Newborn screening involves laboratory tests, diagnostics, and therapeutic measures aimed at pre-symptomatically identifying infants affected by frequent, severe but usually treatable conditions. It has become one of the best accepted preventive pediatric procedures. The screening is a combination of taking a blood sample from infants 2-5 days after birth, testing the sample for various disorders like phenylketonuria, congenital hypothyroidism, and galactosemia, and reporting or recalling babies based on the results within 10 days for optimal health monitoring. Timely sample collection, shipping, laboratory work, and reporting of results is important for newborn screening.
Implementing wellness testing and preanesthetic testing in veterinary clinics can help detect underlying health problems, promote optimal medical care, and increase longevity. A study of dogs and cats found that 17% of cats and 23% of dogs in good health had clinically significant diseases. Preanesthetic testing with bloodwork, urinalysis, and ECG allows modification of anesthetic protocols and establishment of health baselines to identify abnormalities and ensure safe surgery. Wellness testing should start annually for adult dogs and cats aged 7 or older, or earlier for giant breeds, and can include blood chemistry panels and complete blood counts to monitor health over time.
Management of febrile young infants (0 3 monthsTaher Kagalwala
This document provides guidance on the management of febrile young infants aged 0-3 months. It discusses the importance of fever in this age group and the challenges in identifying infants with serious infections. It outlines recommendations for history taking, physical examination, investigations, use of clinical scoring systems, empirical antibiotic treatment, and other important considerations in the management of febrile young infants. The goal is to properly identify infants who need treatment for potential serious bacterial infections while avoiding overtreatment of others.
This document summarizes the pre-operative diagnosis, operative findings, and specimens collected for a patient undergoing an exploratory laparotomy for a suspected ovarian tumor. The 53-year-old patient presented with abdominal distension and discomfort and imaging showed a large pelvic mass arising from the left ovary. During surgery, an extensive left adnexal mass measuring 20x20x22cm was found involving the left pelvic side wall and colon. The uterus, right ovary, and both fallopian tubes were embedded in the mass. Specimens including the uterus with left ovarian tumor, omentum, and appendix were sent for histopathological examination.
1. The document provides information on examining patients in labor, including frequency of examinations, symbols used on partographs, and examples of completed partographs for different patients.
2. It includes details on vaginal examinations like cervical dilation, fetal position and heart rate, membrane status, and descent/moulding that should be recorded regularly during labor.
3. Examples of partographs show progression of labor over time for patients with details on vital signs and fetal/maternal status.
The document provides performance indicators for newborn and child health programs in the region. Key metrics include admission and outcome data for Special Newborn Care Units (SNCU) such as inborn vs outborn admissions, case types, birth weight categories and outcomes of discharged, referred, left against medical advice and deaths. Performance is also reported for Newborn Stabilization Units (NBSU), Newborn Care Corners (NBCC) and Nutritional Rehabilitation Centres (NRC). Charts show trends in child mortality and progress towards national and international targets. Programs reviewed include facility and community-based newborn and child care as well as quality mechanisms.
This document presents a case of a 23-year-old woman who presented with vaginal bleeding at 37 weeks gestation. Her biophysical profile showed non-reactive non-stress testing and an abnormal biophysical profile score of 2/10. She underwent an emergency cesarean section for non-reassuring biophysical profile. The case is used to discuss the components and physiological basis of the biophysical profile as a tool for assessing fetal well-being. Factors that can affect the different components of the biophysical profile like fetal movements, breathing, heart rate patterns on non-stress testing and amniotic fluid volume are also reviewed.
Intrapartum fetal surveillance involves monitoring the fetus during labor and delivery to ensure well-being and prevent acute hypoxia, which can cause neurological problems or stillbirth. Current monitoring methods include intermittent auscultation for low-risk pregnancies and electronic fetal monitoring, scalp blood sampling, and fetal stimulation tests for high-risk pregnancies. These methods aim to detect signs of hypoxia like changes in heart rate patterns, scalp pH levels, lactate levels, or a lack of heart rate acceleration in response to stimulation. Clinical assessments like checking for meconium or maternal fever are also important parts of surveillance. Effective monitoring requires integrating results from different tests and timely interventions when needed.
