1. The document describes a case of a 26-year-old woman presenting with abdominal pain and vaginal bleeding who is diagnosed with a ruptured ectopic pregnancy.
2. Key details include the patient's medical history, symptoms, physical exam findings, ultrasound results showing free fluid and no intrauterine gestational sac, and diagnosis of ruptured ectopic pregnancy.
3. The patient underwent an emergency laparotomy which found hemoperitoneum and a ruptured tubal pregnancy that was treated with salpingectomy.
A 32-year-old woman presented with 6 weeks of amenorrhea and diffuse abdominal pain. An ultrasound found gallstones, an intrauterine gestational sac without a fetal heartbeat, and a fibroid. A follow-up ultrasound showed a gestational sac with a yolk sac but no fetal cardiac activity and hemoperitoneum. This led to a provisional diagnosis of a heterotopic pregnancy, with differential diagnoses including an intrauterine pregnancy with a ruptured hemorrhagic cyst or ruptured luteal cyst, or a ruptured ectopic pregnancy. The classic triad of symptoms for an ectopic pregnancy are abdominal pain, vaginal bleeding, and an adnexal mass, but the differential diagnosis
This case presentation describes a 24-year-old woman who presented with complaints of amenorrhea for 21+ weeks, per vaginal bleeding for two days, and passage of grape-like substances for one day. Her medical history and examination findings were presented. Initial diagnosis of a molar pregnancy was made based on her history and ultrasound findings. She underwent suction and evacuation surgery, which confirmed the diagnosis of a molar pregnancy based on histopathology. She was discharged with advice for follow up, contraception, and monitoring of beta hCG levels. The case discussion then provides an overview of gestational trophoblastic diseases including classification, etiology, pathogenesis, clinical features and management of hydatidiform mole.
This document summarizes the medical case of a 36-year-old African American woman who presented to the emergency department experiencing dizziness, faintness, and possible transient loss of vision and leg weakness. Her medical history was significant for a previous diagnosis of anemia about 8 years prior, as well as a 5-year history of heavy menstrual bleeding. A physical exam in the emergency department revealed elevated blood pressure but was otherwise normal.
A 19-year-old woman presented with left lower abdominal pain and a history of ovarian cysts seen on prior imaging. On examination, she had tenderness in her lower abdomen. Ultrasound showed a new 5 cm hemorrhagic cyst on her left ovary. She underwent a laparoscopic cystectomy which found a hemorrhagic cyst with clots but no torsion. Her postoperative course was uncomplicated. Ovarian cysts are common and most are functional, resolving without treatment. Evaluation involves history, exam, ultrasound and considering tumor markers or laparoscopy if concerned for a neoplasm.
The document describes degrees of uterine prolapse from first to third degree. It also discusses pelvic organ prolapse staging from 0 to 4. Symptoms include feeling of something coming down, backache, dyspareunia, urinary and bowel symptoms. Clinical examination involves inspection of vagina and cervix in dorsal, standing, and squatting positions while performing Valsalva maneuver. Levator ani muscle tone is assessed digitally. Investigations like urine test and renal function tests may be done if urinary symptoms persist or renal failure is suspected.
This document summarizes an obstetric case of a 30-year-old pregnant woman. She presents with amenorrhea and easy fatigability for the past 2 months. Her medical history and examination reveal she is anemic, with a hemoglobin level of 7.4g/dl. She has two previous normal deliveries. A diagnosis of anemia is made based on her symptoms and laboratory results.
Mrs. M, a 24-year-old pregnant woman, presented to the emergency department with abdominal cramping and heavy vaginal bleeding. Her physical exam and diagnostic tests indicated an abnormal gestational sac near her cervical canal. She was diagnosed with an inevitable abortion, where continuation of the pregnancy was not possible. For treatment of inevitable abortions before 12 weeks, options include dilation and evacuation followed by curettage or suction evacuation. After 12 weeks, options include oxytocin to accelerate uterine contractions or abdominal hysterotomy. Complications can include injury, perforation, bleeding, shock, or infection if tissue remains in the uterus.
The patient profile document provides information about a 27 year old woman, Nisha, who was admitted to the labor ward on December 5, 2010 at 8am for labor. Her chief complaints were amenorrhea for 9 months and labor pains since 4am. On examination, her cervical dilation was 2cm and effacement was 30%. Her labor progressed normally over 7 hours with full dilation at 3pm and she delivered a healthy male child at 4pm.
A 32-year-old woman presented with 6 weeks of amenorrhea and diffuse abdominal pain. An ultrasound found gallstones, an intrauterine gestational sac without a fetal heartbeat, and a fibroid. A follow-up ultrasound showed a gestational sac with a yolk sac but no fetal cardiac activity and hemoperitoneum. This led to a provisional diagnosis of a heterotopic pregnancy, with differential diagnoses including an intrauterine pregnancy with a ruptured hemorrhagic cyst or ruptured luteal cyst, or a ruptured ectopic pregnancy. The classic triad of symptoms for an ectopic pregnancy are abdominal pain, vaginal bleeding, and an adnexal mass, but the differential diagnosis
This case presentation describes a 24-year-old woman who presented with complaints of amenorrhea for 21+ weeks, per vaginal bleeding for two days, and passage of grape-like substances for one day. Her medical history and examination findings were presented. Initial diagnosis of a molar pregnancy was made based on her history and ultrasound findings. She underwent suction and evacuation surgery, which confirmed the diagnosis of a molar pregnancy based on histopathology. She was discharged with advice for follow up, contraception, and monitoring of beta hCG levels. The case discussion then provides an overview of gestational trophoblastic diseases including classification, etiology, pathogenesis, clinical features and management of hydatidiform mole.
This document summarizes the medical case of a 36-year-old African American woman who presented to the emergency department experiencing dizziness, faintness, and possible transient loss of vision and leg weakness. Her medical history was significant for a previous diagnosis of anemia about 8 years prior, as well as a 5-year history of heavy menstrual bleeding. A physical exam in the emergency department revealed elevated blood pressure but was otherwise normal.
A 19-year-old woman presented with left lower abdominal pain and a history of ovarian cysts seen on prior imaging. On examination, she had tenderness in her lower abdomen. Ultrasound showed a new 5 cm hemorrhagic cyst on her left ovary. She underwent a laparoscopic cystectomy which found a hemorrhagic cyst with clots but no torsion. Her postoperative course was uncomplicated. Ovarian cysts are common and most are functional, resolving without treatment. Evaluation involves history, exam, ultrasound and considering tumor markers or laparoscopy if concerned for a neoplasm.
The document describes degrees of uterine prolapse from first to third degree. It also discusses pelvic organ prolapse staging from 0 to 4. Symptoms include feeling of something coming down, backache, dyspareunia, urinary and bowel symptoms. Clinical examination involves inspection of vagina and cervix in dorsal, standing, and squatting positions while performing Valsalva maneuver. Levator ani muscle tone is assessed digitally. Investigations like urine test and renal function tests may be done if urinary symptoms persist or renal failure is suspected.
This document summarizes an obstetric case of a 30-year-old pregnant woman. She presents with amenorrhea and easy fatigability for the past 2 months. Her medical history and examination reveal she is anemic, with a hemoglobin level of 7.4g/dl. She has two previous normal deliveries. A diagnosis of anemia is made based on her symptoms and laboratory results.
Mrs. M, a 24-year-old pregnant woman, presented to the emergency department with abdominal cramping and heavy vaginal bleeding. Her physical exam and diagnostic tests indicated an abnormal gestational sac near her cervical canal. She was diagnosed with an inevitable abortion, where continuation of the pregnancy was not possible. For treatment of inevitable abortions before 12 weeks, options include dilation and evacuation followed by curettage or suction evacuation. After 12 weeks, options include oxytocin to accelerate uterine contractions or abdominal hysterotomy. Complications can include injury, perforation, bleeding, shock, or infection if tissue remains in the uterus.
The patient profile document provides information about a 27 year old woman, Nisha, who was admitted to the labor ward on December 5, 2010 at 8am for labor. Her chief complaints were amenorrhea for 9 months and labor pains since 4am. On examination, her cervical dilation was 2cm and effacement was 30%. Her labor progressed normally over 7 hours with full dilation at 3pm and she delivered a healthy male child at 4pm.
