The document discusses amniocentesis, which involves extracting a small amount of amniotic fluid from the amniotic sac using ultrasound guidance to analyze fetal cells for chromosomal abnormalities, genetic disorders, and lung maturity. Amniocentesis allows for diagnosis of conditions like Down syndrome and helps assess risks from factors like advanced maternal age or family history. While generally low risk, potential complications include abortion and uterine infection in rare cases.
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When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Multiple pregnancy is used to describe the development of more than one fetus in the uterus at the same time. It is a high risk pregnancy. Careful supervision and proper monitoring is needed for prevention of further complications.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Multiple pregnancy is used to describe the development of more than one fetus in the uterus at the same time. It is a high risk pregnancy. Careful supervision and proper monitoring is needed for prevention of further complications.
Amniotic fluid maintain the perfect homeostasis between mother and fetus. It protect both mother and fetus from various complications. Details is enclosed in presentation.
Oligohydramnios by dr alka mukherjee dr apurva mukherjee nagpur m.s.alka mukherjee
• Oligohydramnios refers to amniotic fluid volume that is less than expected for gestational age. It is typically diagnosed by ultrasound examination and may be described qualitatively (eg, reduced amniotic fluid volume) or quantitatively (eg, amniotic fluid index ≤5 cm, single deepest pocket <2 cm).
• Oligohydramnios may be idiopathic or have a maternal, fetal, or placental cause The fetal prognosis depends on several factors, including the underlying cause, the severity (reduced versus no amniotic fluid), and the gestational age at which oligohydramnios occurs. Because an adequate volume of amniotic fluid is critical to normal fetal movement and lung development and for cushioning the fetus and umbilical cord from uterine compression, pregnancies complicated by oligohydramnios from any cause are at risk for fetal deformation, pulmonary hypoplasia, and umbilical cord compression.
• Oligohydramnios is associated with an increased risk for fetal or neonatal death, which may be related to the underlying cause of the reduced amniotic fluid volume or due to sequelae of the reduced amniotic fluid volume.
• This topic will discuss issues related to oligohydramnios. Methods of amniotic fluid volume assessment are reviewed separately.
• Oligohydramnios occurs when the amniotic fluid is < 5th centile for gestational age.
• The most common causes are premature rupture of membranes (often missed by the mother) and placental insufficiency, however structural abnormalities such as renal agenesis should be considered.
• Prognosis is linked to gestation at diagnosis and likely development of pulmonary hypoplasia and premature delivery.
• Treatment is by optimising gestation of delivery
this slide helps a physician in understanding the basics of miscarriages(definition, types/classification, causes, clinical presentation, investigations and complications. In understanding the basics, this helps a physician to able to treat or manage abortions.
3. The Fetal Membranes
Definition:
Fetal membranes are all the structures that develop from the
zygote and do not share in the formation of the embryo
(extraembryonic structures from the primitive blastomeres).
Fetal membranes are:
a. Chorion.
b. Amnion.
c. Yolk sac.
d. The umbilical cord including allantois and body stalk.
4. Amnion & Amniotic cavity
- It is a membrane which bounds the amniotic
cavity.
- It is continuous with the ectoderm of the embryo.
- It contains about 800-1000 ml of watery and clear
fluid at full term.
5. Amniotic Fluid
The amniotic fluid is that fluid surrounding the developing fetus
that is found within the amniotic sac contained in the mother's
womb.
• Physical characteristics ;
- It
is clear pale yellow fluid.
- pH of is around 7.2.
- Specific gravity of 1.0069 – 1.008.
-
-
6. Composition of amniotic fluid
- 98% water, 2% solid substances like inorganic &
organic salts, fetal epithelium, protein & enzymes.
Origin: The following forms the amniotic fluid:
1- Amniotic membrane
2- Maternal tissue (interstitial) fluid by diffusion across the
amnio-chorionic membrane from the deciduas parietalis.
3- Filtrated from maternal blood.
4- Fluid is also secreted by the fetal respiratory tract (300 – 400
ml daily) and enters the amniotic cavity.
5-Fetal urine.
7. Circulation
- The amniotic fluid, formed by amniotic
membrane & filtrated from maternal blood
accumulates in the amniotic cavity,
- Then, it is swallowed by the embryo.
- Lastly, it passes as fetal urine to accumulate
again in the amniotic cavity.
Volume of the amniotic fluid:
The volume of amniotic fluid increases slowly
from 30 ml at 10 weeks gestation to 350 ml at
20 weeks to 700 – 1000 ml by 37 weeks.
9. Function
Before labour:
1-It forms an isolating bag around the embryo protecting him
from external trauma, shock & temperature.
2-It prevents adhesion of the embryo to its membranes.
3-It allows homogenous media needed for the growth of the
embryo.
4-It permits the free movement of the embryo needed for
muscular exercise.
10. Function
During labor:
1- It forms the bags of fore water and hind water.
2-The bag of fore water allows regular dilatation of the
cervix.
3-After rupture of membrane the amniotic fluid serves
as a lubricant for fetus descent.
4-Also the amniotic fluid is bacteriostatic.
11. Clinical importance of AF:
• Screening for fetal malformation (serum α-fetoprotien).
