This document discusses hypertensive disorders of pregnancy, including gestational hypertension, preeclampsia, and eclampsia. It defines the conditions and describes their typical symptoms of hypertension, edema, and protein in the urine. The pathophysiology involves vasoconstriction, endothelial damage, and increased capillary permeability. Management involves medications to lower blood pressure like magnesium sulfate and antihypertensives. Close monitoring of the mother and fetus is needed to watch for complications that could require early delivery.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Please find the power point on Puerperal sepsis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Please find the power point on Puerperal sepsis. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
This presentation deals with information regarding a minor disorder of pregnancy i.e hyperemesis gravidarum, its manifestations, causes, diagnostic evaluation,complications, management, nursing interventions etc.Though its a minor disorder, delayed treatment can be fatal.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- 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
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
2. Hypertensive Disorders of
Pregnancy
1. Chronic Hypertension (before pregnancy)
2. Gestational (in pregnancy) Hypertension
-
Pre-eclampsia
Severe pre-eclampsia
Eclampsia
HELLP syndrome
3. Hypertensive Disorders of
Pregnancy
• Most commonly reported disorder of
pregnancy
• May occur in 20% of all pregnancies
• One of the leading causes of maternal
morbidity and mortality worldwide
4. Pathophysiology/Etiology
1. Actual cause is unknown.
2. Theories of the etiology include the exposure to chorionic villi for the
first time, or in large amounts, along with
immunologic, genetic, and endocrine factors.
3. The disease is primarily seen in primagravidas.
4. Chronic hypertension, hydatidiform mole, multiple
gestation, polyhydramnios, and diabetes mellitus may
predispose to PIH.
5. Adolescents and women over 35 years of age are at higher risk.
6. Approximately 6% to 8% of pregnancies may be affected.
7. Vasospasms occur and result in increased resistance in vascular
flow, increasing the arterial blood pressure.
8. Increased sensitivity to angiotensin II occurs before the onset of
hypertension.
9. Hemoconcentration occurs due to the vasoconstriction or as a
result of increased vascular permeability or a combination of both.
9. Clinical Manifestations
1. Hypertension, which is defined as a blood pressure of 140/90
mm Hg or greater on two occasions at least 6 hours apart
2. Proteinuria , +, ++, +++, ++++
3. Edema, nondependent, present after 8 to 12 hours of bed rest
,
4. Frequently, a sudden weight gain will occur, of 2 lb or more in
1 week, or 6 lb or more in 1 month. This often occurs before
the edema is present.
5. Altered level of consciousness, visual changes, headache
6. Oliguria
7. Epigastric pain, chest pressure
8. Hyperreflexia with or without clonus
11. Hypertensive Disorders of
Pregnancy
• Pre-eclampsia
Severe
Preeclampsia
PLUS one of the following:
1. Systolic BP > 160 mmHg
2. Diastolic BP > 110mmHg
3. Persistent headache, visual
changes or epigastric pain
4. Creatinine > 1.2 mg/dL
5. Platelets < 100,000
6. Increase liver function tests
14. Hypertensive Disorders of
Pregnancy
• Risk factors
1.
2.
3.
4.
5.
6.
First pregnancy
More than one fetus
Pre-existing disease (diabetes, hypertension)
Obesity
Maternal age (< 20 years, > 40 years)
Family history
15. Diagnostic Evaluation
1. A 24-hour urine for protein of 300 mg or
greater
2. Serum BUN and creatine to evaluate
renal function
3. Sonogram, nonstress testing to evaluate
placenta and fetus
16. Management
1. Directed toward decreasing the maternal blood pressure through the
use of bed rest and antihypertensive medications along with
increase in dietary protein
2. Hospitalization and seizure
3. Medication
a. Magnesium sulfate (MgS04) may be given either IV or IM
Side effect, loss of knee reflex, should be given calcium gluconate
b. Antihypertensive drug; Hydralazine (Apresoline)
* Side effects include
tachycardia, palpitations, dizziness, faintness, headache.
c. Diazepam (Valium) and amobarbital sodium (Amytal Sodium) may
be used if convulsions occur that respond to MgS04.