A 42-year-old teacher presented with menorrhagia for 6 months with lethargy and palpitations. On examination, she was pale with a pulse of 108 bpm. Investigations showed Hb levels decreasing from 8.1 to 7.8 g/dL. Ultrasound found an endometrial thickness of 6 mm without masses. She was diagnosed with dysfunctional uterine bleeding (DUB) and admitted for further management including IV fluids and iron supplements. DUB is abnormal bleeding due to hormonal imbalances that can cause heavy periods, and is diagnosed after excluding other causes. It is typically treated with hormonal therapy.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
Uterine fibroid - Case scenarios and DiscussionHaynes Raja
This presentation is prepared to meet out the undergraduate medical student needs especially to understand the practical aspects of uterine fibroid and to rapidly revise some important viva questions.
Dedicated to my Great Teachers in the Dept. of Obstetrics & Gynaecology Dr. Lavanya Kumari and Dr. Sangeereni, Inspiring Friends Dr. Paulin Benedict, Dr. Jeyakumar Meyyappan and Dr. Hannah Jane and our REVELLIONZ 08’ batch.
Postpartum Haemorrhage : Case Illustrationlimgengyan
A 35-year-old woman experienced postpartum hemorrhage (PPH) after delivering a 3.9kg baby at a private facility. Despite treatments including ergometrine injections and oxytocin infusion, her uterus remained atonic and she experienced massive bleeding. She was transferred to a general hospital in a moribund state and died soon after arrival. A 30-year-old woman at a district hospital also experienced PPH after a vaginal delivery. Despite treatments including ergometrine, oxytocin, and uterine massage, she continued to bleed heavily and became lethargic with low blood pressure. She was transferred to a general hospital where a cervical laceration was suture
Maram, a 34-year-old pregnant woman at 32 weeks gestation, presented to the emergency room complaining of a sudden gush of clear fluid from her vagina for 1 hour. She has a history of bacterial vaginosis treated one week ago. On examination, fluid was leaking from her cervical opening when she coughed. Ultrasound showed decreased amniotic fluid and a breech presentation. The working diagnosis was premature rupture of membranes.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
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.
This document discusses occiput posterior position, its definition, causes, diagnosis, and management. It defines occiput posterior position as the fetal head descending into the pelvis with the sagittal suture in the transverse plane. Causes include pelvic abnormalities and fetal positioning. Diagnosis involves vaginal examination to feel head position. Management includes careful assessment, cesarean for modern obstetrics, or manual rotation and assisted delivery if vaginal is possible. Manual rotation involves inserting the hand into the vagina to rotate the fetal head to the occiput anterior position, and can be done with the whole or half hand.
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
This case presentation describes a 37-year-old woman who presented with abdominal pain in her right lower quadrant. She had a history of miscarriage and a positive pregnancy test. On examination, she had tenderness in her right lower quadrant and adnexal tenderness on bimanual examination. An ultrasound revealed a mass in her right adnexa consistent with an ectopic pregnancy. The differential diagnoses considered were ectopic pregnancy, appendicitis, renal colic, UTI, ovarian cyst, salpingitis, and IBS. The diagnosis was confirmed to be an ectopic pregnancy, which was treated with a laparoscopic salpingectomy.
The document provides guidelines for taking a thorough gynecology history. It emphasizes maintaining patient comfort and privacy, using sensitive communication, and exploring all relevant medical, surgical, obstetric, menstrual, sexual and family histories. The key components of history taking are outlined, including chief complaints, menstrual, obstetric and medical histories. Factors to assess for various presenting issues like abnormal bleeding, discharge, masses and infertility are described.
Mrs. Rahela Begum, a 55-year-old shopkeeper, presented with postcoital bleeding, foul-smelling discharge, bleeding with straining, and back pain for several months. Examination revealed severe anemia and a cauliflower-like cervical growth involving the whole vagina. The provisional diagnosis was stage IVa cervical cancer. Treatment options included blood transfusion, antibiotics, chemoradiation, or ultraradical surgery and palliation given the advanced stage.
Case Study on Intrauterine Growth RestrictionAbhineet Dey
A clinically based study of a case of Intrauterine Growth Restriction (IUGR) or Foetal Growth Restriction (FGR).
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
42: Liza Hazarika
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
The document discusses the interpretation and management of CTG (cardiotocography). It describes the steps to interpret a CTG tracing, including evaluating the fetal heart rate baseline, variability, accelerations, decelerations and their correlation with uterine contractions. It provides a structured DR C BRA VADO method to categorize CTG tracings as normal, suspicious or pathological. The management strategies for each category are then outlined, such as continued monitoring, additional tests like fetal scalp blood pH, or expedited delivery depending on the severity of the CTG abnormalities. Specific situations like the second stage of labor, placental abruption or fetal abnormalities are also addressed.
This document summarizes a medical case involving a 52-year-old female patient presenting with a lower abdominal mass. She reported a 5 month history of the mass along with weight loss and pain over the past 3 months. Physical examination revealed a large abdominal mass. Imaging studies including ultrasound and CT scan showed a large solid-cystic pelvic mass likely originating from the left ovary. Based on findings and elevated CA-125 level, the impression was of a likely malignant ovarian tumor. The recommended management was surgical staging and tumor debulking followed by chemotherapy.
This document discusses screening for gestational diabetes mellitus (GDM). It defines GDM and explains that pregnancy increases insulin resistance. There are two approaches to screening - a single step 75g oral glucose tolerance test (OGTT), or a two step approach using a 50g glucose challenge test followed by a 100g OGTT if thresholds are met. Threshold values for diagnosing GDM on OGTT tests are provided. The Seshiah test, recommended in India, performs a 75g OGTT in the non-fasting state, diagnosing GDM if the 2hr value is ≥140mg/dL.
Mrs. Vasanthamma, a 30-year old housewife, presented with 8 months of amenorrhea and easy fatigability for the past 2 months. On examination, she was found to be anemic with a hemoglobin level of 8.4 gm%. She was diagnosed with anemia during her current pregnancy. A full obstetric examination estimated her gestational age at 32 weeks with a fetal weight of approximately 2.48 kg in the breech position.
This document describes the Ballard Score, an examination used to assess gestational age in newborns. It compares the original Ballard Score to the new Ballard Score. The new score is more accurate, assessing gestational age from birth to 96 hours rather than 26-44 weeks. It also includes additional assessments of the eyes. The Ballard Score considers neuromuscular maturity and physical maturity. Studies show the new Ballard Score has high inter-rater reliability and is generally valid for assessing gestational age, though it may overestimate age in some populations.
Case presentation post caesarean pregnancyymadhu326
A 28-year-old woman, G3P1L1A1 with 9 months of amenorrhea, presented with complaints of abdominal pain for 2 hours. She had a previous cesarean section delivery. On examination, her uterus was enlarged corresponding to 36 weeks gestation with a single live fetus in cephalic presentation. She was diagnosed with 36 weeks gestation with 1 previous cesarean section and scar tenderness. An emergency cesarean section was performed under spinal anesthesia and a live preterm male baby was delivered. The postoperative period was uneventful.
1. The document provides information on examining patients in labor, including frequency of examinations, symbols used on partographs, and examples of completed partographs for different patients.
2. It includes details on vaginal examinations like cervical dilation, fetal position and heart rate, membrane status, and descent/moulding that should be recorded regularly during labor.
3. Examples of partographs show progression of labor over time for patients with details on vital signs and fetal/maternal status.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. It presents risks to a woman's health. Ectopic pregnancies are often caused by factors that delay the transit of the fertilized egg through the fallopian tubes. Diagnosis can be made through a combination of clinical history, examination, and investigations like ultrasound and blood tests. Early diagnosis through increased awareness and diagnostic tests has lowered the risks associated with ectopic pregnancies.
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in one of the fallopian tubes. It has become more common in recent decades due to rising rates of pelvic inflammatory disease, infertility treatments, and intrauterine device use.
2. Ectopic pregnancies are usually diagnosed through clinical history and examination combined with serum human chorionic gonadotropin (hCG) levels and transvaginal ultrasound. hCG levels that are rising slower than normal or an ultrasound that shows an empty uterus with a pregnancy sac located elsewhere can indicate an ectopic pregnancy.
3. Treatment depends on the individual case but typically involves surgery to remove the ectopic pregnancy
A 42-year-old teacher presented with menorrhagia for 6 months with lethargy and palpitations. On examination, she was pale with a pulse of 108 bpm. Investigations showed Hb levels decreasing from 8.1 to 7.8 g/dL. Ultrasound found an endometrial thickness of 6 mm without masses. She was diagnosed with dysfunctional uterine bleeding (DUB) and admitted for further management including IV fluids and iron supplements. DUB is abnormal bleeding due to hormonal imbalances that can cause heavy periods, and is diagnosed after excluding other causes. It is typically treated with hormonal therapy.
