1. The document provides guidance on managing COVID-19 in pregnancy and delivery. It finds that COVID-19 infection does not generally increase risks of miscarriage, birth defects, or indicate termination, though it may increase risks of adverse pregnancy outcomes like preterm birth.
2. It recommends minimizing antenatal contacts by reducing unnecessary visits, using telemedicine, and limiting visitors. It outlines home monitoring, hygiene practices, and warning signs requiring medical attention.
3. For pregnant women with suspected or confirmed COVID-19, it provides an algorithm for assessment, testing, isolation, and in-hospital management depending on symptoms and obstetric needs.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Muniswaran Ganeshan, Maternal Fetal Medicine Consultant at the Women and Children’s Hospital Kuala Lumpur, Ministry of Health Malaysia.
Prevention of Mother to Child Transmission of HIV 2018Helen Madamba
Babies of pregnant women living with HIV can be born free of HIV infection. HIV counselling and testing is the gateway to diagnosis, treatment, care and support. Healthcare services need to provide enabling environments to support and empower women living with HIV and their children, to increase HIV knowledge and reduce stigma and discrimination.
Webinar Series on COVID-19 vaccine: Jointly organized by Malaysian Society of Infection Control and Infectious Diseases (MyICID) & Institute for Clinical Research (ICR), NIH
Speaker: Dr. Muniswaran Ganeshan, Maternal Fetal Medicine Consultant at the Women and Children’s Hospital Kuala Lumpur, Ministry of Health Malaysia.
Prevention of Mother to Child Transmission of HIV 2018Helen Madamba
Babies of pregnant women living with HIV can be born free of HIV infection. HIV counselling and testing is the gateway to diagnosis, treatment, care and support. Healthcare services need to provide enabling environments to support and empower women living with HIV and their children, to increase HIV knowledge and reduce stigma and discrimination.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Surrogacy Regulation Act 2021 has been notified in the Gazette on 25th December 2021 and there are important implications for all who practice surrogacy in India both for patients and clinics and ART Banks.
A lecture orientation to first year medical students, this lecture was lifted from the PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
NIPT (Non-Invasive Prenatal Testing) otherwise known as NIPD (Non-Invasive Prenatal Diagnosis) is used to analyze the cell-free fetal DNA which is circulated in maternal blood.
Uterus Transplantation Utx (obstetric and gynecology) D.A.B.M
Is the surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased.
As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile.
This phenomenon is known as Absolute Uterine Factor Infertility (AUFI).
Uterine transplant is a potential treatment for this form of infertility.
Uterus is a dynamic, complex organ. It is hugely blood-flow dependent.
More than 116,000 Number of men, women and children on the national transplant waiting list as of August 2017.
33,611 transplants were performed in 2016.
20 people die each day waiting for a transplant.
every 10 minutes another person is added to the waiting list.
Surrogacy Regulation Act 2021 has been notified in the Gazette on 25th December 2021 and there are important implications for all who practice surrogacy in India both for patients and clinics and ART Banks.
A lecture orientation to first year medical students, this lecture was lifted from the PIDSOG HANDBOOK: A GUIDANCE FOR CLINICIANS ON THE OBSTETRIC MANAGEMENT OF PATIENTS WITH CORONAVIRUS DISEASE 2019 (COVID-19). APRIL 2020.
COVID-19 affects different people in different ways. Information about the virus and COVID-19 continues to accrue, and interim guidance by multiple organizations is constantly being updated and expanded.
*I hope its help you all for preparation part 1 exam for MRCOG & MOG and your daily job.Good Luck May ALLAH bless our work and study,Good luck to all.dont forget to pray to ALLAH.if i wrong please correct me..process of learning..
NIPT (Non-Invasive Prenatal Testing) otherwise known as NIPD (Non-Invasive Prenatal Diagnosis) is used to analyze the cell-free fetal DNA which is circulated in maternal blood.
CARE OF PREGNANT WOMEN DURING COVID 19 PANDEMICkhushboo singh
Pregnant women do not appear more likely to contact the infection than the general population.
