Abortion is a leading cause of maternal mortality, accounting for 13% of maternal deaths worldwide and 32% in Ethiopia. Complications from unsafe abortion, which is defined as procedures done without proper skills or in unsanitary conditions, can cause severe infections and hemorrhaging. Post-abortion care aims to treat complications from both spontaneous and induced abortions, provide contraceptive services to prevent future unintended pregnancies, and offer counseling and referrals for other health needs. Recurrent spontaneous abortion, defined as 3 or more consecutive early pregnancy losses, can have causes such as chromosomal abnormalities, uterine anomalies, or immunological factors.
Covers the basic information about abortions that you need to know with in depth discussion of the different types of abortions and their characteristics
This presentation covers an introduction to Abortion, classification, etiologies, clinical types, diagnostic criteria and basic management.
At the end its a detailed discussion of Post abortion management.
Covers the basic information about abortions that you need to know with in depth discussion of the different types of abortions and their characteristics
This presentation covers an introduction to Abortion, classification, etiologies, clinical types, diagnostic criteria and basic management.
At the end its a detailed discussion of Post abortion management.
Contracted pelvis, CEPHALOPELVIC DISPROPORTION, PELVIC ABNORMALITY, CPD, TYPES OF PELVIS , TYPES OF PELVIS AND ITS OUT COME, MECHANISM OF LABOUR IN CONTRACTED PELVIS, DIAGNOSIS OF CPD, DIAGNOSIS and MANAGEMENT OF CONTRACTED PELVIS, PELVIMETRY, PELVIC ASSESSMENT, TRIAL OF LABOUR
a detail study on normal labour ( definition, stages of labour, management ,p...martinshaji
The World Health Organization (WHO) defines normal birth as follows: The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy. this is study on detailed study on physiology and stages of normal labour .
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Contracted pelvis, CEPHALOPELVIC DISPROPORTION, PELVIC ABNORMALITY, CPD, TYPES OF PELVIS , TYPES OF PELVIS AND ITS OUT COME, MECHANISM OF LABOUR IN CONTRACTED PELVIS, DIAGNOSIS OF CPD, DIAGNOSIS and MANAGEMENT OF CONTRACTED PELVIS, PELVIMETRY, PELVIC ASSESSMENT, TRIAL OF LABOUR
a detail study on normal labour ( definition, stages of labour, management ,p...martinshaji
The World Health Organization (WHO) defines normal birth as follows: The birth is spontaneous in onset and low risk at the start of labor and remains so throughout labor and delivery. The infant is born spontaneously in the vertex position between 37 and 42 weeks of pregnancy. this is study on detailed study on physiology and stages of normal labour .
please comment
thank u
Causes and management of first and second trimester abortions
anatomical, chromosomal, immunological, hormonal causes and infections. Investigation for detection of cause and possible treatment. Surgical correction of cervical incompetence and medical treatment, progestational drugs
Diabetes is a rapidly and serious health problem in Pakistan. This chronic condition is associated with serious long-term complications, including higher risk of heart disease and stroke. Aggressive treatment of hypertension and hyperlipideamia can result in a substantial reduction in cardiovascular events in patients with diabetes 1. Consequently pharmacist-led diabetes cardiovascular risk (DCVR) clinics have been established in both primary and secondary care sites in NHS Lothian during the past five years. An audit of the pharmaceutical care delivery at the clinics was conducted in order to evaluate practice and to standardize the pharmacists’ documentation of outcomes. Pharmaceutical care issues (PCI) and patient details were collected both prospectively and retrospectively from three DCVR clinics. The PCI`s were categorized according to a triangularised system consisting of multiple categories. These were ‘checks’, ‘changes’ (‘change in drug therapy process’ and ‘change in drug therapy’), ‘drug therapy problems’ and ‘quality assurance descriptors’ (‘timer perspective’ and ‘degree of change’). A verified medication assessment tool (MAT) for patients with chronic cardiovascular disease was applied to the patients from one of the clinics. The tool was used to quantify PCI`s and pharmacist actions that were centered on implementing or enforcing clinical guideline standards. A database was developed to be used as an assessment tool and to standardize the documentation of achievement of outcomes. Feedback on the audit of the pharmaceutical care delivery and the database was received from the DCVR clinic pharmacist at a focus group meeting.
Artificial Reefs by Kuddle Life Foundation - May 2024punit537210
Situated in Pondicherry, India, Kuddle Life Foundation is a charitable, non-profit and non-governmental organization (NGO) dedicated to improving the living standards of coastal communities and simultaneously placing a strong emphasis on the protection of marine ecosystems.
