This document discusses cord prolapse and vasa previa. It defines cord prolapse as the abnormal descent of the umbilical cord by the side of the presenting part. It notes the different types of cord prolapse and lists various risk factors. The document discusses diagnosis and management approaches for cord presentation and prolapse, which depends on factors like whether the baby is alive or dead and ability to perform immediate vaginal delivery. It also summarizes vasa previa, defined as fetal blood vessels lying over the internal os, and recommends ultrasound diagnosis and emergency c-section for confirmed cases with bleeding.
Abnormalities of placenta and cord obgjagan _jaggi
Has a velamentous insertion of the cord (the umbilical cord inserts abnormally into the fetal membranes, instead of the center of the placenta) Has placenta previa (a low-lying placenta that covers part or all of the cervix) or certain other placental abnormalities.
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.
Abnormalities of placenta and cord obgjagan _jaggi
Has a velamentous insertion of the cord (the umbilical cord inserts abnormally into the fetal membranes, instead of the center of the placenta) Has placenta previa (a low-lying placenta that covers part or all of the cervix) or certain other placental abnormalities.
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.
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
Hi, myself Dipanwita Maity ,' Clinical Instructor ' of 'Shova Rani Nursing College ' (A unit of KPC Medical College & Hospital , Jadavpur , Kolkata ) , am sharing my PPT on "Cord Prolapse"( Subject: Midwifery & Obstetrical Nursing ) with all of you .
types of breech
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How many patients does case series should have In comparison to case reports.pdfpubrica101
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Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
4. TYPES
• Occult prolapse –
The cord is placed by
the side of the
presenting part and is
not felt by fingers
5. • Cord presentation –
The cord is slipped down
below the presenting
part and is felt laying in
the intact bag of
membranes.
6. • Cord prolapse –
The cord is laying
inside the vagina or
outside the vulva
following rupture of
membranes.
7. INCIDENCE:
• 1:300 deliveries.
• Mostly confined to parous women
• Incidence is reduce with the increased use
of elective CS in noncephalic presentations.
8. ETIOLOGY:
• Anything which interference with perfect
adaptation of the presenting part to the
lower uterine segment, disturbing the ball
valve action may favor cord prolapse.
9. The following are the associated factors:
1. Malpresentation – the most common being
Transverse lie
presentation (5-10%)
10. Breech(3%)especially with flexed leg or
footling and compound (10%)
Breech presentation
Flexed leg or Footling
Compound
presentation
14. 7. Iatrogenic -
8. Stabilizing induction
Low rupture of the
membrane
Manual rotation of
the head
External cephalic
version
15. DIAGNOSIS:
Occult prolapse
• Continuous
electronic fetal
monitoring
Cord
presentation
• Feeling the
pulsation of the
cord through the
intact
membranes
Cord prolapse
• The cord is
palpated
directly by the
fingers and it’s
pulsation can be
felt if the fetus is
alive
• Auscultation for
FHS
• USG for cardiac
movements
16. EARLY DETECTION:
1. Internal
examination
(Whenever the
membrane rupture
prematurely or
during labor in all
cases of
malpresentation)
2. Surgical
induction
(everything ready
for CS)
- Uterine
contraction is
initiated by oxytocin
- If the head is not
engaged prior to
low rupture of the
membranes.
-Internal
examination both
before and after
amniotomy should
be done
3. One
should
exclude cord
presentation
or cord
prolapse, in
unexplained
fetal distress
during labor
17. MANAGEMENT:
• Cord Presentation:
Once the diagnosis is
made ,no attempt should
be made to replace the
cord
If immediate vaginal
delivery is not possible
or contraindicated,
cesarean section is the
best method of delivery
A rare occasion watchful
expectancy can be adopted till
full dilatation of cervix.
Delivery can be completed by
forceps or breech extraction
18. Baby alive Baby dead
CS delivery
(Treatment of
choice
Immediate
vaginal
delivery not
possible
Immediate safe
vaginal delivery
possible
First aid Definite management
Vertex
Forceps or
Ventouse
Breech
Breach extraction in
expert hands only
•Conform with USG
•Wait for spontaneous
delivery or
•Destructive operation
•Baby living or dead
•Maturity of the baby
•Cervical dilatation
Cesarean section
Cord prolapse
19. • Bladder filling
• To lift presenting part of the cord
• Posture – exaggerated and elevated Sims
position or Trendelenburg or knee chest
position – to refer to an equipped hospital
20. •To replace the cord into vagina to
minimize vasospasm due to irritation
Baby dead:
• Labor is allowed to
proceed awaiting spontaneous
delivery
21. PROGNOSIS
Maternal
• The fetus is at risk of
anoxia from the moment
cord is prolapsed
• The hazards due to the
fetus is more in vertex
presentation.
• Perinatal mortality is
about 15-50%
Fetal
• The maternal risks are
incidental due to
emergency operative
delivery, especially through
the vaginal route.
• Operative delivery involves
the risk of anesthesia, blood
loss and infection
23. MEANING:
The term vasa previa is derived from the Latin
word;
“vasa’’ :-means vessel
“previa’’ :- pre- before
Via- way
so vasa previa means vessels lie before the
baby in the birth canal and in the way.
24. • The term vasa previa is used when a fetal
blood vessel lies over the os, in front of the
presenting part.
• This occurs when fetal vessels from a
velamentous insertion of the cord or to a
succenturiate lobe cross the area of the
internal os to the placenta.
27. MANAGEMENT
• Management depends on
Fetal
gestational
age
Severity of
bleeding
Persistence
or
recurrence
of bleeding
Availabilities
of
appropriate
neonatal
care facilities
28. A Patient with
confirmed vasa
previa
-Needs antenatal admission at 28-32weeks
of gestation
-Antenatal corticosteroids should be given
for fetal lungs maturity
B Any case with
bleeding vasa
previa
-Delivery should be done by emergency
cesarean section
-Intrapartum diagnosis of vasa previa, needs
expeditious delivery
C A case of confirmed
vasa previa
-At term (≥ 37weeks) should be delivered by
elective cesarean section prior to onset of
labor
D Neonatal blood
transfusion