Face presentations occur when the fetal chin is the presenting part instead of the vertex. They are classified into four positions based on the position of the chin. Mentoanterior positions are more common and favorable than mentoposterior positions. Labor is usually prolonged in face presentations due to delayed engagement and lack of molding of the facial bones. Management depends on the position, with mentoanterior positions usually allowing vaginal delivery while mentoposterior positions often requiring assistance. Brow presentations are the rarest type and usually do not have a defined mechanism of labor.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of 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 leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
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. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
- 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
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
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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3 malpresentations.warda (3)- FACE PRESENTATION
1. MALPRESENTATIONS
FACE & BROW PRESENTATIONS
Osama M Warda MD
Prof. Obstetrics & Gynecology
Mansoura University-Egypt
3
2.
3. Face Presentation
• Definition: Cephalic malpresentation in which presenting part is
face, denominator is mentum (chin) & head is extended.
• Incidence: 1/300: 1/400 of deliveries.
4. There are 4 classical positions:
1) Rt mentoposterior (RMP): <--1st position (back is Lt anterior).
2) * Lt mentoposterior (LMP): <--2nd position (back is Rt anterior).
3) Lt mentoanterior (LMA): <--3rd position (back is Rt posterior).
4) Rt mentoanterior (RMA): <--4th position (back is Lt posterior).
• MA positions (70%) are more common than MP positions (30%) because
face presentation is the result of extension of deflexed head in OP position
(ROP extends to LMA while LOP extends to RMA). Commonest position is LMA
Face Presentation: Positions
7. A) 1ry face: Occurs during pregnancy before onset of labor (rare) & may be due to:
1- Congenital anomalies:
a) Anencephaly: Commonest. b) Dolico-cephaly: Head with long A-P diameters.
2- Abnormalities of neck that prevent flexion of head:
a) Abnormal tone of extensor muscles of neck.
b) Multiple coils of cord around neck.
c) Tumors of neck (as cystic hygroma & goiter).
3- Idiopathic.
Face Presentation: Etiology
9. B) 2ry face: Develops during labor (common) & occurs in cases of OP
positions associated with any condition which retards descent of occiput &
encourages descent of sinciput as in the following conditions:
1- Contracted pelvis: Specially flat pelvis.
2- Pendulous abdomen.
3- Large sized fetus.
Face Presentation: Etiology
11. A) Mentoanterior positions:
1- Descent: Slow. 2- Engagement: Engaging longitudinal diameter is SMB (9.5 cm).
3) ↑↑ extension: Chin becomes the lower most part of head.
4) Internal rotation: Chin reaches pelvic floor 1st → rotates anteriorly 1/8 circle → becomes
direct mento-anterior (DMA).
5) Flexion: Submental region impinges under symphysis pubis & head is delivered by flexion.
6) Restitution: Chin rotates 1/8 circle in opposite direction of internal rotation.
7) External rotation: Chin rotates 1/8 circle in the same direction of restitution due to
internal rotation of anterior shoulder from oblique diameter to A-P diameter.
8) Delivery of shoulders, trunk & the rest of body: As normal labor.
Face Presentation: Mechanism of Labor
16. B) Mentoposterior positions:
1) Descent: Slower.
2) Engagement: Engaging longitudinal diameter is SMB (9.5 cm).
3) ↑↑ extension: Chin becomes the lower most part of head.
4) Internal rotation: (see later)
a) Normal mechanism: anterior rotation 3/8 circle
b) No mechanism as in OP. ((anterior rotation 1/8 circle, or No rotation, or posterior rotation
1/8 circle)
Face Presentation: Mechanism of Labor
17. a) Normal mechanism (long anterior rotation): 2/3 of cases.
In fully extended head + roomy pelvis & strong uterine contractions →
chin reaches pelvic floor 1st → rotates anteriorly 3/8 circle → becomes
DMA → delivered by flexion.
Restitution occurs (its degree depends on how shoulders follow head
during internal rotation) then external rotation then delivery of shoulders,
trunk & the rest of body.
Face Presentation: Mechanism of Labor
18. b) No mechanism (failed long anterior rotation): 1/3 of cases.
1- Short anterior rotation: Chin reaches pelvic floor 1st → rotates anteriorly 1/8 circle
→ becomes direct mentotransverse → arrest of rotation → deep transverse arrest (DTA).
In this condition, head can't be delivered spontaneously (undeliverable presentation)
because longitudinal diameter of head isn't in A-P diameter of pelvic outlet.
2- No rotation: Chin & sinciput reach pelvic floor simultaneously → no rotation →
persistent oblique MP.
In this condition, head can't be delivered spontaneously (undeliverable presentation)
because longitudinal diameter of head isn't in A-P diameter of pelvic outlet.
