Antepartum hemorrhage refers to vaginal bleeding after 24 weeks of gestation until birth, and can be caused by placenta previa, abruptio placentae, vasa previa, or other non-placental issues; initial management focuses on stabilizing the mother and fetus, administering IV fluids and blood products if needed, and determining the appropriate mode of delivery depending on the diagnosis and severity of bleeding. Complications of conditions like abruptio placentae and placenta previa can impact both mother and fetus if not properly managed.
Obstetrics and Gynecological Nursing
The PPT contains detailed information about Abnormal uterine action, its classifications, causes, sign and symptoms and management.
Obstetrics and Gynecological Nursing
The PPT contains detailed information about Abnormal uterine action, its classifications, causes, sign and symptoms and management.
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 topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
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 topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
Prelabour Rupture of Membrane (PROM) by Sunil Kumar Dahasunil kumar daha
Please find the power point on Prelabour Rupture of Membrane (PROM). I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Labour induction
Induction of labour
Guidelines on induction of labour
Guidelines on labour induction
induction of labour is not risk free
prostaglandins for induction of labour
Bishop score
Cervical ripening techniques
mechanical and pharmacological induction of labour
Post dates induction
options for cervical ripening
oral vs. vaginal misoprostol
advantages diadvantages and techniques for induction of labour
gynecology & obstetrics
Labour induction methods
review of guidelines for labour induction
Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and before the birth of the baby. The most important causes of APH are placenta praevia and placental abruption
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
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.
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.
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We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
2. Definition
Hemorrhage from the vagina after the
24th week of gestation till end of
pregnancy
Blood loss of greater than 300mls
Incidence : 3-5% of all pregnancies
4. Abruptio Placentae
Premature separation of the placenta.
Pathophysiology of placental
abruption:
◦ Bleeding into the decidua basalis layer
◦ Hematoma forms causing further
placental separation
◦ Fetal blood supply is further compromised
◦ Complication - Couvelaire Uterus
(Retroplacental blood goes into the peritoneal cavity)
5. Classification
Clinical classification
Class 0 - Asymptomatic
Class 1 - Mild (represents
approximately 48% of all cases)
Class 2 - Moderate (represents
approximately 27% of all cases)
Class 3 - Severe (represents
approximately 24% of all cases)
6. Placental abruption: types
Placental abruption can be broadly
classified into two types:
◦ Revealed
◦ Concealed
◦ Mixed
7. Presentation
Symptoms
◦ Vaginal bleeding - 80%
◦ Abdominal or back pain and uterine
tenderness - 70%
◦ Fetal distress - 60%
◦ Abnormal uterine contractions
(eg, hypertonic, high frequency) - 35%
◦ Idiopathic premature labor - 25%
◦ Fetal death – 15%
8. Presentation
Physical Examination
◦ Should be done after stabilizing the
patient
◦ Ultrasound should be done first to assess
the location of placenta. Only then should
a digital pelvic exam be conducted
◦ Profuse bleeding in waves
◦ Uterine contraction / Uterine hypertonus
◦ Shock
◦ Absence of fetal heart sounds
◦ Increased fundal height (due to hematoma)
9. Risk factors of Abruptio
Placentae
◦ Maternal hypertension
◦ Maternal trauma
◦ Cigarette smoking
◦ Alcohol consumption
◦ Cocaine use
◦ Short umbilical cord
◦ Maternal age <20 or >35 years
◦ Low socioeconomic status
◦ Elevated second trimester maternal serum
alpha-fetoprotein (associated with up to a 10-
fold increased risk of abruption)
◦ Previous placental abruption
12. Complications of Abruptio placentae –
Fetal
Fetal complications include
◦ Hypoxia or hypoxic-ischemic encephalopathy
(HIE)
◦ growth retardation
◦ CNS abnormalities
◦ Intra uterine death.
13. Placenta praevia
Implantation of placenta over the internal
cervical os and therefore in front of the
presenting part
Pathophysiology
◦ Delay in implantation of blastocyst so that it
occurs in the lower part of uterus
◦ In third trimester isthmus of uterus thins to form
lower uterine segment
◦ Placental attachment is disrupted as the area
gradually thins in preparation of the onset of
labor
◦ This leads to bleeding from the venus sinuses
15. Grading of placenta previa:
Grade I – The placenta is in the lower
segment, but the lower edge does not reach
the internal os.
Grade II – The lower edge of the low-lying
placenta reaches, but does not cover the
internal os.