Newborn screening involves laboratory tests, diagnostics, and therapeutic measures aimed at pre-symptomatically identifying infants affected by frequent, severe but usually treatable conditions. It has become one of the best accepted preventive pediatric procedures. The screening is a combination of taking a blood sample from infants 2-5 days after birth, testing the sample for various disorders like phenylketonuria, congenital hypothyroidism, and galactosemia, and reporting or recalling babies based on the results within 10 days for optimal health monitoring. Timely sample collection, shipping, laboratory work, and reporting of results is important for newborn screening.
Implementing wellness testing and preanesthetic testing in veterinary clinics can help detect underlying health problems, promote optimal medical care, and increase longevity. A study of dogs and cats found that 17% of cats and 23% of dogs in good health had clinically significant diseases. Preanesthetic testing with bloodwork, urinalysis, and ECG allows modification of anesthetic protocols and establishment of health baselines to identify abnormalities and ensure safe surgery. Wellness testing should start annually for adult dogs and cats aged 7 or older, or earlier for giant breeds, and can include blood chemistry panels and complete blood counts to monitor health over time.
Management of febrile young infants (0 3 monthsTaher Kagalwala
This document provides guidance on the management of febrile young infants aged 0-3 months. It discusses the importance of fever in this age group and the challenges in identifying infants with serious infections. It outlines recommendations for history taking, physical examination, investigations, use of clinical scoring systems, empirical antibiotic treatment, and other important considerations in the management of febrile young infants. The goal is to properly identify infants who need treatment for potential serious bacterial infections while avoiding overtreatment of others.
This document summarizes the pre-operative diagnosis, operative findings, and specimens collected for a patient undergoing an exploratory laparotomy for a suspected ovarian tumor. The 53-year-old patient presented with abdominal distension and discomfort and imaging showed a large pelvic mass arising from the left ovary. During surgery, an extensive left adnexal mass measuring 20x20x22cm was found involving the left pelvic side wall and colon. The uterus, right ovary, and both fallopian tubes were embedded in the mass. Specimens including the uterus with left ovarian tumor, omentum, and appendix were sent for histopathological examination.
1. The document provides information on examining patients in labor, including frequency of examinations, symbols used on partographs, and examples of completed partographs for different patients.
2. It includes details on vaginal examinations like cervical dilation, fetal position and heart rate, membrane status, and descent/moulding that should be recorded regularly during labor.
3. Examples of partographs show progression of labor over time for patients with details on vital signs and fetal/maternal status.
The document provides performance indicators for newborn and child health programs in the region. Key metrics include admission and outcome data for Special Newborn Care Units (SNCU) such as inborn vs outborn admissions, case types, birth weight categories and outcomes of discharged, referred, left against medical advice and deaths. Performance is also reported for Newborn Stabilization Units (NBSU), Newborn Care Corners (NBCC) and Nutritional Rehabilitation Centres (NRC). Charts show trends in child mortality and progress towards national and international targets. Programs reviewed include facility and community-based newborn and child care as well as quality mechanisms.
This document presents a case of a 23-year-old woman who presented with vaginal bleeding at 37 weeks gestation. Her biophysical profile showed non-reactive non-stress testing and an abnormal biophysical profile score of 2/10. She underwent an emergency cesarean section for non-reassuring biophysical profile. The case is used to discuss the components and physiological basis of the biophysical profile as a tool for assessing fetal well-being. Factors that can affect the different components of the biophysical profile like fetal movements, breathing, heart rate patterns on non-stress testing and amniotic fluid volume are also reviewed.
Intrapartum fetal surveillance involves monitoring the fetus during labor and delivery to ensure well-being and prevent acute hypoxia, which can cause neurological problems or stillbirth. Current monitoring methods include intermittent auscultation for low-risk pregnancies and electronic fetal monitoring, scalp blood sampling, and fetal stimulation tests for high-risk pregnancies. These methods aim to detect signs of hypoxia like changes in heart rate patterns, scalp pH levels, lactate levels, or a lack of heart rate acceleration in response to stimulation. Clinical assessments like checking for meconium or maternal fever are also important parts of surveillance. Effective monitoring requires integrating results from different tests and timely interventions when needed.