This document provides information from Dr. Kirtan Vyas about fetal growth restriction (FGR). It discusses the challenges in identifying and managing FGR. Key points include:
1) Timely identification of FGR is difficult but crucial for proper management and a favorable neonatal outcome, as it is the second leading cause of perinatal mortality after prematurity.
2) FGR remains extensively studied but still confusing and controversial to researchers.
3) The major concern with FGR is not the small size of the fetus but the possibility of life-threatening fetal compromise.
4) Screening approaches, management recommendations, and postnatal care for babies with FGR are discussed.
Uterine fibroid - Case scenarios and DiscussionHaynes Raja
This presentation is prepared to meet out the undergraduate medical student needs especially to understand the practical aspects of uterine fibroid and to rapidly revise some important viva questions.
Dedicated to my Great Teachers in the Dept. of Obstetrics & Gynaecology Dr. Lavanya Kumari and Dr. Sangeereni, Inspiring Friends Dr. Paulin Benedict, Dr. Jeyakumar Meyyappan and Dr. Hannah Jane and our REVELLIONZ 08’ batch.
Postpartum Haemorrhage : Case Illustrationlimgengyan
A 35-year-old woman experienced postpartum hemorrhage (PPH) after delivering a 3.9kg baby at a private facility. Despite treatments including ergometrine injections and oxytocin infusion, her uterus remained atonic and she experienced massive bleeding. She was transferred to a general hospital in a moribund state and died soon after arrival. A 30-year-old woman at a district hospital also experienced PPH after a vaginal delivery. Despite treatments including ergometrine, oxytocin, and uterine massage, she continued to bleed heavily and became lethargic with low blood pressure. She was transferred to a general hospital where a cervical laceration was suture
Maram, a 34-year-old pregnant woman at 32 weeks gestation, presented to the emergency room complaining of a sudden gush of clear fluid from her vagina for 1 hour. She has a history of bacterial vaginosis treated one week ago. On examination, fluid was leaking from her cervical opening when she coughed. Ultrasound showed decreased amniotic fluid and a breech presentation. The working diagnosis was premature rupture of membranes.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
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.
This document discusses occiput posterior position, its definition, causes, diagnosis, and management. It defines occiput posterior position as the fetal head descending into the pelvis with the sagittal suture in the transverse plane. Causes include pelvic abnormalities and fetal positioning. Diagnosis involves vaginal examination to feel head position. Management includes careful assessment, cesarean for modern obstetrics, or manual rotation and assisted delivery if vaginal is possible. Manual rotation involves inserting the hand into the vagina to rotate the fetal head to the occiput anterior position, and can be done with the whole or half hand.
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
This case presentation describes a 37-year-old woman who presented with abdominal pain in her right lower quadrant. She had a history of miscarriage and a positive pregnancy test. On examination, she had tenderness in her right lower quadrant and adnexal tenderness on bimanual examination. An ultrasound revealed a mass in her right adnexa consistent with an ectopic pregnancy. The differential diagnoses considered were ectopic pregnancy, appendicitis, renal colic, UTI, ovarian cyst, salpingitis, and IBS. The diagnosis was confirmed to be an ectopic pregnancy, which was treated with a laparoscopic salpingectomy.
The document provides guidelines for taking a thorough gynecology history. It emphasizes maintaining patient comfort and privacy, using sensitive communication, and exploring all relevant medical, surgical, obstetric, menstrual, sexual and family histories. The key components of history taking are outlined, including chief complaints, menstrual, obstetric and medical histories. Factors to assess for various presenting issues like abnormal bleeding, discharge, masses and infertility are described.
Mrs. Rahela Begum, a 55-year-old shopkeeper, presented with postcoital bleeding, foul-smelling discharge, bleeding with straining, and back pain for several months. Examination revealed severe anemia and a cauliflower-like cervical growth involving the whole vagina. The provisional diagnosis was stage IVa cervical cancer. Treatment options included blood transfusion, antibiotics, chemoradiation, or ultraradical surgery and palliation given the advanced stage.
Case Study on Intrauterine Growth RestrictionAbhineet Dey
A clinically based study of a case of Intrauterine Growth Restriction (IUGR) or Foetal Growth Restriction (FGR).
Moderator:
Dr M. K. Mazumdar
Asst. Professor,
Dept. of Obstetrics and Gynaecology,
Gauhati Medical College & Hospital
Presented by:
29: Abhineet Dey
30: Devasree Kalita
31: Parishmita Sharma
33: Ankur Jain
34: Dhurjyoti Nath
35: Mousumi Mehtaz
42: Liza Hazarika
Students of 8th Semester,
Gauhati Medical College & Hospital, Guwahati, Assam
The document discusses the interpretation and management of CTG (cardiotocography). It describes the steps to interpret a CTG tracing, including evaluating the fetal heart rate baseline, variability, accelerations, decelerations and their correlation with uterine contractions. It provides a structured DR C BRA VADO method to categorize CTG tracings as normal, suspicious or pathological. The management strategies for each category are then outlined, such as continued monitoring, additional tests like fetal scalp blood pH, or expedited delivery depending on the severity of the CTG abnormalities. Specific situations like the second stage of labor, placental abruption or fetal abnormalities are also addressed.
This document summarizes a medical case involving a 52-year-old female patient presenting with a lower abdominal mass. She reported a 5 month history of the mass along with weight loss and pain over the past 3 months. Physical examination revealed a large abdominal mass. Imaging studies including ultrasound and CT scan showed a large solid-cystic pelvic mass likely originating from the left ovary. Based on findings and elevated CA-125 level, the impression was of a likely malignant ovarian tumor. The recommended management was surgical staging and tumor debulking followed by chemotherapy.
This document discusses screening for gestational diabetes mellitus (GDM). It defines GDM and explains that pregnancy increases insulin resistance. There are two approaches to screening - a single step 75g oral glucose tolerance test (OGTT), or a two step approach using a 50g glucose challenge test followed by a 100g OGTT if thresholds are met. Threshold values for diagnosing GDM on OGTT tests are provided. The Seshiah test, recommended in India, performs a 75g OGTT in the non-fasting state, diagnosing GDM if the 2hr value is ≥140mg/dL.
Mrs. Vasanthamma, a 30-year old housewife, presented with 8 months of amenorrhea and easy fatigability for the past 2 months. On examination, she was found to be anemic with a hemoglobin level of 8.4 gm%. She was diagnosed with anemia during her current pregnancy. A full obstetric examination estimated her gestational age at 32 weeks with a fetal weight of approximately 2.48 kg in the breech position.
This document describes the Ballard Score, an examination used to assess gestational age in newborns. It compares the original Ballard Score to the new Ballard Score. The new score is more accurate, assessing gestational age from birth to 96 hours rather than 26-44 weeks. It also includes additional assessments of the eyes. The Ballard Score considers neuromuscular maturity and physical maturity. Studies show the new Ballard Score has high inter-rater reliability and is generally valid for assessing gestational age, though it may overestimate age in some populations.
Case presentation post caesarean pregnancyymadhu326
A 28-year-old woman, G3P1L1A1 with 9 months of amenorrhea, presented with complaints of abdominal pain for 2 hours. She had a previous cesarean section delivery. On examination, her uterus was enlarged corresponding to 36 weeks gestation with a single live fetus in cephalic presentation. She was diagnosed with 36 weeks gestation with 1 previous cesarean section and scar tenderness. An emergency cesarean section was performed under spinal anesthesia and a live preterm male baby was delivered. The postoperative period was uneventful.
1. The document provides information on examining patients in labor, including frequency of examinations, symbols used on partographs, and examples of completed partographs for different patients.
2. It includes details on vaginal examinations like cervical dilation, fetal position and heart rate, membrane status, and descent/moulding that should be recorded regularly during labor.
3. Examples of partographs show progression of labor over time for patients with details on vital signs and fetal/maternal status.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. It presents risks to a woman's health. Ectopic pregnancies are often caused by factors that delay the transit of the fertilized egg through the fallopian tubes. Diagnosis can be made through a combination of clinical history, examination, and investigations like ultrasound and blood tests. Early diagnosis through increased awareness and diagnostic tests has lowered the risks associated with ectopic pregnancies.
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in one of the fallopian tubes. It has become more common in recent decades due to rising rates of pelvic inflammatory disease, infertility treatments, and intrauterine device use.
2. Ectopic pregnancies are usually diagnosed through clinical history and examination combined with serum human chorionic gonadotropin (hCG) levels and transvaginal ultrasound. hCG levels that are rising slower than normal or an ultrasound that shows an empty uterus with a pregnancy sac located elsewhere can indicate an ectopic pregnancy.
