The document provides guidance on managing seizure disorders in pregnancy. It outlines steps to take if a pregnant friend has a convulsive episode such as placing her in a left lateral position and protecting her from injury. It recommends transporting her to the hospital while maintaining sedation if needed. At the hospital, the airway, breathing and circulation should be assessed and appropriate treatment given. Investigations should be performed to determine the cause, with eclampsia, epilepsy and other conditions considered. Magnesium sulfate is the anticonvulsant of choice to manage eclampsia seizures, with phenytoin as a second line option. Hypertension should be treated and obstetric management including delivery considerations are outlined.
this is a short presentation on eclampsia, i have made it for my class presentation, it includes definition, pathophysiology,clinical features and management.. i hope u vil like it
this is a short presentation on eclampsia, i have made it for my class presentation, it includes definition, pathophysiology,clinical features and management.. i hope u vil like it
Eclampsia labor room protocol by dr alka mukherjee dr apurva mukherjee nag...alka mukherjee
Eclampsia is a uniquely pregnancy-related disorder that manifests as new onset of generalized tonic colonic seizures. It typically occurs after 20 weeks of concluded gestation, although it may occur sooner with plural gestations or molar pregnancies, and may additionally occur in the 6-week postpartum window. It represents the severe end of the preeclampsia spectrum. Preeclampsia spectrum includes symptoms of the central nervous system (CNS), for example, severe headaches or vision changes, and may involve hepatic abnormalities (such as elevated liver transaminases with right upper quadrant/epigastric discomfort), elevated blood pressures, and also may include thrombocytopenia, renal abnormalities, and pulmonary edema. In developed countries, resultant maternal mortality may be as high as 1.8%, and in the developing countries, it may be as high as 14%.The etiology of the disorder remains elusive. The placenta seems to have a prime role in its etiology. An increase in placental mass, as in plural pregnancies, increases the risk for the preeclampsia-eclampsia spectrum, as does placental edema that occurs in pregnancies complicated by fetal hydrops. Molar pregnancies that impact placental architecture also have a higher risk of the complication. In the developed countries, the incidence of preeclampsia has been described to be between 1.5 to 10 cases in 100,000 deliveries. The condition is more prevalent in the developing countries. The risk factors of preeclampsia are similar to those of preeclampsia and include nulliparity, non-white, low socioeconomic backgrounds, plural pregnancies, and extremes of maternal age. Additionally, it is associated with and an array of maternal medical conditions such as chronic hypertension, chronic renal disease, and autoimmune disorders. Obesity and maternal diabetes are also recognized as increasingly important etiologies. Fetal conditions such as fetal hydrops have been associated with preeclampsia. Women known to have preeclampsia may develop eclamptic, generalized, tonic-clonic seizures that conclude with no persistent neurologic deficit, meaning they do not deserve diagnostic evaluation beyond that performed for preeclampsia. A preeclampsia workup would include an evaluation of renal function, liver function, complete blood count, and imaging of fetoplacental unit. Obstetric ultrasound imaging of the fetus includes an assessment of fetal growth as well as fetal health (biophysical profile and as indicated umbilical artery cord Doppler studies), including fetal heart rate stri Clinical monitoring for placental abruption is heightened and is maternal monitoring for evolving complications such as pulmonary edema or renal dysfunctionNeuroimaging should be considered if:
• There are persistent neurologic deficits
• The loss of consciousness is prolonged
• The onset of seizures is 48 hours beyond delivery
• An eclamptic seizure occurs before 20 weeks
