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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
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean section.
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
Cephalopelvic disproportion (CPD) is a pregnancy complication that may interferes with vaginal delivery; making it dangerous or impossible and requires caeserean 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.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
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.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
BREECH PRESENTATION obstetrics and gynacology mbbs final yearsarath267362
BREECH PRESENTATION obstetrics and gynacology mbbs final year
presentation , pregnancy
final year mbbs
normal labor
breech labor complications
management
BREECH
tdmc kerala
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Obstetric analgesia and anesthesia 2021OBGYN Notes
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This is a clinically oriented maternal anatomy, prepared by Dr Gebresilassie Andualem
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This Note is Prepared by A OBGYN resident @ SPHMMC, Addis Ababa, Ethiopia (March 2019)
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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
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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
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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!
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
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.
2. Contents
• Definition
– CPD is failure of the fetus to pass safely through the birth canal because the fetal head being relatively larger
than the maternal pelvic size
– A disproportion in the size of the fetus relative to the maternal pelvis can result in failure to progress in the
second stage
• Common Causes
– fetal malposition
• extended or asynclitic fetal head, occiput posterior or transverse position
– Malpresentation
• mentum posterior, brow
• a true disparity between fetal size and maternal pelvic dimensions is rare
• However, true CPD may occur if
– fetus has a large surface anomaly (eg, teratoma, conjoined twin),
– maternal pelvic bone is very small or deformed (eg, after pelvic trauma), or
– fetus is extremely large (although vaginal deliveries have been described in infants weighing 13 to 17 pounds
and more).
2
3. Diagnosis of CPD
• CPD is a subjective clinical assessment based on
– physical examination and
– course of labor (Trial of labor is best diagnostic tool)
• Antepartum, the clinician's ability to predict maternal pelvis-fetal size
discordance leading to arrest of labor requiring cesarean delivery has been
disappointing
– Clinical and radiologic assessments of the maternal pelvis and fetal size (ie, pelvimetry)
are inexact and poorly predict the course and outcome of labor
– Radiographic pelvimetry is not recommended
– Ultrasound evaluation of fetal position is accurate, but common malpositions such as
occiput posterior (OP) usually rotate intrapartum
• Suggestive findings - Intrapartum
– abnormal progress of labor
– physical findings: Progressive Caput & Molding
– protracted or arrested descent with increased molding, especially overlap of the parietal
bones at the sagittal suture, is suggestive of CPD
3
4. Clinical Pelvimetry (👉👈)
4
• Hip bone (os coxae)
– Sacrum, Ilium, Ischium
• Sacrum
– 5 fused bones
– Sacral promontory
• Coccyx
• Hip bones – 3 main articulations
– Sacroiliac joint
– Pubic symphysis
– Hip joint
7. Planes and Diameters of the Pelvis
• Pelvis - divided into
– False (lesser) pelvis: lies
above the linea
terminalis
• bounded posteriorly by
lumbar vertebra;
laterally by iliac fossa;
• Anteriorly by the lower
portion of the anterior
abdominal wall
– True: lies below the
linea terminalis
7
8. Pelvic Joints
• Anteriorly - symphysis pubis
• limited degree of mobility
• During pregnancy, these joints relax remarkably at
term
– upward gliding of sacroiliac joint
• greatest in the dorsal lithotomy position
• may increase the diameter of the outlet by 1.5 - 2.0 cm for
delivery
– Sacroiliac joint mobility
• aids McRoberts maneuver to release an obstructed shoulder in
cases of shoulder dystocia
– These changes may also contribute to the success of the
modified squatting position to hasten SSOL
• squatting position may ↑ interspinous diameter & pelvic outlet
diameter
8
10. Estimation of Pelvic Capacity
• Clinically
– Inlet: Diagonal conjugate, prominence of sacral promontory
– Mid pelvis: Interspinous diameter
– Outlet:
• Subpubic angle (< 900 can signify a narrow pelvis)
• Intertuberous distances
• X-Ray Pelvimetry
• Computed Tomographic (CT) Scanning
• Magnetic Resonance (MR) Imaging
• In current obstetric practice
– Radiographic CT and MRI pelvimetry are rarely used
• lack of evidence of benefit
• some data that show possible harm
– Clinical pelvimetry
• the only method of assessing the shape and dimensions of the bony pelvis in labor
10
11. • Pelvis is described as having four imaginary
planes
• greatest distance = transverse diameter = 13 cm
