This document summarizes a medical case involving a 38-year-old pregnant woman. She has a history of chronic cholecystitis and has been diagnosed with intrahepatic cholestasis of pregnancy and a urinary tract infection. Her lab work shows elevated liver enzymes and bilirubin levels. An ultrasound shows the fetus is in a cephalic longitudinal position and estimated to be 34 weeks. The patient's condition involves high risk factors for complications during pregnancy and delivery such as preterm birth, fetal death, and preeclampsia. Treatment involves ursodeoxycholic acid and delivery between 36-39 weeks.
This case report describes the diagnosis and management of a fetus with a left-sided diaphragmatic hernia detected on ultrasound at 23 weeks gestation. Diaphragmatic hernias occur when abdominal organs protrude into the chest cavity through a defect in the diaphragm. The fetus was monitored closely with serial ultrasounds and delivered via cesarean section at 36 weeks for pre-eclampsia. The newborn was referred to the neonatal intensive care unit for surgery and management of pulmonary issues associated with the condition.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
This document summarizes recent advances in the diagnosis and treatment of ectopic pregnancy. It begins by describing ectopic pregnancy as occurring when the gestational sac is outside the uterus, which can be life-threatening. It then discusses the following key points:
- Diagnosis is challenging but important given the condition's prevalence among pregnant patients presenting with bleeding or pain.
- Ultrasound is now the initial investigation, while serum human chorionic gonadotropin and progesterone levels can help when ultrasound results are unclear.
- Advances have allowed less invasive surgical and medical treatments like laparoscopy and methotrexate to become more common options.
- The review aims to summarize the current literature on impacts of
Massive ascites as a presentation in a young womanTariq Mohammed
A 26-year-old woman presented with massive ascites and an increased CA-125 level suggestive of ovarian cancer. Laparotomy revealed 5L of hemorrhagic ascites, bilateral ovarian cysts, and areas of reddish color within the pelvis consistent with endometriosis. Histopathology of biopsy specimens confirmed endometriosis. The patient received GnRH analogue treatment for 6 months, experienced a reduction in ascites, and had full remission after 2 years. This case report highlights that endometriosis should be considered as a potential cause of ascites in reproductive-aged women, as it can mimic ovarian cancer.
A 27-year-old woman presented with severe abdominal pain and was found to have a heterotopic pregnancy, with an intrauterine twin gestation and a ruptured right tubal ectopic pregnancy. She underwent laparoscopic salpingectomy for the ectopic pregnancy. Heterotopic pregnancies occur when a simultaneous intrauterine and extrauterine pregnancy occur, with the latter usually being ectopic. Risk factors include assisted reproductive techniques and pelvic inflammatory disease. The presence of an intrauterine pregnancy does not rule out a coexisting ectopic pregnancy. The patient's intrauterine twins were successfully delivered via c-section at 35 weeks.
This document presents 4 multiple choice questions related to ectopic pregnancy. It begins by describing a case of a woman presenting with abdominal pain and irregular menstrual bleeding, asking what the most appropriate diagnostic test would be. It then presents a case of a woman at 7 weeks pregnant with an ultrasound finding of a mass near the ovary but no intrauterine pregnancy, asking for the most likely diagnosis. The third question asks about the most appropriate treatment for a hemodynamically stable patient with an unruptured ectopic pregnancy. The fourth question asks about the most common etiologic factor for ectopic pregnancy. The document provides answers and explanations for each question.
Liver diseases in pregnancy (Dr. Amenda Ann Davis)Amenda Ann Davis
This document provides an outline and overview of liver diseases in pregnancy. It begins by discussing normal liver changes during pregnancy, such as increases in plasma volume and coagulation factors. It then covers approaches to evaluating liver disease in pregnancy and classifying diseases by trimester and etiology. Specific conditions discussed in detail include intrahepatic cholestasis of pregnancy (ICP), including risk factors, pathophysiology, diagnosis, complications, and treatment with ursodeoxycholic acid. Other conditions mentioned more briefly include hyperemesis gravidarum, HELLP syndrome, acute fatty liver of pregnancy, and viral or autoimmune hepatitis.
This case report describes the diagnosis and management of a fetus with a left-sided diaphragmatic hernia detected on ultrasound at 23 weeks gestation. Diaphragmatic hernias occur when abdominal organs protrude into the chest cavity through a defect in the diaphragm. The fetus was monitored closely with serial ultrasounds and delivered via cesarean section at 36 weeks for pre-eclampsia. The newborn was referred to the neonatal intensive care unit for surgery and management of pulmonary issues associated with the condition.
A 32-year-old woman, G3P2L2, presented with 9 months of amenorrhea and abdominal pain for 2 hours. She had a history of two previous cesarean sections. On examination, the uterus was enlarged corresponding to 32 weeks with a single fetus in cephalic presentation. An emergency cesarean section was performed under spinal anesthesia due to scar tenderness, delivering a healthy male baby. The postoperative period was uneventful.
Drs. Lena, Avery, and Davis’s CMC Abdominal Imaging Mastery Project: August C...Sean M. Fox
Dr. Kelsey Lena is an Emergency Medicine Resident and Drs. Michael Avery and Joshua Davis are Surgery Residents at Carolinas Medical Center in Charlotte, NC. They are interested in medical education. With the guidance of Drs. Kyle Cunningham and Michael Gibbs, they aim to help augment our understanding of emergent abdominal imaging. Follow along with the EMGuideWire.com team as they post these monthly educational, self-guided radiology slides. This month’s topics include:
• Splenic Rupture
• Obstructive jaundice
• Ovarian Torsion
This document summarizes recent advances in the diagnosis and treatment of ectopic pregnancy. It begins by describing ectopic pregnancy as occurring when the gestational sac is outside the uterus, which can be life-threatening. It then discusses the following key points:
- Diagnosis is challenging but important given the condition's prevalence among pregnant patients presenting with bleeding or pain.
- Ultrasound is now the initial investigation, while serum human chorionic gonadotropin and progesterone levels can help when ultrasound results are unclear.
- Advances have allowed less invasive surgical and medical treatments like laparoscopy and methotrexate to become more common options.
- The review aims to summarize the current literature on impacts of
Massive ascites as a presentation in a young womanTariq Mohammed
A 26-year-old woman presented with massive ascites and an increased CA-125 level suggestive of ovarian cancer. Laparotomy revealed 5L of hemorrhagic ascites, bilateral ovarian cysts, and areas of reddish color within the pelvis consistent with endometriosis. Histopathology of biopsy specimens confirmed endometriosis. The patient received GnRH analogue treatment for 6 months, experienced a reduction in ascites, and had full remission after 2 years. This case report highlights that endometriosis should be considered as a potential cause of ascites in reproductive-aged women, as it can mimic ovarian cancer.
A 27-year-old woman presented with severe abdominal pain and was found to have a heterotopic pregnancy, with an intrauterine twin gestation and a ruptured right tubal ectopic pregnancy. She underwent laparoscopic salpingectomy for the ectopic pregnancy. Heterotopic pregnancies occur when a simultaneous intrauterine and extrauterine pregnancy occur, with the latter usually being ectopic. Risk factors include assisted reproductive techniques and pelvic inflammatory disease. The presence of an intrauterine pregnancy does not rule out a coexisting ectopic pregnancy. The patient's intrauterine twins were successfully delivered via c-section at 35 weeks.
This document presents 4 multiple choice questions related to ectopic pregnancy. It begins by describing a case of a woman presenting with abdominal pain and irregular menstrual bleeding, asking what the most appropriate diagnostic test would be. It then presents a case of a woman at 7 weeks pregnant with an ultrasound finding of a mass near the ovary but no intrauterine pregnancy, asking for the most likely diagnosis. The third question asks about the most appropriate treatment for a hemodynamically stable patient with an unruptured ectopic pregnancy. The fourth question asks about the most common etiologic factor for ectopic pregnancy. The document provides answers and explanations for each question.
Liver diseases in pregnancy (Dr. Amenda Ann Davis)Amenda Ann Davis
This document provides an outline and overview of liver diseases in pregnancy. It begins by discussing normal liver changes during pregnancy, such as increases in plasma volume and coagulation factors. It then covers approaches to evaluating liver disease in pregnancy and classifying diseases by trimester and etiology. Specific conditions discussed in detail include intrahepatic cholestasis of pregnancy (ICP), including risk factors, pathophysiology, diagnosis, complications, and treatment with ursodeoxycholic acid. Other conditions mentioned more briefly include hyperemesis gravidarum, HELLP syndrome, acute fatty liver of pregnancy, and viral or autoimmune hepatitis.
