This document discusses early pregnancy bleeding and differentials, implantation in early pregnancy, ultrasound findings, miscarriage definitions and management options, ectopic pregnancy risk factors and treatments, and recurrent miscarriage evaluation. It defines miscarriage as loss of intrauterine pregnancy before 24 weeks and describes expectant, medical, and surgical management options. For ectopic pregnancies, it notes fallopian tubes as the most common site and lists risk factors. Treatment may involve methotrexate or laparoscopic salpingectomy.
This slide presents some Gynecologic diseases and disorders in females and their proper management. It is a third-year course for those wishing to major PA or Nursing.
This slide presents some Gynecologic diseases and disorders in females and their proper management. It is a third-year course for those wishing to major PA or Nursing.
Ectopic Pregnancy - Obstetrical & Gynaecological NursingJaice Mary Joy
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Ectopic Pregnancy - Obstetrical & Gynaecological NursingJaice Mary Joy
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Ksshzhz
Nsjkskskskskkosososszh
Smkakaiaioasizjhz
Shhzhsghwiwooaoajzhz
Skaklaoasiosisiis
Dmndjdiskswmw
A
S
Smmskdkdkwm
Sa
S
Smsmd
D
D
D
D
S
W
Er
R
Ff
F
F
C
D
D
D
D
D
D
Dd
D
Ff
Gg
G
T
Dbdbdnd
S
Smsmdme
S
Smajsm
S
Amansjsmsms
Ss
S
Ssmjxjd
R
Javshzu
Nsndidieiwowwosijsjdxhdueisjhhshshshshdhxhyxyddhebeheieksjdbdbdhshaujsbxd
Mewkjeejjdj jfisieksmdnei
Dmsnsj
Mejsjdnd
Nxnxnejwksj
Soapsodidkeowowwow
Mdkeeoeodjfnmd
Dmeleooerkrjdjd
Kddkncncjfjfjfjru
The
T
The only way I could see the light was through a hole and I was looking for a way out and it looked so weird I was just wondering what was
I’m trying out and it looks so strange but it was just weird I I was like oh I didn’t see that you had to be in a different place I I thought you had a new phone and and then you were like I was
Ioioooo
NO1 Uk Black Magic Specialist Expert In Sahiwal, Okara, Hafizabad, Mandi Bah...Amil Baba Dawood bangali
Contact with Dawood Bhai Just call on +92322-6382012 and we'll help you. We'll solve all your problems within 12 to 24 hours and with 101% guarantee and with astrology systematic. If you want to take any personal or professional advice then also you can call us on +92322-6382012 , ONLINE LOVE PROBLEM & Other all types of Daily Life Problem's.Then CALL or WHATSAPP us on +92322-6382012 and Get all these problems solutions here by Amil Baba DAWOOD BANGALI
#vashikaranspecialist #astrologer #palmistry #amliyaat #taweez #manpasandshadi #horoscope #spiritual #lovelife #lovespell #marriagespell#aamilbabainpakistan #amilbabainkarachi #powerfullblackmagicspell #kalajadumantarspecialist #realamilbaba #AmilbabainPakistan #astrologerincanada #astrologerindubai #lovespellsmaster #kalajaduspecialist #lovespellsthatwork #aamilbabainlahore#blackmagicformarriage #aamilbaba #kalajadu #kalailam #taweez #wazifaexpert #jadumantar #vashikaranspecialist #astrologer #palmistry #amliyaat #taweez #manpasandshadi #horoscope #spiritual #lovelife #lovespell #marriagespell#aamilbabainpakistan #amilbabainkarachi #powerfullblackmagicspell #kalajadumantarspecialist #realamilbaba #AmilbabainPakistan #astrologerincanada #astrologerindubai #lovespellsmaster #kalajaduspecialist #lovespellsthatwork #aamilbabainlahore #blackmagicforlove #blackmagicformarriage #aamilbaba #kalajadu #kalailam #taweez #wazifaexpert #jadumantar #vashikaranspecialist #astrologer #palmistry #amliyaat #taweez #manpasandshadi #horoscope #spiritual #lovelife #lovespell #marriagespell#aamilbabainpakistan #amilbabainkarachi #powerfullblackmagicspell #kalajadumantarspecialist #realamilbaba #AmilbabainPakistan #astrologerincanada #astrologerindubai #lovespellsmaster #kalajaduspecialist #lovespellsthatwork #aamilbabainlahore #Amilbabainuk #amilbabainspain #amilbabaindubai #Amilbabainnorway #amilbabainkrachi #amilbabainlahore #amilbabaingujranwalan #amilbabainislamabad
how can I sell pi coins after successfully completing KYCDOT TECH
Pi coins is not launched yet in any exchange 💱 this means it's not swappable, the current pi displaying on coin market cap is the iou version of pi. And you can learn all about that on my previous post.