This document outlines nursing care during the prenatal period. It discusses assessment of the pregnant woman including estimating due date, gestational age, obstetric history and physical assessment. Common diagnostic tests are described like ultrasound, amniocentesis, non-stress test and biophysical profile. The nursing care plan involves nutrition assessment, prenatal exercises, hygiene, travel advice, immunizations, managing discomforts, and regular prenatal visits. The goal is to monitor the health of the mother and fetus during pregnancy.
The document discusses various methods for antenatal assessment of fetal well-being, including clinical monitoring, biophysical monitoring, and biochemical monitoring. Clinical monitoring includes assessing maternal weight gain, symphysis-fundal height, and blood pressure. Biophysical monitoring tests include non-stress tests, contraction stress tests, biophysical profiles, fetal movement monitoring, and Doppler ultrasound assessments. Biochemical monitoring includes analyzing levels of alpha-fetoprotein, pregnancy-associated plasma protein A, and human chorionic gonadotropin from maternal blood samples to screen for fetal abnormalities. Together, these various monitoring methods aim to assess fetal health and identify risks in order to optimize delivery timing and decrease perinatal morbidity and mortality.
This document discusses induction of labor (IOL), including definitions, methods, indications, assessments, and complications. IOL is the artificial stimulation of uterine contractions and cervical changes to start labor before its spontaneous onset. Common methods include vaginal prostaglandins like misoprostol or mechanical techniques. Indications for IOL include post-dates, PROM, diabetes, suspected macrosomia, and others. Assessments before IOL include maternal and fetal well-being. Complications can include failure to progress, hyperstimulation, and pain. Special circumstances like previous cesarean are also addressed.
* These are Dr Gebresilassie's Amazing Notes.
* If you have feedback, contact me on https://t.me/Hanybal2021
* For further OBGYN notes - join us on telegram https://t.me/OBGYN_Note_Book
1. The document discusses fetal maturity and intrauterine growth restriction (IUGR), including definitions, clinical symptoms, signs, biochemical markers, and fetal maturity tests. Fetal maturity tests assess surfactant levels in amniotic fluid to predict risk of respiratory distress syndrome in newborns.
2. IUGR is defined as fetal weight below the 10th percentile and can be symmetric or asymmetric, early or late onset. It increases risks of complications. Management depends on gestational age and Doppler ultrasound results, with delivery generally between 34-37 weeks.
3. There is no worldwide consensus on specific management strategies for IUGR, and guidelines from organizations like RCOG and ACOG have some differences.
Approching children with poor weight gain.pptxFadhlyShariman
A 1 month 13 day old infant presented with poor weight gain since birth. The infant was born at term via SVD with a birth weight of 3.13kg. Initial weight loss and poor subsequent weight gain was noted. Investigations revealed metabolic acidosis and the infant required intubation. The case discusses evaluating growth patterns in infants, identifying causes of failure to thrive, and obtaining a thorough feeding history to determine the underlying cause of poor nutrition.
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.
An audit was conducted of outpatient inductions of labor (IOL) compared to inpatient IOLs between February and March 2010. Out of 65 total IOLs, 16 were conducted on an outpatient basis. Women who underwent outpatient IOL had similar fetal and maternal outcomes as those who had inpatient IOLs. Outpatient IOL allows low-risk women to stay with their families and keeps hospital beds available for higher-risk deliveries while maintaining normalcy of birth. The process involves community midwives offering membrane sweeps starting at 40 weeks and arranging outpatient IOL appointments.
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...Pradeep Garg
The document summarizes information on preterm labor and premature rupture of membranes. It defines preterm labor as regular contractions before 37 weeks of gestation that are associated with cervical changes. It notes the incidence of preterm labor is 8-10% and discusses definitions, magnitude, causes, risk factors, signs and symptoms, biological markers, cervical length screening, infections associated with preterm labor, and treatments including tocolytics and antenatal corticosteroids.
The document discusses key success factors for IVF laboratories. It emphasizes the importance of quality control, optimal staffing ratios, concentrating on each sample individually, and staff taking responsibility for correctly following protocols. Other factors discussed include stable culture conditions, air quality control, sufficient time per cycle, and teamwork. New technologies that can benefit IVF laboratories are also reviewed, such as time-lapse imaging, vitrification, preimplantation genetic screening, and 'omics' analyses.