Focused approach to antenatal care - First trimester screeningBharti Gahtori
This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
Mternal death review lecture by dr. evelina r. castro 102413Jesart De Vera
The document provides information on maternal death reviews and prenatal care. It discusses how to determine true labor contractions from false contractions. It outlines the schedule of prenatal visits and assessments that should be done at each visit, including medical history, physical exams, lab tests, fetal monitoring, and growth assessments. The summary also reviews guidelines for screening and testing for conditions like gestational diabetes, anemia, STDs, and Group B Strep during each trimester of pregnancy.
Association between the congenital abdominal wall defects
(CAWD) with early maternal age in the years 2001-2017 and
the temporal tendency of the prevalence in the years 2011-
2017 in the cities of Bogotá and Cali.
Omphalocele and gastroschisis are the most common CAWD: in the United States the prevalence is 1.86 and 4.49 per 10,000
live births respectively.
Between 1999 and 2007, the prevalence of omphalocele increased by 11%, whereas the prevalence of gastroschisis increased by 83%.
The document discusses antenatal assessment, which involves the systematic supervision of a pregnant woman. It involves determining risk factors through a comprehensive history and physical exam. Regular checkups are recommended, starting with monthly visits until week 28, then twice monthly until week 36, and weekly during the last 4 weeks. The assessments monitor maternal and fetal health and wellbeing through tests, exams, ultrasounds and more. The goal is to promote a healthy pregnancy and delivery.
This patient presented with retained placenta after a vaginal delivery. Her ultrasound and MRI showed placenta increta, where placental villi had invaded into the myometrium. She was initially managed conservatively with methotrexate injection, which led to a partial reduction in her beta-hCG levels. However, she later developed heavy bleeding and required an emergency hysterectomy. Placenta accreta spectrum (PAS) describes abnormal placental invasion that can cause life-threatening bleeding. Risk factors include prior uterine surgery. Management challenges include delayed referrals, lack of blood product availability, and counseling patients on prolonged hospitalization sometimes required.
This document outlines the management of early pregnancy loss by Dr. Mohammed Lukman Abolaji. It begins with definitions of key terms like miscarriage, threatened abortion, and blighted ovum. It then discusses the epidemiology, risk factors, and potential causes of early pregnancy loss. The document covers approaches to diagnosis using ultrasound and HCG levels. It outlines treatment options for early pregnancy loss including expectant, medical, and surgical management. Post-abortion care and potential complications are also summarized. The role of family physicians in caring for patients experiencing early pregnancy loss is emphasized.
A case of an ovarian tumour pre-operatively thought to be malignant, which was per-operatively diagnosed as benign and later confirmed as a mucinous cystadenoma.
Ob-Gyn Department, BIRDEM-2 General Hospital, Shegunbagicha, Dhaka, Bangladesh
Gestational trophoblastic disease is a spectrum of interrelated disease processes originating from the placenta.
GTD is a spectrum of tumours with a wide range of biologic behaviour and potential for metastases
They are characterised by an abnormally high amount of HcG levels in the blood
Hepatitis C and pregnancy can affect both mother and fetus. While pregnancy does not typically affect the course of HCV infection, HCV can increase maternal risks like gestational diabetes and postpartum hemorrhage. It may also increase fetal risks such as preterm delivery and low birthweight. Management includes screening all pregnant women for HCV, treating the mother if needed to reduce viral load and risk of transmission, and monitoring the fetus for complications. Delivery by cesarean is not routinely recommended, and breastfeeding is considered safe if nipples are intact.
This document summarizes key information about ovarian cancer, including epidemiology, risk factors, screening, staging, treatment with surgery and chemotherapy. It notes that ovarian cancer incidence is stable worldwide, with most women diagnosed at advanced stage. Screening with CA125 and ultrasound has not proven mortality benefit. Surgical staging and optimal debulking improves outcomes, while platinum-based chemotherapy is standard first-line treatment and improves survival. Ongoing research focuses on maintenance therapies and intraperitoneal chemotherapy administration.
This document summarizes key information about ovarian cancer, including epidemiology, risk factors, screening, staging, treatment with surgery and chemotherapy. It notes that ovarian cancer incidence is stable worldwide, with most women diagnosed at advanced stage. Screening with CA125 and ultrasound has not proven mortality benefit. Surgical staging and optimal debulking improves outcomes, while platinum-based chemotherapy is standard first-line treatment and improves survival. Ongoing research evaluates incorporating targeted therapies and intraperitoneal chemotherapy administration.
This document discusses issues in liver health and disease for non-hepatologists. It provides an overview of the changing epidemiology of viral hepatitis and new hepatitis B vaccines. It also addresses non-alcoholic fatty liver disease (NAFLD) and how increased recognition of this condition has led to new screening and potential therapy approaches. The document uses audience response questions to highlight clinical cases involving liver disease in HIV patients and discusses topics like viral hepatitis coinfections, hepatitis B vaccine strengths and limitations, and the natural history and risk factors associated with NAFLD.
This document discusses gestational diabetes, maternal obesity, and related conditions. It contains the following key points:
- Pre-existing medical conditions such as diabetes, obesity, and hypertension exacerbated by pregnancy account for a significant percentage of maternal deaths.
- Over the last 30 years, the global prevalence of obesity and diabetes has doubled, with onset of diabetes occurring at younger ages. Gestational diabetes, maternal diabetes, and obesity are associated with adverse outcomes for children.
- Early intervention and prevention of gestational weight gain and obesity prior to and during pregnancy can help prevent gestational diabetes and related complications for both mother and baby. Lifestyle intervention programs show promise.
Antenatal care screening involves regular checkups during pregnancy to monitor the health of the mother and baby. The goals are to ensure the mother and baby's health, have a good birth outcome, identify high-risk pregnancies, and decrease mortality rates. Checkups include checking weight gain, screening for conditions like anemia, providing dietary advice, and assessing fetal well-being through ultrasounds and monitoring. Women see their provider monthly until 32 weeks, every two weeks until 36 weeks, and weekly after that until delivery.
This document discusses the presentation, diagnosis and management of non-HIV sexually transmitted infections (STIs) during pregnancy. It notes that STIs like chlamydia, gonorrhea and trichomoniasis are common in young women and can have serious consequences for the pregnant woman and fetus if untreated. While initial antenatal screening focuses on HIV, hepatitis and syphilis, other STIs may be missed without considering a woman's risk factors and testing appropriately. The document provides guidance on risk assessment, indications for testing specific STIs, and treatment and partner management during pregnancy to help optimize outcomes for both mother and baby.
The document discusses gallbladder pathology and cholecystectomy. It notes that 90% of cholecystectomies are now performed laparoscopically. For acute cholecystitis, early laparoscopic cholecystectomy within the first few days has lower conversion and complication rates than delayed surgery. The document also outlines criteria for diagnosing and classifying the severity of acute cholecystitis based on clinical signs, lab values, and imaging findings. Surgical management depends on the severity and includes laparoscopic cholecystectomy, drainage with possible delayed cholecystectomy, or open cholecystectomy for severe cases with organ dysfunction.
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTAboubakr Elnashar
The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
This document discusses the relationship between COVID-19 infection and preeclampsia in pregnant women. It suggests that COVID-19 may increase the risk of developing preeclampsia due to the virus' ability to downregulate ACE2 expression in the placenta. There are immunological and pathological similarities between the two conditions, including endothelial dysfunction. Studies have found higher rates of hypertensive disorders of pregnancy in women infected with COVID-19. Close monitoring is recommended for pregnant COVID-19 patients.
The normal twin, called the pump twin, drives blood through both fetuses. It is called reversed arterial perfusion because in the acardiac twin the blood flows in a reversed direction. TRAP sequence occurs in 1% of monochorionic twin pregnancies and in 1 in 35,000 pregnancies overall.
Necrotizing enterocolitis is an acquired intestinal disease of unknown etiology that commonly affects premature infants. The main risk factors are prematurity, genetic factors, maternal health conditions like cocaine use, medications like indomethacin and dexamethasone, and certain enteral feeding practices. The pathogenesis involves an initial hypoxic-ischemic insult to the intestine combined with microbial factors and an excessive inflammatory response that can lead to necrosis of the intestinal tissue. Timely diagnosis and management are important for improving outcomes.
PPT on Direct Seeded Rice presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Travis Hills of MN is Making Clean Water Accessible to All Through High Flux ...Travis Hills MN
By harnessing the power of High Flux Vacuum Membrane Distillation, Travis Hills from MN envisions a future where clean and safe drinking water is accessible to all, regardless of geographical location or economic status.
Focused approach to antenatal care - First trimester screeningBharti Gahtori
This document discusses focused antenatal care and first trimester screening. It describes the essential elements of antenatal care including targeted assessments based on individual risk factors. First trimester screening aims to detect conditions like aneuploidy through measuring the nuchal translucency, analyzing maternal serum markers, and assessing fetal heart rate between 11-13 weeks of gestation. Screening tests are evaluated based on their sensitivity, specificity, and rates of false positives and negatives.