• clinically important: obstetrical conjugate
– shortest distance between the sacral promontory
and the symphysis pubis
– ≥ 10 cm, but unfortunately, it cannot be measured
directly
– So OC = DC – (1.5 to 2 cm)
Contracted Inlet
• Before labor, fetal BPD averages from 9.5 - 9.8
cm
• incidence of difficult deliveries rises when
– AP diameter of the inlet is <10 cm or
– transverse diameter is <12 cm
• inlet contraction usually is defined as a
diagonal conjugate <11.5 cm
11
12. • measured at the level of the ischial spines
• smallest pelvic diameter = Interspinous diameter ≥ 10
cm
Contracted Midpelvis
• more common than inlet contraction
• Average midpelvis measurements
– Interischial spinous:10.5 cm
– AP (from lower border of symphysis pubis to the
junction of S4–5) = 11.5 cm
• No established definition of midpelvic contraction
– suspected whenever the interspinous diameter is
<10 cm
– When it measures < 8 cm, the midpelvis is
contracted
• Other suggestive features
– Prominent ischial spines
– pelvic sidewalls converge, or the sacrosciatic notch is
narrow
– narrowing of intertuberous diameter is a clue for
narrowing of the interspinous diameter
– A normal intertuberous diameter, however, does not
always exclude a narrow interspinous diameter
12
13. • two approximately triangular areas
• Subpubic angle = ≥ 90 to 100 degrees
• Unless there is significant pelvic bony
disease, the pelvic outlet seldom obstructs
vaginal delivery
Contracted Outlet (Rare ~ 1%)
• usually is defined as an interischial tuberous
diameter of ≤ 8 cm
• Outlet contraction without concomitant
midplane contraction is rare.
• Although the disproportion between the fetal
head and the pelvic outlet is not sufficiently
great to give rise to severe dystocia, it may play
an important part in perineal tears
• of no obstetrical significance
13
• Any contraction of the pelvic diameters that diminishes
pelvic capacity can create dystocia during labor
14. Grossly contracted pelvic if
o True conjugate is < 10 cm
o bituberous diameter of < 8 cm
• Other suggestive pelvic findings
– prominent ischial spine
– diverging pelvic walls
– flat sacrum
– narrow sacrosciatic notch
14
Critical limit values are measurements
15. Pelvic Shapes
• Caldwell–Moloy (1933, 1934) anatomical
classification of the pelvis is based on shape
1. Gynecoid = found in 50% of females
– classic female shape
2. Anthropoid
– exaggerated oval shape of the inlet, largest AP
diameter, and limited anterior capacity
– more often associated with delivery in OP
position
3. Android = male
– increased risk of CPD
4. Platypelloid
– theoretically predisposes to a transverse arrest
Q: A pelvis characterized by an anteroposterior
diameter of the inlet greater than the transverse
diameter is classified as
a. Gynecoid b.Android
c.Anthropoid d. Platypelloid
15
17. Clinical classification
1. Absolute CPD
– true mechanical obstruction as a result of
– Permanent (maternal factors): contracted pelvis
(commonest), pelvic exostoses, spondylolisthesis,
anterior sacrococcygeal tumors or
– Temporary (fetal factors): Hydrocephalus, Large
infant
2. Relative CPD
– where the fetus may be delivered vaginally if a
favorable combination of other factors can be
achieved
– Example: brow presentation, face presentation and
occipito-posterior positions (rotation / flexion of
the head may occur during labor progress)
1. Suspect CPD
– Previous prolonged labor with bad obstetric
history or operative delivery
– Primigravida especially if age is less than 16 years
– True conjugate of 8 – 10 cm (borderline CPD)
– Prominent ischial spines, flat sacrum etc
– The cervicogram crossing the alert line without
signs of CPD (see section on abnormal labor)
2. Gross CPD
– Estimated fetal weight of 4 or more kg (in an
average sized Ethiopian)
– Hydrocephalus
– Gross traumatic or congenital pelvic abnormality
– True (obstetric) conjugate and/ or bituberous
diameter of less than 8 cm
17
18. Diagnostic approach and risk assessment
• Diagnosis of CPD in the absence of gross CPD is confirmed
after trial of labor:
– Severe molding at a higher station (3/5th or more above the pelvic
prim);
– Increasing molding with no progress in descent
– Secondary arrest of cervical dilation and descent with good
contraction;
– In the primigravida, failure of progress of labor after augmentation
18
19. Antepartum evaluation
• Clinical pelvimetry
• EFW (Sonography)
Intrapartum evaluation
• CPD, with very few exceptions, is diagnosed after a properly conducted trial of labor
• Abdominal and pelvic assessment should be done in all laboring mothers to rule out CPD
• Findings that may indicate CPD are
– Abnormal progress of labor
– Abnormal clinical pelvimetry
– Molding
– Caput Succedaneum – due to prolonged labor and CPD
• Severe degree of caput is diagnosed when the scalp oedema hampers identification and assessment of the
suture lines
– Abnormal degree of head flexion (deflexion)
– Fetal distress
– Asynclitism
– Fetal Macrosomia
19
20. Trial of labor
• conducted in a woman with suspected CPD to determine whether it is
safe for the woman to deliver vaginally or not
• in an equipped and staffed hospital for operative procedures in case vaginal
delivery fails.
