Postpartum hemorrhage (PPH) is the leading cause of maternal mortality worldwide, accounting for over 100,000 deaths per year. Active management of the third stage of labor (AMTSL) involving prophylactic oxytocin, controlled cord traction, and uterine massage can prevent 60% of PPH cases. For women without risk factors, oxytocin is the recommended agent for AMTSL, while carboprost is effective for treatment of PPH. Clinical evidence shows carboprost provides powerful uterine contraction with fewer side effects compared to other uterotonics like methylergometrine. Proper identification of risk factors and preparedness are important for reducing the burden of PPH.
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
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
In settings with limited access to health care, misoprostol is an important intervention that could reduce maternal deaths both directly and through the more cost-effective use of health services. Misoprostol is, however, a powerful drug that needs to be used with care. Evidence-based information about the safest regimens should be widely disseminated so as to prevent its inappropriate use
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
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
In settings with limited access to health care, misoprostol is an important intervention that could reduce maternal deaths both directly and through the more cost-effective use of health services. Misoprostol is, however, a powerful drug that needs to be used with care. Evidence-based information about the safest regimens should be widely disseminated so as to prevent its inappropriate use
Recent evidence based guideline regarding Ovarian drilling very helpful for Gynaecologist, laparoscopic surgeon, Infertility specialist, Post doctoral fellows and post graduates
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
In a prospective double blind randomized study we evaluated the prophylactic anti emetic efficacy of granisetron, a 5HT3 receptor antagonist and metoclopramide, a benzamide anti emetic on postoperative nausea and vomiting after major gynaecological surgery under general anaesthesia. The patients received a single dose of granisetron, 40mcg/kg (Group A, n = 25) or metoclopramide, 0.15mg/kg (Group B, n = 25) before induction of anaesthesia in a coded syringe. The response was assessed during 0-4 hrs, 4-8 hrs, 8-16hrs and 16-24 hrs time intervals after recovery from anaesthesia by means of presence or absence of nausea, retching or vomiting. The overall control of PONV during early postoperative period (0-4 hrs) did not show statistically significant differences after administration of either drug. The incidence of PONV during the next 20 hours was 12% and 48% with Group A (Granisetron) and Group B (Metoclopramide) respectively. Nausea scores are significantly lower in-group A (Granisetron) than in Group B (Metoclopramide) in all the four assessment periods. Although there were no emetic episodes in the granisetron group, 32% of patients in metoclopramide group were observed to have such episodes during the assessment periods. (P value< 0.05). No clinically important adverse events due to drugs were observed in any of the groups. In conclusion, the prophylactic use of granisetron is more effective and superior to metoclopramide in preventing postoperative nausea and vomiting in patients under going major gynaecological surgery under general anaesthesia.
Antiemetic Prophylaxis in Major Gynaecological Surgery With Intravenous Grani...inventionjournals
In a prospective double blind randomized study we evaluated the prophylactic anti emetic efficacy of granisetron, a 5HT3 receptor antagonist and metoclopramide, a benzamide anti emetic on postoperative nausea and vomiting after major gynaecological surgery under general anaesthesia. The patients received a single dose of granisetron, 40mcg/kg (Group A, n = 25) or metoclopramide, 0.15mg/kg (Group B, n = 25) before induction of anaesthesia in a coded syringe. The response was assessed during 0-4 hrs, 4-8 hrs, 8-16hrs and 16-24 hrs time intervals after recovery from anaesthesia by means of presence or absence of nausea, retching or vomiting. The overall control of PONV during early postoperative period (0-4 hrs) did not show statistically significant differences after administration of either drug. The incidence of PONV during the next 20 hours was 12% and 48% with Group A (Granisetron) and Group B (Metoclopramide) respectively. Nausea scores are significantly lower in-group A (Granisetron) than in Group B (Metoclopramide) in all the four assessment periods. Although there were no emetic episodes in the granisetron group, 32% of patients in metoclopramide group were observed to have such episodes during the assessment periods. (P value< 0.05). No clinically important adverse events due to drugs were observed in any of the groups. In conclusion, the prophylactic use of granisetron is more effective and superior to metoclopramide in preventing postoperative nausea and vomiting in patients under going major gynaecological surgery under general anaesthesia.
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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
- 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
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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.