Mternal death review lecture by dr. evelina r. castro 102413Jesart De Vera
The document provides information on maternal death reviews and prenatal care. It discusses how to determine true labor contractions from false contractions. It outlines the schedule of prenatal visits and assessments that should be done at each visit, including medical history, physical exams, lab tests, fetal monitoring, and growth assessments. The summary also reviews guidelines for screening and testing for conditions like gestational diabetes, anemia, STDs, and Group B Strep during each trimester of pregnancy.
Association between the congenital abdominal wall defects
(CAWD) with early maternal age in the years 2001-2017 and
the temporal tendency of the prevalence in the years 2011-
2017 in the cities of Bogotá and Cali.
Omphalocele and gastroschisis are the most common CAWD: in the United States the prevalence is 1.86 and 4.49 per 10,000
live births respectively.
Between 1999 and 2007, the prevalence of omphalocele increased by 11%, whereas the prevalence of gastroschisis increased by 83%.
The document discusses antenatal assessment, which involves the systematic supervision of a pregnant woman. It involves determining risk factors through a comprehensive history and physical exam. Regular checkups are recommended, starting with monthly visits until week 28, then twice monthly until week 36, and weekly during the last 4 weeks. The assessments monitor maternal and fetal health and wellbeing through tests, exams, ultrasounds and more. The goal is to promote a healthy pregnancy and delivery.
This patient presented with retained placenta after a vaginal delivery. Her ultrasound and MRI showed placenta increta, where placental villi had invaded into the myometrium. She was initially managed conservatively with methotrexate injection, which led to a partial reduction in her beta-hCG levels. However, she later developed heavy bleeding and required an emergency hysterectomy. Placenta accreta spectrum (PAS) describes abnormal placental invasion that can cause life-threatening bleeding. Risk factors include prior uterine surgery. Management challenges include delayed referrals, lack of blood product availability, and counseling patients on prolonged hospitalization sometimes required.
This document outlines the management of early pregnancy loss by Dr. Mohammed Lukman Abolaji. It begins with definitions of key terms like miscarriage, threatened abortion, and blighted ovum. It then discusses the epidemiology, risk factors, and potential causes of early pregnancy loss. The document covers approaches to diagnosis using ultrasound and HCG levels. It outlines treatment options for early pregnancy loss including expectant, medical, and surgical management. Post-abortion care and potential complications are also summarized. The role of family physicians in caring for patients experiencing early pregnancy loss is emphasized.
A case of an ovarian tumour pre-operatively thought to be malignant, which was per-operatively diagnosed as benign and later confirmed as a mucinous cystadenoma.
Ob-Gyn Department, BIRDEM-2 General Hospital, Shegunbagicha, Dhaka, Bangladesh
Gestational trophoblastic disease is a spectrum of interrelated disease processes originating from the placenta.
GTD is a spectrum of tumours with a wide range of biologic behaviour and potential for metastases
They are characterised by an abnormally high amount of HcG levels in the blood
Hepatitis C and pregnancy can affect both mother and fetus. While pregnancy does not typically affect the course of HCV infection, HCV can increase maternal risks like gestational diabetes and postpartum hemorrhage. It may also increase fetal risks such as preterm delivery and low birthweight. Management includes screening all pregnant women for HCV, treating the mother if needed to reduce viral load and risk of transmission, and monitoring the fetus for complications. Delivery by cesarean is not routinely recommended, and breastfeeding is considered safe if nipples are intact.
This document summarizes key information about ovarian cancer, including epidemiology, risk factors, screening, staging, treatment with surgery and chemotherapy. It notes that ovarian cancer incidence is stable worldwide, with most women diagnosed at advanced stage. Screening with CA125 and ultrasound has not proven mortality benefit. Surgical staging and optimal debulking improves outcomes, while platinum-based chemotherapy is standard first-line treatment and improves survival. Ongoing research focuses on maintenance therapies and intraperitoneal chemotherapy administration.
This document summarizes key information about ovarian cancer, including epidemiology, risk factors, screening, staging, treatment with surgery and chemotherapy. It notes that ovarian cancer incidence is stable worldwide, with most women diagnosed at advanced stage. Screening with CA125 and ultrasound has not proven mortality benefit. Surgical staging and optimal debulking improves outcomes, while platinum-based chemotherapy is standard first-line treatment and improves survival. Ongoing research evaluates incorporating targeted therapies and intraperitoneal chemotherapy administration.
This document discusses issues in liver health and disease for non-hepatologists. It provides an overview of the changing epidemiology of viral hepatitis and new hepatitis B vaccines. It also addresses non-alcoholic fatty liver disease (NAFLD) and how increased recognition of this condition has led to new screening and potential therapy approaches. The document uses audience response questions to highlight clinical cases involving liver disease in HIV patients and discusses topics like viral hepatitis coinfections, hepatitis B vaccine strengths and limitations, and the natural history and risk factors associated with NAFLD.
This document discusses gestational diabetes, maternal obesity, and related conditions. It contains the following key points:
- Pre-existing medical conditions such as diabetes, obesity, and hypertension exacerbated by pregnancy account for a significant percentage of maternal deaths.
- Over the last 30 years, the global prevalence of obesity and diabetes has doubled, with onset of diabetes occurring at younger ages. Gestational diabetes, maternal diabetes, and obesity are associated with adverse outcomes for children.
- Early intervention and prevention of gestational weight gain and obesity prior to and during pregnancy can help prevent gestational diabetes and related complications for both mother and baby. Lifestyle intervention programs show promise.
Antenatal care screening involves regular checkups during pregnancy to monitor the health of the mother and baby. The goals are to ensure the mother and baby's health, have a good birth outcome, identify high-risk pregnancies, and decrease mortality rates. Checkups include checking weight gain, screening for conditions like anemia, providing dietary advice, and assessing fetal well-being through ultrasounds and monitoring. Women see their provider monthly until 32 weeks, every two weeks until 36 weeks, and weekly after that until delivery.
This document discusses the presentation, diagnosis and management of non-HIV sexually transmitted infections (STIs) during pregnancy. It notes that STIs like chlamydia, gonorrhea and trichomoniasis are common in young women and can have serious consequences for the pregnant woman and fetus if untreated. While initial antenatal screening focuses on HIV, hepatitis and syphilis, other STIs may be missed without considering a woman's risk factors and testing appropriately. The document provides guidance on risk assessment, indications for testing specific STIs, and treatment and partner management during pregnancy to help optimize outcomes for both mother and baby.
The document discusses gallbladder pathology and cholecystectomy. It notes that 90% of cholecystectomies are now performed laparoscopically. For acute cholecystitis, early laparoscopic cholecystectomy within the first few days has lower conversion and complication rates than delayed surgery. The document also outlines criteria for diagnosing and classifying the severity of acute cholecystitis based on clinical signs, lab values, and imaging findings. Surgical management depends on the severity and includes laparoscopic cholecystectomy, drainage with possible delayed cholecystectomy, or open cholecystectomy for severe cases with organ dysfunction.
WHAT IS NEW IN ESHRE 2022 AND FIGO 2022 FOR GENERAL GYNAECOLOGISTAboubakr Elnashar
The document summarizes key information from the ESHRE 2022 and FIGO 2022 conferences. It discusses several topics including:
- The ESHRE conference included 97 sessions with 317 oral and 801 poster presentations.
- The FIGO classification system for ovulatory disorders was updated, categorizing disorders into 4 types based on their hypothalamic, pituitary, ovarian, or PCOS origin.
- Subtle distal fallopian tube abnormalities may be treated with laparoscopy, leading to a 46.58% natural pregnancy rate.
- Children born after frozen embryo transfer have a higher risk of childhood cancer than those born after fresh embryo transfer or spontaneously.
This document discusses the relationship between COVID-19 infection and preeclampsia in pregnant women. It suggests that COVID-19 may increase the risk of developing preeclampsia due to the virus' ability to downregulate ACE2 expression in the placenta. There are immunological and pathological similarities between the two conditions, including endothelial dysfunction. Studies have found higher rates of hypertensive disorders of pregnancy in women infected with COVID-19. Close monitoring is recommended for pregnant COVID-19 patients.
The normal twin, called the pump twin, drives blood through both fetuses. It is called reversed arterial perfusion because in the acardiac twin the blood flows in a reversed direction. TRAP sequence occurs in 1% of monochorionic twin pregnancies and in 1 in 35,000 pregnancies overall.
Necrotizing enterocolitis is an acquired intestinal disease of unknown etiology that commonly affects premature infants. The main risk factors are prematurity, genetic factors, maternal health conditions like cocaine use, medications like indomethacin and dexamethasone, and certain enteral feeding practices. The pathogenesis involves an initial hypoxic-ischemic insult to the intestine combined with microbial factors and an excessive inflammatory response that can lead to necrosis of the intestinal tissue. Timely diagnosis and management are important for improving outcomes.