RIGHT NOW THE ONLY WAY you can sell pi coins is through verified pi merchants. A pi merchant is someone who buys pi coins and resell them to exchanges and crypto whales. Looking forward to hold massive quantities of pi coins before the mainnet launch.
This is because pi network is not doing any pre-sale or ico offerings, the only way to get my coins is from buying from miners. So a merchant facilitates the transactions between the miners and these exchanges holding pi.
I and my friends has sold more than 6000 pi coins successfully with this method. I will be happy to share the contact of my personal pi merchant. The one i trade with, if you have your own merchant you can trade with them. For those who are new.
Message: @Pi_vendor_247 on telegram.
I wouldn't advise you selling all percentage of the pi coins. Leave at least a before so its a win win during open mainnet. Have a nice day pioneers ♥️
#kyc #mainnet #picoins #pi #sellpi #piwallet
#pinetwork
What price will pi network be listed on exchangesDOT TECH
The rate at which pi will be listed is practically unknown. But due to speculations surrounding it the predicted rate is tends to be from 30$ — 50$.
So if you are interested in selling your pi network coins at a high rate tho. Or you can't wait till the mainnet launch in 2026. You can easily trade your pi coins with a merchant.
A merchant is someone who buys pi coins from miners and resell them to Investors looking forward to hold massive quantities till mainnet launch.
I will leave the telegram contact of my personal pi vendor to trade with.
@Pi_vendor_247
how to sell pi coins effectively (from 50 - 100k pi)DOT TECH
Anywhere in the world, including Africa, America, and Europe, you can sell Pi Network Coins online and receive cash through online payment options.
Pi has not yet been launched on any exchange because we are currently using the confined Mainnet. The planned launch date for Pi is June 28, 2026.
Reselling to investors who want to hold until the mainnet launch in 2026 is currently the sole way to sell.
Consequently, right now. All you need to do is select the right pi network provider.
Who is a pi merchant?
An individual who buys coins from miners on the pi network and resells them to investors hoping to hang onto them until the mainnet is launched is known as a pi merchant.
debuts.
I'll provide you the Telegram username
@Pi_vendor_247
how to sell pi coins at high rate quickly.DOT TECH
Where can I sell my pi coins at a high rate.
Pi is not launched yet on any exchange. But one can easily sell his or her pi coins to investors who want to hold pi till mainnet launch.
This means crypto whales want to hold pi. And you can get a good rate for selling pi to them. I will leave the telegram contact of my personal pi vendor below.
A vendor is someone who buys from a miner and resell it to a holder or crypto whale.
Here is the telegram contact of my vendor:
@Pi_vendor_247
Latino Buying Power - May 2024 Presentation for Latino CaucusDanay Escanaverino
Unlock the potential of Latino Buying Power with this in-depth SlideShare presentation. Explore how the Latino consumer market is transforming the American economy, driven by their significant buying power, entrepreneurial contributions, and growing influence across various sectors.
**Key Sections Covered:**
1. **Economic Impact:** Understand the profound economic impact of Latino consumers on the U.S. economy. Discover how their increasing purchasing power is fueling growth in key industries and contributing to national economic prosperity.
2. **Buying Power:** Dive into detailed analyses of Latino buying power, including its growth trends, key drivers, and projections for the future. Learn how this influential group’s spending habits are shaping market dynamics and creating opportunities for businesses.
3. **Entrepreneurial Contributions:** Explore the entrepreneurial spirit within the Latino community. Examine how Latino-owned businesses are thriving and contributing to job creation, innovation, and economic diversification.
4. **Workforce Statistics:** Gain insights into the role of Latino workers in the American labor market. Review statistics on employment rates, occupational distribution, and the economic contributions of Latino professionals across various industries.
5. **Media Consumption:** Understand the media consumption habits of Latino audiences. Discover their preferences for digital platforms, television, radio, and social media. Learn how these consumption patterns are influencing advertising strategies and media content.
6. **Education:** Examine the educational achievements and challenges within the Latino community. Review statistics on enrollment, graduation rates, and fields of study. Understand the implications of education on economic mobility and workforce readiness.
7. **Home Ownership:** Explore trends in Latino home ownership. Understand the factors driving home buying decisions, the challenges faced by Latino homeowners, and the impact of home ownership on community stability and economic growth.
This SlideShare provides valuable insights for marketers, business owners, policymakers, and anyone interested in the economic influence of the Latino community. By understanding the various facets of Latino buying power, you can effectively engage with this dynamic and growing market segment.
