This document defines puerperal sepsis and provides guidance on diagnosing, managing, and referring cases of puerperal sepsis. It defines puerperal sepsis as a genital tract infection between rupture of membranes or labor through 42 days postpartum with two or more symptoms including fever, abnormal discharge, abdominal pain, or tender uterus. It describes risk factors, causes, signs, and management approaches including antibiotics and referral for serious cases. The document emphasizes that puerperal sepsis is largely preventable through measures to improve hygiene and treat infections during the antenatal, intranatal, and postpartum periods.
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.
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.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
PELVIC INFLAMMATORY DISEASE (PID)
This presentation is prepared as a case based discussion.
References include American Academy of Family Physicians AAFP
I WOULD LIKE TO DEDICATE SPECIAL THANKS TO
DR ALI AL KHALAF FOR REVISING THIS MATERIAL
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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
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
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
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
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This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
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- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
1. 1
Puerperal Sepsis
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
BEMoC - Presentation 6 (b)
Session 6b
2. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
2
Objectives
Define puerperal sepsis
Acquire skills to diagnose , manage and refer
cases of puerperal sepsis
3. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
3
Puerperal Sepsis
Definition:
Puerperal sepsis is an infection of the genital tract at any
time between the onset of rupture of membranes or labour
and the 42nd day following delivery or abortion in which any
two or more of the following signs and symptoms are
present:
Fever of >100.4 Fahrenheit (>38.5 ºC)
Abnormal, Foul smelling vaginal discharge
Lower abdominal pain
Subinvoluted uterus which is tender
4. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
4
How Puerperal Sepsis Occurs ?
Occurs due to colonization of the genital tract by
microorganisms
Organisms can be introduced from within (infection
of endogenous origin), or from outside (infection of
exogenous origin).
• Endogenous Infections: bacteria living within
vagina brought into uterus by pelvic
examination, instruments, dead tissue.
Microorganisms ascend into the uterus during
premature & PROM.
• Exogenous Infections: introduced from
outside by unclean hands, unsterile
instruments, Foreign substances & sexual
activity
5. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
5
How Puerperal Sepsis Occurs ?
Intrapartum:
• due to PROM & can cause Chorioamnionitis
Extrapartum:
• may be localized or
• can spread and lead to parametritis,
peritonitis, septicaemia & DIC
6. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
6
Risk Factors for Puerperal Sepsis
Patient-related
Poor patient hygiene
Pre-existing anaemia &
malnutrition
Pre-existing sexually
transmitted infections
(STIs)/RTIs
Not immunized against
tetanus
Pre-existing diabetes
Related to delivery
Failure to follow Asepsis
Frequent vaginal examinations
Manipulations high in the birth canal
Dead tissue in the birth canal
PROM
Prolonged/obstructed labour
C- section/ Instrumental delivery
Unrepaired vaginal/cervical
lacerations
PPH
7. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
7
Risk Factors For Puerperal Sepsis – Contd...
Related to health service delivery
Delivery by untrained persons
Lack of asepsis during delivery
Lack of routine postpartum care
Inadequate monitoring of the temperature during prolonged
labour and after delivery
Non-availability of proper antibiotics
Inadequate management with appropriate antibiotics in a
case in whom puerperal sepsis has set in
Further operative intervention in a case where puerperal
sepsis has set in
8. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
8
Causes of Fever in Puerperium
Infectious
Localized infection of vaginal/cervical laceration or
episiotomy
Infection of a laceration or episiotomy which has spread
to the underlying soft tissue
Ischiorectal abscess
Endometritis
Salpingitis
Parametritis
Generalized peritonitis
Septic thrombophlebitis
Cystitis
Acute Pyelonephritis
9. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
9
Causes of Fever in Puerperium: Infectious –
Contd...
Tubo-ovarian abscess;
Broad ligament abscess;
Abscess in the pouch of Douglas
Abscesses at other sites in the abdomen or chest
Septicaemia
Septic shock
Breast infection such as mastitis or, at a later stage, breast
abscess
UTI
Malaria
Wound infection
Thromboembolic disorders (superficial thrombophlebitis &
DVT)
10. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
10
Causes of Fever in Puerperium
Non – Infectious
Dehydration
Tissue trauma
Reaction to foetal proteins
Breast engorgement
11. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
11
Causes of Fever in Puerperium
Most common causes are
Endometritis
Breast engorgement, mastitis, breast abscess
Urinary tract infection
Leg vein thrombosis
Non obstetric causes
12. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
12
Features of Puerperal Sepsis
High grade fever
Tachycardia, hypotension
Excessive or foul smelling discharge
Persistent lower abdominal pain
On abdominal examination, uterus feels soft,
tender and subinvoluted
On per speculum examination, foul smelling
purulent discharge is seen which may be
blood stained.
13. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
13
Management of Puerperal Fever
Detailed history regarding onset, severity and
associated symptoms
Complete physical examination including general,
systemic and local examination
Manage according to the underlying cause
Blood & urine for routine & microscopic investigation
Encourage increased oral fluid intake
Cold sponging to help decrease temperature
Antibiotics
Treat the cause
Refer if required
14. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
14
Management of Puerperal Sepsis
If the general condition of the woman is non toxic i.e., low
grade fever & pulse not rapid, give her a combination of
oral antibiotics
• Ampicillin 500 mg. QDS PLUS
• Tab Metronidazole 400mg. TDS PLUS
• Inj Gentamicin 80 mg. TDS
Rule out presence of retained placental bits
Monitor vitals every 2 hrly.
Watch for 24 hrs
If vital signs improving, then complete the course of
Antibiotic
15. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
15
Management of puerperal sepsis
If fever persists after 72 hours of initiating
antibiotics:
Re-evaluate and consider other causes of fever
Consider if antibiotic cover sufficient; and
REFER to FRU
16. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
16
Management of Puerperal Sepsis
If the general condition of the woman is toxic i.e.,
with high grade fever & rapid pulse
Start her on intravenous fluids and
Give her the first dose of IV antibiotics:
• Ampicillin 1 gm IV PLUS
• Tab Metronidazole 500mg PLUS
• Inj Gentamicin 80 mg IM
Rule out presence of retained placental bits
Refer the woman to FRU immediately
17. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
17
Management of Puerperal Sepsis
18. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
18
Prevention
Puerperal sepsis is to a great extent preventable;
Measures to be taken in
• Antenatal Period:
Improve Hb level to > 11 gms %
Treat any septic focus (skin, throat etc.)
• Intranatal Period:
Asepsis during delivery
• Postpartum Period:
Maintain perineal hygiene
Use of clean sanitary pad
19. PUERPERAL SEPSIS
Maternal Health Division
Ministry of Health & Family Welfare
Government of India
19
Key Messages
Puerperal sepsis is important cause of
maternal mortality and morbidity
It is, to a great extent, preventable
Early detection and treatment helps complete
recovery
Serious cases require referral