2. Hemorrhage 28.7%
Embolism 19.7%
P.I.H. 17.6%
Infection 13.1%
Cardiomyopathy 5.6%
Anesthesia compl 2.5%
Others 2.7%
The commonest complication in at risk
pregnancy is PPH.
PPH: Post Partum Hemorrhage
Margaret C. Hogan et al., Lancet 2010
Int J Gynecol Obstet 2009,
3. Primary PPH is defined as excessive
bleeding that occurs in the first 24 hours
after delivery
Traditionally the definition of PPH has been
blood loss in excess of 500 mL after vaginal
delivery and in excess of 1000 mL after
abdominal delivery
For clinical purposes, any blood loss that
has the potential to produce hemodynamic
instability should be considered PPH
WHO guidelines for the management of postpartum
hemorrhage and retained placenta
4. The amount of blood loss required to
cause hemodynamic instability will
depend on the pre-existing condition
of the woman
Hemodynamic compromise more
likely anaemia (e.g., iron deficiency,
thalassemia) or volume-contracted
states (e.g., dehydration, gestational
hypertension with proteinuria)
WHO guidelines for the management of postpartum
hemorrhage and retained placenta
5. 342,900 Maternal deaths worldwide ( 2008)
Global MMR has decreased from 422 ( 1980) to
251(2008) per 100,000 live births
PPH is the leading cause of maternal mortality
The WHO statistics suggest that 25% of maternal
deaths are due to PPH, accounting for more than
100,000 maternal deaths per year
PPH occurs in 5% of all deliveries
The majority of these deaths occur within 4 hours
of delivery, which indicates that they are a
consequence of the third stage of labour
Margaret C. Hogan et al., Lancet 2010
Int J Gynecol Obstet 2009
6. Tone - abnormalities of uterine
contraction
Tissue - retained products of
conception
Trauma - of the genital tract
Thrombin - abnormalities of
coagulation
The most common cause of primary
PPH is uterine atony
8. Active management of the third stage
of labour should be offered to all
women during childbirth
Administration of a uterotonic soon
after the birth of the baby;
Clamping of the cord following the
observation of uterine contraction
Delivery of the placenta by controlled
cord traction, followed by uterine
massage.
Int J Gynecol Obstet 2009
11. Clear practice implication in favour of
using oxytocin- in terms of reducing
PPH and the need for therapeutic
Oxytocics, when compared to using no
uterotonic
Cotter A, Ness A, Tolosa J. Prophylactic oxytocin for the third
stage of labour (Cochrane Review). In: The Cochrane Library,
Issue 1, 2006.
12. Oxytocin is associated with fewer manual
removals and less raised blood pressure of
the placenta
For all other outcomes definite conclusions
cannot be drawn
Cotter A, Prophylactic oxytocin for the third stage of labour
(Cochrane Review). In: The Cochrane Library, Issue 1, 2006.
13. Carboprost low dose IM (125 µg) for AMTSL
Carboprost high dose IM (250 µg) for High
risk cases & Management of PPH
Mainly compared with Methylergometrine
14. Bhattacharya P (Late), Devi PK. Acta Obstet Gynecol Scand Suppl 145:13-15,
Blood Loss Duration 3rd Stage
15. 50
100
200
250
300
150
ml
283
Postpartum blood loss Blood loss at 2 hrs.
Control
100
Prostodin
27
Prostodin
163
Control
Duration of third stage
Control
11 min.
Prostodin
5 min.