One of the key areas we work in is Artificial Reefs. This presentation captures our journey so far and our learnings. We hope you get as excited about marine conservation and artificial reefs as we are.
Please visit our website: https://kuddlelife.org
Our Instagram channel:
@kuddlelifefoundation
Our Linkedin Page:
https://www.linkedin.com/company/kuddlelifefoundation/
and write to us if you have any questions:
info@kuddlelife.org
Micro RNA genes and their likely influence in rice (Oryza sativa L.) dynamic ...Open Access Research Paper
Micro RNAs (miRNAs) are small non-coding RNAs molecules having approximately 18-25 nucleotides, they are present in both plants and animals genomes. MiRNAs have diverse spatial expression patterns and regulate various developmental metabolisms, stress responses and other physiological processes. The dynamic gene expression playing major roles in phenotypic differences in organisms are believed to be controlled by miRNAs. Mutations in regions of regulatory factors, such as miRNA genes or transcription factors (TF) necessitated by dynamic environmental factors or pathogen infections, have tremendous effects on structure and expression of genes. The resultant novel gene products presents potential explanations for constant evolving desirable traits that have long been bred using conventional means, biotechnology or genetic engineering. Rice grain quality, yield, disease tolerance, climate-resilience and palatability properties are not exceptional to miRN Asmutations effects. There are new insights courtesy of high-throughput sequencing and improved proteomic techniques that organisms’ complexity and adaptations are highly contributed by miRNAs containing regulatory networks. This article aims to expound on how rice miRNAs could be driving evolution of traits and highlight the latest miRNA research progress. Moreover, the review accentuates miRNAs grey areas to be addressed and gives recommendations for further studies.
WRI’s brand new “Food Service Playbook for Promoting Sustainable Food Choices” gives food service operators the very latest strategies for creating dining environments that empower consumers to choose sustainable, plant-rich dishes. This research builds off our first guide for food service, now with industry experience and insights from nearly 350 academic trials.
Natural farming @ Dr. Siddhartha S. Jena.pptxsidjena70
A brief about organic farming/ Natural farming/ Zero budget natural farming/ Subash Palekar Natural farming which keeps us and environment safe and healthy. Next gen Agricultural practices of chemical free farming.
UNDERSTANDING WHAT GREEN WASHING IS!.pdfJulietMogola
Many companies today use green washing to lure the public into thinking they are conserving the environment but in real sense they are doing more harm. There have been such several cases from very big companies here in Kenya and also globally. This ranges from various sectors from manufacturing and goes to consumer products. Educating people on greenwashing will enable people to make better choices based on their analysis and not on what they see on marketing sites.
"Understanding the Carbon Cycle: Processes, Human Impacts, and Strategies for...MMariSelvam4
The carbon cycle is a critical component of Earth's environmental system, governing the movement and transformation of carbon through various reservoirs, including the atmosphere, oceans, soil, and living organisms. This complex cycle involves several key processes such as photosynthesis, respiration, decomposition, and carbon sequestration, each contributing to the regulation of carbon levels on the planet.
Human activities, particularly fossil fuel combustion and deforestation, have significantly altered the natural carbon cycle, leading to increased atmospheric carbon dioxide concentrations and driving climate change. Understanding the intricacies of the carbon cycle is essential for assessing the impacts of these changes and developing effective mitigation strategies.
By studying the carbon cycle, scientists can identify carbon sources and sinks, measure carbon fluxes, and predict future trends. This knowledge is crucial for crafting policies aimed at reducing carbon emissions, enhancing carbon storage, and promoting sustainable practices. The carbon cycle's interplay with climate systems, ecosystems, and human activities underscores its importance in maintaining a stable and healthy planet.
In-depth exploration of the carbon cycle reveals the delicate balance required to sustain life and the urgent need to address anthropogenic influences. Through research, education, and policy, we can work towards restoring equilibrium in the carbon cycle and ensuring a sustainable future for generations to come.
Willie Nelson Net Worth: A Journey Through Music, Movies, and Business Venturesgreendigital
Willie Nelson is a name that resonates within the world of music and entertainment. Known for his unique voice, and masterful guitar skills. and an extraordinary career spanning several decades. Nelson has become a legend in the country music scene. But, his influence extends far beyond the realm of music. with ventures in acting, writing, activism, and business. This comprehensive article delves into Willie Nelson net worth. exploring the various facets of his career that have contributed to his large fortune.