The document discusses key success factors for IVF laboratories. It emphasizes the importance of quality control, optimal staffing ratios, concentrating on each sample individually, and staff taking responsibility for correctly following protocols. Other factors discussed include stable culture systems, air quality control, sufficient time per cycle, and teamwork. New technologies that can benefit IVF laboratories are also reviewed, such as time-lapse imaging, vitrification, preimplantation genetic screening, and 'omics' analyses.
This document discusses post-term pregnancy, which refers to pregnancies that go beyond 42 weeks gestation. It defines key terms like early, full, late, and post-term. Post-maturity syndrome affects 10-20% of pregnancies at 42 weeks and is characterized by wrinkled skin and wasting. Risk factors for post-term pregnancy include inaccurate dating, genetic factors, and previous post-term pregnancies. Complications include fetal distress, meconium aspiration, and increased need for induction and C-section. Management of post-term pregnancy involves induction of labor at or beyond 42 weeks or expectant management with fetal surveillance.
Endoscopy - conducting a start and stop time auditNHS Improvement
Presentation from NHS Improvement endoscopy workshop held at Ambassadors Hotel, London on 29 January 2013
http://www.improvement.nhs.uk/diagnostics/EndoscopyImprovement/Events.aspx
Conducting a start and stop time audit
Janet Bates, Endoscopy Department Digestive Diseases Centre
Brighton and Sussex University Hospitals NHS Trust
The document summarizes a surgical flow improvement initiative at the Salisbury VA Medical Center. It includes a list of team members, aim statements to decrease average room turnover time and increase lag time, metrics and targets. It describes the current and target state attributes. It outlines ideas for improving processes, assigns accountability, and tracks progress. Metrics after the event show room turnover time is decreasing but lag time is unchanged. Reflections note communication and getting anesthesia involved earlier could improve, and the pre-op board and supply closet changes helped efficiency.
The document discusses the partogram, which is a graph used to monitor labor. It should be used for all women in labor according to WHO guidelines. The partogram tracks cervical dilation, fetal position, contractions, and other parameters to allow early detection of abnormalities. Proper use of the partogram through adherence to monitoring principles can reduce complications of labor like obstructed labor and ruptured uterus, leading to lower maternal and infant mortality and morbidity rates.
Clinic psychosocial Case on Antenatal cum Post Natal CareYogesh Arora
A 27-year-old woman living in Chandigarh is a third gravida at 37+4 weeks pregnant with a history of 1 previous cesarean section and 2 abdominal surgeries. She has been admitted to the hospital for a planned vaginal birth after cesarean. Her previous pregnancies and medical history were unremarkable except for a history of abdominal tuberculosis 3 years ago. On examination, she is stable and her pregnancy is progressing normally.
To review and act on the results of the screening or special investigations done at the booking visit.
2. To perform the second assessment for risk factors.
If possible, all the results of the screening tests should be obtained at the first visit.
The document discusses various methods for evaluating fetal lung maturity prior to delivery, including quantifying pulmonary surfactant components in amniotic fluid. The lecithin/sphingomyelin (L/S) ratio is the most common approach, where an L/S ratio of 2.0 or greater indicates maturity. Phosphatidylglycerol (PG) appears at 35 weeks and further ensures lung maturity. Tests help determine the risks of respiratory distress syndrome and guide management decisions.
This document discusses various methods of antepartum fetal assessment and surveillance. It provides definitions for terms like fetal death, live birth, antepartum vs intrapartum stillbirths. It then summarizes some of the key findings from literature on causes of antepartum fetal deaths. Specifically, it indicates that approximately 30% of antepartum deaths are due to asphyxia, 30% due to maternal complications, 15% due to congenital abnormalities, and 20% have no clear etiology. The document advocates that antepartum fetal assessment can help identify at-risk fetuses and reduce antenatal fetal deaths. It describes various tests that may be used like non-stress tests, bi
This document outlines nursing care during the prenatal period. It discusses assessment of the pregnant woman including estimating due date, gestational age, obstetric history and physical assessment. Common diagnostic tests are described like ultrasound, amniocentesis, non-stress test and biophysical profile. The nursing care plan involves nutrition assessment, prenatal exercises, hygiene, travel advice, immunizations, managing discomforts, and regular prenatal visits. The goal is to monitor the health of the mother and fetus during pregnancy.