3. Treatment depends on the individual case but typically involves surgery to remove the ectopic pregnancy
This document provides information on ectopic pregnancy, including its definition, types, risk factors, diagnosis, and management. Some key points:
- Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It can seriously endanger a woman's health if not promptly recognized and treated.
- Risk factors include previous pelvic inflammatory disease, previous ectopic pregnancy, infertility, and certain contraceptive methods. Diagnosis involves clinical history, examination, ultrasound, and beta-hCG levels.
- Management options depend on the clinical situation and include expectant management for stable patients, medical management using methotrexate, and surgical management including laparoscopy
1) An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include prior pelvic infection, surgery on the fallopian tubes, prior ectopic pregnancy, IUD use, DES exposure, and assisted reproduction.
2) In a tubal pregnancy, the fertilized egg implants and develops in the fallopian tube. This is not viable and can lead to tubal rupture due to the thin tube wall.
3) Without treatment, outcomes of tubal ectopic pregnancy include tubal mole, abortion, or rupture.
This document discusses various types of ectopic pregnancies and their management. It begins with a brief history and then covers medical and surgical management options. Specific procedures like salpingostomy, salpingectomy and methotrexate administration are described. Criteria for different treatments are provided. Rare types of ectopic pregnancies like interstitial, cervical and ovarian are defined along with their diagnostic criteria and management approaches. Monitoring of treatment is outlined.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes, and can be life-threatening if ruptured. Risk factors include previous pelvic infections, tubal surgery, ectopic pregnancy, smoking, and in vitro fertilization. Transvaginal ultrasound and quantitative hCG blood tests can usually diagnose ectopic pregnancies. Treatment options include surgical removal of the fallopian tube or dissecting the ectopic pregnancy, or medical management with methotrexate injections.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, pelvic surgery, or an intrauterine device. Without treatment, a tubal pregnancy risks rupturing the fallopian tube due to the limited space for growth. Diagnosis involves a pregnancy test and ultrasound, while treatment focuses on resolving the ectopic pregnancy through medication or surgery to avoid life-threatening bleeding. Rare sites of ectopic implantation include the ovaries, cervix, or peritoneal cavity.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It provides details on the classification, risk factors, symptoms, diagnosis, and treatment of ectopic pregnancy. Ectopic pregnancies are typically diagnosed through transvaginal ultrasound or serum hCG levels. Treatment options include medical management with methotrexate or surgical intervention like laparoscopy or laparotomy depending on the stability of the patient and size of the ectopic mass. The goal is to resolve the ectopic pregnancy while preserving the patient's future fertility if possible.
This document discusses early pregnancy complications including miscarriage, ectopic pregnancy, and molar pregnancy. It defines each condition and describes their causes, clinical features, diagnosis, and management. Miscarriage is defined as expulsion of pregnancy tissue before 22 weeks gestation and can be threatened, inevitable, incomplete, missed, or complete. Ectopic pregnancy occurs when implantation occurs outside the uterus, usually in the fallopian tubes. Molar pregnancy results from abnormal fertilization and can be complete or partial hydatiform moles, or develop into choriocarcinoma. The document provides details on evaluating and treating each complication.
This document provides information on ectopic pregnancy, including:
1. Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes.
2. Risk factors include STIs, IUD use, infertility history, smoking, and assisted reproduction.
3. Symptoms can include abdominal/pelvic pain, vaginal bleeding, and in severe cases, hypovolemic shock from rupture. Diagnosis involves ultrasound and beta-hCG levels.
4. Treatment options are expectant management, surgery (laparoscopy or laparotomy), or medical management with methotrexate depending on factors like size and symptoms. The goal is to preserve
This document discusses the diagnosis and management of extrauterine pregnancies. Diagnosis involves history, physical exam, and investigations like blood tests of HCG and progesterone levels and ultrasound imaging. Treatment options include medical management with methotrexate or surgery like salpingostomy. The choice of treatment depends on factors like size of ectopic, stability of the patient, and desire for future fertility. Surgical approaches range from conservative to radical depending on location and extent of ectopic pregnancy.
Management of ectopic pregnancy involves expectant, medical, or surgical treatment options. Ruptured ectopic pregnancies require emergency laparotomy for salpingectomy and resuscitation. Medical management with methotrexate is appropriate for stable patients with HCG <3,000 and no fetal pole. Follow up HCG levels are needed to monitor resolution and detect persistent trophoblast requiring further treatment. Expectant management can be considered for asymptomatic patients with HCG <1,000 and adnexal mass <5cm if HCG decreases by 50% within a week.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. Common symptoms include abdominal/pelvic pain and vaginal bleeding. Diagnosis is suggested by high beta-HCG levels and an empty uterus on ultrasound. Treatment options include expectant management for stable patients, medical management with methotrexate, or surgical intervention via laparoscopy or laparotomy for unstable patients or surgical candidates. The prognosis depends on the treatment, with methotrexate associated with higher subsequent intrauterine pregnancy rates compared to surgery.
This document summarizes the clinical manifestations, diagnosis, and management of ectopic pregnancies. Ectopic pregnancies occur when a fertilized egg implants outside the uterus, usually in a fallopian tube. Diagnosis is based on quantitative hCG levels and transvaginal ultrasound findings. Treatment options include expectant management for very low-risk cases, systemic methotrexate or surgery. Surgical options include salpingostomy to remove the ectopic pregnancy or salpingectomy to remove the fallopian tube. Close monitoring of hCG levels is important after any treatment.
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A 29-year-old female presented with intense back and pelvic pain for twelve hours. Ultrasound revealed no intrauterine gestational sac but moderate free fluid in the pelvis. Given her history of pregnancy and pain, ectopic pregnancy was considered the leading differential diagnosis. She underwent surgery and pathology confirmed an ectopic pregnancy. Follow up CT after surgery found no complications and her symptoms had resolved.
Ectopic pregnancy occurs when a fertilized egg implants and grows outside of the uterus, most commonly in the fallopian tubes. It is a serious condition that can cause life-threatening bleeding. Symptoms include missed period, abdominal pain, and vaginal bleeding. Diagnosis is confirmed through blood tests of beta-hCG and progesterone levels, ultrasound showing empty uterus, and sometimes laparoscopy. Treatment depends on severity but may include medication, surgery, or in rare cases expectant management.
This document discusses abortion and spontaneous abortion. It defines abortion as pregnancy termination prior to 28 weeks or less than 500g birth weight, which can occur spontaneously or intentionally. Spontaneous abortion, also called miscarriage, is defined as abortion occurring without medical intervention. The document then discusses the pathology, etiology, and maternal and fetal factors involved in spontaneous abortion. It also discusses incompetent cervix as a cause of recurrent early pregnancy loss and describes treatments like cerclage procedures.
This document discusses human sexuality, the male and female reproductive systems, the menstrual cycle, fertilization and early fetal development. It defines key terms related to sexuality and gender identity. It describes the external genitalia and internal reproductive organs of both males and females, including how they change and function throughout puberty and the menstrual or spermatogenesis cycles. It explains the process of fertilization and the initial pre-embryonic development of the zygote and blastocyst, including implantation in the uterus.
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in a fallopian tube. A 27-year-old woman presented with lower abdominal pain and spotting since day 7 of her menstrual cycle and a 10-day history of fever. Ultrasound revealed a heterogenous lesion in her left adnexa and a ring lesion in her left fallopian tube, and her beta-hCG level was 672 mIU/ml, confirming an ectopic pregnancy. Ectopic pregnancies can be treated medically with methotrexate or surgically with salpingectomy.
This document discusses ectopic pregnancy, which occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tubes. It defines ectopic pregnancy and lists risk factors and causes. Symptoms can include abdominal pain and vaginal bleeding. Diagnosis involves beta-hCG levels, ultrasound, and laparoscopy. Management options for unruptured ectopic pregnancies include expectant monitoring, medical treatment with methotrexate, and surgical treatment such as salpingostomy or salpingotomy.