Pregnancy itself alters the body’s immune system and response to viral infections in general, which can occasionally be related to more severe symptoms and this will be the same for COVID-19.
GOVT. OF INDIA GUIDELINES 2014ON STANDARDS OF FEMALE STERILISATION, Dr. Sh...Lifecare Centre
GOVT. OF INDIA GUIDELINES 2014ON STANDARDS OF FEMALE STERILISATION, Dr. Sharda Jain , Female sterilisation new, Dr. Sharda Jain , sterlisation , contraceptive
Family planning class for MBBS students based on Park textbook including details on MTP, abortion, Family planning infrastructure and delivery systems in India and National Family Welfare Programme.
Abortion remains a topical issue, globally, primary because it affects one of the fundamental rights. This presentation is not for debate, but simply highlights the South African laws and regulations as they relate to Termination of Pregnancy (TOP), and the different methods available.
Slideshow on Unexplained infertility presented in 2009 - treatment options, diagnosis and more. Assisted reproductive technologies and its details
Discussion of IUI, IVF and other infertility treatment options
STUDY TO ASSESS THE KNOWLEDGE OF GOVERNMENT PRIMARY SCHOOL TEACHERS REGARDING...Kailash Nagar
STUDY TO ASSESS THE KNOWLEDGE OF GOVERNMENT PRIMARY SCHOOL TEACHERS REGARDING ATTENTION DEFICIT HYPER ACTIVITY DISORDER IN SELECTED GOVERNMENT PRIMARY SCHOOL OF NADIAD CITY”
Comparative Study of Teaching Approach Nursing Simulation Vs Group Discussion...Kailash Nagar
Comparative Study of Teaching Approach Nursing Simulation Vs Group Discussion on Respiratory Assessment in Terms of Knowledge and Critical Thinking Abilities Among Nursing Students
Perception and Behavioural Outcome towards COVID-19 Vaccine among Students an...Kailash Nagar
ntroduction: Perception and behaviour towards corona vaccine among peoples in India was poor due to some side effects and negative media publicity in primary phases of vaccination. India has developed two types of vaccine (Covaxin and Covishield). During primary phase of corona vaccine we don’t have appropriate research and literature, about side effects and how far vaccine is reliable that why due so some minor side effect and negative media publicity peoples are very scared to take vaccine. So few peoples were started denial get vaccinated. The researcher wan to explore the positivity through the research result to reduce the negative mindset of the peoples toward corona vaccine, Because in India few peoples has fear to take vaccine against corona due to negative media publicity and scared of side effect.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
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NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
COVID management in pregnancy and safe delivery
1. 1
COVID MANAGEMENT IN PREGNANCY AND SAFE
DELIVERY
MODULE FOR THIRD COVID WAVE CAPACITY BUILDING FOR MEDICAL OFFICERS
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
2. 2
EFFECT ON FOETUS
There are currently no data suggesting an increased risk of miscarriage or
early pregnancy loss in relation to COVID
There is no evidence currently that the virus is teratogenic.
Long term data is awaited.
COVID infection is currently not an indication for Medical termination of
pregnancy.
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
3. 3
EFFECT ON HEALTH OF THE PREGNANT WOMAN
Most (>90 percent) infected pregnant women recover without need for
hospitalization.
Compared with pregnant women without COVID-19, those with symptomatic
COVID-19 are at increased risk of adverse pregnancy outcomes, including
admission to the ICU, iatrogenic preterm birth, pre-eclampsia-like symptoms,
Caesarean section and death.
4. 4
EFFECT ON NEWBORNS OF
COVID-19 POSITIVE MOTHERS
Most (over 95 percent) of newborns of COVID-19 positive mothers have been
in good condition at birth.
However, Covid-19 in pregnancy increases the chances of preterm birth,
increasing the possibility of hospitalization for the neonate
5. 5
ANTE-NATAL CARE FOR NON-COVID PREGNANT
WOMEN IN CURRENT PANDEMIC
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
6. 6
ANC FOR NON-COVID PREGNANT WOMEN
Reduce antenatal contact for ANC visits to minimum needed. Postpone unnecessary visits
and utilize telemedicine.
