Antepartum hemorrhage refers to bleeding from the vagina between 24 weeks of gestation until birth. It can be caused by placenta previa, abruptio placentae, vasa previa, or non-placental causes like infection. Initial management focuses on stabilizing the mother and fetus. For placenta previa, delivery is usually by c-section after 36 weeks to avoid hemorrhage. Abruptio placentae requires delivery, often by c-section, along with transfusions and treating coagulopathy. Vasa previa mandates a c-section before labor due to risk of fetal exsanguination.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Adherent placenta occurs when there is a defect in the decidua basalis, Resulting in an abnormal invasion of the placenta directly into the substance of the uterus
Uterine rupture - All you need to know.Sandeep Das
This presentation gives the detailed information about uterine rupture - definition, epidemiology, classification, signs and symptoms, prevention and management.
Uterine rupture - All you need to know.Sandeep Das
This presentation gives the detailed information about uterine rupture - definition, epidemiology, classification, signs and symptoms, prevention and management.
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
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
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
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
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
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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.
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!
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