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Introduction
Willie Nelson net worth is a testament to his enduring influence and success in many fields. Born on April 29, 1933, in Abbott, Texas. Nelson's journey from a humble beginning to becoming one of the most iconic figures in American music is nothing short of inspirational. His net worth, which estimated to be around $25 million as of 2024. reflects a career that is as diverse as it is prolific.
Early Life and Musical Beginnings
Humble Origins
Willie Hugh Nelson was born during the Great Depression. a time of significant economic hardship in the United States. Raised by his grandparents. Nelson found solace and inspiration in music from an early age. His grandmother taught him to play the guitar. setting the stage for what would become an illustrious career.
First Steps in Music
Nelson's initial foray into the music industry was fraught with challenges. He moved to Nashville, Tennessee, to pursue his dreams, but success did not come . Working as a songwriter, Nelson penned hits for other artists. which helped him gain a foothold in the competitive music scene. His songwriting skills contributed to his early earnings. laying the foundation for his net worth.
Rise to Stardom
Breakthrough Albums
The 1970s marked a turning point in Willie Nelson's career. His albums "Shotgun Willie" (1973), "Red Headed Stranger" (1975). and "Stardust" (1978) received critical acclaim and commercial success. These albums not only solidified his position in the country music genre. but also introduced his music to a broader audience. The success of these albums played a crucial role in boosting Willie Nelson net worth.
Iconic Songs
Willie Nelson net worth is also attributed to his extensive catalog of hit songs. Tracks like "Blue Eyes Crying in the Rain," "On the Road Again," and "Always on My Mind" have become timeless classics. These songs have not only earned Nelson large royalties but have also ensured his continued relevance in the music industry.
Acting and Film Career
Hollywood Ventures
In addition to his music career, Willie Nelson has also made a mark in Hollywood. His distinctive personality and on-screen presence have landed him roles in several films and television shows. Notable appearances include roles in "The Electric Horseman" (1979), "Honeysuckle Rose" (1980), and "Barbarosa" (1982). These acting gigs have added a significant amount to Willie Nelson net worth.
Television Appearances
Nelson's char
2. Introduction
• Abortion is one of the leading cause
of maternal mortality it accounts
• 13% world wide
• 4% in Africa
• 32%in Ethiopia (facility based)
3.
4. Primary Causes of Maternal Death in
Africa
34%
17%
10% 9%
6%
4% 4% 4%
Source: Khan et al. , Lancet 2006
6. Definition
Abortion is expulsion of the products of
conception prior to viability of the fetus
(before 28 weeks of gestation) or less than
1000gm weight
WHO gest. age<20 weeks or weight less
than 500 gm.
7. Cont..
• 50 % all fertilized eggs die and are lost
(aborted) spontaneously, usually before
the woman knows she is pregnant.
• Among those 15-20% the miscarriage rate
women who know they are pregnant
• Most miscarriages occur during the first 7
weeks of pregnancy.
• The rate of miscarriage drops after the
baby's heart beat is detected.
8. Cont..
• Septic abortion:-when any of the stage of
abortion complicated by pelvic infection
• Recurrent abortion:-three or more consecutive
spontaneous termination of pregnancies
• Unsafe abortion :-is characterized by lack or
inadequate of skill of provider, hazardous
technique and unsanitary facilities or both
• Therapeutic abortion :-termination of
pregnancy before the time of fetal viability for
the purpose of saving the life of the mother
9. Types of abortion
• Spontaneous
• Induced
Spontaneous abortion defined as the loss of a
fetus during pregnan cy due to natural
causes…before fetal development has
reached 28 weeks…the term spontaneous
abortion refers to naturally occurring events,
not elective or therapeutic abortion
procedures…”
10. pathology In spontaneous abortion
• Hemorrhage into the decidua basalis often
occurs.
• Necrosis and inflammation appear in the area
of implantation.
• The pregnancy becomes partially or entirely
detached.
• Uterine contractions and dilatation of the
cervix result in expulsion of most or all of the
products of conception.
11. Etiology
• chromosome problems(common≈50%)
• Endocrine disorder like Luteal Phase defects
• Advanced age
• Drug and any poisons
• Exposure to environmental toxins
• Hormone problems
• Infection like TORCH
12. cont..