4. If symptoms are uncontrollable, delivery is planned.
18. Nursing Assessment
• Assessment of mother
1. Blood pressure
2. Protein in the urine
3. Complaints of headache, liver pain,
or strange bruises or bleeding
19. Nursing Diagnoses
A. Fluid Volume Excess related to IV fluid
overload(edema)
B. Altered Tissue Perfusion, Fetal Cardiac
and Cerebral, related to altered placental
blood flow(fetal distress)
C. Risk for Injury related to convulsions
D. Anxiety related to concern for self and
fetus
20. A. Maintaining Fluid Balance
1. Control IV fluid intake using a continuous infusion
pump.
2. Monitor intake and output strictly; notify health
care provider if urine output is less than 30 mL/h.
4. Monitor hematocrit levels to evaluate intravascular
fluid status.
5. Monitor vital signs every hour.
6. Auscultate breath sounds every 2 hours and
report signs of pulmonary edema
(wheezing, crackles, shortness of
breath, increased pulse rate, increased respiratory
rate).
21. B. Promoting Adequate Tissue
Perfusion
1. Position on side, preferably the left side to
promote placental perfusion.
2. Monitor fetal activity.
3. Evaluate nonstress tests to determine
fetal status.
4. Increase protein intake to replace protein
lost through kidneys.
22. C. Preventing Injury
1. Instruct on the importance of reporting
headaches, visual changes, dizziness, and
epigastric pain.
2. Instruct to lie down on left side if symptoms are
present.
3. Keep the environment quiet and as calm as possible.
4. If hospitalized, side rails should be padded and
remain up to prevent injury if seizure occurs.
5. If hospitalized, have oxygen and suction setup, along
with a tongue blade and emergency medications
immediately available for treatment of seizures.
23. D. Decreasing Anxiety
1. Explain the disease process and
treatment plan.
2. Explain that PIH does not lead to chronic
hypertension.
3. Explain that PIH usually does not occur with
subsequent pregnancies.
4. Discuss the effects of all medications on the
mother and fetus.
5. Allow time to ask questions and discuss
feelings regarding the diagnosis and
treatment plan.
24. Patient Education/Health
Maintenance
1. Teach the woman the importance of bed rest in
helping to control symptoms.
2. Encourage the support of family and friends while
on bed rest.
3. Provide and suggest diversional activities while on
bed rest.
4. Provide information on tests and procedures to
evaluate maternal-fetal status, such as laboratory
tests, sonogram, nonstress tests.
5. Include support of the neonatal team for
discussion of fetal prognosis with the woman and
her family.
25. Evaluation
A. No evidence of pulmonary edema; urine
output adequate
B. Fetal heart rate within normal range;
reactivity present
C. No seizure activity
D. Expresses concern for self and the fetus
Editor's Notes
HELLP syndrome is a severe complication of pregnancy-induced hypertension. It is comprised of Hemolysis, Elevated Liver enzymes, and Low Platelets.1. These findings are frequently associated with DIC and in fact may be diagnosed as DIC.2. The hemolysis of erythrocytes is seen in the abnormal morphology of the cells.3. The elevated liver enzyme measurement is associated with the decreased blood flow to the liver as a result of fibrin thrombi.4. The low platelet count is related to vasospasm and platelet adhesions.5. Treatment is similar to treatment for PIH with close monitoring of liver function and bleeding.6. These women are at increased risk for postpartum hemorrhage
Evaluate blood pressure with patient in a sitting position and in the left lateral position. 2. Check the protein level of a spot urine specimen. 3. Evaluate edema, carefully noting the presence after 12 hours or more of bed rest. Measure weight. 4. Evaluate deep tendon reflexes and clonus.