PPT on Direct Seeded Rice presented at the three-day 'Training and Validation Workshop on Modules of Climate Smart Agriculture (CSA) Technologies in South Asia' workshop on April 22, 2024.
Travis Hills of MN is Making Clean Water Accessible to All Through High Flux ...Travis Hills MN
By harnessing the power of High Flux Vacuum Membrane Distillation, Travis Hills from MN envisions a future where clean and safe drinking water is accessible to all, regardless of geographical location or economic status.
Microbial interaction
Microorganisms interacts with each other and can be physically associated with another organisms in a variety of ways.
One organism can be located on the surface of another organism as an ectobiont or located within another organism as endobiont.
Microbial interaction may be positive such as mutualism, proto-cooperation, commensalism or may be negative such as parasitism, predation or competition
Types of microbial interaction
Positive interaction: mutualism, proto-cooperation, commensalism
Negative interaction: Ammensalism (antagonism), parasitism, predation, competition
I. Mutualism:
It is defined as the relationship in which each organism in interaction gets benefits from association. It is an obligatory relationship in which mutualist and host are metabolically dependent on each other.
Mutualistic relationship is very specific where one member of association cannot be replaced by another species.
Mutualism require close physical contact between interacting organisms.
Relationship of mutualism allows organisms to exist in habitat that could not occupied by either species alone.
Mutualistic relationship between organisms allows them to act as a single organism.
Examples of mutualism:
i. Lichens:
Lichens are excellent example of mutualism.
They are the association of specific fungi and certain genus of algae. In lichen, fungal partner is called mycobiont and algal partner is called
II. Syntrophism:
It is an association in which the growth of one organism either depends on or improved by the substrate provided by another organism.
In syntrophism both organism in association gets benefits.
Compound A
Utilized by population 1
Compound B
Utilized by population 2
Compound C
utilized by both Population 1+2
Products
In this theoretical example of syntrophism, population 1 is able to utilize and metabolize compound A, forming compound B but cannot metabolize beyond compound B without co-operation of population 2. Population 2is unable to utilize compound A but it can metabolize compound B forming compound C. Then both population 1 and 2 are able to carry out metabolic reaction which leads to formation of end product that neither population could produce alone.
Examples of syntrophism:
i. Methanogenic ecosystem in sludge digester
Methane produced by methanogenic bacteria depends upon interspecies hydrogen transfer by other fermentative bacteria.
Anaerobic fermentative bacteria generate CO2 and H2 utilizing carbohydrates which is then utilized by methanogenic bacteria (Methanobacter) to produce methane.
ii. Lactobacillus arobinosus and Enterococcus faecalis:
In the minimal media, Lactobacillus arobinosus and Enterococcus faecalis are able to grow together but not alone.
The synergistic relationship between E. faecalis and L. arobinosus occurs in which E. faecalis require folic acid
Discovery of An Apparent Red, High-Velocity Type Ia Supernova at 𝐳 = 2.9 wi...Sérgio Sacani
We present the JWST discovery of SN 2023adsy, a transient object located in a host galaxy JADES-GS
+
53.13485
−
27.82088
with a host spectroscopic redshift of
2.903
±
0.007
. The transient was identified in deep James Webb Space Telescope (JWST)/NIRCam imaging from the JWST Advanced Deep Extragalactic Survey (JADES) program. Photometric and spectroscopic followup with NIRCam and NIRSpec, respectively, confirm the redshift and yield UV-NIR light-curve, NIR color, and spectroscopic information all consistent with a Type Ia classification. Despite its classification as a likely SN Ia, SN 2023adsy is both fairly red (
�
(
�
−
�
)
∼
0.9
) despite a host galaxy with low-extinction and has a high Ca II velocity (
19
,
000
±
2
,
000
km/s) compared to the general population of SNe Ia. While these characteristics are consistent with some Ca-rich SNe Ia, particularly SN 2016hnk, SN 2023adsy is intrinsically brighter than the low-
�
Ca-rich population. Although such an object is too red for any low-
�
cosmological sample, we apply a fiducial standardization approach to SN 2023adsy and find that the SN 2023adsy luminosity distance measurement is in excellent agreement (
≲
1
�
) with
Λ
CDM. Therefore unlike low-
�
Ca-rich SNe Ia, SN 2023adsy is standardizable and gives no indication that SN Ia standardized luminosities change significantly with redshift. A larger sample of distant SNe Ia is required to determine if SN Ia population characteristics at high-
�
truly diverge from their low-
�
counterparts, and to confirm that standardized luminosities nevertheless remain constant with redshift.
EWOCS-I: The catalog of X-ray sources in Westerlund 1 from the Extended Weste...Sérgio Sacani
Context. With a mass exceeding several 104 M⊙ and a rich and dense population of massive stars, supermassive young star clusters
represent the most massive star-forming environment that is dominated by the feedback from massive stars and gravitational interactions
among stars.
Aims. In this paper we present the Extended Westerlund 1 and 2 Open Clusters Survey (EWOCS) project, which aims to investigate
the influence of the starburst environment on the formation of stars and planets, and on the evolution of both low and high mass stars.
The primary targets of this project are Westerlund 1 and 2, the closest supermassive star clusters to the Sun.
Methods. The project is based primarily on recent observations conducted with the Chandra and JWST observatories. Specifically,
the Chandra survey of Westerlund 1 consists of 36 new ACIS-I observations, nearly co-pointed, for a total exposure time of 1 Msec.
Additionally, we included 8 archival Chandra/ACIS-S observations. This paper presents the resulting catalog of X-ray sources within
and around Westerlund 1. Sources were detected by combining various existing methods, and photon extraction and source validation
were carried out using the ACIS-Extract software.
Results. The EWOCS X-ray catalog comprises 5963 validated sources out of the 9420 initially provided to ACIS-Extract, reaching a
photon flux threshold of approximately 2 × 10−8 photons cm−2
s
−1
. The X-ray sources exhibit a highly concentrated spatial distribution,
with 1075 sources located within the central 1 arcmin. We have successfully detected X-ray emissions from 126 out of the 166 known
massive stars of the cluster, and we have collected over 71 000 photons from the magnetar CXO J164710.20-455217.
Authoring a personal GPT for your research and practice: How we created the Q...Leonel Morgado
Thematic analysis in qualitative research is a time-consuming and systematic task, typically done using teams. Team members must ground their activities on common understandings of the major concepts underlying the thematic analysis, and define criteria for its development. However, conceptual misunderstandings, equivocations, and lack of adherence to criteria are challenges to the quality and speed of this process. Given the distributed and uncertain nature of this process, we wondered if the tasks in thematic analysis could be supported by readily available artificial intelligence chatbots. Our early efforts point to potential benefits: not just saving time in the coding process but better adherence to criteria and grounding, by increasing triangulation between humans and artificial intelligence. This tutorial will provide a description and demonstration of the process we followed, as two academic researchers, to develop a custom ChatGPT to assist with qualitative coding in the thematic data analysis process of immersive learning accounts in a survey of the academic literature: QUAL-E Immersive Learning Thematic Analysis Helper. In the hands-on time, participants will try out QUAL-E and develop their ideas for their own qualitative coding ChatGPT. Participants that have the paid ChatGPT Plus subscription can create a draft of their assistants. The organizers will provide course materials and slide deck that participants will be able to utilize to continue development of their custom GPT. The paid subscription to ChatGPT Plus is not required to participate in this workshop, just for trying out personal GPTs during it.
Mending Clothing to Support Sustainable Fashion_CIMaR 2024.pdfSelcen Ozturkcan
Ozturkcan, S., Berndt, A., & Angelakis, A. (2024). Mending clothing to support sustainable fashion. Presented at the 31st Annual Conference by the Consortium for International Marketing Research (CIMaR), 10-13 Jun 2024, University of Gävle, Sweden.
Immersive Learning That Works: Research Grounding and Paths ForwardLeonel Morgado
We will metaverse into the essence of immersive learning, into its three dimensions and conceptual models. This approach encompasses elements from teaching methodologies to social involvement, through organizational concerns and technologies. Challenging the perception of learning as knowledge transfer, we introduce a 'Uses, Practices & Strategies' model operationalized by the 'Immersive Learning Brain' and ‘Immersion Cube’ frameworks. This approach offers a comprehensive guide through the intricacies of immersive educational experiences and spotlighting research frontiers, along the immersion dimensions of system, narrative, and agency. Our discourse extends to stakeholders beyond the academic sphere, addressing the interests of technologists, instructional designers, and policymakers. We span various contexts, from formal education to organizational transformation to the new horizon of an AI-pervasive society. This keynote aims to unite the iLRN community in a collaborative journey towards a future where immersive learning research and practice coalesce, paving the way for innovative educational research and practice landscapes.