• Multiple pregnancies
• Physical problems with the mother's
reproductive organs
• Problem with the body's immune response
• systemic diseases in the mother e.g.
diabetes
• Smoking and alcohol
• Trauma
13. Clinical stages of abortion writing
Threatened abortion
oslight intermittent bleeding with or without
cramping
o The cervix remains closed and no cervical
effacement
oAt least 20–30% of pregnant women have
some first-trimester bleeding.
oIn most cases, this is thought to represent an
implantation bleed.
oMore than 50-80% go to term
14.
15. Inevitable abortion
The cervix has dilated, but the products of
conception have not been expelled
Abdominal or back pain and mild to severe
vaginal bleeding
cervical effacement, cervical dilatation,
and/or rupture of the membranes is noted.
It is Irreversible
16. Incomplete abortion
• Some, but not all, of the products of
conception have been passed; retained
products may be part of the fetus,
placenta, or membranes
• In gestations of less than 10 weeks'
duration, the fetus and placenta are
usually passed together. After 10 weeks,
they may be passed separately, with a
portion of the products retained in the
uterine cavity.
17. Sign and symptoms
• Cramps are usually present
• Profuse persistent bleeding
• HX of passing concepts tissue
• Some times visible or palpable concepts
tissue through the opening cervix
Complications
Anemia, hemorrhage and infection
18. Missed abortion
Def. a pregnancy in which there is a fetal
demise (usually for a number of weeks) but
no uterine activity to expel the products of
conception
Regress sx/s of pregnancy , Uterine size
decreased, cervix closed, Brownish vaginal
discharge
Complications
Infection, DIC, AF embolism
19. Complete abortion
• All products of conception have been passed
without need for surgical or medical
intervention.
• Slight bleeding may continue for a short time
• pain usually ceases after pregnancy has
traversed the cervix.
20. Blighted Ovum
• Blighted ovum or an embryonic pregnancy
represents a failed development of the
embryo so that only a gestational sac, with
or without a yolk sac, is present.
• An alternative hypothesis proposes that
the fetal pole has been resorbed prior to
ultrasound diagnosis
21. Differential diagnosis
• Idiopathic bleeding in a viable pregnancy
• Ectopic pregnancy
• Molar pregnancy
• Infection of the vagina or cervix
• Cervical abnormalities
–Malignancy, polyps, trauma
• Vaginal trauma
23. Abortion ?or not?
Progesterone HCG Ultrasound Abortion?
>25 ng per mL
Increases
(48 hours)
Normal No
<5 ng per mL
Plateau or
decrease
Nonviable
pregnancy
Yes
24. Complications
• Severe or persistent hemorrhage life
threatening.
• Sepsis develops most frequently after
self-induced abortion.
• Intra abdominal injury
- Perforation of the uterine wall may
- injury to the bowel and bladder
25. Cont..
• Multiple pregnancy with the loss of 1
fetus and retention of another
("vanishing twin").
• Other complications of abortion
-Anemia
- Renal failure
-Infertility(if hysterectomy done
due to complication)
26. Prevention
• Early obstetric care
• Treatment maternal disorders like
diabetes and hypertension
• Protection of pregnant women from
environmental hazards and exposure
to infectious diseases.
27. Laboratory investigations
• Blood type and RH factor
• Complete blood count
• HCG to confirm pregnancy
• WBC and differential to rule out
infection
28. General management writing ?
first-trimester loss
MVA ,E&D or D&C
After the first trimester
• hospitalization should be considered
• Oxytocics are helpful in contracting the
uterus, limiting blood loss, and aiding in
expulsion of clots and tissue.
29. Cont..
• Anti D for RH negative
• Surgical evacuation
-Patient is unstable:-Heavy bleeding
-Septic abortion
-Patient choice
• Medical therapy
Missed spontaneous abortion
• Expectant management
• Completed spontaneous abortion
• Incomplete spontaneous abortion??
30. Treatment
For treated abortion
Bed rest and pelvic rest
Avoid coitus, douching and strenuous
exercise
• Prognosis is good when bleeding
and/or cramping resolve.
31. For inevitable abortion
• According to gestational age
<14 weeks MVA
>14weeks oxytocin infusion and
E/C with pethdine or sedative
32. For incomplete abortion
• Evacuation based on gestational age
• Uterotonic agents
• Blood and fluid replacement
• Antibiotic
• The prognosis for the mother is excellent
if the retained tissue is promptly and
completely evacuated.
33. For complete abortion
• observed for further bleeding.
• The products of conception should be
examined.