Devi et al. Acta Obstet Gynecol Scand 1988;S145:7-8
17. Goyal U., Chabra S. Obs. & Gynae Today , 1998
Group I: No uterotonic
Group II: Methylergometrine
Group III: Carboprost (125 µg)
Significant reduction in duration of 3rd stage and amount of
blood loss in group II and III (p< 0.01)
16% patients had rise in blood-pressure in group II
No major side effects in group III
Carboprost (125 µg) Vs
Methylergometrine
19. RCT methyl ergometrine 0.2 mg, misoprostol 400
mcg S/L and carboprost 125 mcg ( N-200
women)
Median blood loss, blood loss >500ml, need of
additional oxytocics and drop in Hb were same in
all groups
Significant side effect of shivering, pyerexia and
vomitting in misoprostol though self limiting
Diarrhoea was common in carboprost and
hypertension in methyl ergometrine group
Three women in methyl ergometrine group
required MRP
Vaid A, Dadhwal V, Mittal S, Arch Obstet Gynecol, 2009
20. RCT Syntometrine Vs Carboprost 125 mcg
(N-112 women)
Similar results in duration of third stage,
blood loss and need for blood transfusion
Significant side effect of diarrhoea with
carboprost
Chua S, Aust N Z J Obstet Gynecol, 1995
21. Clinical evidences suggest CARBOPROST
when given postpartum will result in:
Powerful uterine contraction
• Immediate cessation of bleeding (88 – 98%)1,2
Adequate uterine retraction3
• Significantly reduced blood loss4
• Reduced need for blood transfusion/blood products4
• Obviates need for hysterectomy/surgical intervention2
Abdel-Aleem et al. Int J Gynecol Obstet 1993
Thiery & Parewijck. Z. Geburtsh U. Perinat. 1985
Arulkumaran S et al. The Management of Labour. Orient
Longman 2005 (2nd edn.):276
F. Boyoumeu et al. Eur J Obstet Gynecol Reprod Biol 2003
22. Sustained action for up to 7 hours
Stimulates endogenous PGF2
Does not require supplementation with
additional uterotonics
Reduced risk of delayed/secondary
Abdel-Aleem et al. Int J Gynecol Obstet 1993
Thiery & Parewijck. Z. Geburtsh U. Perinat. 1985
Arulkumaran S et al. The Management of Labour. Orient Longman
2005 (2nd edn.):276
F. Boyoumeu et al. Eur J Obstet Gynecol Reprod Biol 2003
23. No evidence was found relating to the priority
outcomes regarding blood loss
Of 60 patients in the carboprost group, none
received a blood transfusion compared with 1
of 60 in the misoprostol group
None of the patients in the carboprost group
reported shivering, compared with 5 in the
misoprostol group
WHO 2009
24. Active management of third stage of labour
can prevent 60% of postpartum hemorrhage
Overall there is little evidence of differential
effects of Oxytocin and ergot alkaloids
Oxytocin is more safe as compare to ergot
alkaloids
Misoprostol is inferior to Oxytocin in
prevention of PPH
Pyrexia and shivering are common side
effects with Misoprostol
25. Carboprost (125 µg) is more effective and
safe as compare to Methylergometrine
Carboprost (125 µg) is well tolerated in
various clinical studies as compare to
Methylergometrine
26. Prophylactic oxytocics should be offered routinely
in the management of the third stage of labour in
all women as they reduce the risk of PPH by about
60%.
For women without risk factors for PPH delivering
vaginally, oxytocin (5 iu or 10 iu by intramuscular
injection) is the agent of choice for prophylaxis in
the third stage of labour.
For women delivering by caesarean section,
oxytocin (5 iu by slowintravenous injection) should
be used
RCOG Guidelines: Prevention and Management of PPH, 2011
27. Carboprost 0.25 mg by intramuscular
injection repeated at intervals of not less than
15 minutes to a maximum of 8 doses
(contraindicated in women with asthma)
Direct intramyometrial injection of carboprost
0.5 mg (contraindicated in women with
asthma),
Misoprostol 1000 micrograms rectally
RCOG Guidelines: Prevention and Management of PPH, 2011
28. Two case series from the USA comprising 26
and 237 cases, respectively, reported success
in controlling hemorrhage, without resort to
surgical means in 85% and 95% of cases
Two of the four failures in the smaller series
were associated with placenta accreta
Buttino L Jr, Garite TJ. Am J Perinatol 1986;86:241–3.
Oleen MA,Mariano JP. Am J Obstet Gynecol 1990;90:205–8.
29. If bleeding occurs at LSCS or laparotomy
intra myometrial injection of carboprost
should be used
It is also possible to inject intra myometrial
carboprost through the abdominal wall in
the absence of laparotomy
Buttino L Jr, Garite TJ. Am J Perinatol 1986;86:241–3.
30.
31. Oxytocin
Methergine
PGF2
Misoprostol
15-25o C
2-8o C (protect from light)
2-8o C
Long self life – Room temp
WHO guidelines for the management of Postpartum Hemorrhage and
retained placenta
32. The pregnancy with comorbid conditions like
anaemia, PIH gestational diabetes are
considered to be AT RISK for PPH and thus
have to be prepared accordingly throughout.
Thus increased importance of AMTSL in these
MMR: Maternal Mortality Rate