The debris of the ‘last major merger’ is dynamically youngSérgio Sacani
The Milky Way’s (MW) inner stellar halo contains an [Fe/H]-rich component with highly eccentric orbits, often referred to as the
‘last major merger.’ Hypotheses for the origin of this component include Gaia-Sausage/Enceladus (GSE), where the progenitor
collided with the MW proto-disc 8–11 Gyr ago, and the Virgo Radial Merger (VRM), where the progenitor collided with the
MW disc within the last 3 Gyr. These two scenarios make different predictions about observable structure in local phase space,
because the morphology of debris depends on how long it has had to phase mix. The recently identified phase-space folds in Gaia
DR3 have positive caustic velocities, making them fundamentally different than the phase-mixed chevrons found in simulations
at late times. Roughly 20 per cent of the stars in the prograde local stellar halo are associated with the observed caustics. Based
on a simple phase-mixing model, the observed number of caustics are consistent with a merger that occurred 1–2 Gyr ago.
We also compare the observed phase-space distribution to FIRE-2 Latte simulations of GSE-like mergers, using a quantitative
measurement of phase mixing (2D causticality). The observed local phase-space distribution best matches the simulated data
1–2 Gyr after collision, and certainly not later than 3 Gyr. This is further evidence that the progenitor of the ‘last major merger’
did not collide with the MW proto-disc at early times, as is thought for the GSE, but instead collided with the MW disc within
the last few Gyr, consistent with the body of work surrounding the VRM.
CLASS 12th CHEMISTRY SOLID STATE ppt (Animated)eitps1506
Description:
Dive into the fascinating realm of solid-state physics with our meticulously crafted online PowerPoint presentation. This immersive educational resource offers a comprehensive exploration of the fundamental concepts, theories, and applications within the realm of solid-state physics.
From crystalline structures to semiconductor devices, this presentation delves into the intricate principles governing the behavior of solids, providing clear explanations and illustrative examples to enhance understanding. Whether you're a student delving into the subject for the first time or a seasoned researcher seeking to deepen your knowledge, our presentation offers valuable insights and in-depth analyses to cater to various levels of expertise.
Key topics covered include:
Crystal Structures: Unravel the mysteries of crystalline arrangements and their significance in determining material properties.
Band Theory: Explore the electronic band structure of solids and understand how it influences their conductive properties.
Semiconductor Physics: Delve into the behavior of semiconductors, including doping, carrier transport, and device applications.
Magnetic Properties: Investigate the magnetic behavior of solids, including ferromagnetism, antiferromagnetism, and ferrimagnetism.
Optical Properties: Examine the interaction of light with solids, including absorption, reflection, and transmission phenomena.
With visually engaging slides, informative content, and interactive elements, our online PowerPoint presentation serves as a valuable resource for students, educators, and enthusiasts alike, facilitating a deeper understanding of the captivating world of solid-state physics. Explore the intricacies of solid-state materials and unlock the secrets behind their remarkable properties with our comprehensive presentation.
JAMES WEBB STUDY THE MASSIVE BLACK HOLE SEEDSSérgio Sacani
The pathway(s) to seeding the massive black holes (MBHs) that exist at the heart of galaxies in the present and distant Universe remains an unsolved problem. Here we categorise, describe and quantitatively discuss the formation pathways of both light and heavy seeds. We emphasise that the most recent computational models suggest that rather than a bimodal-like mass spectrum between light and heavy seeds with light at one end and heavy at the other that instead a continuum exists. Light seeds being more ubiquitous and the heavier seeds becoming less and less abundant due the rarer environmental conditions required for their formation. We therefore examine the different mechanisms that give rise to different seed mass spectrums. We show how and why the mechanisms that produce the heaviest seeds are also among the rarest events in the Universe and are hence extremely unlikely to be the seeds for the vast majority of the MBH population. We quantify, within the limits of the current large uncertainties in the seeding processes, the expected number densities of the seed mass spectrum. We argue that light seeds must be at least 103 to 105 times more numerous than heavy seeds to explain the MBH population as a whole. Based on our current understanding of the seed population this makes heavy seeds (Mseed > 103 M⊙) a significantly more likely pathway given that heavy seeds have an abundance pattern than is close to and likely in excess of 10−4 compared to light seeds. Finally, we examine the current state-of-the-art in numerical calculations and recent observations and plot a path forward for near-future advances in both domains.
Candidate young stellar objects in the S-cluster: Kinematic analysis of a sub...Sérgio Sacani
Context. The observation of several L-band emission sources in the S cluster has led to a rich discussion of their nature. However, a definitive answer to the classification of the dusty objects requires an explanation for the detection of compact Doppler-shifted Brγ emission. The ionized hydrogen in combination with the observation of mid-infrared L-band continuum emission suggests that most of these sources are embedded in a dusty envelope. These embedded sources are part of the S-cluster, and their relationship to the S-stars is still under debate. To date, the question of the origin of these two populations has been vague, although all explanations favor migration processes for the individual cluster members. Aims. This work revisits the S-cluster and its dusty members orbiting the supermassive black hole SgrA* on bound Keplerian orbits from a kinematic perspective. The aim is to explore the Keplerian parameters for patterns that might imply a nonrandom distribution of the sample. Additionally, various analytical aspects are considered to address the nature of the dusty sources. Methods. Based on the photometric analysis, we estimated the individual H−K and K−L colors for the source sample and compared the results to known cluster members. The classification revealed a noticeable contrast between the S-stars and the dusty sources. To fit the flux-density distribution, we utilized the radiative transfer code HYPERION and implemented a young stellar object Class I model. We obtained the position angle from the Keplerian fit results; additionally, we analyzed the distribution of the inclinations and the longitudes of the ascending node. Results. The colors of the dusty sources suggest a stellar nature consistent with the spectral energy distribution in the near and midinfrared domains. Furthermore, the evaporation timescales of dusty and gaseous clumps in the vicinity of SgrA* are much shorter ( 2yr) than the epochs covered by the observations (≈15yr). In addition to the strong evidence for the stellar classification of the D-sources, we also find a clear disk-like pattern following the arrangements of S-stars proposed in the literature. Furthermore, we find a global intrinsic inclination for all dusty sources of 60 ± 20◦, implying a common formation process. Conclusions. The pattern of the dusty sources manifested in the distribution of the position angles, inclinations, and longitudes of the ascending node strongly suggests two different scenarios: the main-sequence stars and the dusty stellar S-cluster sources share a common formation history or migrated with a similar formation channel in the vicinity of SgrA*. Alternatively, the gravitational influence of SgrA* in combination with a massive perturber, such as a putative intermediate mass black hole in the IRS 13 cluster, forces the dusty objects and S-stars to follow a particular orbital arrangement. Key words. stars: black holes– stars: formation– Galaxy: center– galaxies: star formation
The binding of cosmological structures by massless topological defectsSérgio Sacani
Assuming spherical symmetry and weak field, it is shown that if one solves the Poisson equation or the Einstein field
equations sourced by a topological defect, i.e. a singularity of a very specific form, the result is a localized gravitational
field capable of driving flat rotation (i.e. Keplerian circular orbits at a constant speed for all radii) of test masses on a thin
spherical shell without any underlying mass. Moreover, a large-scale structure which exploits this solution by assembling
concentrically a number of such topological defects can establish a flat stellar or galactic rotation curve, and can also deflect
light in the same manner as an equipotential (isothermal) sphere. Thus, the need for dark matter or modified gravity theory is
mitigated, at least in part.
Evidence of Jet Activity from the Secondary Black Hole in the OJ 287 Binary S...Sérgio Sacani
Wereport the study of a huge optical intraday flare on 2021 November 12 at 2 a.m. UT in the blazar OJ287. In the binary black hole model, it is associated with an impact of the secondary black hole on the accretion disk of the primary. Our multifrequency observing campaign was set up to search for such a signature of the impact based on a prediction made 8 yr earlier. The first I-band results of the flare have already been reported by Kishore et al. (2024). Here we combine these data with our monitoring in the R-band. There is a big change in the R–I spectral index by 1.0 ±0.1 between the normal background and the flare, suggesting a new component of radiation. The polarization variation during the rise of the flare suggests the same. The limits on the source size place it most reasonably in the jet of the secondary BH. We then ask why we have not seen this phenomenon before. We show that OJ287 was never before observed with sufficient sensitivity on the night when the flare should have happened according to the binary model. We also study the probability that this flare is just an oversized example of intraday variability using the Krakow data set of intense monitoring between 2015 and 2023. We find that the occurrence of a flare of this size and rapidity is unlikely. In machine-readable Tables 1 and 2, we give the full orbit-linked historical light curve of OJ287 as well as the dense monitoring sample of Krakow.