• CPD is suspected if
– previous history of prolonged labor with bad obstetric history or operative
delivery
– parturient is teenage
– borderline pelvis: obstetric conjugate is 8 to 10 cm
– cervicogram is crossing the alert line without signs of CPD.
• The trial continues as long as labor progresses well and as long as there is
reassuring fetal and maternal status.
20
21. Modified Mueller-Hillis Maneuver
• performed in the late active phase of the first stage of labor
• For predicting abnormalities in second stage labor
• positive modified Mueller-Hillis maneuver in second stage labor
– Definition: descent of the fetal head of > 1cm with fundal pressure
– had a high predictive value for vaginal delivery
• Negative maneuver
– was significantly associated with high operative delivery rate, prolonged second
stage labor and abnormal position
21
22. Fetal pelvic index (FPI) to predict CPD
• Calculated based on on the basis of four circumference differences between the fetus and
the maternal pelvis by subtracting the maternal pelvic inlet and midpelvic circumferences
(IC and MC, respectively) from the fetal HC and AC
– (HC–IC, HC–MC,AC–IC,AC–MC)
• An index value was derived by adding the two most positive circumference differences
• FPI = (HC–IC) + (HC–MC) + (AC–IC) + (AC–MC)
• IC: pelvic inlet circumference
• MC: midpelvic circumference
– Positive FPI (cut-off zero): fetuses larger than the maternal pelvis
– Negative FPI: fetuses smaller than the maternal pelvis
• not a clinically useful tool to predict the mode of delivery for patients at high risk of
cephalopelvic disproportion
• The pooled analysis of the current and previous studies strengthened this conclusion
22
23. Route of delivery
• CS
– Gross CPD during labor
– In permanent absolute disparities
• severe pelvic contracture (OC of 6 - 8 cm) or
• extreme pelvic contracture (OC < 6 cm)
– Macrosomia
• > 4.5 kg (IDM) or > 5 kg for non diabetic infant
• Avoid Induction and augmentation in fetal macrosomia
• Fetal hydrocephalus may be managed by Cephalocentesis
• Craniotomy is indicated if the fetus is dead and prerequisites for
destructive delivery are fulfilled.
23
24. Treatment plan
• CS for gross CPD with normal fetus
– Hydrocephalus is managed by craniocentesis
– If gross CPD with normal fetus is diagnosed, elective CS is appropriate
• Suspected CPD:
– Plan place of delivery at a hospital (where CS service is available) or health
center with timely referral service to a hospital.
– Conduct trial of labor using Partogram
– Emergency CS is done when CPD is diagnosed after trial of labor
• Obstructed labor or ruptured uterus
24
25. Complications
• Maternal
– Prolonged / obstructed labor: If CPD is not
diagnosed & properly managed the end
result is obstructed labor and its
associated complications.
– PPH
– Maternal sepsis
• Fetal / neonatal
– Fetal distress
– Perinatal asphyxia
– Neonatal infections
– Perinatal death
Discharge counselling & education
• A woman who delivered by CS should
be explained about the indication
(CPD) and the need for repeat CS in
future pregnancy
• Besides verbal explanation, a written
note should be given that could also
serve as referral feedback to referring
health centers
• Previous CS for CPD can be followed
at a nearby health center and referred
after 36 - 37 weeks of gestation
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26. Common Q & As
Bones forming pelvis: Innominate, Sacrum, Coccyx
Clinical evaluation of the pelvic inlet: Diagonal conjugate
Shortest anteroposterior diameter of the pelvic inlet: Obstetrical
conjugate
regarding relaxation of the pelvic joints at term in pregnancy
– Displacement of the SI joint increases outlet diameters by 1.5 to 2.0
cm in the dorsal lithotomy position.
Midpelvis - is measured at the level of the ischial spines
the narrowest pelvic dimension that must be navigated by the fetal head:
Interspinous diameter
The pubococcygeus muscle is now preferably called which of the following?
– Pubovisceral muscle
The posterior triangle of the pelvic outlet is limited at its apex by which of
the following?
– A. Coccyx B. Last sacral vertebrae C. S4 D. S3
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