The document discusses various methods for antenatal assessment of fetal well-being, including clinical monitoring, biophysical monitoring, and biochemical monitoring. Clinical monitoring includes assessing maternal weight gain, symphysis-fundal height, and blood pressure. Biophysical monitoring tests include non-stress tests, contraction stress tests, biophysical profiles, fetal movement monitoring, and Doppler ultrasound assessments. Biochemical monitoring includes analyzing levels of alpha-fetoprotein, pregnancy-associated plasma protein A, and human chorionic gonadotropin from maternal blood samples to screen for fetal abnormalities. Together, these various monitoring methods aim to assess fetal health and identify risks in order to optimize delivery timing and decrease perinatal morbidity and mortality.
This document discusses induction of labor (IOL), including definitions, methods, indications, assessments, and complications. IOL is the artificial stimulation of uterine contractions and cervical changes to start labor before its spontaneous onset. Common methods include vaginal prostaglandins like misoprostol or mechanical techniques. Indications for IOL include post-dates, PROM, diabetes, suspected macrosomia, and others. Assessments before IOL include maternal and fetal well-being. Complications can include failure to progress, hyperstimulation, and pain. Special circumstances like previous cesarean are also addressed.
* These are Dr Gebresilassie's Amazing Notes.
* If you have feedback, contact me on https://t.me/Hanybal2021
* For further OBGYN notes - join us on telegram https://t.me/OBGYN_Note_Book
1. The document discusses fetal maturity and intrauterine growth restriction (IUGR), including definitions, clinical symptoms, signs, biochemical markers, and fetal maturity tests. Fetal maturity tests assess surfactant levels in amniotic fluid to predict risk of respiratory distress syndrome in newborns.
2. IUGR is defined as fetal weight below the 10th percentile and can be symmetric or asymmetric, early or late onset. It increases risks of complications. Management depends on gestational age and Doppler ultrasound results, with delivery generally between 34-37 weeks.
3. There is no worldwide consensus on specific management strategies for IUGR, and guidelines from organizations like RCOG and ACOG have some differences.
Approching children with poor weight gain.pptxFadhlyShariman
A 1 month 13 day old infant presented with poor weight gain since birth. The infant was born at term via SVD with a birth weight of 3.13kg. Initial weight loss and poor subsequent weight gain was noted. Investigations revealed metabolic acidosis and the infant required intubation. The case discusses evaluating growth patterns in infants, identifying causes of failure to thrive, and obtaining a thorough feeding history to determine the underlying cause of poor nutrition.
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.
An audit was conducted of outpatient inductions of labor (IOL) compared to inpatient IOLs between February and March 2010. Out of 65 total IOLs, 16 were conducted on an outpatient basis. Women who underwent outpatient IOL had similar fetal and maternal outcomes as those who had inpatient IOLs. Outpatient IOL allows low-risk women to stay with their families and keeps hospital beds available for higher-risk deliveries while maintaining normalcy of birth. The process involves community midwives offering membrane sweeps starting at 40 weeks and arranging outpatient IOL appointments.
Preterm Labour and Premature Rupture of Membranes Mob: 7289915430, www.drprad...Pradeep Garg
The document summarizes information on preterm labor and premature rupture of membranes. It defines preterm labor as regular contractions before 37 weeks of gestation that are associated with cervical changes. It notes the incidence of preterm labor is 8-10% and discusses definitions, magnitude, causes, risk factors, signs and symptoms, biological markers, cervical length screening, infections associated with preterm labor, and treatments including tocolytics and antenatal corticosteroids.
The document discusses key success factors for IVF laboratories. It emphasizes the importance of quality control, optimal staffing ratios, concentrating on each sample individually, and staff taking responsibility for correctly following protocols. Other factors discussed include stable culture conditions, air quality control, sufficient time per cycle, and teamwork. New technologies that can benefit IVF laboratories are also reviewed, such as time-lapse imaging, vitrification, preimplantation genetic screening, and 'omics' analyses.