Face Presentation: Mechanism of Labor
19. 3- Posterior rotation:
Sinciput reaches pelvic floor 1st → rotates anteriorly 1/8 circle → chin rotates
posteriorly 1/8 circle → becomes direct mento-posterior (DMP).
In this condition (unlike DOP), head can't be delivered spontaneously (undeliverable
presentation) because:
a- Head needs to be extended to be delivered & it is already maximally extended.
b- Length of sacrum is 10 cm & length of extended fetal neck is 5 cm so, neck can't
hinge on sacrum to allow head to be delivered by flexion (this is also against power).
c- Shoulders enter pelvis at the same time with occiput → impaction → prevention of
further descent.
Face Presentation: Mechanism of Labor
20. A) During pregnancy:
Rarely diagnosed during pregnancy.
1) History: In MA positions, fetal movements are painful & felt on both sides of
abdomen.
2) Abdominal examination: (Summarized in the table in next slide)NEXT
- Inspection
- Palpation ( obstetrical grips)
- Auscultation of the FHS
3) Ultrasound: To confirm diagnosis & exclude congenital anomalies.
Face Presentation: Diagnosis
21. MA positions MP positions
Inspection Sub-umbilical flattening
Sub-umbilical transverse groove (neck) &
suprapubic bulge (occiput)
Palpation
Fundal level ≥ period of amenorrhea (due to non engagement)
Fundal grip Buttocks are felt
Umbilical grip
Back is felt posterior è difficulty Back is felt anterior
Smooth curve of flexed fetal spines isn't felt (extended)
1st pelvic grip
Head is felt smaller & chin is felt as a
horse shoe shaped structure
Cephalic prominence (occiput) is felt at
the same side of back (it is important
diagnostic sign of extension attitude)
2nd pelvic grip Difficult to be done
Head isn't engaged & extended (occiput is
felt at higher level than sinciput)
Auscultation
FHS is heard below umbilicus & more distinct on side of limbs being conducted
through fetal chest
Face Presentation: Diagnosis
22. B) During labor:
1) History & abdominal examination: As during pregnancy.
2) Vaginal examination:
a) Confirmation of diagnosis:
1- Longitudinal axis of face is in oblique diameter of pelvis.
2- Palpation of supraorbital ridge, ala nasi, alveolar margins & chin (chin is
directed anteriorly in MA positions & directed posteriorly in MP positions).
Face Presentation: Diagnosis
23. B) During labor (continued)
3- Presence of mouth with suckling of examining fingers.
4- Late in labor, landmarks of face may be masked by edema (tumefaction of face)
however, alveolar margins can be always felt as its venous supply isn't compressed.
b) Differentiation of face from brow: Neither chin nor mouth are felt in brow
presentation.
c) Differentiation of face from frank breech: See breech presentation.
3) Ultrasound: To confirm diagnosis & exclude congenital anomalies.
Face Presentation: Diagnosis
24.
25. A) During pregnancy:
1) Anencephaly or other congenital anomalies: termination of pregnancy [TOP].
2) Normal fetus:
a) Antenatal correction (Schatz's maneuver): To correct face to vertex.
b) Trial labor: In small fetus + normal pelvis + young multipara with history of
previous normal deliveries.
c) Elective CS: If there is indication.
Face Presentation: Management
28. B) During labor:
1) 1st stage: As OP position (see before).
2) 2nd stage:
a) Mento-Anterior (MA) positions:
1- Spontaneous vaginal delivery + episiotomy: In 90% of cases.
2- Low forceps extraction + episiotomy: If arrest occurs below pelvic brim.
3- Cesarean section: If arrest occurs above pelvic brim.
Face Presentation: Management
29. Face Presentation: Management
b) Mento-Posterior (MP) positions: Wait for 2 hours +
observe mother & fetus + give oxytocin drip to correct inertia (if there
are no contraindications).
1- If long anterior rotation occurred: The rest of
management is as MA.
2- If long anterior rotation didn't occur: Delivery is by
one of the followings:
a- Manual rotation & forceps extraction.
b- Forceps rotation & extraction: By Kielland's forceps.
c- Conversion of MP to OA (Thorn maneuver).
d- Internal podalic version & breech extraction.
30. e- Cesarean section:
The best method & it is indicated in the following conditions:
1. Head isn't engaged.
2. Contracted outlet.
3. If the above measures are failed.
4. Other indications for CS.
NB. Craniotomy: If fetus is dead (was a method in the past, done in modern
obstetrics).
Face Presentation: Management
31. 3) 3rd stage: As OP position (see before).
Complications: General complications of malpresentations (see before) specially
Perineal lacerations & tears which are more common in face deliveries due to:
1) Distension of posterior vaginal wall by bulky occiput giving maximum
perineal stretch.
2) Distension of vulva by large SMV diameter (11.5 cm).