Grade III – The placenta covers the internal
os.
Grade IV – The placenta covers and entirely
surrounds the internal os
16. Presentation
Symptoms
◦ Painless vaginal bleeding
◦ Bleeding stops spontaneously and recurs
with labor
◦ Malpresentation (Breech, transverse lie)
Physical Exam
◦ Digital exam is contraindicated
◦ Uterus is soft and non tender
◦ Concurrent contractions with bleeding are
present
17. Placenta previa : Risk factors
Previous placenta previa.
Multiple pregnancies- due to the
placenta occupying a large surface
area.
Cigarette smoking
Increased maternal age
Uterine scar (previous caesarean
section)
Endometritis
19. Abruptio Placentae Placenta Previa
Pain Abdominal pain, low back pain Painless unless in labour
Nontender, soft (unless
Uterus Tender, irritable
contracting)
Not associated with abnormal
Presentation Breech or high presenting part
presentation
Fetal heart tracing abnormal, Fetal tracing not affected since
Fetus
atypical blood is maternal
Shock/anemia out of
Shock/anemia proportionate
Shock proportion to amount of
to blood seen
blood seen
Imaging U/S cannot rule out U/S sensitive
20. Differential Diagnosis
Abruptio Placentae Placenta Previa
Labour with bloody show Abruptio Placentae
Vasa previa Cervicitis
Vaginal trauma Premature rupture of membranes
Vaginitis Vaginitis
Preterm labour Preterm labour
22. Vasa previa:
Vasa previa is a condition when fetal
vessels traverse the fetal membranes over
the internal os.
These vessels course within the
membranes (unsupported by the umbilical
cord or placental tissue) and are at risk of
rupture when the supporting membranes
rupture.
24. Initial management
Assessing the airways:
Assessing the breathing:
Assessing the circulation
Cannula inserted for
◦ Drug adminstration
◦ Blood sampling
◦ IV fluid adminstration
25. Placenta previa
If uncomplicated pregnancy no need of
intervention
Vitamins and Iron supplements should be
taken
If minimal bleeding expected management
may be continued
If needed tocolytics may be considered to
administer antenatal steroids
Before the delivery the following should be
consulted
◦ Obstetric anesthesiologist
◦ Interventional radiologist
◦ General surgeon
◦ Urologist
26. Placenta previa
If placental edge is more than 2cm from
internal cervial os trial of labour can be
offered.
If the distance is less than 2cm cesarian
section is done although an SVD can be
done
Delivery is mostly done at 36-37 weeks
of gestation
Low transverse uterine incision is used
If the patient is at risk of invasive
placentation than informed consent
should be taken for cesarian
hysterectomy
27. Abruptio placentae
Vitamins and Iron supplements should be
taken
Initial management
Transfusion, correction of coagulopathy and
Rh immune globulin if needed
Cesarian section preferable mode of delivery
◦ Vertical incision
◦ Hysterectomy might be needed if severe blood
loss
Tocolytics may be used in case of preterm
delivery only if
◦ Hemodynamically stable
◦ No fetal distress
◦ Preterm fetus may benefit from corticosteroid
therapy
28. Types of tocolytics
Types of Tocolytics
B2 agonist
Calcium channel blockers
Oxytocin antagonist – Atosiban
NSAIDs
29. Uterine rupture-management
It is an emergency
Laprotomy is urgently done
Uterine rupture can be an antepartum
or postpartum event
30. Vasa previa
When vasa previa is diagnosed
antenatally, an elective Caesarean
section should be offered prior to the
onset of labour.
In cases of vasa previa, premature
delivery is most
likely, therefore, consideration should
be given to administration of
corticosteroids at 28 to 32 weeks
31. Antepartum hemorrhage
Massive bleeding
Call for help
Evaluate ABCs
Administer IV fluids
Consider
transfusion
Consider CS
History and Physical Examination
Fetal monitoring
Normal Bloody Severely Uterine pain ?? Inflamed cervix or
show distressed fetus mucopurulent
discharge
Routine Suspect Vasa
No pain or pain only Pain between Probable cervical
Evaluation Previa
with contractions. contractions and infection
Non tender fundus tender fundus
Culture and treat
as appropriate
Suspect Placenta
previa
Consider abruptio
placentae Consider uterine
Immediate rupture
ultrasound
examination if Monitor fetus.
available Supportive mother
care
Urgent Cesarean Cesarean delivery Cesarean if fetal Consider urgent
SVD if fetal death
delivery if in labour distress lapartomy