Dr. Sourav Chowdhury provides a detailed overview of ectopic pregnancy in 3 paragraphs. He begins by defining ectopic pregnancy as implantation of a fertilized egg outside the uterine cavity, noting it poses serious health risks. He then discusses the various sites of implantation and causes of ectopic pregnancy, including pelvic inflammatory disease, previous tubal surgery or infertility treatments. Diagnosis involves ultrasound, beta-HCG levels, laparoscopy and considering differential diagnoses. Treatment depends on stability and includes expectant management, medical management with methotrexate or surgical options like salpingostomy or salpingectomy.
approach to patient vaginal bleeding in 2nd half of pregnancyYahyia Al-abri
Vaginal bleeding in the second half of pregnancy can be caused by placenta previa, placental abruption, or uterine rupture. Placenta previa is when the placenta lies low in the uterus over or near the cervical opening, which can cause painful bleeding. Placental abruption occurs when the placenta separates prematurely from the uterine wall, commonly causing painful bleeding and contractions. Uterine rupture is a medical emergency characterized by a complete tear through the uterine wall. The document discusses these conditions in detail and presents a case study of a pregnant patient who presented with vaginal bleeding.
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
1. The document provides guidance on diagnosing and managing bleeding during early pregnancy, including conditions like pregnancies of unknown location or viability, threatened miscarriage, and molar changes in a missed miscarriage.
2. Diagnosis involves a clinical examination and transvaginal ultrasound, noting features like a gestational sac size and presence of a fetal heartbeat provide clues to viability.
3. Management options for conditions like ectopic pregnancy or miscarriage are discussed, including expectant management, medication, or surgery depending on the situation. Serial ultrasounds and beta-hCG monitoring help guide treatment decisions.
Bleeding in early pregnancy can be due to miscarriage, ectopic pregnancy, or other causes. Signs and symptoms may include vaginal bleeding, abdominal or pelvic pain, and a positive pregnancy test. Evaluation involves assessing the last menstrual period, risk factors, ultrasound findings, and serum hCG levels. Management depends on the diagnosis and clinical situation, and may involve expectant monitoring, medical treatment with misoprostol or methotrexate, or surgical evacuation. The goal is to identify life-threatening ectopic pregnancies while preserving future fertility when possible.
This document discusses ectopic pregnancy, which occurs outside the uterine cavity, most commonly in the fallopian tubes. Risk factors include previous pelvic infections, tubal surgery, or ectopic pregnancy. Symptoms may include abdominal pain, vaginal bleeding, and shoulder pain. Diagnosis involves ultrasound to locate the pregnancy and measure beta-hCG levels. Management options are expectant, medical using methotrexate, or surgical laparoscopy or laparotomy depending on stability and location of ectopic pregnancy. Prompt treatment is needed to prevent rupture and life-threatening hemorrhage.
1) Evaluation of infertility is indicated after 12 months for women under 35 years old, 6 months for women over 35, and immediately for women over 40.
2) Certain conditions require immediate evaluation, including irregular cycles, bleeding issues, uterine/tubal abnormalities, male factor infertility, or genetic conditions.
3) A complete workup involves assessing the entire reproductive axis through history, examination, and targeted diagnostic testing to identify common causes like ovulatory disorders, endometriosis, tubal issues, and male factor infertility.
1) Evaluation of infertility is indicated after 12 months for women under 35 years old, 6 months for women over 35, and immediately for women over 40.
2) Testing should also be done immediately if irregular cycles, bleeding issues, uterine/tubal abnormalities, male factor infertility, or genetic conditions are present.
3) Causes of infertility include ovulatory disorders, endometriosis, pelvic adhesions, tubal blockage, tubal/uterine abnormalities, and unknown factors. A thorough evaluation of the entire reproductive system is needed.
Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, usually in the fallopian tubes. It is increasingly common, affecting about 1 in 100 pregnancies. Left untreated, it can cause life-threatening bleeding if the embryo implants grow large enough to rupture the fallopian tube. Diagnosis involves serial beta-hCG tests and ultrasound imaging. Treatment options include medication with methotrexate or surgery like laparoscopy or laparotomy to remove the ectopic pregnancy. With early detection and proper treatment, ruptured ectopic pregnancies can often be avoided.
This document contains a patient case report for Januka Katuwal, a 32-year-old female presenting with cessation of menstruation for over a month, abdominal pain for 8 hours, and vomiting for 8 hours. Her examination and investigations revealed a ruptured ectopic pregnancy in her right fallopian tube, which was then managed via an emergency laparotomy and right salpingectomy with left tubal ligation. The document also provides definitions, classifications, risk factors, clinical approaches, diagnostic methods, and management options for ectopic pregnancies.
An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in one of the fallopian tubes. Risk factors include previous ectopic pregnancy, pelvic inflammatory disease, IUD use, and infertility treatments. Ectopic pregnancies are diagnosed through transvaginal ultrasound, serum hCG and progesterone levels, and sometimes laparoscopy. Treatment options include expectant management for very early ectopic pregnancies, systemic methotrexate injections to terminate the pregnancy, or surgery to remove the ectopic pregnancy if it has ruptured or growth is threatening rupture. Methotrexate treatment involves either a single dose or two doses of the drug followed by monitoring of hCG levels.
1. Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a leading cause of maternal mortality.
2. Risk factors include a history of pelvic inflammatory disease, previous ectopic pregnancy, or tubal ligation. Symptoms include abdominal pain, vaginal bleeding, and amenorrhea.
3. Diagnosis involves using ultrasound to locate the pregnancy and measuring serum hCG levels. If the pregnancy cannot be located, hCG levels will help determine if the pregnancy is intrauterine or ectopic.
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
This document provides guidance on evaluating and managing common adolescent gynecologic issues. It discusses indications and techniques for pelvic exams and evaluating vaginal discharge. It also reviews causes and treatments for gynecologic pain, abnormal uterine bleeding, amenorrhea, polycystic ovary syndrome, and more. Key topics include ovarian cysts, ectopic pregnancy, endometriosis, and approaches to chronic pelvic pain.
An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the uterus, usually in the fallopian tubes. Ectopic pregnancies account for 2% of pregnancies and are the leading cause of maternal death in early pregnancy. Symptoms include missed period, abdominal pain, and vaginal bleeding. Diagnosis is confirmed through blood tests of human chorionic gonadotropin and progesterone levels and transvaginal ultrasound. Treatment depends on the stability of the patient and may involve medication with methotrexate or surgery either laparoscopically or through laparotomy. Prompt diagnosis and treatment are important to prevent life-threatening complications.
This document discusses endometrial carcinoma (cancer of the uterus). It covers the epidemiology, risk factors, types/classification, diagnosis, staging, treatment and prognosis. Some key points:
- It is the 3rd most common female cancer in India, occurring most often in post-menopausal women aged 60-70. The 5-year survival rate is approximately 75%.
- There are two main types - Type 1 is associated with estrogen exposure, is lower grade, and has a better prognosis. Type 2 occurs without estrogen stimulation, is higher grade and has a poorer prognosis.
- Risk factors include family history, nulliparity, early menarche/late menopause, obesity,
This document discusses endometrial carcinoma (cancer of the uterus). It covers the epidemiology, risk factors, types/classification, diagnosis, staging, treatment and prognosis. Some key points:
- It is the 3rd most common female cancer in India, occurring most often in post-menopausal women aged 60-70. The 5-year survival rate is approximately 75%.
- There are two main types - Type 1 is associated with estrogen exposure, is lower grade, and has a better prognosis. Type 2 occurs without estrogen stimulation, is higher grade and has a poorer prognosis.
- Risk factors include family history, nulliparity, early menarche/late menopause, obesity,
Know the difference between Endodontics and Orthodontics.Gokuldas Hospital
Your smile is beautiful.
Let’s be honest. Maintaining that beautiful smile is not an easy task. It is more than brushing and flossing. Sometimes, you might encounter dental issues that need special dental care. These issues can range anywhere from misalignment of the jaw to pain in the root of teeth.
Breast cancer: Post menopausal endocrine therapyDr. Sumit KUMAR
Breast cancer in postmenopausal women with hormone receptor-positive (HR+) status is a common and complex condition that necessitates a multifaceted approach to management. HR+ breast cancer means that the cancer cells grow in response to hormones such as estrogen and progesterone. This subtype is prevalent among postmenopausal women and typically exhibits a more indolent course compared to other forms of breast cancer, which allows for a variety of treatment options.
Diagnosis and Staging
The diagnosis of HR+ breast cancer begins with clinical evaluation, imaging, and biopsy. Imaging modalities such as mammography, ultrasound, and MRI help in assessing the extent of the disease. Histopathological examination and immunohistochemical staining of the biopsy sample confirm the diagnosis and hormone receptor status by identifying the presence of estrogen receptors (ER) and progesterone receptors (PR) on the tumor cells.
Staging involves determining the size of the tumor (T), the involvement of regional lymph nodes (N), and the presence of distant metastasis (M). The American Joint Committee on Cancer (AJCC) staging system is commonly used. Accurate staging is critical as it guides treatment decisions.