Evidence of Jet Activity from the Secondary Black Hole in the OJ 287 Binary S...
cole embarazo.pptx
1. Dr. Ruiz Villanueva Noe.
Asesor de caso.
Medico Familiar adscrito UMF #82
Caso clínico.
R2MF: Marín Hernández
Neftalí Alejandro.
2. Ficha de identificación.
AVMM nsss
01
APNP.
Residencia los lobos, municipio de los
reyes, religión católica, toxicomanías
negadas.
02
AHF.
abuela materna diabética.
03
APQX.
Fracturas de la diáfisis del cubito a los
9 años, Quirúrgicos una cesárea,
04
3. APP.
9 años 2017 22/08/2018 21/07/2020 2020
Varicela Mastitis
desde
los 22
años.
Colecistiti
s litiasica,
ultima val
22/08/21
Policont
undida
caida de
bicicleta
IVU
recurren
tes, EAP
(24/09/2
0
4. APP.
24/11/20 18/02/2022
02/06/2021 2022 2021
Lumbalgia
cronica
SARS CoV-2
en dos
ocasiones.
Tenosinovitis
de hombre
derecho
Vacunada
para covid-
19
Cuadro de
vacunacion
completo
8. Control prenatal 11/12/21
FUP: 21/07/2021
(BACTERIAS BACILAR,
INFLAMACION X, NEGATIVO
A CANCER)
Fecha de ultiva cesarea
14/03/15
Bajo peso al nacer <2500 grs
Total de consultas 10
Infección de vías urinarias primer y
segundo, trim.
suplementos vitamínicos ácido fólico y
vitaminas y minerales..
10. NOM 007.
- determinación del grupo sanguíneo ABO y Rho, (en embarazadas con Rh negativo y se sospeche
riesgo, determinar Rho antígeno D y su variante débil Dμ),
- Valoración del riesgo obstetrico.
- aplicación de al menos dos dosis de toxoide tetánico (primera durante el primer
contacto de la paciente con los servicios médicos y la segunda a las cuatro u ocho semanas posteriores,
- orientación nutricional tomando en cuenta las condiciones sociales, económicas y sociales de la
embarazada;
11. - Detección del virus de la inmunodeficiencia adquirida humana VIH en mujeres
de alto riesgo (transfundidas, drogadictas y prostitutas), bajo conocimiento y
consentimiento de la mujer y referir los casos positivos a centros especializados,
respetando el derecho a la privacidad y a la confidencialidad.
- Prescripción profiláctica de hierro y ácido fólico;
- examen general de orina desde el primer control.
A las 24, 28,32 y 36.
¿ A QUE SEMANA SE SOLICITAN EGO?
12. FUA 21/07/22.
¿Cuál es la fecha probable de
parto?
Riesgo obstétrico ???
Femenina de 27 años, presento COVID hace 4
meses. FUR 05/11/2021, FPP 12/08/2022
cursa embarazo de ¿?????? semanas de
gestación, con riesgo obstétrico de 8.
12/082022
13.
14.
15. PA: Niega perdidas transvaginales --paciente quien ha presento
prurito generalizado con exacerbación de 2 semanas de mayor
predomino en mano y pies en ocasiones se refiere estar amarilla...
paciente quien ya ha estado internada en varias ocasiones. ultimo
internamiento el 13 de julio de 2022 y acudió a valoración con
ginecología 16/07/2022 sin dejar cita a paciente.
Padecimiento actual.
16. ¿Que
estudios
solicitarias?
laboratorio del dia 13/07/22.
BH: normal.
Grupo y Rh A positivo glucosa 66.5 mg/dl 870/110 mg/dl), crea
0.5 mg/dl (0.6-1.3), ac urico 5.8 mg/dl (3.5-7.2), BT 0.66 (0-1
mg/dl), BD 0.42 (0-0.30 mg/dl), BI 0.24 (0-1.1 mg/dl), TGP/ALT
318 (30-65 U/L), TGO/AST 202 (15/37 U/l), DHL 221 (135/225
U/l), EGO color amarillo, DU 1.020 pH 6, sedimento, leuoc 18-20
bacterias moderada.
ULTRASONIDO OBSTETRICO.
Producto único vivo cefalico longitudinal dorso al izquierda placenta
normoinserta G 2 aparente circular de cordon a cuello.
dx embarazo de de 34 semasna peso fetal 2363 placenta normoinserta g
2 ila normal circualr de cordon dra erandi ceja medico radiologo.
17.
18. Ultrasonido abdomen superior:
Se observa imagenes en relación con esteatosis hepatica
leve / ccl sin datos de a gudizacion luz vesicular en totalidad
por litos
28/02/2022
19. Exploración Fisica.
Consciente activa con
palidez de piel y
mucosas no se observa
tinte ictérico, cavidad
oral húmeda tórax
ventilados sin ruidos
agregados Ruidos
Cardiacos rítmicos de
buena intensidad no
soplo ni terceros ruidos.
Abdomen Globoso por
PUVI altura de fondo
uterino. 33 cm Fcf 137 X
minuto presentación
cefálico longitudinal
dorso a la derecha
Giordano y puntos
ureterales negativos n o
palpo datos de irritación
peritoneal. Exploración
Genital y Tacto vaginal
diferido Extremidades
sin edema con buen
llenado capilar..
25. Complicaciones fetales de la
patologia?
- Presencia de meconio.
- Diestres respiratorio.
- RCIU
Ovadia C, Seed PT, Sklavounos A, et al. Association of adverse perinatal outcomes of intrahepatic cholestasis of
pregnancy with biochemical markers:results of aggregate and individual patient data meta-analyses. Lancet 2019;
393:899.
26. 4.3 embarazo de alto riesgo: Aquel en el que se tiene la certeza o la probabilidad de estados
patológicos o condiciones anormales concomitantes con la gestación y el parto, que aumentan los
peligros para la salud de la madre o del producto, o bien, cuando la madre procede de un medio
socioeconómico precario.
4.24 calidad de la atención: Se considera a la secuencia de actividades que relacionan al prestador
de
los servicios con el usuario (oportunidad de la atención, accesibilidad a la unidad, tiempo de espera,
así
como de los resultados).
4.25 calidez en la atención: El trato cordial, atento y con información que se proporciona al usuario
del
servicio.
5.2.2 El control prenatal debe estar dirigido a la detección y control de factores de riesgo obstétrico,
a la
prevención, detección y tratamiento de la anemia, preeclampsia, infecciones cérvicovaginales e
infecciones
urinarias, las complicaciones hemorrágicas del embarazo, retraso del crecimiento intrauterino y otras
patologías intercurrentes con el embarazo.
28. Colestasis intrahepatica o
cholestasis obstetrica.
- Finales del Segundo trimester o tercer trimester.
- Prurito manos y plantas de los pies
- PFH alteradas.
- Bilirrubinas helevadas.
Clinical Updates in Women's Health Care Summary: Liver Disease:
Reproductive Considerations. Obstet Gynecol 2017; 129:236.
29. La incidencia.
- oscilandoentre <1 y 27.6 por ciento (indios araucanos en Chile)
ETIOLOGÍA.
No se entiende completamente, pero
probablemente implica una combinación
de:
- Susceptibilidad genética (mayor riesgo en
parientes de primer grado), el gen ABCB4 .
- Factores hormonales (el estrógeno causa
colestasis,
toman anticonceptivos de estrógeno-
progestina ) y factores ambientales.
Referencias 1,2,3,4,5,6
30. Progesterona no hay evidencia de colestasis.
hidroxiprogesterona describe una incidencia del 8 por ciento de prurito en
mujeres tratadas y enumera la ictericia colestásica del embarazo,los tumores
hepáticos (benignos o malignos) o la enfermedad hepática activa como
contraindicaciones para la terapia.
Bacq Y, Sapey T, Bréchot MC, et al. Colestasis intrahepática del embarazo: un estudio prospectivo
francés. Hepatología 1997; 26:358.
31. - El examen físico puede mostrar marcas de rasguños, excoriaciones y nódulos de prurigo
secundarios al rascado (pero no hay lesionescutáneas).
- La ictericia ocurre en el 14 al 25 por ciento de los pacientes, generalmente se desarrolla de
una a cuatro semanas después del inicio de la picazón
Laboratorio
- Aminotransferasas séricas (elevadas en el 60 por ciento de los casos) dos veces el límite
superior de lo normal.
- Fosfatasa alcalina, que puede estar elevada cuatro veces.
- Concentraciones totales y directas de bilirrubina (elevadas en el 25 por ciento de los casos),
rara vez superan los 6 mg/dL.
- El tiempo de protrombina suele ser normal (se prolonga por la deficiencia de vitamina k
secundario a la esteatorrea).
