A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
A serious pregnancy complication in which the placenta detaches from the womb (uterus).
Placental abruption occurs when the placenta detaches from the inner wall of the womb before delivery. The condition can deprive the baby of oxygen and nutrients.
Symptoms include vaginal bleeding, stomach pain and back pain in the last 12 weeks of pregnancy.
Depending on the degree of placental separation and how close the baby is to full-term, treatment may include bed rest or a Caesarean (C-section).
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.
Obstetrics and Gynecological Nursing
The PPT contains detailed information about Abnormal uterine action, its classifications, causes, sign and symptoms and management.
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
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.
Obstetrics and Gynecological Nursing
The PPT contains detailed information about Abnormal uterine action, its classifications, causes, sign and symptoms and management.
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
This slide presents some Gynecologic diseases and disorders in females and their proper management. It is a third-year course for those wishing to major PA or Nursing.
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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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!
- 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.
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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
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
4. SpontaneousAbortion
Defined as the involuntary loss of the
products of conception prior to 24 weeks
gestation
It is thought that 15% of conceptions result in
miscarriage
Majority occur within first trimester
6. SpontaneousAbortion
Causes
Maldevelopment of the conceptus
Most common cause
Chromosomal abnormalities account for 70% of
defective conceptions
Spontaneous mutations may still arise
Defective Implantation
Hydatidiform Mole
Fibroids
7. SpontaneousAbortion
Causes
Maternal Infection
Due to high temperature relating to general
metabolic effect of fever
Result of transplacental passage of viruses, e.g.
Influenza
Rubella
Pneumonia
Toxoplasmosis
Cytomegalovirus
Listeriosis
Syphilis
Brucellosis
Appendicitis
9. SpontaneousAbortion
Causes
Endocrine Abnormalities
Poor development of the corpus luteum
Inadequate secretory endometrium
Low serum progesterone levels
UterineAbnormalities
Structural abnormalities implicated in 15% of early
pregnancy losses e.g.
Double uterus
Unicornuate, bicornuate, septate or subseptate uterus
Failure of uterus to develop to adult size,
remaining infantile
10. SpontaneousAbortion
Causes
Retroversion of the Uterus
Does not itself cause abortion
As uterus fails to enlarge into abdomen, vaginal and
abdominal manipulation to correct the retroversion
causes abortion
CervicalWeakness
Caused by laceration of cervix or undue stretching of
internal os as a result of previous medical abortion or
childbirth
Membranes bulge through cervical canal and rupture
Characterised by recurrent late pregnancy losses
11. SpontaneousAbortion
Causes
Environmental Factors
Environment teratogens such as lead and
radiation
Ingested teratogenetic substances such as drugs
(namely cocaine) and alcohol
Smoking
Maternal Age
Women in late 30’s and older at higher risk,
irrespective of previous obstetric history
12. SpontaneousAbortion
Causes
Stress and Anxiety
Severe emotional upset may disrupt hypothalmic
and pituitary functions
Paternal Factors
Poor sperm quality
Source of chromosomal abnormalities
Immunologocial Factors
Maternal lymphocytes with natural killer cell
activity may affect trophoblast development
Autoimmune diseases such as antiphospholipid
syndrome
14. SpontaneousAbortion
ThreatenedMiscarriage
Signs and Symptoms
Pain: Variable, possibly slight lower
abdominal pain or backache
Bleeding: Scant, during first 3 months
Cervical Os: Closed, no dilation
Uterus: If palpable, soft and not tender
15. SpontaneousAbortion
ThreatenedMiscarriage
No vaginal assessment as may provoke uterine
activity
No evidence that bedrest is effective
Woman should be referred for medical
attention straight away
A pregnancy test is carried out and ultrasound
performed to assess viability
Heavy or increased amount of bleeding in an
ominous sign and may precede inevitable
abortion
17. SpontaneousAbortion
InevitableMiscarriage
As name indicates, it is unavoidable pregnancy