The document discusses key success factors for IVF laboratories. It emphasizes the importance of quality control, optimal staffing ratios, concentrating on each sample individually, and staff taking responsibility for correctly following protocols. Other factors discussed include stable culture systems, air quality control, sufficient time per cycle, and teamwork. New technologies that can benefit IVF laboratories are also reviewed, such as time-lapse imaging, vitrification, preimplantation genetic screening, and 'omics' analyses.
This document discusses post-term pregnancy, which refers to pregnancies that go beyond 42 weeks gestation. It defines key terms like early, full, late, and post-term. Post-maturity syndrome affects 10-20% of pregnancies at 42 weeks and is characterized by wrinkled skin and wasting. Risk factors for post-term pregnancy include inaccurate dating, genetic factors, and previous post-term pregnancies. Complications include fetal distress, meconium aspiration, and increased need for induction and C-section. Management of post-term pregnancy involves induction of labor at or beyond 42 weeks or expectant management with fetal surveillance.
Endoscopy - conducting a start and stop time auditNHS Improvement
Presentation from NHS Improvement endoscopy workshop held at Ambassadors Hotel, London on 29 January 2013
http://www.improvement.nhs.uk/diagnostics/EndoscopyImprovement/Events.aspx
Conducting a start and stop time audit
Janet Bates, Endoscopy Department Digestive Diseases Centre
Brighton and Sussex University Hospitals NHS Trust
The document summarizes a surgical flow improvement initiative at the Salisbury VA Medical Center. It includes a list of team members, aim statements to decrease average room turnover time and increase lag time, metrics and targets. It describes the current and target state attributes. It outlines ideas for improving processes, assigns accountability, and tracks progress. Metrics after the event show room turnover time is decreasing but lag time is unchanged. Reflections note communication and getting anesthesia involved earlier could improve, and the pre-op board and supply closet changes helped efficiency.
The document discusses the partogram, which is a graph used to monitor labor. It should be used for all women in labor according to WHO guidelines. The partogram tracks cervical dilation, fetal position, contractions, and other parameters to allow early detection of abnormalities. Proper use of the partogram through adherence to monitoring principles can reduce complications of labor like obstructed labor and ruptured uterus, leading to lower maternal and infant mortality and morbidity rates.
Clinic psychosocial Case on Antenatal cum Post Natal CareYogesh Arora
A 27-year-old woman living in Chandigarh is a third gravida at 37+4 weeks pregnant with a history of 1 previous cesarean section and 2 abdominal surgeries. She has been admitted to the hospital for a planned vaginal birth after cesarean. Her previous pregnancies and medical history were unremarkable except for a history of abdominal tuberculosis 3 years ago. On examination, she is stable and her pregnancy is progressing normally.
To review and act on the results of the screening or special investigations done at the booking visit.
2. To perform the second assessment for risk factors.
If possible, all the results of the screening tests should be obtained at the first visit.
The document discusses various methods for evaluating fetal lung maturity prior to delivery, including quantifying pulmonary surfactant components in amniotic fluid. The lecithin/sphingomyelin (L/S) ratio is the most common approach, where an L/S ratio of 2.0 or greater indicates maturity. Phosphatidylglycerol (PG) appears at 35 weeks and further ensures lung maturity. Tests help determine the risks of respiratory distress syndrome and guide management decisions.
This document discusses various methods of antepartum fetal assessment and surveillance. It provides definitions for terms like fetal death, live birth, antepartum vs intrapartum stillbirths. It then summarizes some of the key findings from literature on causes of antepartum fetal deaths. Specifically, it indicates that approximately 30% of antepartum deaths are due to asphyxia, 30% due to maternal complications, 15% due to congenital abnormalities, and 20% have no clear etiology. The document advocates that antepartum fetal assessment can help identify at-risk fetuses and reduce antenatal fetal deaths. It describes various tests that may be used like non-stress tests, bi
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1. Describe the organisation of respiratory center
2. Describe the nervous control of inspiration and respiratory rhythm
3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
5. Explain the role of Hering-Breur inflation reflex in regulation of inspiration
6. Explain the role of central chemoreceptors in regulation of respiration
7. Explain the role of peripheral chemoreceptors in regulation of respiration
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2. Chapter 36, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 13, Human Physiology by Lauralee Sherwood, 9th edition
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Mercurius is named after the roman god mercurius, the god of trade and science. The planet mercurius is named after the same god. Mercurius is sometimes called hydrargyrum, means ‘watery silver’. Its shine and colour are very similar to silver, but mercury is a fluid at room temperatures. The name quick silver is a translation of hydrargyrum, where the word quick describes its tendency to scatter away in all directions.