Advice
Vaccination (TT and COVID)
Diet
Quarantine
Avoid travel
Limit visitors
Hygiene: Infection Prevention (masks, social distancing, handwashing) and Shielding
Antenatal Advice to Pregnant HCP
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
7. 7
MINIMIZE ANTENATAL CONTACT
WHO prescribed minimum visits at 12, 20, 28 and 36 weeks to be followed in
uncomplicated cases
Reduce/Postpone/increase interval between follow up visits/scans
Shorten Duration of consultation
Limit Visitors in hospital
Individualize patients who require frequent review
Continue to provide ANC as per established protocol to High Risk Pregnancy
Telemedicine/Videoconferencing when direct observation is not required
Virtual/Online Consultation with Counselors/Fetal Medicine/Mental Health
Experts
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
8. 8
HOME CARE/MONITORING
Blood Pressure
Maternal weight
Daily fetal movement count
Urine Checks for Albumin/Sugar
Home blood glucose monitoring if feasible and required for the mother
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
9. 9
HYGIENE
Wash hands frequently
Social distancing and avoid direct physical contact as much as possible
Avoid touching nose/mouth/face
Cough/Sneeze into elbows
Stay Home and void visiting crowded places
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
10. 10
TRAVEL & QUARANTINE
Avoid non essential travel
Home quarantine as per national protocol
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
11. 11
WARNING SYMPTOMS
Cough
Fever, weakness,bodyache
Headache
Worsening shortness of breath
Inability to tolerate oral hydration or needed medications
Persistent pleuritic chest pain
New-onset confusion or lethargy
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
12. 12
WARNING SYMPTOMS (CONTD.)
Obstetrical complaints, such as preterm contractions, vaginal bleeding, or
decreased fetal movement
Tachypnea
Unremitting fever (greater than 39 °C) despite antipyretics
Oxygen saturation less than 95% either at rest or on exertion
Cyanotic lips, face, or fingertips
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
13. 13
SHIELDING
To protect clinically vulnerable women like mothers with heart disease,
immuno-compromised status
How?
Minimize interaction with others and avoid non essential contact
Stay at home at least for 12 weeks
Remote medical assistance
Family members role in shielding
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
14. 14
ANTENATAL ADVICE FOR PREGNANT HCP
Vaccination, if not yet vaccinated
Work from home when possible
Choice should be offered to pregnant HCPs: whether to work in direct patient
contact or otherwise,
For less than 28 weeks pregnant
Practice social distancing and use precautions appropriately while facing
direct patient contact
For more than 28 weeks pregnant
Should avoid direct patient contact and work from home
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
15. 15
ANC FOR SUSPECTED / CONFIRMED PATIENTS
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
16. 16
PREGNANCY WITH SUSPECT COVID INFECTION
Avoid panicking under all circumstances
Immediately contact care giver if severe symptoms develop
Do not attend routine clinic but special clinic area for triage and screening
area with minimum number of attendants in private transport with a view to
minimize contact with others and reduce risk of transmission
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
17. 17
ALGORITHM FOR MANAGEMENT OF PREGNANT WOMEN
Antenatal contact categories:
0. Asymptomatic from hotspot
1. With suspected COVID infection
2. With confirmed COVID infection
Asymptomatic
Symptomatic
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
18. 18
ASYMPTOMATIC
Pregnant women residing in cluster/containment area or from hotspot districts
presenting in labor or likely to deliver in next 5 days should be tested even if
asymptomatic.
All such asymptomatic pregnant women should be tested in the health facility
where they are expected to deliver, hence testing facilities to be made in all
such centers or arrangements should be in place for safe & appropriate
transfer of samples to testing facilities.
