rh immunoglobulin to the mother during
- Dr. Laxmi Shrikhande is a medical director and chairperson of several organizations focused on obstetrics and gynecology in India.
- She has received numerous national awards for her work in women's health issues like the Nagpur Ratan Award and the Bharat Excellence Award.
- The document discusses diabetes in pregnancy, including the types of diabetes (pre-existing vs. gestational), prevalence, pathophysiology, screening and diagnostic criteria, management, and monitoring during pregnancy.
- Key aspects of managing gestational diabetes include medical nutrition therapy, exercise, self-monitoring of blood glucose, glycemic targets, fetal monitoring, and insulin treatment if needed to control blood sugar
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
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
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.
A Bartholin's cyst is a fluid-filled sac within the Bartholin's gland of the vagina. Bartholin's cysts typically occur in nulliparous women of child-bearing age and other risk factors include a personal history of Bartholin's cyst, being sexually active, or a history of vulval surgery. Bartholin's cysts can cause vulvar pain, dyspareunia, and may rupture spontaneously, relieving pain. Treatment options include incision and drainage with placement of a Word catheter or marsupialization to prevent reaccumulation of fluid.
This document provides information on gestational diabetes mellitus (GDM), including its definition, causes, physiological changes during pregnancy that can lead to GDM, effects on pregnancy, fetal and neonatal hazards, diagnosis, screening recommendations, treatment including medical nutrition therapy and insulin management, monitoring during labor and delivery, and postpartum care considerations. GDM is defined as glucose intolerance that begins or is first recognized during pregnancy and results from changes in insulin resistance and secretion during pregnancy. Left untreated, GDM can increase risks for the mother and fetus, so proper screening, diagnosis, and treatment are important aspects of prenatal care.
Presentation on the description of normal and abnormal uterine bleeding, menstrual cycle, FIGO classification with PALM-COEIN, common differentials of AUB, assessment, diagnosis, and management.
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
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.
The total value of the WDF project portfolio reached USD 377 million, excluding WDF’s own advocacy and strategic platforms.
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.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
These lecture slides, by Dr Sidra Arshad, offer a simplified look into the mechanisms involved in the regulation of respiration:
Learning objectives:
1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
8. Explain the regulation of respiration during exercise
9. Integrate the respiratory regulatory mechanisms
10. Describe the Cheyne-Stokes breathing
Study Resources:
1. Chapter 42, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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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
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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