obstetric and gyneacology; Changes in pregnancy, cardiovascular changes, respiratory changes, endocrine changes, gastrointestinal changes, related organ changes in pregnancy. hormonal changes during pregnancy.
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.
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.
Detailed account of the various changes that occur in maternal anatomy, physiology, and metabolism of pregnant women. These physiological changes are often very precise, and deviations of physiological responses can be a prelude to possible disease/infectious states. In this second part of Labor, we will examine the various systems of the human body,its altered states during pregnancy, and how those changes affect the woman preparing for delivery. Special care is imperative in properly determining the needs of an expecting mother, so developing an intimate, trusting relationship between the mother and fully understanding her physiological output will lead to the best chances of a successful delivery.
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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.
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.
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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
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.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
Best Ayurvedic medicine for Gas and IndigestionSwastikAyurveda
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
How STIs Influence the Development of Pelvic Inflammatory Disease.pptx
Anatomy and physiological changes in pregnancy
1. FOUNDATION OF MIDWIFERY
ANATOMY AND PHYSIOLOGYCAL
CHANGES DURING PREGNANCY
IN OTHER RELATED SYSTEM
2. GROUP 1
ANASTASIA WILLIAM
ANNIE ANAK JADAM
ASBIH BINTI JITAL
BIBIANA IVY @ IVY AMIN
BOKIAH BINTI JAINAL PUDDIN
CHAIRIN OSIIN
DAINE CHRISTY LEBA ANAK UJAI
DAYANA GEORGE TIMIN
3. LEARNING OBJECTIVE
At the end of this session, student should be able to
1. Described the gross structure of related system in reproductive system.
2. Described the macroscopic and microscopic of system
3. Explained the function of related system to pregnancy
4. Explain the changes of related system during pregnancy, labour, and
puerperium
5. Explained the contribution of the reproductive system
4. INTRODUCTION
The changes that occur in the pregnant mother’s body are
caused by a several factors.
Many of these changes are caused by the growth of the fetus
inside the uterus.
7. LOCATION
Heart enlarged by chamber dilation
and hyperthropy. Upward
displacement of the diapgram causes
the heart shifted to the left and
upwards..
Displacement diapgram and
shifted of the heart during
pregnancy
8. FUNCTION
1. Meet the increase metabolic demands of the mother and foetus
2. Promote growth and development of uteroplacenta-foetal unit.
3. Compensated for blood loss at the end of labour.
9. RELATIONSHP WITH OTHER ORGAN
To promote blood circulation to other organ ( pulmonary and
systemic )
Utero placenta – fetal circulation is supply oxygen and
nutrient to fetus.
10. BLOOD SUPPLY
Coronary artery is the blood supply to
heart. Its divided to left coronary artery
and right coronary artery.
11. NERVES SUPPLY
The cardiac nerve are autonomic nerves which supply to the
heart. They are superior cardiac nerve, middle cardiac nerve
and inferior cardiac nerve.
12. SUPPORT
Supported by thoracic cavity where the diaphgram separating
the thorax from the abdomen.
13. CHANGES CVS DURING PREGNANCY CHANGES CVS DURING
LABOUR
CHANGES CVS DURING
PUERPERIUM
Blood volume increase 30-40% at 6 – 8 week
-Cardiac output increase 30 – 50 at first
trimester.
-Blood pressure normal lowering in early
pregnancy and back to normal during term
-Heart rate modest increase
-Anemia due toincrease plasma volume
followed small increase in RBC 20 – 30%
-Varicose vein develop because of enlarged
uterus puts pressure to the inferior vena cava
and pressure to the leg veins
-Aortacaval compression in mid pregnancy
Oxygen consumption increased
-Intravascular volume increased
300 – 500 ml blood from the
contracting uterus to the
venouse system
-Cardiac output increased
during contracting due to
response of cathecolamine
secretion.
-Heart rate increased
-Blood pressure increased
Stroke volume increased
despite blood loss secondary
to increased venouse returned
Cardiac output not changes
after 2 weeks delivery
- Heart rate back to normal
16. FUNCTION
Digestive system is unique and specialized function of
turning food into the energy you need to survive and
packaging the residue for waste disposal.