• Recurrent seizures in spite of adequate magnesium sulfate
Eclampsia labor room protocol by dr alka mukherjee dr apurva mukherjee nag...alka mukherjee
Eclampsia is a uniquely pregnancy-related disorder that manifests as new onset of generalized tonic colonic seizures. It typically occurs after 20 weeks of concluded gestation, although it may occur sooner with plural gestations or molar pregnancies, and may additionally occur in the 6-week postpartum window. It represents the severe end of the preeclampsia spectrum. Preeclampsia spectrum includes symptoms of the central nervous system (CNS), for example, severe headaches or vision changes, and may involve hepatic abnormalities (such as elevated liver transaminases with right upper quadrant/epigastric discomfort), elevated blood pressures, and also may include thrombocytopenia, renal abnormalities, and pulmonary edema. In developed countries, resultant maternal mortality may be as high as 1.8%, and in the developing countries, it may be as high as 14%.The etiology of the disorder remains elusive. The placenta seems to have a prime role in its etiology. An increase in placental mass, as in plural pregnancies, increases the risk for the preeclampsia-eclampsia spectrum, as does placental edema that occurs in pregnancies complicated by fetal hydrops. Molar pregnancies that impact placental architecture also have a higher risk of the complication. In the developed countries, the incidence of preeclampsia has been described to be between 1.5 to 10 cases in 100,000 deliveries. The condition is more prevalent in the developing countries. The risk factors of preeclampsia are similar to those of preeclampsia and include nulliparity, non-white, low socioeconomic backgrounds, plural pregnancies, and extremes of maternal age. Additionally, it is associated with and an array of maternal medical conditions such as chronic hypertension, chronic renal disease, and autoimmune disorders. Obesity and maternal diabetes are also recognized as increasingly important etiologies. Fetal conditions such as fetal hydrops have been associated with preeclampsia. Women known to have preeclampsia may develop eclamptic, generalized, tonic-clonic seizures that conclude with no persistent neurologic deficit, meaning they do not deserve diagnostic evaluation beyond that performed for preeclampsia. A preeclampsia workup would include an evaluation of renal function, liver function, complete blood count, and imaging of fetoplacental unit. Obstetric ultrasound imaging of the fetus includes an assessment of fetal growth as well as fetal health (biophysical profile and as indicated umbilical artery cord Doppler studies), including fetal heart rate stri Clinical monitoring for placental abruption is heightened and is maternal monitoring for evolving complications such as pulmonary edema or renal dysfunctionNeuroimaging should be considered if:
• There are persistent neurologic deficits
• The loss of consciousness is prolonged
• The onset of seizures is 48 hours beyond delivery
• An eclamptic seizure occurs before 20 weeks
• Recurrent seizures in spite of adequate magnesium sulfate
This File Explain The Management About Pre-eclampsia & Eclampsia , Which are Emergency Condition with Woman who is Pregnant and it Need Immediate Management .
The use of algorithms & emergency boxes in obstetric emergencyWafaa Benjamin
obstetric hemorrhage Is the major cause of maternal mortality globally.
Substandard management identified as a contributor for maternal mortality in UK in 80% of the cases.
Is the major cause of mortality in Egypt ,according to the last Egyptian Maternal Mortality Report in 2001.
So we need to Work in a team, Do all needed steps, In the proper sequence of the steps,
competent emergency team should have Knowledge ,Skills , Attitude & exposed to regular Labor Ward drills.
Ready available Algorithms & Emergency Boxes are found to be helpful in emergency situations.
Eclampsia is conclusive and convulsive phase of a wide spectrum disease pre eclampsia. More conclusive RCT are required to assert the efficacy of biomarkers as a sensitive predictability of eclampsia.