loss
Gestational sac separates from uterine wall
and uterus contracts to expel the contents of
conception
Midwife should attend at once when called as
woman may collapse from blood loss
Speculum examination in hospital, input from
obstetrician or gynaecologist
Oxytocic drug may be given after products
expelled
19. SpontaneousAbortion
IncompleteMiscarriage
Gestational sac is incompletely expelled, with
usually the placental tissue retained
Static or slowly falling HCG levels
Evacuation of retained products of conception
from the uterus carried out
Medical management possible using
prostaglandin analogues such as misoprostol
If surgical evacuation required, woman should
be screened for chlamydial infection
Transfusion may be given if blood loss
excessive
21. SpontaneousAbortion
CompleteMiscarriage
Gestational sac completely expelled
History of abdominal pain, bleeding with
passing of clots and tissue
Once miscarriage is complete, pain and
bleeding subside, cervix closes
Ultrasound shows empty uterus coupled with
falling HCG levels
23. SpontaneousAbortion
MissedMiscarriage
Also known as delayed or silent abortion
Usually follows threatened abortion
Bleeding occurs between uterine wall and
gestational sac and embryo dies
Layers of blood clots form and later become
organised
Retainment of fetus inhibits menses
Other signs of pregnancy diminish
Confirmed by ultrasound
Surgical evacuation or expectant management
possible
25. SpontaneousAbortion
MissedMiscarriage–GestationalTrophoblasticDisease
Clinical presentation of Hydatidiform Mole
Exaggerated signs of pregnancy, appearing by 6-8
weeks due to high levels of HCG
Bleeding or a blood stained vaginal discharge after
period of amenorrhoea
Ruptured vesicles, resulting in light pink or brown
vaginal discharge, or detached vesicles, which may be
passed vaginally
Anaemia as a result of the gradual loss of blood
Early-onset pre-eclampsia
On examination, uterine size exceeding that expected
for gestation
On palpation, a uterus that feels ‘doughy’ or elastic
26. SpontaneousAbortion
MissedMiscarriage–GestationalTrophoblasticDisease
Hydatidiform Mole
Gross malformation of trophoblast
Chorionic villi proliferate and become avascular
Found in cavity of uterus and rarely within uterine
tube
Can lead to development of cancer, therefore
accurate and rapid diagnosis, treatment and follow-
up paramount
Two forms of mole
Complete hydatidiform mole (risk of choriocarcinoma)
Partial mole
27. SpontaneousAbortion
MissedMiscarriage–GestationalTrophoblasticDisease
Treatment of Hydatidiform Mole
Treatment is to remove all trophoblastic tissue
In some cases, mole will abort spontaneously
If this does not occur, vacuum aspiration or D and C
necessary
Spontaneous abortion carries less risk of malignant
change
Pregnancy to be avoided in follow up period
IUCDs contraindicated and hormonal methods of
contraception to be avoided until HCG levels normal
28. SpontaneousAbortion
MissedMiscarriage–GestationalTrophoblasticDisease
Choriocarcinoma
Malignant disease of trophoblastic tissue
HCG levels will rise and test will become strongly
positive again
May occur in next pregnancy following evacuation
of mole
Condition rapidly fatal unless treated
Disease spreads by local invasion and via
bloodstream
Metastases my occur in lungs, liver or brain
29. SpontaneousAbortion
MissedMiscarriage–GestationalTrophoblasticDisease
Treatment of Choriocarcinoma
Responds extremely well to chemotherapy
Cytotoxic drugs are used singly or in combination
with other therapy
Nearly always completely successful
Pregnancy should be avoided for at least one year
on completion of treatment
Subsequent pregnancy will require close HCG
monitoring as there is a risk of recurrance
31. SpontaneousAbortion
SepticMiscarriage
May occur after spontaneous or induced abortion,
more likely after incomplete miscarriage
Causitive organisms include Staphyloccus aureus,
Clostridium welchii, Escherichia coli, Klebsiella,
Serratia and Bacteroides species, and group B
haemolytic streptococci
Woman will feel acutely ill with fever, tachycardia,
headache, nausea and general malaise
High vaginal swab and blood cultures should be
taken
Antibiotics before any surgical intervention
Risks include septicaemia, endotoxic shock, DIC,
liver and renal damage, salpingitis and infertility
32. SpontaneousAbortion
MidwiferyAssessments
Blood loss
Amount?
Nature?
When did it start?
What were you doing
at the time?
Pain
Menstrual History
Confirm LMP
Symptoms of Pregnancy
Still present?
Have they changed?