17. Changes during pregnancy Changes during labour Changes during
puerperium
Mouth
-Become highly vascularised, oedematous, have less
resistance to infection and easily irritate (
progesterone and oestrogen)
-Increase thirsty and appetite
Oesophagus
-Heartburn and burning sensation affecting 30 -70%
- lower tone of the oesophagus spintcer caused
impaired and regurgitation of gastric acids.(
progesterone and oestrogen)
Stomach
-Decreased of acid gastric secretion and motility
delayed the gastric empty
-Delayed chymes increase heartburn and nauseated
Intestine and colon
-Constipation due to reduced gastrointestinal muscle
tone and motility
-Mendelson’s syndrome
Only during LSCS
-chemical pneumonitis
cased by reflux of acid
gastric
-caused of pressure of
gravid uterus
-progesterone relaxant
smooth and cardiac
muscle
-Increase gas distension due
to relaxed of abdomen
-Haemorrhoid will be more
painful if there is presence of
haemorrhoid and will
disappear within a few
weeks.
18. BLOOD & NERVES SUPPLY
The organs of the GIT receive arterial blood supply from three arteries:
-Coeliac trunk for foregut
-Superior mesenteric artery for mid gut
-Inferior mesenteric artery for hindgut
-The veins drain into the portal vein and from thence to the liver and ultimately inferior
vena cava.
-The vagus nerve supplies parasympathetic innervation up to the proximal 2/3rd of the
transverse colon where it hands over to the sacral outflow. Sympathetic innervation is
derived from the greater, lesser and least splanchnic nerves (T6-T12). Sensory fibres
run with the sympathetic.
23. ANATOMIC CHANGES
Upper airway
Hyperemia, friability, mucosal oedema, hypersecretion of the airway
mucosa.
Nasal obstruction, epistaxis, sneezing episodes and vocal changes may
occur, and worsen when lies down.
Preferential mouth breathing and intolerant of nasal canula delivery of O₂.
24. CONT….
Lower airway
Mucosal changes occur in larynx and trachea.
Nonspecifec complaints of airway irritinat ( irritant cough or sputum
production)
Estrogen increse tisu hydration and edema,also cause capillary
congestion and hyperplastic and hypersecretory mucous glands.
25. Subcostal
angle 68˚ −
103˚
Thoracic cage
upwards by
5 -7
circumference
Displacement of the ribcage in pregnancy and non pregnancy showing elevated diaphragm,
the increase tranverse and circumference, flaring out of ribs and the subcostal angle
27. CHANGES DURING PREGNANCY CHANGES DURING LABOUR CHANGES DURING
PUERPERIUM
- RR ↑ in pregnancy.
- Breath more deeply event at rest.
-Anterior posterior and transverse -
diameter ↑ about 2cm resulting in a 5-7
expansion of the chest circumference.
- Progressively increase the
subscostal angle from 68ᵒ to 103ᵒ at
term.
- Changes mediated by progesterone
and relaxin which ↑ ribcage elasticity
by relaxing ligaments.
-By 8/52 gestation: Expansion of the
ribcage cause the Tidal Volume (TV)↑ by
30-40%.
-Respiratory responses are
greatly affected by stage of
labour and the respond to pain
and anxiety.
- TV ( tidal volume ) range from
350 to 2250ml and minute
ventilations from 7 to 90 L/min
Back to normal
31. The Endocrine
system
-the collection of glands of an organism that secrete
hormones directly into the circulatory system to be carried
towards a distant target organ.
- The major endocrine glands in female include the pineal
gland, pituitary gland, pancreas, ovaries, thyroid gland,
parathyroid gland, hypothalamus, and adrenal glands
Figure 1: The endocrine system in non pregnant female
32. What changes in the Endocrine
system during pregnancy?
