Anaemia is a reduction in haemoglobin levels below normal. It is common in pregnancy, with prevalence as high as 56% in some areas of India. Anaemia increases risks for both mother and baby, including preterm birth, low birth weight, maternal death. Treatment involves iron supplementation, though oral iron has side effects. Parenteral iron can be given via injection or IV for more severe cases. Blood transfusions are needed in some severe anaemias. Prevention strategies include screening, diet, and supplementation programs. Care during pregnancy and delivery aims to address risks from anaemia.
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
Anemia management of anemia in pregnancyDR MUKESH SAH
Treatment for Anemia
If you are anemic during your pregnancy, you may need to start taking an iron supplement and/or folic acid supplement in addition to your prenatal vitamins. Your doctor may also suggest that you add more foods that are high in iron and folic acid to your diet.
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Series of events that takes place in the genital organ in an effort to expel the viable products of conception out of the womb through the vagina into the outer world is called labour.
there are four stages of labour.
Anemia management of anemia in pregnancyDR MUKESH SAH
Treatment for Anemia
If you are anemic during your pregnancy, you may need to start taking an iron supplement and/or folic acid supplement in addition to your prenatal vitamins. Your doctor may also suggest that you add more foods that are high in iron and folic acid to your diet.
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Incidence and Management of Ovarian Cancer Cases in a Tertiary Hospital- A 10...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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.
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
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.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
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2. What is Anaemia ?
Anaemia is defined as reduction in circulating
haemoglobin mass below the
critical level.
The normal haemoglobin (Hb) is 12-14 gm%.
WHO has accepted up to 11 gm% as the normal
haemoglobin level in pregnancy.
Therefore any haemoglobin level below 11gm
in pregnancy should be considered as anaemia
3. Anaemia in pregnancy is present in very high
percentage of pregnant women in India.
Exact data is not available about the prevalence
of nutritional anaemia. However according to
WHO, the prevalence of Anaemia in pregnancy in
south East Asia is around 56 %.
In India incidence of anaemia pregnancy has
been noted as high as 40-80%.
4. Total iron requirement is 1000 mg.
Fetus and placenta -- 300 mg
↑ in red cell mass – 500 mg
Basal loss – 200 mg
Average requirement is 4-6mg/day.
2.5 mg/day in early pregnancy
5.5 mg/day from 20-32 weeks
6-8 mg/day from 32 weeks onwards
5. Anaemia is often classified as
Mild degree (9-11 gm %)
Moderate (7-9 gms %)
Severe (4-7 gm %)
Very severe (<4gm %)
It is also classified according to Haematocrit
(PCV) %.
6. Antenatal Period
-Poor weight gain
-Preterm labour
-PIH
-Placenta Previa
-PROM Postnatal Period
-Postnatal sepsis
-Sub involution
-Embolism
Intranatal Period
-Dysfunctional Labour
-Intranatal
-Hemorrhage
-Shock
-Cardiac Failure
-Anaethesia risk
What are the maternal risk factors ?
7. • Prematurity
• Low birth weight
• Poor apgar score
• Foetal distress
• Neonatal Anaemia
What are the fetal and neonatal risk factors ?
8. Physiological
Nutritional: Iron deficiency
Folate &/orVit B12 deficiency
Dimorphic
Hemorrhagic: Acute or Chronic
Hemoglobinopathies
Hemolytic: Congenital or acquired
Aplastic anaemia
9. Symptoms
Fatigue
Loss of appetite
Digestive upset
Dyspnoea
Palpitation
Signs
Pallor
Pale nails
Koilonychias
PaleTongue
Severe Case - Oedema
11. Serum Folate
RBC folate
SerumVit B12
Serum Bilirubin
Coombs test
HB electrophoresis
NESTROF test
Red cell osmotic fragility
12. Routine screening for anaemia for adolescent
girls from school days
Encouraging iron rich foods
Fortification of widely consumed food with iron
Providing iron supplementation from school days
Annual screening for those with risk factors
13. Prophylaxis of non-pregnant women – 60 mg of elemental
iron daily for 3 months.
Iron supplementation during pregnancy.
Routine iron supplementation is debatable in western
countries
It has to be given in non-industrialized countries
W.H.O RECOMMENDATION: Universal oral iron
supplementation for pregnant women (60 mg of elemental
iron and 400 µg of folic acid) for 6 months in pregnancy
and additional of 3 months post-partum where the
prevalence is more than 40%.
14. MINISTRY OF HEALTH, GOVT. OF INDIA
RECOMMENDATION: [CSSM] 100 mg of elemental iron with
500 µg of folic acid in second half of pregnancy for atleast 100
days. 2 injections of iron dextran (250 mg each) given IMI at 4
weeks interval with TT injection.
Treatment of hook worm infestation
Single albendazole (400 mg) or mebendazole (100 mg x BD x 3
days)
Change in defecation habits and avoidance of walking bare
footed.
18. ORAL IRONTHERAPY
1. Safe,inexpensive and effective way to
administer iron
2. National nutritional anemia prophylaxis
program suggest 60 milligrams of elemental
iron and 500 micrograms of folic acid daily
3. However it is suggested that 120 milligram of
elemental iron and 1 milligram of folicacid are
the optimum daily dose needed
20. SIDE EFFECTS OF ORAL IRON
A. UPPER GITRACT
Nausea,gastric discomfort,loss of apetite,staining
of teeth
A. LOWER GITRACT
Constipation,diarrhoea,flatulance
21. PARENTRAL IRONTHERAPY
Preparation
Iron sucrose-Imax S[100mg/5ml],orofer s[50mg
/2.5ml]
Iron sorbital citric acid complex-jectocos
Iron dextran-imferon
22. Intramuscular iron
1. 0.5ml test dose should be given
2. 75/100mg/day is given daily on alternate days
3. Given deep Im by Z-techniue to prevent skin
staining
4. Side effects-painful,discolouration,injection
abscess
23. INTRAVENOUS IRON
1. Formula-0.66*% deficit of Hb*wt in kg=mg of iron
2. Total dose in mg/50=ml of imferon
3. Total dose is given in normal saline
COMPLICATION
Local-thrombophlebitis at IV site
Systemic-malaise,fever,arthralgia,utricaria
lymphadenopathy
24. BLOODTRANFUSION
1. Indicated insevere anemia at any GA,moderate
anemia beyond 36wks and when there is a
failure of response to iron therapy,severe
hemorrhage likeAPH,PPH,rupture
uterus,cesarean section,first trimester
hemorrhage,thalassemiasand sickling disorders
in pregnancy
25. ADVERSE REACTIONS
1. Tranfusion reaction
2. Infection
3. Volume overload
4. Others like hypothermia,citrate
toxicity,hyperkalemia,hypocalcemia and rarely
air embolism
26. First stage – Comfortable position
Adequate analgesia
Arrangement for oxygen,
Digitalization maybe required in cardiac failure
due to severe anaemia
Antibiotic prophylaxis
27. Second stage – Cut short by forceps application.
Active management of third stage
During puerperium
Adequate rest
Iron and folate therapy for 3 months
Infection if any should be treated energetically
Careful watch for puerperal sepsis, failing lactation; sub
involution of uterus and thromboembolism