Furrer R, Winter K, Schäffer L, et al. Postpartum Blood Loss in Women Treated for Intrahepatic Cholestasis
of Pregnancy. Obstet Gynecol 2016;128:1048.
32. Acido ursodesoxicólico.
es el tratamiento preferido del prurito
materno, 300 mg tres veces al día (o 15
/ kg por día) hasta el parto.
Tratamiento.
American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Society for
Maternal-Fetal Medicine. Medically Indicated Late-Preterm and Early-Term Deliveries: ACOG Committee
Opinion, Number 831. Obstet Gynecol 2021; 138:e35.
33. La guía del Royal College of Obstetricians and Gynecologists (RCOG)
sobre ICP afirma que los datos disponibles pueden justificar la inducción
deltrabajo de parto a las mujeres después de los 37 años
El Colegio Americano de Obstetras y Ginecólogos (ACOG) recomienda el
parto a los 36 años hasta 39 semanas de gestación para pacientes
conniveles totales de ácidos biliares <100 micromol/L, o en el momento
del diagnóstico si se diagnostican a >39 semanas
34. 1.- Pataia V, Dixon PH, Williamson C. Embarazo y trastornos de ácidos biliares. Am J Physiol Gastrointest
Liver Physiol 2017; 313:G1.
2.- Gonzalez MC, Reyes H, Arrese M, et al. Colestasis intrahepática del embarazo en embarazos
gemelares. J Hepatol 1989; 9:84.
3.-Dixon PH, Williamson C. La fisiopatología de la colestasis intrahepática del embarazo. Clin Res
Hepatol Gastroenterol 2016; 40:141.
4.- Sookoian S, Castaño G, Burgueño A, et al. Asociación de las variantes del gen de la proteína
asociada a la resistencia a múltiples fármacos (ABCC2) conla colestasis intrahepática del embarazo. J
Hepatol 2008; 48:125.
5.- Wånggren K, Sparre LS, Wramsby H. Ictericia severa en el embarazo temprano de FIV. Eur J Obstet
Gynecol Reprod Biol 2004; 112:228.
6.- Mutlu MF, Aslan K, Guler I, et al. Dos casos de colestasis intrahepática de primer inicio del
embarazo asociados con el síndrome de hiperestimulaciónovárica moderada después del tratamiento
de FIV y la revisión de la literatura. J Obstet Gynaecol 2017; 37:547.
39. Infographic Style
Your Text Here Your Text Here Your Text Here
You can simply impress
your audience and add a
unique zing and appeal to
your Presentations. Easy
to change colors, photos
and Text.
Add Text Here Add Text Here Add Text Here
Contents _ Here
Contents _ Here
Contents _ Here
You can simply impress
your audience and add a
unique zing and appeal to
your Presentations. Easy
to change colors, photos
and Text.
Contents _ Here
Contents _ Here
Contents _ Here
You can simply impress
your audience and add a
unique zing and appeal to
your Presentations. Easy
to change colors, photos
and Text.
Contents _ Here
Contents _ Here
Contents _ Here
Your Text Here
You can simply impress
your audience and add a
unique zing and appeal to
your Presentations. Easy
to change colors, photos
and Text.
Add Text Here
Contents _ Here
Contents _ Here
Contents _ Here
40. Infographic Style
You can simply impress your audience and
add a unique zing and appeal to your
Presentations. Get a modern PowerPoint
Presentation that is beautifully designed.
Easy to change colors, photos and Text. I
hope and I believe that this Template will
your Time, Money and Reputation. Easy to
change colors, photos and Text.
Contents A
LOREM IPSUM DOLOR SIT AMET,
CU USU AGAM INTEGRE IMPEDIT.
Contents B
LOREM IPSUM DOLOR SIT AMET,
CU USU AGAM INTEGRE IMPEDIT.
You can simply impress your audience and
add a unique zing and appeal to your
Presentations. Get a modern PowerPoint
Presentation that is beautifully designed.
Easy to change colors, photos and Text. I
hope and I believe that this Template will
your Time, Money and Reputation. Easy to
change colors, photos and Text.
41. Infographic Style
01 Add Text You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text.
Add Contents Title
02 Add Text You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text.
Add Contents Title
03 Add Text You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text.
Add Contents Title
04 Add Text You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text.
Add Contents Title
42. Graphic
Infographic
Designed
Get a modern PowerPoint Presentation that is beautifully
designed. I hope and I believe that this Template will your Time,
Money and Reputation. Easy to change colors, photos and Text.
Get a modern PowerPoint Presentation that is beautifully
designed. You can simply impress your audience and add a
unique zing and appeal to your Presentations. I hope and I believe
that this Template will your Time, Money and Reputation. Get a
modern PowerPoint Presentation that is beautifully designed.
Simple Presentation
ALLPPT Layout
Clean Text Slide
for your
Presentation
43. Infographic Style
Content Here
Get a modern PowerPoint Presentation
that is beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
Content Here
Get a modern PowerPoint Presentation
that is beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
Content Here
Get a modern PowerPoint Presentation
that is beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
Content Here
Get a modern PowerPoint Presentation
that is beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
Content Here
Get a modern PowerPoint Presentation
that is beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
Content Here
Get a modern PowerPoint Presentation
that is beautifully designed. You can simply
impress your audience and add a unique
zing and appeal to your Presentations.
44. Infographic Style
Content
A
Content Here
Get a modern
PowerPoint
Presentation that is
beautifully designed.
Content
C
Content Here
Get a modern
PowerPoint
Presentation that is
beautifully designed.
Content
B
Content Here
Get a modern
PowerPoint
Presentation that is
beautifully designed.
45. L O R E M I P S U M D O L O R S I T A M E T
A W E S O M E
S L I D E
Get a modern PowerPoint Presentation that is beautifully designed. I hope
and I believe that this Template will your Time. You can simply impress your
audience and add a unique zing and appeal to your Presentations.
I hope and I believe
that this Template will
your Time, Money and
Reputation. Easy to
change colors, photos
and Text. You can
simply impress your
audience and add a
unique zing and appeal
to your Presentations. I
hope and I believe that
this Template will your
Time, Money and
Reputation. Get a
modern PowerPoint
Presentation that is
beautifully designed.
You can simply
impress your audience
and add a unique zing
and appeal to your
Presentations.
Easy to change colors,
photos and Text.
46. Infographic Style
Add Text
Get a modern PowerPoint Presentation
that is beautifully designed. Easy to
change colors, photos.
Add Text
Get a modern PowerPoint Presentation
that is beautifully designed. Easy to
change colors, photos.
Add Text
Get a modern PowerPoint Presentation
that is beautifully designed. Easy to
change colors, photos.
Add Text
Get a modern PowerPoint Presentation
that is beautifully designed. Easy to
change colors, photos.
Add Text
Get a modern PowerPoint Presentation
that is beautifully designed. Easy to
change colors, photos.
Add Text
Get a modern PowerPoint Presentation
that is beautifully designed. Easy to
change colors, photos.
47. Simple
PowerPoint
Presentation
You can simply impress your audience and add a unique zing and
appeal to your Presentations.
Your Text Here
You can simply impress your audience and add a unique zing and
appeal to your Presentations.
Your Text Here
You can simply impress your audience and add a unique zing and
appeal to your Presentations.
Your Text Here
You can simply impress your audience and add a unique zing and
appeal to your Presentations.
Your Text Here
48. You can simply impress your audience and add a
unique zing and appeal to your Presentations. Easy to
change colors, photos and Text.
Contents Here
You can simply impress your audience
and add a unique zing and appeal to
your Presentations. Easy to change
colors, photos and Text.
Contents Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations. Easy to
change colors, photos and Text.
Contents Here
Add Contents
Here
49. Infographic Style
50%
18%
Your Text Here
Your Text Here
50%
You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text. Get a modern PowerPoint
Presentation that is beautifully designed. I hope and I believe that this Template
will your Time, Money and Reputation.
You can simply impress your audience and add a unique zing and appeal to your Presentations.
Easy to change colors, photos and Text. Get a modern PowerPoint Presentation that is beautifully
designed. You can simply impress your audience and add a unique zing and appeal to your
Presentations. Easy to change colors, photos and Text
Contents Title
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
Item 1 Item 2 Item 3 Item 4 Item 5 Item 6 Item 7
50. Infographic Style
You can simply impress your
audience and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text.
Your Text Here
You can simply impress your
audience and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text.
Your Text Here
You can simply impress your
audience and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text.
Your Text Here
51. AWESOME
SLIDE
$ 64,090
$124,090
$234,090
Easy to change colors,
photos and Text.
Your Text Here
LOREM IPSUM DOLOR SIT AMET,
CU USU AGAM INTEGRE IMPEDIT.