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Decision to delivery interval in emergency caesarean section
1. Decision to delivery interval in
emergency caesarean Section
February 2018
Bushra Saeed SPR
Obstetrics and Gynaecology Department
Princess Alexandra Hospital
Harlow, Essex, United Kingdom
1
2. A monthly audit looking at the decision to delivery
times of category 1 ,2 and 3 caesarean sections
2
Introduction
3. Based on original National Sentinel Caesarean Section
Audit, RCOG 2001
Auditable standards recommended:
Urgency
Indication
Condition of FHR
Result of FBS
‘Decision to delivery time’ interval,
ICU/NICU/SCBU admission
Apgar scores
3
Introduction (2)
4. A retrospective case note review of all Cat 1, 2, 3
EMCS that were performed in the Unit between 1st
and 28th Feb ‘18
Data was collected from:
1. Completed audit proforma
2. COSMIC Electronic record
3. The Birth Register
4
Methodology
6. Method of delivery Number %
SVD 372,836 59.4
Instrumental 79,806 12.7
LSCS 174,720 27.8
6
National Statistics-Delivery Episodes
from HES, 2016-17
7. Method of delivery Number
Total number of
deliveries
( LW 236 +BU 44) 280
EMCS 51
ELCS 46
7
PAH Deliveries during February
2018
8. 8
PAH EMCS - Dec
No.
Cat 1 11
Cat 2 31
Cat 3 9
TOTAL 51
9. Immediate threat to the life of the mother or fetus
Needs to de done within 30 minutes from decision
Examples: - Prolonged fetal bradycardia,
- Cord prolapse
- Uterine rupture
- APH/abruption
- Pathological CTG
9
Category 1
10. Maternal or fetal compromise that is not
immediately life-threatening
Needs to done within 75 minutes from
decision to avoid any deterioration of maternal
or fetal condition
Examples:
- Suspicious CTG with slow
progress in labour
- Failure to progress in labour
10
Category 2
11. Represents the mother who needs early delivery but there is no
maternal or fetal compromise
Ideally <24 hours
Example: - Previous c/section or breech
presentation in labour but
planned for elective caesarean
section
- Failed IOL
11
Category 3
12. Time interval in mins12
Time to Cat 1 sections
Numberofsections
0
1
2
3
4
5
6
7
≤6 <30
13. 13
Indication of Cat 1 sections
Number of sections
Unsuccessful Forceps 6
Placental abruption 1
Abnormal CTG 1
Fetal Bradycardia 1
Station -2 at Full dilatation 1
14. Time interval in mins14
Time to Cat 2 sections
0
5
10
15
20
25
<75 <200
Numberofsections
15. Failure to progress 17
Suspicious CTG 4
Undiagnosed Breech in labour 1
Booked ELCS , Contracting 2
Severe PET 1
Twins + Breech+SROM 1
Scar tenderness in VBAC 1
Declined Instrument at full dilatation 1
Brow Presentation 1
Not Documented 2
15
Indication of Cat 2
16. Time interval in hrs16
Time to Cat 3 sections
0
1
2
3
4
5
6
<10 <24
Numberofsections
18. Compliance %
Cat 1 (≤30 mins) 100
Cat 2 (≤75 mins) 70.9
Cat 3 (≤24 hrs) 100
18
Dec % Compliance with standard
19. Majority of caesarean sections are done within
recommended time frames
Need to gather more information - reasons for time delay
Majority of proformas not filled, most filled in incorrectly
Needs to use updated proformas and include indication for
caesarean section
19
Conclusions