Obstetric History
Gynaecological History
Cervical infections
Cervical operations
Contraceptive History
Blood Group and Rhesus
Status
33. SpontaneousAbortion
MidwiferyResponsibilities
Referral
Support groups
Recurrent miscarriage clinic
GP/gynaecologist-obstetrician
Advice
Expect a grief reaction
Dependent on gestation, lactation may occur
Understand it takes weeks – months to recover from a miscarriage
physically and even longer emotionally
Menstruation may return four to six weeks later
Await the next normal period before trying to conceive
Expect bleeding for up to two weeks
No intercourse, swimming, tampons for two weeks or duration of
bleeding
Support
Remember the partner too
35. ImplantationBleeding
As the trophoblast erodes the endometrial
endothelium and the blastocyst implants, a
small vaginal loss may be apparent
Occurs at approximately 10-12 days post
conception, around the same time as
expected menses and may be mistaken for a
woman’s period, although abnormal (usually
bright red and lighter)
It is significant when calculating LMP for
estimation of due date
37. Decidual Bleeding
Occasionally there is bleeding from the decidua
during the first 10 weeks, usually at around the
time menses is expected
Caused by menstrual hormones
Especially common in the early stages of
pregnancy, before the lining has completely
attached to the placenta
Not thought to be a health threat to mother
or fetus
May affect calculation of EDD
39. EctopicPregnancy
Occurs when a fertilised ovum implants itself
outside the uterine cavity
Sites can include the uterine tube, an ovary,
the cervix or the abdomen
95% implant in the uterine tube (tubal
pregnancy), of which 64% are implanted in
the ampulla of the fallopian tube (where
fertilisation takes place)
40. EctopicPregnancy
RiskFactors
Any alterations of the normal function of the uterine
tube in transporting gametes contributes to the risk of
ectopic pregnancy:
Previous ectopic pregnancy
Previous surgery on the uterine tube, pelvic or abdominal
surgery which may cause adhesions
Exposure to diethylstillboestrol in utero (postcoital
contraception)
Congenital abnormalities of the tube
Endometriosis
Previous infection including chlamydia, gonorrhoea and pelvic
inflammatory disease
Use of intrauterine contraceptive devices
Assisted reproductive technology
Delayed childbearing (>35 years)
42. EctopicPregnancy
ClinicalPresentation
Pelvic pain can be very severe
Acute symptoms are the result of tubal rupture (more
likely to occur between 5-7 weeks gestation) and relate
to the degree of haemorrhage there has been
Ultrasound enables an accurate diagnosis of tubal
pregnancy, making management more proactive
Vaginal ultrasound, combined with the use of sensitive
blood and urine tests which detect the presence of
HCG, helps to ensure diagnosis is made earlier
If the tube ruptures, shock may ensue; therefore
resuscitation, followed by laparotomy, is needed
The mother should be offered follow-up support and
information regarding subsequent pregnancies
43. EctopicPregnancy
Diagnosis
The woman will give a history of early pregnancy signs
The uterus will have enlarged and feel soft
Abdominal pain may occur as the tube distends and
uterine bleeding may be present
Abdomen may be tender and distended
Shoulder tip pain due to referred pain
Woman may appear pale, complain of nausea and
collapse
Severe pain felt during pelvic exam
A mass may be felt on one side of the uterus
Hormonal assay will find progesterone levels low and
hCG levels falling
USS may show fluid or and mass in pelvic cavity and
absence of intrauterine pregnancy
45. EctopicPregnancy
Treatment
Common perception is that everyone with an
ectopic needs an operation to deal with it
However, a number of treatment options are
available including expectant management if
no bleeding, pain or shock
If there is evidence of pain and bleeding
producing shock, immediate treatment is
essential, as it is a life-threatening condition
This is a surgical emergency and in most
cases a laparotomy is performed
46. EctopicPregnancy
SurgicalTreatment
Salpingectomy
Salpingectomy (tubal removal) is the principle
treatment especially where there is tubal rupture
Salpingotomy
Conservative surgical management may be
employed when the ectopic has not ruptured and
where the tube appears normal
This is called salpingotomy, where the ectopic is
removed and the tube allowed to heal
47. EctopicPregnancy
ExpectantTreatment
Used when pain is less and indicators are that the
ectopic is a small one or it is not bleeding too much
Expectant approach involves close follow up with hCG
tests every 2-7 days until levels have returned to
normal
Is successful in 90% of selected patients