No patient should be sent to testing center for lack of testing (swab) facility at
the center they are supposed to deliver
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
19. 19
ASSESSMENT IN TRIAGE
Fever > 380 C (100.40 f)
Cough
Shortness of breath
Diarrhea
History of travel in affected country in last 14 days
Close contact with lab confirmed COVID positive case ( <1 m for more than
15 min, living together, direct contact with body fluids)
Give the woman a face mask and keep a distance of at least 1 meter
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
20. 20
ASSESSMENT
Infection risk by ID
specialist or physician
Obstetric issue
(labor/emergency)
High Yes Need admission
Low No • Isolation at home for 14
days
• Clinical self monitoring
• If symptoms persist test
for COVID infection
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
21. 21
ADMISSION (SUSPECTED, NOT IN LABOUR)
IPC practices to be followed
Transfer the patient to isolation room
Donning appropriate PPE by HCP
Testing
Do not delay Obstetric Care if testing is pending, need to do both on
urgent basis
NP/OP Swab samples to be taken
Till Results awaited treat all as COVID positive
Multidisciplinary approach
(Obstetrician/Neonatologist/Anesthesiologist/physician)
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
22. 22
ASYMPTOMATIC (CONFIRMED)
COVID positive pregnant woman
Asymptomatic
No co-morbidities
No obstetric emergency/labour
Should be kept on home isolation with for 2 weeks with telemedicine follow-up
at 1 week and then fetal monitoring for growth and well being to be done after
the period of isolation
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
23. 23
ANC FOR SUSPECTED OR CONFIRMED COVID
Routine ANC appointments, OGTT, growth scans are to be delayed until the
period of isolation prescribed.
No additional tests to be performed and if pregnant woman has any concern
for fetal well being, she should contact obstetric team
COVID care as per protocol
Additional care if any complication arise during the period of isolation whether
medical or obstetric
Counseling for potential risk or adverse pregnancy outcomes can be
discussed
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
24. 24
MANAGEMENT OF CONFIRMED SYMPTOMATIC CASES
Hospitalize in dedicated area based on severity of symptoms and need for labor & delivery (ward/labor
room/OB-OT/ICU)
Continue maternal surveillance
ICU admission criteria
Systolic BP<90 or >160 mmHg
Diastolic BP>100 mmHg
HR<50 or >120/min
RR<10 or >30/min
Room air spo2<94%
Oliguria urine output <35ml/hr for 2 hours
Confusion/agitation/unresponsive
Poor QSOFA score
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
25. 25
MANAGEMENT OF CONFIRMED SYMPTOMATIC CASES (CONTD.)
Severe failure criteria:
Consider C section delivery in consultation with treating physician
Septic shock
Acute organ failure
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
26. 26
MATERNAL SURVEILLANCE: CONFIRMED SYMPTOMATIC
Temperature, pulse, BP, respiratory rate (3-4 times a day)
Chest imaging (x-ray) (Only if clinically needed with abdomen shield after
consent)
Oxygen therapy to maintain spo2 > 94%
Encourage oral hydration and restrict IV fluids especially in cardiac conditions
Antipyretic therapy (for maternal comfort, to mitigate fetal effects of maternal
hyperthermia)
Screen for other viral/bacterial infection/s
Consider IV antiviral/antibacterial/antiviral treatment
Consider thromboprophylaxis
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
27. 27
FETAL SURVEILLANCE: CONFIRMED SYMPTOMATIC
FHR, daily FM count
Women at risk of preterm birth (24-34 weeks) can be considered for AN
corticosteroids provided there is no clinical evidence of infection (maybe of
benefit in mild COVID infection)
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
28. 28
ANC: SUSPECTED /CONFIRMED COVID INFECTION
Recovery
Little is known about natural history of COVID in pregnant women
If patient recovers in first trimester: consider mid trimester anatomical
ultrasound
If patient recovers in later half of pregnancy: consider USG growth
assessment 2 weeks after infection
www.gujhealth.gujarat.gov.in Health and Family Welfare Dept., Govt. of Gujarat
29. 29
TAKE HOME MESSAGE
Pregnant women should follow the same recommendation for avoiding
exposure to coinfection as the nonpregnant population.