• prognosis for the mother is excellent
34. For missed abortion
Expectant management
-3-4 weeks follow up
-Clotting profile
>14weeks
-Prostaglandin or balloon catheter to dilate
cervix
-Pitocin
<14 weeks :-MVA or D/c
35. Treatment of complication
Managed accordingly
• laparotomy are indicated to determine
the extent of laceration or bowel injury
• Broad spectrum antibiotics for sepsis
36. Recurrent spontaneous abortion
• Defined as 3 or more consecutive, spontaneous
pregnancy losses before 28 weeks of gestation from
the last menstrual period , by the same partner ,
each with a fetus weighing less than 1000 g.
• Approximately 1% of women are habitual aborters.
• The risk of having a spontaneous abortion for the
first time is about 15%, and this risk is at least
doubled in women experiencing recurrent abortion
37. Etiology
Three generally accepted etiologies of
recurrent miscarriages are:-
• Chromosomal abnormalities
• uterine malformations
- bicornuate or septate uterus
- cervical incompetence
• Immunologic Factors
-Antiphospholipid antibodies
38. Others etiology
• sub mucous myomas
• Hormonal causes like hyper and
hypothyroidism
• Infection
• Maternal system disease e.g. diabetes
• Chronic malnutrition
39. Treatments
• Pre implantation diagnosis, or prenatal
testing on subsequent conceptions.
• Uterine operation: hysteroscopy resection
• Cervical cerclage
• myomectomy.
• Appropriate antibiotics
40. Induced abortion
Induced abortion is the medical or surgical
termination of pregnancy before the time of fetal
viability. it can be legal or illegal, therapeutic
(safe) or un safe( septic )
septic or Unsafe abortion defined by WHO:
“. . .any procedure for terminating an unwanted
pregnancy (carried out) either by persons
lacking the necessary skills or in an
environment lacking minimal medical
standards, or both . . .”
41. Pathogenesis
• Instrument by illegal abortion or
ascending infection from the vaginal
cavity to normal sterile uterus
42. Sign and symptoms
• fever, shivering
• malodorous vaginal discharge
• pelvic and abdominal pain
• Rebound tenderness
• cervical motion tenderness.
• Peritonitis and sepsis
43. Investigations
• A complete blood count
• Hct ,blood group and cross match
• Urine culture and sensitivity
• endometrial cultures
• abdominal x-ray to rule out uterine
perforation should be obtained
• Ultrasound may be helpful in ruling out
retained products of conception.
44. Management
• Hospitalization and intravenous antibiotic therapy
• Broad spectrum antibiotic (ciprofloxacin+
gentamycin)
• Monitor v/s
• Blood transfusion if Hgb is low
• Remove focus of infection
• T.A.T to prevent tetanus
• Anti D for RH negative
• Post abortion care
• Hysterectomy for pelvic abscess and severe
perforation
45. Post abortion care
PAC is an approach for:-
Reducing morbidity and mortality
from complications of unsafe and
spontaneous abortion, and
improving women’s sexual and
reproductive health and lives.
46. Why is PAC an important intervention?
• Saves women’s lives, increases use of FP, and
prevents repeat abortion
• Is acceptable where induced abortion is legally
restricted
• Links curative service (treatment for
complications) with preventive service (FP)
• Should be included in the existing range of
services and should not be a separate , vertical
service
• Can be offered successfully in low resource
settings
47. Magnitude of the problem of
unsafe abortion
• About 40-50 million women experience
abortions annually and 50% of these are unsafe
• 13% of maternal mortality–67,000 women–8
women die every hour
• 38 to 68% are less than 20 years old
• 10 to 50% need medical care
• More than 95% of deaths and injuries from
unsafe abortion occur in developing countries.
• ratio of 1 unsafe abortion for every 7 live births
.
48. Other factors that complicate the problem of
unsafe abortion:-
• Unmet need for contraception to delay, space
or limit pregnancies
• Unmet need for sexually transmitted infection
(STI)/HIV prevention and care
49. Essential Elements of Post abortion
Care
1. Treatment
• Treat incomplete and un safe abortion and
potentially life threatening complications.
2. Contraceptive and family planning services
• Help women prevent unwanted pregnancy or
practice birth spacing.
50. cont..
3. Reproductive and other health services
• Preferably provide on - site, or via referrals to
other accessible facilities in provides’ networks.
51. Cont..
4. Community and service provider partnerships
• Prevent unwanted pregnancies and unsafe
abortion.
• Mobilize resources to help women receive
appropriate and timely care for complications
from abortion.