Treatment Options
Endocrine Therapy
Endocrine therapy is the cornerstone of treatment for HR+ breast cancer in postmenopausal women. The primary goal is to reduce the levels of estrogen or block its effects on cancer cells. Commonly used agents include:
Selective Estrogen Receptor Modulators (SERMs): Tamoxifen is a SERM that binds to estrogen receptors, blocking estrogen from stimulating breast cancer cells. It is effective but may have side effects such as increased risk of endometrial cancer and thromboembolic events.
Aromatase Inhibitors (AIs): These drugs, including anastrozole, letrozole, and exemestane, lower estrogen levels by inhibiting the aromatase enzyme, which converts androgens to estrogen in peripheral tissues. AIs are generally preferred in postmenopausal women due to their efficacy and safety profile compared to tamoxifen.
Selective Estrogen Receptor Downregulators (SERDs): Fulvestrant is a SERD that degrades estrogen receptors and is used in cases where resistance to other endocrine therapies develops.
Combination Therapies
Combining endocrine therapy with other treatments enhances efficacy. Examples include:
Endocrine Therapy with CDK4/6 Inhibitors: Palbociclib, ribociclib, and abemaciclib are CDK4/6 inhibitors that, when combined with endocrine therapy, significantly improve progression-free survival in advanced HR+ breast cancer.
Endocrine Therapy with mTOR Inhibitors: Everolimus, an mTOR inhibitor, can be added to endocrine therapy for patients who have developed resistance to aromatase inhibitors.
Chemotherapy
Chemotherapy is generally reserved for patients with high-risk features, such as large tumor size, high-grade histology, or extensive lymph node involvement. Regimens often include anthracyclines and taxanes.
Debunking Nutrition Myths: Separating Fact from Fiction"AlexandraDiaz101
In a world overflowing with diet trends and conflicting nutrition advice, it’s easy to get lost in misinformation. This article cuts through the noise to debunk common nutrition myths that may be sabotaging your health goals. From the truth about carbohydrates and fats to the real effects of sugar and artificial sweeteners, we break down what science actually says. Equip yourself with knowledge to make informed decisions about your diet, and learn how to navigate the complexities of modern nutrition with confidence. Say goodbye to food confusion and hello to a healthier you!
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.
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
Osvaldo Bernardo Muchanga-GASTROINTESTINAL INFECTIONS AND GASTRITIS-2024.pdfOsvaldo Bernardo Muchanga
GASTROINTESTINAL INFECTIONS AND GASTRITIS
Osvaldo Bernardo Muchanga
Gastrointestinal Infections
GASTROINTESTINAL INFECTIONS result from the ingestion of pathogens that cause infections at the level of this tract, generally being transmitted by food, water and hands contaminated by microorganisms such as E. coli, Salmonella, Shigella, Vibrio cholerae, Campylobacter, Staphylococcus, Rotavirus among others that are generally contained in feces, thus configuring a FECAL-ORAL type of transmission.
Among the factors that lead to the occurrence of gastrointestinal infections are the hygienic and sanitary deficiencies that characterize our markets and other places where raw or cooked food is sold, poor environmental sanitation in communities, deficiencies in water treatment (or in the process of its plumbing), risky hygienic-sanitary habits (not washing hands after major and/or minor needs), among others.
These are generally consequences (signs and symptoms) resulting from gastrointestinal infections: diarrhea, vomiting, fever and malaise, among others.
The treatment consists of replacing lost liquids and electrolytes (drinking drinking water and other recommended liquids, including consumption of juicy fruits such as papayas, apples, pears, among others that contain water in their composition).
To prevent this, it is necessary to promote health education, improve the hygienic-sanitary conditions of markets and communities in general as a way of promoting, preserving and prolonging PUBLIC HEALTH.
Gastritis and Gastric Health
Gastric Health is one of the most relevant concerns in human health, with gastrointestinal infections being among the main illnesses that affect humans.
Among gastric problems, we have GASTRITIS AND GASTRIC ULCERS as the main public health problems. Gastritis and gastric ulcers normally result from inflammation and corrosion of the walls of the stomach (gastric mucosa) and are generally associated (caused) by the bacterium Helicobacter pylor, which, according to the literature, this bacterium settles on these walls (of the stomach) and starts to release urease that ends up altering the normal pH of the stomach (acid), which leads to inflammation and corrosion of the mucous membranes and consequent gastritis or ulcers, respectively.
In addition to bacterial infections, gastritis and gastric ulcers are associated with several factors, with emphasis on prolonged fasting, chemical substances including drugs, alcohol, foods with strong seasonings including chilli, which ends up causing inflammation of the stomach walls and/or corrosion. of the same, resulting in the appearance of wounds and consequent gastritis or ulcers, respectively.
Among patients with gastritis and/or ulcers, one of the dilemmas is associated with the foods to consume in order to minimize the sensation of pain and discomfort.
STUDIES IN SUPPORT OF SPECIAL POPULATIONS: GERIATRICS E7shruti jagirdar
Unit 4: MRA 103T Regulatory affairs
This guideline is directed principally toward new Molecular Entities that are
likely to have significant use in the elderly, either because the disease intended
to be treated is characteristically a disease of aging ( e.g., Alzheimer's disease) or
because the population to be treated is known to include substantial numbers of
geriatric patients (e.g., hypertension).
5-hydroxytryptamine or 5-HT or Serotonin is a neurotransmitter that serves a range of roles in the human body. It is sometimes referred to as the happy chemical since it promotes overall well-being and happiness.
It is mostly found in the brain, intestines, and blood platelets.
5-HT is utilised to transport messages between nerve cells, is known to be involved in smooth muscle contraction, and adds to overall well-being and pleasure, among other benefits. 5-HT regulates the body's sleep-wake cycles and internal clock by acting as a precursor to melatonin.
It is hypothesised to regulate hunger, emotions, motor, cognitive, and autonomic processes.
- Video recording of this lecture in English language: https://youtu.be/Pt1nA32sdHQ
- Video recording of this lecture in Arabic language: https://youtu.be/uFdc9F0rlP0
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
PGx Analysis in VarSeq: A User’s PerspectiveGolden Helix
Since our release of the PGx capabilities in VarSeq, we’ve had a few months to gather some insights from various use cases. Some users approach PGx workflows by means of array genotyping or what seems to be a growing trend of adding the star allele calling to the existing NGS pipeline for whole genome data. Luckily, both approaches are supported with the VarSeq software platform. The genotyping method being used will also dictate what the scope of the tertiary analysis will be. For example, are your PGx reports a standalone pipeline or would your lab’s goal be to handle a dual-purpose workflow and report on PGx + Diagnostic findings.
The purpose of this webcast is to:
Discuss and demonstrate the approaches with array and NGS genotyping methods for star allele calling to prep for downstream analysis.
Following genotyping, explore alternative tertiary workflow concepts in VarSeq to handle PGx reporting.
Moreover, we will include insights users will need to consider when validating their PGx workflow for all possible star alleles and options you have for automating your PGx analysis for large number of samples. Please join us for a session dedicated to the application of star allele genotyping and subsequent PGx workflows in our VarSeq software.
2. Case
• 26 years old lady, presented on 7th may 2014
at 1230 hrs with C/O of
– Amenorrhoea 4 weeks 6 days
– Irregular bleeding P/V 3-4 days
– Severe lower abdominal pain since morning
– Loss of consciousness(syncope) 01 episode since
morning
3. HOPI
• G2P1 lady
• LMP 04 April 2014
• Underwent LSCS 2 years back, live baby
delivered(indication-unfavorable cervix)
• No H/O of Tuberculosis in past
• No H/O DM or HTN
4. On Examination
• Temp-98.6
.
F
• Pulse-68/min
• RR-20/min
• BP-80/40mmHg rt.arm supine
• SpO2 95%
• Pallor +++
• P/A
– Distension +
– Tenderness over suprapubic region ++
• Other systems-NAD
11. Introduction
• When Fertilized Ovum is implanted and develops
outside the normal Endometrial Cavity
• Contributes significantly to maternal morbidity
and mortality
• Prompt recognition and early aggressive
intervention is of paramount importance
12. Is one in which fertilized ovum is implanted &
develops outside normal uterine cavity
15. ACQUIRED
Pelvic Inflammatory disease (6-10 times)
Chlamydia is most common
Contraceptive Faliure
Cu T - 4%
Progestasart -17%
Minipills -4-10%
Norplant -30%
16. Tubal sterilization faliure - 40%
Depends on sterilization technique and age of the patient
Bipolar Cauterisation -65%
Unipolar Cautery -17%
Reversal of sterilisation
- Depends on method of sterilization, Site of
tubal occlusion, residual tubal length.