Teleconferencing/videoconferencing is key for quality care in a pandemic
Triage based on symptom severity and need for obstetric emergency
Multidisciplinary approach to management of COVID-suspected/confirmed
pregnant women
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MANAGEMENT DURING INTRANATAL CARE FOR
PREGNANT WOMEN WITH COVID-19
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OBJECTIVES
Preparation of isolation LR and OT
Labour triage
Management in labour
Management of neonate
Postpartum care
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PRINCIPLES OF MANAGEMENT OF PATIENT IN LABOUR
Provide client-centred, respectful skilled care and support
Inform MDT: consultant obstetrician, consultant anaesthetist, paediatrician,
nurse in charge and infection control team.
Manage in designated COVID Area
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COVID LABOUR ROOM COMPLEX
TRIAGE AND DELIVERY
ROOM
RECOVERY ROOM
OPERATION
THEATRE
ISOLATION AREA IN NICU
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ISOLATION LABOUR ROOM
Separate delivery room of adequate size where triage and labour can be
managed
Donning and doffing area
Labour table, portable light, emergency drugs tray, EFM, delivery tray, baby
tray, oxygen, disposables tray
Keep the room free from any unnecessary items which could act as infected
fomites
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ISOLATION LABOUR ROOM
Personnel: obstetrician, nurse, paediatrician, cleaning staff
Keep anaesthetist on stand by
Baby corner 2 mtr away from labour table
PPE for 4
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ISOLATION OT
Equipment: OT table, light,
anaesthesia trolley cum ventilator,
multipara monitor, gases
Drugs, surgical instruments,
disposables, electrocautery
OT personnel: obstetrician,
assistant, staff sister, circulating
nurse, anaesthetist, paediatrician,
cleaning staff
PPE for 6-7 persons
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ISOLATION RECOVERY AREA
Equipment for monitoring:
Oxygen
Multipara monitor
Ventilator
Drugs
Staff: obstetrician, nursing staff, anaesthetist, cleaning staff
Drugs and disposables
PPE for 4
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LABOUR TRIAGE: RECEIVING THE PATIENT
Prehospital notification i.e. call in advance
Private transport or ambulance
Receiving staff in PPE
Give mask to patient
Reception and triage in the same room as labour and delivery.
General and obstetric assessment
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LABOUR TRIAGE: GENERAL ASSESSMENT
Asymptomatic or pre-symptomatic infection – positive test for sars-cov-2
but no symptoms.
Mild illness – Signs and symptoms (eg. fever, cough, sore throat, malaise, headache, muscle
pain) without shortness of breath, dyspnoea, or abnormal chest imaging.
Moderate illness – evidence of lower respiratory disease by clinical assessment or imaging
and a saturation of oxygen (SaO2) >93 percent on room air at sea level.
ICU ADMISSION
Severe illness – RR>30/minute, SaO2 ≤93 percent on room air at sea level, ratio of arterial
partial pressure of oxygen to fraction of inspired oxygen (PaO2/FiO2) <300, or lung infiltrates
>50 percent
Critical illness – Respiratory failure, septic shock, and/or multiple organ dysfunction.
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OBSTETRIC ASSESSMENT AND DECISION MAKING
Is she in labour?
Check fetal status
Assess for high risk factors
Induction of labor: only for obstetric indications using standard
interventions or medical reasons as per physician
Mode of delivery:
Should not be influenced by the presence of COVID-19, unless the
woman’s respiratory condition demands urgent intervention for birth as
guided by the physician.
Patients with severe or critical illness have
high chance of preterm birth and CS
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MANAGEMENT IN LABOUR
Monitor vital signs, spO2: aim to keep oxygen saturation more than 94%,
titrating oxygen therapy accordingly
Restrict IV fluids:
Labour management as per routine protocol.