Similar to Dr. RKJ~ Management of Seizure Disorders in Pregnengy~ in pregnency (20)
Welcome to TechSoup New Member Orientation and Q&A (May 2024).pdfTechSoup
In this webinar you will learn how your organization can access TechSoup's wide variety of product discount and donation programs. From hardware to software, we'll give you a tour of the tools available to help your nonprofit with productivity, collaboration, financial management, donor tracking, security, and more.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
Ethnobotany and Ethnopharmacology:
Ethnobotany in herbal drug evaluation,
Impact of Ethnobotany in traditional medicine,
New development in herbals,
Bio-prospecting tools for drug discovery,
Role of Ethnopharmacology in drug evaluation,
Reverse Pharmacology.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
3. On Reaching The Hospital CALL FOR HELP - duty obstetric & anaesthetic registrars; senior midwife INFORM CONSULTANTS - obstetrician & anaesthetist on call Is it safe to approach the patient? - consider hazards around patient that will affect your safety Prevent maternal injury during convulsion – place in semi-prone position in a railed cot ,in an isolated room. • Airway: (a) Assess (b) Maintain patency (c) Apply oxygen • Breathing: (a) Assess and also auscultate Lungs for any aspiration. (b) Protect airway (c) Ventilate as required • Circulation: (a) Evaluate pulse & BP If absent, initiate CPR and call arrest team (b) Left lateral tilt (c) Secure IV access with a 16-18 gauge needle as soon as safely possible Attach pulse oximeter, ECG & automatic BP monitors Urinary catheter - hourly urinometer readings Fluid input / output chart (discussed later)
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5. Cont..Approach 3. Principles of fluid balance: BEWARE: Iatrogenic fluid overload is the main cause of maternal death in Pre-eclampsia/Eclampsia Maintenance fluids should be given as crystalloid but additional fluid (colloid) may be necessary prior to vasodilatation to prevent maternal hypotension and fetal compromise. Consideration should also be given to correcting hypovolaemia in women with oliguria 1. Accurate recording of fluid balance (including delivery and postpartum blood loss, input/output deficit) 2. Maintenance crystalloid infusion (R/L) - 85 ml/hour, or urinary output in preceding hour plus 30 ml 3. Selective colloid expansion - prior to pharmacological vasodilatation; oliguria with low CVP 4. Diuretics - only for women with confirmed pulmonary oedema 5. Selective monitoring of CVP- for patients of severe hypertension and reduced Urinary output. NB: Normally, fluid should not exceed 2litres in 24 hours.
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9. MAGNESIUM SULPHATE is the anticonvulsant drug of choice MOA: (a) Reduces Motor end plate sensitivity to Ach hence reducing neuromuscular irritability. (b) Blocks Neuronal calcium Influx. (c) Dilates Cerebral and uterine vessels. (d) Prostacyclin production is increased with inhibition of platelet activation. Regimen: (Intravenous regimen) Loading Dose: 4 g IV over 10-15 minutes Add 8 ml of 50% MgSO4 solution to 12 ml of N Saline = 4 g in 20 ml = 20% solution Maintenance 1 g per hour Dose: Add 25 g MgSO4 (50 ml) to 250 ml N Saline 1 g MgSO4 = 12 ml per hour IV 1 g/hour is infused for 24 hours after last fit provided that: • respiratory rate > 16 breaths/minute • urine output > 25 ml/hour, and • patellar reflexes are present Administer via infusion pump A. SEIZURE MANGEMENT:
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12. Magnesium Toxicity: (a)Urine output < 100 ml in 4 hours: If no clinical signs of magnesium toxicity, decrease rate to 0.5 g/hour Review overall management with attention to fluid balance and blood loss (b)Absent patellar reflexes: Stop MgSO4 infusion until reflexes return (c)Respiratory depression: (i) Stop MgSO4 infusion (ii)Give oxygen via facemask and place in recovery position because of impaired level of consciousness (iii)Monitor closely (d)Respiratory arrest: Stop MgSO4 infusion Give IV Calcium gluconate Intubate and ventilate immediately (e)Cardiac arrest: Commence CPR Stop MgSO4 infusion Give IV Calcium gluconate Intubate and ventilate immediately If antenatal, immediate delivery Antidote: 10% Calcium gluconate 10 ml IV over
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14. (b)Labetalol : If BP still uncontrolled, Labetalol 50 mg IV slowly; if necessary repeat after 20 minutes or IV infusion of 200 mg in 200 ml N Saline, starting at 40 mg/hour, increasing dose at 1/2 hourly intervals as required to a maximum of 160 mg/hour If blood pressure does not respond to the above, discuss with senior renal physicians and anaesthetists. (c)Nifedipine: Oral route is safer and as effective as sublingual route Dose: 10 mg orally. Monitor FH with CTG NOTE: An interaction between nifedipine and magnesium sulphate has been reported to produce profound muscle weakness, maternal hypotension and fetal distress.
15. C. OBSTETRICAL MANAGEMENT A. Initiate steroids if gestation 34 weeks: Inj. Betamethasone 12mg IM two doses 24hour apart. B. If patient in labour: (a)A.R.M. : to cut short second stage of labour (b)C.S. : In case of Obstetrical indications C. If patient not in labour, and fits controlled or not, but baby alive: (a) Termination by A.R.M. or C.S. D. If Patient not in labour, and fits controlled or not, but baby dead: (a) Wait for spontanous expulsion.