Methotrexate – a drug that destroys actively growing
tissues such as the placental tissues that support the
pregnancy is used as an injection in selected cases to
avoid surgery (in non ruptured ectopic)
Side effects include abdominal pain for 3 – 7 days in
50% of cases and mild symptoms of nausea, mouth
dryness and soreness and diarrhoea
49. AntepartumHaemorrhage
Defined as bleeding from the genital tract
after the 24th week of gestation and before
the onset of labour
Bleeding during labour is referred to as
Intrapartum Haemorrhage
Bleeding usually due to placental separation,
but can also be due to incidental causes from
extraplacental sites in the birth canal, such as
cervical polyps or some other local lesion
50. AntepartumHaemorrhage
EffectsontheFetus
Mortality and Morbidity increased as a result
of severe vaginal bleeding in pregnancy
Stillbirth or neonatal death may occur
Premature separation of the placenta and
subsequent hypoxia may result in severe
neurological damage in the baby
51. AntepartumHaemorrhage
EffectsontheMother
If bleeding is severe, it may be accompanied by
shock and disseminated intravascular
coagulation (DIC)
The mother may die or be left with permanent
ill health
APH is unpredictable and the woman’s
condition can deteriorate rapidly at any time
Rapid decisions about the urgency of need for
medical or paramedic presence, or both, must
be made often at the same time as observing
and talking to the woman and her partner
53. AntepartumHaemorrhage
InitialAssessmentofPhysicalCondition
Take a detailed history from the woman
Take observations: Temperature, Pulse,
Respiratory Rate, Blood Pressure
Observe for any pallor or breathlessness
Assess the amount of blood loss
Perform a gentle abdominal examination,
observing signs that the woman is going into
labour
54. AntepartumHaemorrhage
InitialAssessmentofPhysicalCondition
Ask the mother is the baby has been moving as
much as normal
Attempt to auscaltate the fetal heart
Insert large bore canula, take bloods for FBC,
Cross match, LFTs, Clotting times, Kleihaur if
necessary
Obstetric referral
Anti-D administration if applicable
Steroids if <34 weeks gestation
56. DifferentialDiagnosis
Pain
Did the pain precede bleeding and is it continuous or
intermittent?
Onset of bleeding
Was this associate with any event such as coitus?
Amount of blood loss visible
Is there any reason to suspect that some blood has been
retained in utero?
Colour of the blood
Is it bright red or darker in colour?
Degree of shock
Is this commensurate with the amount of blood visible or
more severe?
57. DifferentialDiagnosis
Consistency of the abdomen
Is it soft or tense and board-like?
Tenderness of the abdomen
Does the mother resent abdominal palpation?
Lie, presentation and engagement
Are any of these abnormal when account is taken of parity and
gestation?
Audibility of the fetal heart
Is the fetal heart heard?
Ultrasound scan
Does a scan suggest that the placenta is in the lower uterine
segment?
58. AntenatalHaemorrhage
SupportiveTreatment
Provide woman and partner with emotional
reassurance
Give rapid fluid replacement (warmed) with a
plasma expander, and later with whole blood if
necessary
Give analgesia
If at home, arrange transfer to hospital
Subsequent management depends on the
definite diagnosis
61. PlacentalAbruption
Premature separation of a normally situated
placenta, occurring after the 24th week of
pregnancy
Aetiology is not always clear, some predisposing
factors are:
Pregnancy-induced hypertension or pre-eclampsia
A sudden reduction in uterine size, e.g. SRM with
polyhydramnios or after the birth of a first twin
Short umbilical cord
Direct trauma to the abdomen (risk remains for 2 days
following trauma)
High parity
Previous caesarean section
Cigarette smoking or illicit drug use (esp. Cocaine)
62. PlacentalAbruption
Blood loss may be:
Revealed
Concealed
Mixed
Separation may be:
Mild
Moderate
Severe
Complications of Placental Abruption:
Disseminated Intravascular Coagulation
Postpartum Haemorrhage
Renal Failure
Pituitary Necrosis
63. PlacentalAbruption
MildSeparationofthePlacenta
Separation and the haemorrhage are minimal
Mother and fetus are in a stable condition
No indication of maternal shock
Fetus is alive, with normal heart sounds
Consistency of uterus is normal
No tenderness on abdominal palpation
64. PlacentalAbruption
ManagementofMildSeparationofthePlacenta
Ultrasound scan
Determine placental location
Identify any degree of concealed bleeding
Monitoring of fetal heart rate
Frequently to assess fetal condition whilst bleeding
persists
CTG should be carried out once or twice daily
Admission to hospital
Women who are not yet 37 weeks gestation may be
cared for in an antenatal ward for a few days