3) Absence of moulding (facial bones aren't compressible).
Face Presentation: Management
32. Q1: Why MA positions are favorable than MP positions?
A: because ; 1) Forward rotation of chin is much smaller (1/8 circle) than in MP positions.
2) Apposition of 2 convexities of fetal & maternal spines results in extension of
fetal spines → promotes extension of head (normal mechanism of labor for this presentation).
Q2: Why Labor is usually prolonged in face presentation ?
A: Because: 1) Delayed engagement (face may be low in pelvis while BPD is still not passed
pelvic inlet yet).
2) Absence of moulding (facial bones aren't compressible).
Face Presentation: Important Points
33. Q3: Fetal mortality in face presentation: 10% & is due to
congenital anomalies, asphyxia & edema of glottis.
Q4: Deep transverse arrest (DTA):
Definition: Condition occurring late in labor in OP position & face presentation
& it means "arrest of rotation & descent of head deeply in mid-pelvis in transverse
position in which transverse diameter of pelvis is occupied by longitudinal
diameter of head provided that there are good uterine contractions & fully dilated
cervix".
Types: 2 : (a) DTA of OP (b). DTA of face presentation
Face Presentation: Important Points
34. ITEM DTA-OP DTA-FACE
Incidence 1% of OP position deliveries. As a part of abnormal
mechanism of labor of MP
positions (1/3 of cases).
Mechanism See OP See Face presentation
Diagnosis Sagittal suture is in transverse
diameter of pelvis + posterior
fontanel is directed to one
side & anterior fontanel is
directed to the other side.
Longitudinal axis of face is in
transverse diameter of pelvis +
chin is directed to one side &
forehead is directed to the other
side.
Management See OP See FACE presentation
Complications OBSTRUCTED LABOR OBSTRUCTED LABOR
35. BROW PRESENTATION
Definition: Cephalic
malpresentation in which
presenting part is brow,
denominator is (frontum) i.e.
forehead & head is midway
between flexion & extension.
Incidence: 1/1000 of deliveries
(rarest presentation).
Source: William’s Obstetrics 24th edition.
37. There are 4 classical positions:
1) Rt frontoposterior (RFP): 1st position (back is Lt anterior).
2) Lt frontoposterior (LFP): 2nd position (back is Rt anterior).
3) Lt frontoanterior (LFA): 3rd position (back is Rt posterior).
4) Rt frontoanterior (RFA): 4th position (back is Lt posterior).
Frontoanterior positions are more common than frontoposterior positions
(the cause is the same as in face presentation).
BROW PRESENTATION- Positions
38. Types & Etiology:
A) 1ry brow: Occurs during pregnancy before onset of labor (rare) & its
causes are the same causes of 1ry face.
B) 2ry brow: Develops during labor (common) & its causes are the same
causes of 2ry face.
BROW PRESENTATION
39. Mechanism of labor: Depends on fetal size.
A) Normal sized fetus: No mechanism of labor because head enters
pelvis by MV diameter (13.5 cm) which is longer than any diameter in pelvic
inlet & so, there is no engagement.
B) Small sized fetus + roomy pelvis & strong uterine
contractions: Delivery may occur by compression of head → ↓↓ MV
diameter & ↑↑ OF diameter → descent of brow to pelvic floor & root of nose
impinges below symphysis pubis → delivery of brow, vertex & occiput by
flexion then head drops back over perineum leading to delivery of face & chin.
BROW PRESENTATION
40. Diagnosis:
A) During pregnancy: Rarely diagnosed during pregnancy.
1) History: In frontoanterior positions, fetal movements are painful & felt on both sides of
abdomen.
2) Abdominal examination: Occiput & sinciput are felt at the same level.
3) Ultrasound: To confirm diagnosis & exclude congenital anomalies.
B) During labor:
1) History & abdominal examination: As during pregnancy.
BROW PRESENTATION
41. 2) Vaginal examination:
a) Confirmation of diagnosis: Brow is diagnosed by presence of large
anterior fontanelle, frontal suture, supraorbital ridge & root of nose.
b) Differentiation of brow from face: Neither chin nor mouth are felt in
brow presentation.
3) Ultrasound: confirm diagnosis & exclude congenital anomalies.
BROW PRESENTATION
43. Management:
A) During pregnancy: TOP in cases of anencephaly or other congenital anomalies.
B) During labor:
1) Early in 1st stage: Wait for spontaneous conversion into face (by ↑↑ extension) or vertex (by ↑↑
flexion) as majority of cases are transient brow.
2) Persistent brow in late 1st stage or in 2nd stage:
a) Cesarean section: If fetus is living.
b) Craniotomy: If fetus is dead (but CS is safer to mother).
c) Manual conversion to face or vertex followed by forceps extraction: Very difficult & not done now.
BROW PRESENTATION