The major changes in endocrine system during
pregnancy is the placenta where it acting as a
temporary endocrine gland called Endocrine
placenta.
synthesizes a huge and diverse number of
hormones and cytokines that have major influences
on ovarian, uterine, mammary and fetal physiology
placenta
Foetus
Figure 2: The placenta as temporary endocrine gland
33. Placental hormones
Hormones Changes Roles
1. hCG (human
chorionic
gonadotrophin)
Peaks:
8-10 weeks and
then declines by
week 20th
remains stable
until labour
1. produced by the placental syncytiotrophoblast and
cytootrophoblast cells following implantation
2. stimulates the production of oestrogen and progesterone
within the ovary
2. diminishes once the placenta is mature enough to take
over oestrogen and progesterone production.
- rescue the corpus
luteum from involution
so that it can continue
to produce
progesterone to
maintain the decidua
Table 1: hCG hormones and its contribution
34. Placental hormones
hormones changes Role
2. Progesterone
Peaks :
increases around
8-10 weeks
- produced by the
corpus luteum during
the first 9 weeks of
pregnancy before shift
to placenta
# decreases or disruption of the
progesterone production
promotes the cervical re-modelling
and initiates labour
(Mesiano at el 2011)
1. promotes decidualization
2. prevent menstruation and rejection of the
trophoblast
3. inhibits smooth muscles contractility
4. maintains myometrial quiescent
5. prevent onset of uterine contraction (Feldt-
Rasmussen and Mathiessen 2011)
Table 2: Progesterone hormones and its contribution
35. Placental hormones
hormones Changes Roles
3. Oestrogen -- Primarily produced by the
corpus luteum and follicles
- 3-8 times higher during
pregnancy , it is within 6-7
weeks
Where the secretion had taken
over by the placenta.
- increases uterine blood flow
– facilitates the placental oxygenation and nutrition to
fetus
– prepares the breast for lactation
– simulates the production of hormone-binding globulin
in liver ( Myatt and Powell 2010)
- During last trimester, increasing the excitability of the
myometrium and prostaglandins synsthesis.
Table 3: Oestrogen hormones and its contribution
36. Placental hormones
hormones changes Role
4. Human
placental
Lactogen (hPL)
--Produced by the
syncytiotrophoblast
- increases up to 30
folds throughout
pregnancy
1. regulated the maternal carbohydrate, lipid, protein
metabolism and fetal growth.
2. promote the growth of the breast tissues in
preparation for lactation (Braun at el 2013)
3. It can also decrease maternal tissue sensitivity to
insulin, resulting in gestational diabetes
Table 4: hPL hormones and its contribution
37. Placental hormones
hormones Changes Roles
5. Relaxin -produced by corpus luteum in
both pregnant and non pregnant
female
-levels rise during 1st trimester
and additional relaxin is
produced by the decidua.
- peak is reached during the 14
weeks and at delivery
1. increased cardiac output
2. increased renal blood flow
3. and increased arterial compliance.
4. It also relaxes other pelvic ligaments. It is believed to
soften the pubic symphysis.
Table 5 : Relaxin hormones and it contribution
38. Figure 3 : schematic level of progesterone, oestrogen and HCG
throughout the pregnancy
39. Other Endocrine changes
THE PITUITARY GLAND
The pituitary gland are increasing in size 2- 3 folds from it normal size during pregnancy
Figure 4: The pituitary gland is a pea-sized structure located at the base of the brain, just below the hypothalamus and attached to
it by nerve fibers
40. Pituitary Glands hormones
Anterior Pituitary
- Prolactin Hormone
Changes:
- hypertrophy and hyperplasia of the lactotrophs ( prolactin secreting cells) by the anterior lobe of the
pituitary gland under the influence of oestrogen hormone as a result prolactin level increases
- by term, the levels are about 10 times in preparation of milk production
Roles:
1. prepares the mother’s breasts for lactation and also aids in the final stages of lung maturation for the
baby
2. infant sucking at the breast can cause the prolactin secrection released
Table 6 : prolactin hormones and it contribution
41. Pituitary Glands hormones
Posterior pituitary
- Oxytocin hormone
Changes:
- Low throughout pregnancy but increase in labour (Feldt-Rasmussen and Mathiessen 2011)
Roles:
1. act on the myometrium to increase the length, strength and frequency of contraction during
labour
2. keeping the uterine contractions going continues after the baby is born and begin to shrink the
uterus back to its original size
3. the high levels of oxytocin in both mother and baby at this time promote affection, attachment
and a desire in the mother to protect and guard the baby
4. promotes the let-down reflex, too, which enables the breasts to produce milk
Table 7 : oxytocin hormones and it contribution
42. Other Endocrine changes
Thyroid Gland
Changes in size:
moderately enlarged during pregnancy
due to hormone-induced glandular
hyperplasia and increased vascularity.
