This document discusses dysfunctional labor, defined as any deviation from normal labor progress in terms of cervical dilation or fetal descent. It classifies dysfunctional labor and describes risk factors and treatments. The main types are prolonged latent phase, primary dysfunctional labor, secondary arrest of dilation, and prolonged deceleration phase. Active management including early amniotomy and oxytocin use aims to prevent dysfunctional labor but may increase cesarean delivery risks. Propranolol with oxytocin may shorten labor duration compared to oxytocin alone.
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The comparison of dinoprostone and vagiprost for induction of lobar in post t...iosrphr_editor
The IOSR Journal of Pharmacy (IOSRPHR) is an open access online & offline peer reviewed international journal, which publishes innovative research papers, reviews, mini-reviews, short communications and notes dealing with Pharmaceutical Sciences( Pharmaceutical Technology, Pharmaceutics, Biopharmaceutics, Pharmacokinetics, Pharmaceutical/Medicinal Chemistry, Computational Chemistry and Molecular Drug Design, Pharmacognosy & Phytochemistry, Pharmacology, Pharmaceutical Analysis, Pharmacy Practice, Clinical and Hospital Pharmacy, Cell Biology, Genomics and Proteomics, Pharmacogenomics, Bioinformatics and Biotechnology of Pharmaceutical Interest........more details on Aim & Scope).
The thin endometrium refers to the lining of the uterus, known as the endometrium, being insufficiently thick. This condition is typically characterized by a reduced thickness of the endometrial layer, which plays a crucial role in supporting the implantation and development of a fertilized egg during the menstrual cycle.
A thin endometrium is commonly associated with hormonal imbalances, such as low estrogen levels, which are vital for the growth and maintenance of the endometrial tissue. Inadequate blood flow to the uterus, chronic inflammation, or certain medical conditions can also contribute to this condition. Women with a thin endometrium may experience difficulties in achieving and maintaining pregnancy, as the thin lining may not provide an optimal environment for the embryo to implant and thrive.
Addressing the underlying causes of a thin endometrium often involves hormonal therapies to regulate estrogen levels, lifestyle modifications, and sometimes surgical interventions. Fertility treatments, such as in vitro fertilization (IVF), may be considered to overcome the challenges associated with a thin endometrium.
In conclusion, a thin endometrium can pose challenges to fertility and reproductive health, requiring a comprehensive approach to address the underlying factors and improve the chances of successful conception.
Criteria for preterm labor, evaluation, diagnosis and management of preterm labor. Very summarized and very informative. MSF's guidelines and uptodate recommendations.
The thin endometrium refers to the lining of the uterus, known as the endometrium, being insufficiently thick. This condition is typically characterized by a reduced thickness of the endometrial layer, which plays a crucial role in supporting the implantation and development of a fertilized egg during the menstrual cycle.
A thin endometrium is commonly associated with hormonal imbalances, such as low estrogen levels, which are vital for the growth and maintenance of the endometrial tissue. Inadequate blood flow to the uterus, chronic inflammation, or certain medical conditions can also contribute to this condition. Women with a thin endometrium may experience difficulties in achieving and maintaining pregnancy, as the thin lining may not provide an optimal environment for the embryo to implant and thrive.
Addressing the underlying causes of a thin endometrium often involves hormonal therapies to regulate estrogen levels, lifestyle modifications, and sometimes surgical interventions. Fertility treatments, such as in vitro fertilization (IVF), may be considered to overcome the challenges associated with a thin endometrium.
In conclusion, a thin endometrium can pose challenges to fertility and reproductive health, requiring a comprehensive approach to address the underlying factors and improve the chances of successful conception.
Criteria for preterm labor, evaluation, diagnosis and management of preterm labor. Very summarized and very informative. MSF's guidelines and uptodate recommendations.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
9. •Shifirin & Cohen(1998):
1.Disorders of dilatation:
a. Prolonged latent phase
b. Protracted active phase
c. Secondary arrest
2.Disorders of descent:
a. Failure of descent
b. Protracted descent
c. Arrest of descent.
11. Early diagnosis
1. Partogram: In active phase
Alert line: drawn from cervical dilatation
on admission ,at a rate of 1 cm /h
Action line: drawn 2 h to the right of alert
line (Philpott,1972).
2. Nomogram (Studd,1973):
labor stencil: a series of curves from patient
admission cervical dilatation to 10 cm.
12.
13.
14.
15. Prevention
O,Driscol method of active
management of labor (1969)
• Diagnosis of labor
• 1 h: ARM
• 2h:cervical dilatation <1 cm /h:
oxytocin drip
16. Prolonged latent phase
Define
Freidman: > 20 h in PG, > 14 h in MG
from onset of labor (difficult to determine)
Philpott:> 6h in PG , > 4h in MG from
admission in labor.