May be discharged if there is no further bleeding and
placenta has been found to be in the upper uterine
segment
65. PlacentalAbruption
ManagementofMildSeparationofthePlacenta
Induction of Labour
May be offered for woman who have passed the 37th
week of pregnancy
Especially if there has been more than one episode of
mild bleeding
Further management
Heavy bleeding or evidence of fetal distress may
indicate that a caesarean section is necessary
66. PlacentalAbruption
ModerateSeparationofthePlacenta
Separation of about one-quarter
Considerable amount of blood may be lost, some
of which will escape from the vagina and some
will be retained as a retroplacental clot or an
extravasation into the uterine muscle
Mother will be shocked, with tachycardia and
hypotension
Degree of uterine tenderness with abdominal
guarding
Fetus may be alive, although hypoxic and
intrauterine death is also a possibility
68. PlacentalAbruption
ManagementofModerateSeparationofthePlacenta
If fetus is alive or has already died, vaginal birth
may be contemplated
Such a birth is advantageous because it enables
the uterus to contract and control the bleeding
Spontaneous labour frequently accompanies
moderately severe abruption, but if it does not,
then amniotomy is usually sufficient to induce
labour
Syntocinon may be used with great care, if
necessary
Delivery is often quite sudden, after a short labour
Drugs to attempt to cease labour is usually
inappropriate
69. PlacentalAbruption
SevereSeparationofthePlacenta
Acute obstetric emergency
Two-thirds of the placenta has become
detached
2000 mls of blood or more are lost from the
maternal circulation
Most or all of the blood can be concealed
behind the placenta
Woman will be severely shocked, perhaps to a
degree far beyond what might be expected
from the amount of blood loss visible
70. PlacentalAbruption
SevereSeparationofthePlacenta
Woman will have severe abdominal pain with
excruciating tenderness; the uterus has a
board like consistency
Hypotensive, however woman may be
normotensive owing to preceding
hypertension
The fetus will almost certainly be dead
Features associated with severe haemorrhage:
Coagulation defects (e.g. DIC)
Renal failure
Pituitary failure
71. PlacentalAbruption
ManagementofSevereSeparationofthePlacenta
Treatment is same as for moderate separation
Whole bloods transfused rapidly and subsequent amounts
calculated in accordance with the woman’s central venous
pressure
Labour may begin spontaneously in advance of amniotomy
and the midwife should be alert for signs of uterine
contraction causing periodic intensifying of abdominal pain
However, if bleeding continues of a compromised fetal heart
rate is present, caesarean section may be required as soon as
the woman is adequately stable
The woman requires constant explanation and psychological
support, despite the fact that her shocked condition may
mean she is not fully conscious
Pain relief must be considered
Don’t forget the partner!
73. PlacentaPraevia
Placenta partially or wholly implanted in the
lower uterine segment on either the anterior
or posterior wall
Lower segment of uterus grows and stretches
progressively after the 12th week of
pregnancy
In later weeks, this may cause the placenta to
separate and severe bleeding can occur
74. PlacentaPraevia
DegreeofPlacentaPraevia
Type 1 Placenta Praevia
Majority of placenta is in the upper uterine segment
Blood loss is usually mild
Mother and fetus remain in good condition
Vaginal birth is possible
Type 2 Placenta Praevia
Placenta is partially located in the lower segment near
the internal cervical os
Blood loss is usually moderate
Condition of mother and fetus can vary
Vaginal birth is possible, particularly if placenta is
anterior
75. PlacentaPraevia
DegreeofPlacentaPraevia
Type 3 Placenta Praevia
Placenta is located over the internal cervical os but not
centrally
Bleeding is likely to be severe
Vaginal birth is inappropriate
Type 4 Placenta Praevia
The placenta is located centrally over the internal
cervical os
Torrential haemorrhage is very likely
Caesarean section is essential
76. Indicationsof PlacentaPraevia
Bleeding from vagina is the only sign, and it is
painless
Uterus is not tender or tense
Presence of placenta preavia should be
considered when:
Fetal head is not engaged in a primigravida (after 36
weeks gestation)
There is a malpresentation, especially breech
The lie is oblique or transverse
The lie is unstable, usually in a multigravida
Location of the placenta under USS will confirm
the existence and extent of placenta praevia
77. Managementof PlacentaPraevia
Management of placenta praevia depends
on:
The amount of bleeding
The condition of mother and fetus
The location of the placenta
The stage of pregnancy