• Assessment of fetal well-being (amniotic fluid index).
• Assessment of fetal lung maturity (L/S ratio).
• Diagnosis and follow up of labor.
• Diagnosis of PROM (ferning test).
• Diagnosis of fetal chromosomal abnormalities ( Down
syndrome, Edward syndrome, and others), and for DNA studies for
diagnosis of some single gene disorders.
12. Summary of the routine chemical tests performed on
amniotic fluid
• Tests for the Well-being and Maturity
• __________________________________________________________
• Test Normal values at term Significance
• __________________________________________________________
• Bilirubin scan 0.025 mg/dl Hemolytic disease
of the newborn
• L/S ratio 2.0 Fetal lung maturity
• Phosphatidyl- Present Fetal lung maturity
Glycerol
• Creatinine 1.3 – 4.0 mg/dl Fetal age
• Alpha fetal protein 4.0 mg/dl Neural tube disorders
• __________________________________________________________ 12
13. Amniotic fluid volume assessment
• Clinical assessment is unreliable.
• Objective assessment depends on U/S to measure:
- Deepest vertical pool (DVP).
- Amniotic fluid index (AFI). It is a total of the DVPs in each
four quadrants of the uterus. it is a more sensitive
indicator of AFV throughout pregnancy.
15. Amniotic fluid abnormalities
Oligohydramnios:
Defined as reduced amniotic fluid i.e. amniotic fluid
index of 5 cm or less
or the deepest vertical pool < 2 cm.
Polyhydramnios:
Defined as excessive amount of amniotic fluid of 2000 ml or
more
AFI of > 25 cm
or the deepest vertical pool of > 8 cm) .
18. Etiology of Polyhydramnios:
Fetal Anomalies
• Problems with swallowing and GI
absorption
• Increased transudation of fluid:
anencephaly, spina bifida
• Increased urination: anencephaly (lack of
ADH, stimulation of urination centers)
• Decreased inspiration
23. TREATMENT
• Mild to Moderate hydramnios: rarely requires
treatment
• Hospitalization, bed rest
• Amniocentesis: to relieve maternal distress and to test for
fetal lung maturity. Complications: ruptured membrane,
chorioamnionitis, placental abruption, preterm labour
• Non-steroidal anti-inflammatory analgesia
• Blood sugar control
24. management
• Indomethacin therapy: .
- impairs lung liquid production/enhances absorption.
- ↓fluid movement across fetal membranes.
* complications: premature closure of ductus arteriosus,
impairment of renal function, and cerebral
vasoconstriction. So not used after 34 weeks
28. ETIOLOGY
• Postdate
• Fetal Anomalies: obstruction of fetal
urinary tract/renal agenesis
• IUGR
• ROM
• Twin/Twin transfusion
• Exposure to ACE inhibitors, and
• Non-steroidal anti-inflammatory
29. DIAGNOSIS
SYMPTOMS SIGNS
NO SPECIFIC Uterus – small for
SYMPTOMS date
Malpresentations
H/O leaking p/v
IUGR
Postterm
s/o preeclampsia
Drugs
Less fetal movements
29
36. TREATMENT ACC. TO CAUSE
• Drug induced – OMIT DRUG
• PROM – INDUCTION
• PPROM – Antibiotics,steroid – Induction
• FETAL SURGERY
VESICO AMNIOTIC SHUNT-PUV
Laser photocoagulation for TTTS
36
37.
38. Amniocentesis
• Amniocentesis is the
removal of a small
amount of amniotic fluid
from the sac around the
baby.
• This is usually performed
at 16 weeks in
pregnancy.
• A fine needle is inserted
under ultrasound
guidance through the
mothers' abdomen into a
pool of amniotic fluid.
40. Amniocentesis
Studies of the cells obtained from the amniotic fluid permit:
1- Chromosomal analysis of the cells which can be performed to investigate the
following;
Diagnosis of sex of the fetus
Detection of chromosomal abnormalities e.g. trisomy 21 (Down’s syndrome)
DNA studies
2- The cells may indicate genetically transmitted diseases( Inherited disorders e.g
Cystic Fibrosis).
3-To check for developmental problems e.g. Spina Bifida .
4- Other studies can be done directly on the amniotic fluid including measurement of
alpha-fetoprotein where high levels of alpha-fetoproteins in the amniotic fluid
indicate the presence of a severe neural tube defect whereas low levels of alpha-
fetoproteins may indicate chromosomal abnormalities .
41. Amniocentesis
Who is the proper candidate for an Amniocentesis
investigation?
1-Those whom are suspected to have possible problems indicated
by certain tests conducted previously,(e.g If pregnancy is
complicated by a condition such as Rh-incombatibility,the
doctor can use amniocentesis to find out if the baby's lungs are
developed enough to endure an early delivery).
2- Family history of genetic abnormalities (in this case would be
advisable to seek genetic counseling before becoming
pregnant)
3-Those that have been exposed to certain risk enviromental
factors that might lead to fetal abnormalities .
42.
43. Amniocentesis
What are the risks of amniocentesis?
• - Abortion: about 1 in 200 to 400 women aborted (higher risk if
done in the first quarter)
• - Uterine infection: 1 in 1000