Incidence
PG: 4% MG: 1%
17. Etiology
1. Wrong diagnosis of labor
2.Excess sedation
3. An abnormal or high presenting part
4. PROM
5.Idiopathic.
Risks
are created by aggressive intervention.
If membranes are intact, no risk , only
maternal anxiety.
18. Treatment
True labor or not: PV, CTG, palpation of the
cervix & reexamine after 4h:
1.C stop or no cx changes: not in labor
2. C persist & no cervical changes: sedation.
3. C. persist & cx changes : ARM + Syntocinon
drip. A. In 85% labor will progress rapidly .
B.In 15% adequate C will not cause cx
dilatation. If after 4-8 h of syntocinon, the
cervix is not further dilated, CS.
19. Primary dysfunctional labor
Define
Cx. Dil. < 1cm/h before normal active phase has
been established
Incidence
PG: 20% MG: 8%
Etiology
1. Inefficient C.: the commonest
2. CPD: 1/ 3
3. Malpresentation or malposition
20. Risks
1. F. distress
2. Maternal fear & anxiety , dehydration &
acidosis
3. Incordinate u. activity.
Treatment
Exclude CPD, ARM + oxytocin drip.
15%: vag. Delivery
35%: instrumental delivery
50%: CS for F. distress.
21. 2ndry arrest of labor
Define
Active phase started normally( cervical
dilatation reached 5-7 cm ) then cervical
dilatation stop or slows significantly within 2 h
Incidence
PG: 6% MG: 2%
Etiology
1.CPD:50%
2. Malposition
24. Prolonged deceleration
phase
Define
Arrest or slow of cervical dilatation after 8 cm
(PG > 3h , MG > 1h)
Etiology
1. CPD 2. Uterine exhaustion
Risks
1. High incidence of shoulder dystocia
2. Forceps is difficult
Treatment
Syntocinon is not helpful. C.S.
25. Elnashar et al (2000) compared oxytocin
infusion alone & with propranolol in the
management of DL (Primary DL & 2ndry
arrest).
The study group (50 women) was given propranolol
I.V. in a dose of 2 mg to be repeated after one hour if
there was no response in cervical dilatation.
The control group (50 women) & the study group
received oxytocin infusion for at least 4 hours & for
maximum of 6 hours & if there was no response,CS
was done.
26. There were a significant differences in the drug-
delivery interval (2.2 vs 3.7 hours) & CS rate (20 vs
38 %) between the study & the control groups.
Between the two groups, no statistically significant
differences were observed in low Apgar scores or
incidence of admissions to the NICU.
Conclusion: Propranolol combined with
oxytocin infusion in management of DL safely
shortened the drug-delivery interval & reduced
CS rate.
28. Protocol
1.This approach to management is confined to
nulliparas.
2. Patient education during pregnancy: signs &
symptoms of labor
3.Strict criteria for diagnosis of labor:
painful uterine contractions as well as
complete effacement of the cervix,
ruptured membranes or
passage of blood stained mucous
The diagnosis of labor is made within 1 hr of
presentation.
29. 4.Each woman in labor is assigned to
trained professional companion.
5.Amniotomy within 1 hr of admission.
6.Strict criteria for diagnosis of abnormal labor
progress. partogram or labor graph.
7.Oxytocin high dose infusion:
if progress of labor is < 1 cm/h over 2 h.
Oxytocin infusion is begun at 6mu/min &
increased by 6 mu/min every 15 min until 7
C/15min. or 40 mu/min.
30. 8.Assess FHR by auscultation
intermittently Continuous electronic fetal
heart rate monitoring is used only if there is
me conium stained amniotic fluid
9.All methods of pain relief are freely
available.
10. C.S if no delivery12 hr post admission
or if fetal scalp ph sampling revealed fetal
compromise.
31. Benefits
1.Prevention of dysfunctional labor
2.Decrease the incidence of prolonged labor
from 30% to 7% (Boylan,1997)
3.Decrease incidence of operative delivery.
4. Decrease maternal infectious mrbidity
5.Decrease incidence of C.S to 4.8% (Lopez-
Zeno,1992).
Some found no decrease in CS rate (Fraser et
al,1993) & others found an increase in CS rate
(Boylan et al,1993).
32. Amniotomy for shortening
spontaneous labour
Fraser et al, The Cochrane Library, 2, 2001.
Routine early amniotomy is associated with
both benefits and risks.
•Benefits include a reduction in labor
duration( between 60 and 120 minutes) and
a possible reduction in abnormal 5-minute
Apgar scores.
33. •No support for the hypothesis that routine
early amniotomy reduces the risk of CS.
Indeed there is a trend toward an increase
in CS. An association between early
amniotomy and CS for fetal distress is
noted in one large trial.
This suggests that amniotomy should be
reserved for women with abnormal labor
progress.