- Reanastomosis of cauterised tube -15%
- Reversal of Pomeroy’s - < 3%
17. Tubal reconstructive surgery (4-5 times)
Assisted Reproductive technique(ART)
- Ovulation induction, IVF-ET and GIFT (4-7%)
- Risk of heterotopic pregnancy(1%)
Previous Ectopic Pregnancy
- 7-15% chances of repeat ectopic pregnancy
18. Other Risk factors
Age 35-45 yrs
Previous induced abortion
Previous pelvic surgeries
Cigarette smoking
Infertility
Salpingitis Isthmica Nodosa
Genital Tuberculosis
Fundal Fibroid & Adenomyosis of tube
Transperitoneal migration of ovum
19. Fate of Pregnancy
• Pregnancy is unable to survive due to poor blood
supply, thus resulting in
– a tubal abortion and resorption
– Expulsion from the fimbriated end into the abdominal cavity.
• Continues to grow until the over distended tube
ruptures, resulting profuse intraperitoneal bleeding.
• Isthmic – 6-8 wks,
• Ampulla – 8-12wks,
• Interstitial -4 months
• Abortion is common in ampullary
pregnancies,whereas rupture is in isthmic.
20. • Rarely, tubal pregnancy will be expelled from the
tube and seed onto sites in the abdominal cavity (e.g.
omentum, small or large bowel, or parietal
peritoneum), and gives rise to a viable abdominal
pregnancy.
21. CLINICAL APPROACH
• Diagnosis can be done by history, detail examination and
judicious use of investigation.
• H/o past PID, tubal surgery, current contraceptive measures
• Wide spectrum of clinical presentation from asymptomatic pt. to
others with acute abdomen and in shock.
22. ACUTE ECTOPIC PREGNANCY
• Classical triad is present in 50% of pt. with
rupture ectopic.
- PAIN:- most constant feature in 95% pt
- variable in severity and nature
- AMENORRHOEA:- 60-80% of pt
- there may be delayed period or slight
spotting at the time of expected menses.
- VAGINAL BLEEDING: - scanty dark brown
• Feeling of nausea, vomiting, fainting attack, syncope attack(10%)
due to reflex vasomotor disturbance.
23. • O/E:- patient is restless in agony, looks blanched,
pale, sweating with cold clammy skin.
Features of shock, tachycardia, hypotension.
• P/A:- abdomen tense, tender mostly in lower
abdomen, shifting dullness, rigidity may be
present.
• P/S:- minimal bleeding may be present
• P/V:- uterus may be bulky, deviated to opposite
side, fornix is tender, excitation pain on
movement of cervix.
POD may be full, uterus floats as if in water.
24. CHRONIC ECTOPIC PREGNANCY
• It can be diagnosed by high clinical suspicion.
• Previous attack of acute pain from which she has recovered.
• She may have
– amenorrhoea
– vaginal bleeding with dull pain in abdomen
– bladder and bowel complaints like dysuria,frequency or retention of
urine, rectal tenesmus.
25. • O/E:- patient look ill, varying degree of pallor,
slightly raised temperature. Features of shock
are absent.
• P/A:- Tenderness and muscle guard on the lower
abdomen.
A mass may be felt, irregular and tender.
• P/V:- Vaginal mucosa pale, uterus may be normal
in size or bulky, ill defined boggy tender
mass may be felt in one of the fornix.
26. UNRUPTURED ECTOPIC
• Diagnosed accidentally in Laparoscopy or Laparotomy
C/F – delayed period, spotting with discomfort in
lower abdomen.
P/A – tenderness in lower abdomen
P/V – should be done gently
uterus is normal size, firm
small tender mass may be felt in the fornix
27. DIAGNOSIS
• Patient with acute ectopic can be diagnosed clinically.
• Blood should be drawn for Hb gm%, blood grouping and cross
matching, DC and TWBC, BT, CT.
• Should be catheterized to know urine output.
Bed side test:-
1. Urine pregnancy test:- positive in 95% cases.
ELISA is sensitive to 10-50 mlU/ml of β hCG and
can be detected on 24th day after LMP.
28. 2. Culdocentesis:- (70-90%)(OLD TECHNIQUE)
- Can be done with 16-18 G lumbar
puncture needle through posterior fornix
into POD.
- Positive tap is 0.5ml of non clotting blood.
• Other Investigations:-
1. Ultra Sonography
a) Transvaginal Sonography (TVS):
- Is more sensitive
- It detect intrauterine gestational sac at
4-5wks and at S-β hCG level as low as 1500
IU/L .
29. b) Color Doppler Sonography(TV-CDS):
- Improve the accuracy.
-Identify the placental shape (ring-
of-fire pattern) and blood flow
outside the uterine cavity.
c) Transabdominal Sonography:
- can identify gestational sac at 5-6 wks
- S-β hCG level at which intrauterine gestational
sac is seen by TAS is 1800 IU/L.
30. 2. β-HCG Assay
a) Single β-HCG: little value
b) Serial β-HCG: is required when result of
initial USG is confusing.
- When hCG level < 2000 IU/L doubling time
help to predict viable Vs nonviable pregnancy
(hCG level doubles by 48 hrs in normal pregnancy)
-Rise of β-HCG <66% in 48 hrs indicate
ectopic pregnancy or nonviable intrauterine
pregnancy .
-Biochemical pregnancy is applied to those
women who have two β-HCG values >10 IU/L
31. 3. Serum Progesterone
- level >25 ngm/ml is suggestive of normal
intrauterine pregnancy.
- level <15 ngm/ml is suggestive of ectopic
pregnancy.
- level <5 ngm/ml indicates nonviable
pregnancy, irrespective of its location.
4. Diagnostic Laparoscopy (Gold standard)
- Can be done only when patient is
haemodynamically stable.
-It confirms the diagnosis and removal of
ectopic mass can be done at the same time.
32. 5. Dilatation & Curettage
- Is recommended in suspected case of
incomplete abortion vs ectopic pregnancy.
- Identification of decidua without chorionic
villi is suggestive of extra uterine pregnancy.
6. Other hormonal Tests
- Placenta protein (PP14) decrease in EP
- PAPPA (Pregnancy Associated Plasma Protein A),
PAPPC (schwangerchaft protein 1) has low value in EP
- CA-125, Maternal serum creatine kinase, Maternal serum AFP
elevated in ectopic pregnancy.
33. SUSPECTED ECTOPIC PREGNANCY
Urine Pregnancy test positive
Transvaginal USG
IU sac No IU sac
Quantitative S-hCG
+ S progesterone
< 66% rise in 48 hr or
S progesterone < 5-10 ng/ml
D & C
Villi present Villi absent
Incomplete
abortion
Laparoscopy
>66% rise in 48 hr or
S progesterone > 5-10 ng/ml
Repeat S-hCG in 48 hrs
till USG discrimination zone
No sac IU sac
Continue to monitor
35. MANAGEMENT OF RUPTURED ECTOPIC
PRINCIPLE: Resuscitation and Laparotomy
ANTI SHOCK TREATEMENT:
- IV line made patent, crystalloid is started
- Blood sample for Hb, blood grouping & cross matching, PT,PTTK,INR
- Catheterization done
- Colloids for volume replacement
LAPAROTOMY:
Principle is ‘Quick in and Quick out’
- Rapid exploration of abdominal cavity is done
- Salpingectomy is the definitive surgery (sent for HPE)
- Blood transfusion to be given
36. MANAGEMENT OF UNRUPTURED ECTOPIC
PREGNANCY
OPTIONS: -
• SURGICAL
• SURGICALLY ADMINISTERED MEDICAL (SAM)
TREATMENT
• MEDICAL TREATMENT
• EXPECTANT MANAGEMENT
37. EXPECTANT MANAGEMENT
IDENTIFICATION CRITERIA (Ylostalo et al , 1993)- :
1. Tubal ectopic pregnancies only
2. Haemodynamically stable
3. Haemoperitoneum < 50ml
4. Adnexal mass of < 3.5 cm without heart beat.
5. Initial β HCG <1000 IU/L and falling in titre
SUCCESS RATE - Upto 60%
PROTOCOL:
- Hospitalization with strict monitoring of clinical symptom
- Daily Hb estimation
- Serum β HCG monitoring 3-4 days until it is <10 IU/L
- TVS to be done twice a week.