Delayed cord clamping
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BIRTH COMPANION
Preferably should not be allowed in COVID LR
Video call with companion may be arranged for
If entry is allowed, companion should be screened for fever and other
symptoms before entering the premises
Wear a cloth face cover or face mask
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CESAREAN SECTION
Regional anesthesia preferred
Experienced obstetrician to perform the operation
Electrocoagulation is an aerosol generating procedure. Use minimum settings
and suction out smoke
Surgical difficulties: due to face shield and multiple layers, visibility and tactile
sensation compromised.
The risk of COVID transmission by blood products has not been documented
and is unclear at present
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POSTPARTUM CARE
For patients who are asymptomatic, postpartum maternal monitoring is similar
to that in non-COVID patients
Patients who are symptomatic covid - treat them as per protocol
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NEONATAL ASSESSMENT
The infants of mothers with COVID are considered COVID suspects, and they
should be tested and isolated from other healthy infants
When to test: 2 samples, one at birth & second after 48 hrs
Transport neonate to isolation NICU in a closed chamber
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CO-LOCATION OF MOTHER AND BABY
If both mother and neonate test positive, rooming in can be permitted
Healthy neonates should preferably be cared for by family member not in
contact with mother or other suspected/proven case
Mother can express milk after washing hands and breasts, and while wearing
mask. This expressed milk can be fed to her own baby without pasteurization.
Sick neonates should be managed in an isolation area in NICU
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BREAST FEEDING
No evidence of viral shedding in breast milk
Risk of transmission through close contact with mother is present
Risks and benefits must be explained to the mother
Frequent handwashing, respiratory hygiene, cleaning of all surfaces,
minimum touching of the neonate
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NEONATAL VACCINATION
Follow routine immunization policy in healthy neonates born to mothers with
suspected/proven COVID infection.
In neonates with suspected/proven infection, vaccination should be completed
before discharge from the hospital as per existing policy.
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PERMANENT AND REVERSIBLE CONTRACEPTION
Temporary: LARC (long-acting reversible contraceptive) post-placental and
post partum IUCD preferred
After a vaginal birth sterilization is being elective procedure, should be
deferred.
Progesterone only pills also an option for bridging
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DISCHARGE
Early discharge in postpartum period
24 hours for VD, 48-72 hrs for CS
Postpartum assessments including wound and blood pressure checks with
telehealth
Visit may be planned at 12 weeks
Psychological support
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SUMMARY
Management of labour is not altered in women giving birth during in women
with confirmed COVID
Infected women, especially those who develop pneumonia, appear to have an
increased frequency of preterm birth and caesarean delivery.
Infants born to mothers with known COVID-19 are COVID-19 suspects and
should be tested, isolated from other healthy infants,
To minimize direct contact, ideally, the infant is fed expressed breast milk by
another caregiver until the mother has recovered or proven uninfected
Recommended ICP should be followed
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Editor's Notes
Hello! I am Dr. Shirish Toshniwal an ……
As I understand, obstetrics & gynaecology is …….
There is no available evidence to suggest….
……not an indication for MTP
Most ……
Having said that…….
This underscores the importance ......s
An important component of care of women during pregnancy are antenatal visits wherein she is ......
It is advised to reduce…..
In uncomplicated cases, WHO ….
Of course one size does not fit all ……
Reduced number of visits does not mean reduced quality of care & home care ……
Like speakers before me & the ones after me, I would also like to stress upon COVID appropriate behaviour
Skip
The typical warning symptoms of COVID infection we all know so well
In addition to the typical ones, obstetrical complaints …….
Skip
Vaccination
[Read]
The important point to stress here ….
[Slide 18]
…..in labor or likely to deliver….
Testing in the health facility they are expected to deliver
Coming to pregnant women who may or may not be symptomatic but are with suspected COVID infection.
As I said before, such patients should not be seen ……
Testing
Slide 18
Skip
ICU admission criteria are based on vital parameters measurement
Quick Sequential Organ Failure Assessment Score
[Read]
Mostly management similar to that of non pregnant symptomatic COVID positive patient ….
CXR
O2 therapy
Steroids
Skip
[Read}
Specific details of intranatal care are beyond scope for discussion here