Easy to change colors,
photos and Text.
Your Text Here
LOREM IPSUM DOLOR SIT AMET,
CU USU AGAM INTEGRE IMPEDIT.
Easy to change colors,
photos and Text.
Your Text Here
LOREM IPSUM DOLOR SIT AMET,
CU USU AGAM INTEGRE IMPEDIT.
52. Infographic Style
Content Here
You can simply impress your audience and add a unique zing and appeal
to your Presentations. Easy to change colors, photos and Text.
Content Here
You can simply impress your audience and add a unique zing and appeal
to your Presentations. Easy to change colors, photos and Text.
Content Here
You can simply impress your audience and add a unique zing and appeal
to your Presentations. Easy to change colors, photos and Text.
Content Here
You can simply impress your audience and add a unique zing and appeal
to your Presentations. Easy to change colors, photos and Text.
PowerPoint
Presentation
53. Infographic Style
Awesome
Presentation
Content Here
You can simply impress your audience and
add a unique zing and appeal to your
Presentations.
Content Here
You can simply impress your audience and
add a unique zing and appeal to your
Presentations.
Content Here
You can simply impress your audience and
add a unique zing and appeal to your
Presentations.
54. SAMPLE PPT
PRESENTATION
LOREM IPSUM DOLOR SIT AMET
Portfolio Presentation
Awesome
Presentation
ALLPPT Layout
Clean Text Slide for your Presentation
You can simply impress your audience and add a unique
zing and appeal to your Presentations. Get a modern
PowerPoint Presentation that is beautifully designed. I
hope and I believe that this Template will your Time,
Money and Reputation.
Contents
Title
Contents
Title
Contents
Title
55. Infographic Style
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Easy to change colors, photos.
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Easy to change colors, photos.
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Easy to change colors, photos.
Contents A
Contents B
Contents C
56. Infographic Style
Text Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Text Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Text Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Text Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Text Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Text Here
You can simply impress your audience and add a
unique zing and appeal to your Presentations.
Simple PowerPoint Presentation
57. You can simply impress your
audience and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text.
Get a modern PowerPoint
Presentation that is beautifully
designed.
Example Text : Get a modern
PowerPoint Presentation that is
beautifully designed.
Example Text : Get a modern
PowerPoint Presentation that is
beautifully designed.
Example Text : Get a modern
PowerPoint Presentation that is
beautifully designed.
You can simply impress your
audience and add a unique zing and
appeal to your Presentations. Easy
to change colors, photos and Text.
Get a modern PowerPoint
Presentation that is beautifully
designed.
Example Text : Get a modern
PowerPoint Presentation that is
beautifully designed.
Example Text : Get a modern
PowerPoint Presentation that is
beautifully designed.
Example Text : Get a modern
PowerPoint Presentation that is
beautifully designed.
Awesome Presentation
58. Infographic Style
0
5
10
15
20
25
30
35
40
45
50
Item 1 Item 2 Item 3
Contents _ A Contents _ B Contents _ C
Contents _ D Contents _E
Get a modern PowerPoint Presentation that is beautifully designed. I
hope and I believe that this Template will your Time, Money and
Reputation. Easy to change colors, photos and Text.
You can simply impress your audience and add a unique zing and
appeal to your Presentations. Get a modern PowerPoint Presentation
that is beautifully designed. I hope and I believe that this Template will
your Time, Money and Reputation. Easy to change colors, photos and
Text. Get a modern PowerPoint Presentation that is beautifully designed.
I hope and I believe that this Template will your Time, Money and
Reputation. Easy to change colors, photos and Text.
Contents Title
Contents
Title
Contents
Title
Contents
Title
59. Chart
Infographic
80%
80%
01
Get a modern PowerPoint Presentation that is
beautifully designed. You can simply impress your
audience and add a unique zing and appeal to your
Presentations.
Your Text Here
60%
02
Get a modern PowerPoint Presentation that is
beautifully designed. You can simply impress your
audience and add a unique zing and appeal to your
Presentations.
Your Text Here
40%
03
Get a modern PowerPoint Presentation that is
beautifully designed. You can simply impress your
audience and add a unique zing and appeal to your
Presentations.
Your Text Here
Get a modern PowerPoint Presentation that
is beautifully designed. I hope and I believe
that this Template will your Time, Money and
Reputation. Easy to change colors, photos
and Text. Get a modern PowerPoint
Presentation that is beautifully designed.
Your Content Here
Text
60. POWERPOINT
You can simply
impress your audience
and add a unique zing
and appeal to your
Presentations
CONTENTS
You can simply impress
your audience and add a
unique zing and appeal to
your Presentations.
TEXT
You can simply impress your
audience and add a unique zing
and appeal to your Presentations.
We Create Professional
Presentation Designed
61. Infographic Style
Get a modern PowerPoint Presentation
that is beautifully designed.
Contents Here
Get a modern PowerPoint Presentation
that is beautifully designed.
Contents Here
Get a modern PowerPoint Presentation
that is beautifully designed.
Contents Here
Get a modern PowerPoint Presentation
that is beautifully designed.
Contents Here
Get a modern PowerPoint Presentation
that is beautifully designed.
Contents Here
Get a modern PowerPoint Presentation
that is beautifully designed.
Contents Here
Contents
Here
Contents
Here
62. Infographic Style
A TITTLE B TITTLE C D
01 This text can be replaced with your own text. Text Here Text Text
02 - - - -
03 This text can be replaced with your own text. Text Here Text Text
04 - - - -
05 This text can be replaced with your own text. Text Here Text Text
06 - - - -
07 This text can be replaced with your own text. Text Here Text Text
You can simply impress your audience and add a unique zing and appeal to your Reports and Presentations with our Templates. This text can
be replaced with your own text. This text can be replaced with your own text. Get a modern PowerPoint Presentation that is beautifully
designed. Easy to change colors, photos and Text.
CONTENTS TITTLE
63. Portfolio Presentation
Simple Portfolio
Presentation
0
You can simply impress your audience and add a unique zing
and appeal to your Presentations. Get a modern PowerPoint
Presentation that is beautifully designed. Easy to change
colors, photos and Text. I hope and I believe that this
Template will your Time, Money and Reputation. Easy to
change colors, photos and Text.
64. Infographic Style
Content here
Get a modern PowerPoint Presentation
that is beautifully designed. hope and I
believe that this Template will your Time,
Money and Reputation.
SWOT
Content here
Get a modern PowerPoint Presentation
that is beautifully designed. hope and I
believe that this Template will your Time,
Money and Reputation.
Content here
Get a modern PowerPoint Presentation
that is beautifully designed. hope and I
believe that this Template will your Time,
Money and Reputation.
Content here
Get a modern PowerPoint Presentation
that is beautifully designed. hope and I
believe that this Template will your Time,
Money and Reputation.
65. Infographic Style
You can simply impress your audience and add
a unique zing and appeal to your Presentations.
Easy to change colors, photos and Text.
Your Text Here
You can simply impress your audience and add
a unique zing and appeal to your Presentations.
Easy to change colors, photos and Text.
Your Text Here
Easy to change
colors, photos
and Text.
Add Text
You can simply impress
your audience and add a
unique zing
Add Text
You can simply impress
your audience and add a
unique zing
Add Text
You can simply impress
your audience and add a
unique zing
Add Text
You can simply impress
your audience and add a
unique zing
Add Text
66. Column Style
You can simply impress your audience and add a unique zing and
appeal to your Presentations.
You can simply impress your audience and add a unique zing and appeal to your
Presentations. I hope and I believe that this Template will your Time, Money and
Reputation. You can simply impress your audience and add a unique zing and
appeal to your Presentations.
Get a modern PowerPoint Presentation that is beautifully designed.
You can simply impress your audience and add a unique zing and
appeal to your Presentations.
You can simply impress your audience and add a unique zing and appeal to your
Presentations. I hope and I believe that this Template will your Time, Money and
Reputation. You can simply impress your audience and add a unique zing and
appeal to your Presentations.
Get a modern PowerPoint Presentation that is beautifully designed.
67. Column
Style
You can simply impress your audience and add a unique zing and appeal to
your Presentations. Easy to change colors, photos and Text.
You can simply impress your audience and add a unique zing and appeal to your Presentations.
I hope and I believe that this Template will your Time, Money and Reputation. Get a modern
PowerPoint Presentation that is beautifully designed. Easy to change colors, photos and Text. I
hope and I believe that this Template will your Time, Money and Reputation. You can simply
impress your audience and add a unique zing and appeal to your Presentations. You can simply
impress your audience and add a unique zing and appeal to your Presentations. I hope and I
believe that this Template will your Time, Money and Reputation.
You can simply impress your audience and add a unique zing and appeal to your Presentations.
I hope and I believe that this Template will your Time, Money and Reputation.