38. MEDICAL MANAGEMENT
Surgery-mainstay of management worldwide
Medical management-tried in selected cases
CANDIDATES FOR METHOTREXATE (MTX)
Unruptured sac < 3.5cm without cardiac activity
S-hCG < 10,000 IU/L
Persistant Ectopic after conservative surgery
PHYSICIAN CHECK LIST
CBC, LFT, RFT, S-hCG
Transvaginal USG within 48 hrs
Obtain informed consent
Anti-D Ig if pt is Rh negative
Follow up on day1, 4 and 7.
39. MEDICAL MANAGEMENT
METHOTREXATE:
• Oral/intramuscular /intravenous usually along with folinic acid.
• Mostly used for early resolution of placental tissue in abdominal
pregnancy. Can also be used for tubal pregnancy.
• Mechanism of action
– Methotrexate-folic acid antagonist that inactivates the
enzyme dihydrofolate reductase
– Interferes with the DNA synthesis by inhibiting the
synthesis of pyrimidines leading to trophoblastic cell death
– Auto enzymes and maternal tissues then absorb the
trophoblast.
40. • Advantages –
– Minimal Hospitalisation.Usually outdoor treatment
– Quick recovery
– 90% success if cases are properly selected
• Disadvantages-
– Side effects like GI & Skin
– Monitoring is essential- Total blood count, LFT & serum
HCG once weekly till it becomes negative
41. SURGICALLY ADMINISTERED MEDICAL(SAM)
TREATMENT
• Aim- Trophoblastic destruction without systemic side effects
• Technique- Injection of trophotoxic substance into the ectopic
pregnancy sac or into the affected tube by-
– Laparoscopy or
– Ultrasonographically guided
• Transabdominal (Porreco, 1992)
• Transvaginal (Feichtingar, 1987)
– With Falloposcopic control (Kiss, 1993)
42. Trophotoxic substances used-
Methtrexate (Pansky, 1989)
Potassium Chloride (Robertson, 1987)
Mifiprostone (RU 486)
PGF2 (Limblom, 1987)
Hyper osmolar glucose solution
Actinomycin D
Advantage of local MTX :
- Increase tissue concentration at local site
- Decrease systemic side effects
- Decrease hospitalization
- Greater preservation of fertility
Follow up: - Serum β HCG twice weekly till < 10 IU/L
- TVS weekly for 4-6 weeks
- HCG after 6 months for tubal patency
SURGICALLY ADMINISTERED MEDICAL Tt (SAM)
43. SURGICAL MANAGEMENT OF ECTOPIC
Conservative Surgery
Can be done Laparoscopically or by microsurgical laparotomy
INDICATION:
- Patient desires future fertility
- Contralateral tube is damaged or surgically removed
previously
CHOICE OF TECHNIQUE: depends on
- Location and size of gestational sac
- Condition of tubes
- Accessibility
44. VARIOUS CONSERVATIVE SURGERIES
1.Linear Salpingostomy:
- Indicated in unruptured ectopic <2cm in ampullary region.
- Linear incision given on antimesentric border over the site
and product removed by fingers, scalpel handle or gentle
suction and irrigation.
- Incision line kept open (heals by secondary intention)
2. Linear Salpingotomy :
- Incision line is closed in two layers with 7-0 interrupted
vicryl sutures.
3. Segmental Resection & Anastomosis:
- Indicated in unruptured isthmic pregnancy
- End to end anastomosis is done immediately or at later
date
45. 4. Milking or fimbrial Expression:
- This is ideal in distal ampullary or infundibular pregnancy.
- It has got increased risk of persistent ectopic pregnancy.
ADVANTAGES OF LAPAROSCOPY
- It helps in diagnosis, evaluation, and treatment .
- Diagnose other causes of infertility.
- Decreased hospitalization, operative time, recovery period,
analgesic requirement.
Follow up after conservative surgery
- With weekly Serum β HCG titre till it is negative.
- If titre increases methotrexate can be given.
46. SALPINGECTOMY
VS
SALPINGOSTOMY / SALPINGOTOMY
All tubal pregnancies can be treated by partial or total
Salpingectomy
Salpingostomy / Salpingotomy is only indicated when:
1. The patient desires to conserve her fertility
2. Patient is haemodinamically stable
3. Tubal pregnancy is accessible
4. Unruptured and < 5Cm. In size
5. Contralateral tube is absent or damaged
47. Laparotomy Vs Laparoscopy
- Laparoscopy is reserved for pt.who are
hemodynamically stable.
- Ruptured Ectopic does not necessarily require
Laparotomy, but if large clots are present
Laparotomy should be considered.
Reproductive outcome
Is similar in pt. treated with either Laparoscopy or Laparotomy.
51. OVARIAN ECTOPIC PREGNANCY
Incidence: 1:40,000
Risk factor: - IUCD
- Endometriosis on surface of ovary
Course:
C/F are same as tubal pregnancy
ruptures within 2-3 wks
Diagnosis: On Laparotomy
Spiegelberg’s Criteria
1. Ipsilateral tube is intact and separate from sac
2. Sac occupies the position of the ovary
3. Connected to uterus by ovarian ligament
4. Ovarian tissue found on its wall on HP study
M/M
Ruptured
Laparotomy
Oophorectomy
Unruptured
Ovarian wedge resection
Ovarian Cystectomy
52. ABDOMINAL PREGNANCY
Incidence: Rarest
MMR : 7-8 times > tubal ectopic
90 times > Intrauterine pregnancy
H/O : - Irregular bleeding, spotting
- Nausea, vomiting, flatulence, constipation,
diarrhoea, abdominal pain.
- Fetal movement may be painful and high in
the abdomen
O/E : - Abnormal fetal position, easy in palpating
fetal parts.
- uterus palpated separate from sac
- no uterine contraction after oxytocin
infusion
53. FATE OF SECONDARY ABDOMINAL PREGNANCY :
1. Death of ovum – complete absorption
2. Placental separation – massive intraperitoneal
haemorrhage
3. Infection – fistulous communication with intestine,
bladder, vagina, or umbilicus
4. Fetus dies (majority) – mummification, adipocere
formation, or calcified to lithopaedion
5. Rarely – continue to term (malformation)
M/M:
- Urgent Laparatomy irrespective of period of gestation
- Ideal to remove entire sac fetus, placenta, membrane
- Placenta may be left if attached to vital organs, get
absorbed by aseptic autolysis
54. CERVICAL PREGNANCY
Implantation occurs in cervical canal at or below internal Os.
Incidence: 1 in 18,000
RISK FACTORS :
- Previous induced abortion
- Previous caesarean delivery
- Asherman’s syndrome
- IVF
- DES exposure
- Leiomyoma
55. MANAGEMENT
Surgical
Mainstay therapy in past
Radical
surgery
Hysterectomy
Conservative
D & C
(risk of torrential bleeding)
- Cerclage Bernstein ≈ Mc Donald’s
Wharton ≈ Shirodkar’s
-Transvaginal ligation of Cx branch of
uterine artery
- Angiographic uterine A embolisation
- Intracervical vasopressin inj
- Foley’s catheter as tamponade
Medical
Recently proposed
Single or Combination
OR
Adjunct to surgery
- Methotrexate
- Actinomycin
- KCl
- Etoposide
56. CORNUAL PREGNANCY
SITE: Implantation occurs in rudimentary horn of Bicornuate
uterus
COURSE :Rupture of horn occurs by
12-20 wks
D/D :
1. Interstitial tubal pregnancy
2. Painful leiomyoma along with
pregnancy
3. Ovarian tumor with pregnancy
4. Asymmetrical enlargement of uterus.
Implantation into cornu of normal uterus is sometime
called Angular pregnancy .
TREATEMENT:
- Affected cornu with pregnancy is removed
- Hysterectomy
- Hysteroscopically guided suction curettage if
communication with Cx is patent
57. INTERSTITAL PREGNANCY (2%)
It ruptures late at 3-4 months gestation.
Fatal rupture – severe bleeding as both uterine &
ovarian artery supply.
Early & Unruptured – Local or IM MTX with followup
Cornual resection by Laparotomy may be done.
There is high risk of uterine rupture in
subsequent pregnancy.
Rupture – Hysterectomy is indicated
58. CAESAREAN SCAR ECTOPIC PREGNANCY
Recently reported
USG slows on empty uterine cavity and gestational sac attached
low to the lower segment caesarean scar.
C/F : similar to threatened or inevitable abortion
Diagnosis : Doppler imaging confirms
T/t : Methotrexate injection
Hysterectomy in a multiparous women.
In young pt resection & suturing of scar may be
done (high risk of rupture).