Fetal thyroxine
wholly obtained from maternal sources
in early pregnancy since the fetal
thyroid gland only becomes functional
in the 2nd trimester of gestation.
Figure 5: showing situated on the anterior side of the neck, lying
against and around the larynx and trachea, reaching posteriorly
the oesophagus and carotid sheath
43. Thyroid Gland Hormones
hormones changes Roles
(TBG) Thyroxine binding
globulin
- rise almost 2-3 folds because
estrogen increases TBG
production
1. required for metabolic changes as well as
transfer the thyroxine to fetal brain cells
for normal brain development
2. Maintaining it supply for both mother and
fetal requirement
thyroxine (T4) and
triiodothyronine (T3)
- levels rise from about 6–12
weeks and plateauing at
approximately 20 weeks of
gestation
Parathyroid hormone Parathyroid gland Increase in
size slightly
1. To meet up the increases of the
requirement for the calcium needed in
fetal growth
44. Thyroid Hormones
Figure 6: Changes in thyroid
function indices throughout
gestation. The shaded area
represents the normal range of the
TBG, total T4, TSH, free T4 and hCG.
Level concentration
Weeks of gestation
45. Adrenal gland
•the outer cortex is under the control of ACTH from the
anterior pituitary. It secretes steroid hormones
(corticosteroids).
•the inner medulla is controlled by the sympathetic
nervous system. It secretes adrenaline.
Figure 6: The adrenal glands are located bilaterally in the
retroperitoneum superior and slightly medial to the kidneys
46. Changes during Pregnancy
Size:
does not cause much change in the size of the adrenal glands
Hormone Changes Roles
Cortisol or
glucocorticoid
Marked increase 1. particularly helpful in times of long and short term stress.
2. have anti-insulin, anti-inflammatory, and anti-allergic
actions
3. needed to make the precursors of adrenaline, which the
inner medulla will produce and secrete
Aldosterone increased amounts
by the adrenal
glands as early as 15
weeks of pregnancy
1. regulates absorption of sodium from the distal tubules of
the kidney
47. CONCLUSION
This system plays an important role in growth and development of the
foetus in pregnancy. It is important for the midwives trained staff to know
the changes during pregnancy and to deliver good care and reduces
complication.
48. Reference
Jayne Marshall, Maureen Raynor ( 2014 ) Myles Textbook for Midwives sixteen edition, Churcill Livingstone
Jane Coad, Melvyn Dunstall ( 2007 ) Anatomy and Physiology for Midwives second edition, Churcill Livingstone
Janet Medforth et.al ( 2010 ) Oxford Handbook of Midwives South Asian Eition, oxford
Quick Doctor, physiological changes of pregnancy. Retrieved from www.doctor.com/docs/476537/physiologic_changes_of_pregnancy.
Elizabeth Eden ,MD understanding pregnancy symptoms. Retrieved from
http:www.pregnancy_and_parenting/pregnancy/issue/understanding_pregnancy_symptoms.
Mother & child glossary ( 2002 ) Health on The Net Foundation. Retrieved from www.hon.ch/Dossier/motherchild/preg_changes/circulation.html
Mother& child glossary ( 2002 ) Health on The Net foundation. Retrieved from www.hon.ch/Dossier/motherchild/preg_changes/lungs.html.
Alexandra house, Oldham terrace ( 2013 ) The UK’s for parents. Hormone in pregnancy. Retrived at http://www.nct.org.uk/birth/hormones-labour.