Equip yourself with the knowledge to leverage Latino buying power, tap into their entrepreneurial spirit, and connect with their unique cultural and consumer preferences. Drive your business success by embracing the economic potential of Latino consumers.
**Keywords:** Latino buying power, economic impact, entrepreneurial contributions, workforce statistics, media consumption, education, home ownership, Latino market, Hispanic buying power, Latino purchasing power.
Even tho Pi network is not listed on any exchange yet.
Buying/Selling or investing in pi network coins is highly possible through the help of vendors. You can buy from vendors[ buy directly from the pi network miners and resell it]. I will leave the telegram contact of my personal vendor.
@Pi_vendor_247
Resume
• Real GDP growth slowed down due to problems with access to electricity caused by the destruction of manoeuvrable electricity generation by Russian drones and missiles.
• Exports and imports continued growing due to better logistics through the Ukrainian sea corridor and road. Polish farmers and drivers stopped blocking borders at the end of April.
• In April, both the Tax and Customs Services over-executed the revenue plan. Moreover, the NBU transferred twice the planned profit to the budget.
• The European side approved the Ukraine Plan, which the government adopted to determine indicators for the Ukraine Facility. That approval will allow Ukraine to receive a EUR 1.9 bn loan from the EU in May. At the same time, the EU provided Ukraine with a EUR 1.5 bn loan in April, as the government fulfilled five indicators under the Ukraine Plan.
• The USA has finally approved an aid package for Ukraine, which includes USD 7.8 bn of budget support; however, the conditions and timing of the assistance are still unknown.
• As in March, annual consumer inflation amounted to 3.2% yoy in April.
• At the April monetary policy meeting, the NBU again reduced the key policy rate from 14.5% to 13.5% per annum.
• Over the past four weeks, the hryvnia exchange rate has stabilized in the UAH 39-40 per USD range.
what is the future of Pi Network currency.DOT TECH
The future of the Pi cryptocurrency is uncertain, and its success will depend on several factors. Pi is a relatively new cryptocurrency that aims to be user-friendly and accessible to a wide audience. Here are a few key considerations for its future:
Message: @Pi_vendor_247 on telegram if u want to sell PI COINS.
1. Mainnet Launch: As of my last knowledge update in January 2022, Pi was still in the testnet phase. Its success will depend on a successful transition to a mainnet, where actual transactions can take place.
2. User Adoption: Pi's success will be closely tied to user adoption. The more users who join the network and actively participate, the stronger the ecosystem can become.
3. Utility and Use Cases: For a cryptocurrency to thrive, it must offer utility and practical use cases. The Pi team has talked about various applications, including peer-to-peer transactions, smart contracts, and more. The development and implementation of these features will be essential.
4. Regulatory Environment: The regulatory environment for cryptocurrencies is evolving globally. How Pi navigates and complies with regulations in various jurisdictions will significantly impact its future.
5. Technology Development: The Pi network must continue to develop and improve its technology, security, and scalability to compete with established cryptocurrencies.
6. Community Engagement: The Pi community plays a critical role in its future. Engaged users can help build trust and grow the network.
7. Monetization and Sustainability: The Pi team's monetization strategy, such as fees, partnerships, or other revenue sources, will affect its long-term sustainability.
It's essential to approach Pi or any new cryptocurrency with caution and conduct due diligence. Cryptocurrency investments involve risks, and potential rewards can be uncertain. The success and future of Pi will depend on the collective efforts of its team, community, and the broader cryptocurrency market dynamics. It's advisable to stay updated on Pi's development and follow any updates from the official Pi Network website or announcements from the team.
Poonawalla Fincorp and IndusInd Bank Introduce New Co-Branded Credit Cardnickysharmasucks
The unveiling of the IndusInd Bank Poonawalla Fincorp eLITE RuPay Platinum Credit Card marks a notable milestone in the Indian financial landscape, showcasing a successful partnership between two leading institutions, Poonawalla Fincorp and IndusInd Bank. This co-branded credit card not only offers users a plethora of benefits but also reflects a commitment to innovation and adaptation. With a focus on providing value-driven and customer-centric solutions, this launch represents more than just a new product—it signifies a step towards redefining the banking experience for millions. Promising convenience, rewards, and a touch of luxury in everyday financial transactions, this collaboration aims to cater to the evolving needs of customers and set new standards in the industry.
US Economic Outlook - Being Decided - M Capital Group August 2021.pdfpchutichetpong
The U.S. economy is continuing its impressive recovery from the COVID-19 pandemic and not slowing down despite re-occurring bumps. The U.S. savings rate reached its highest ever recorded level at 34% in April 2020 and Americans seem ready to spend. The sectors that had been hurt the most by the pandemic specifically reduced consumer spending, like retail, leisure, hospitality, and travel, are now experiencing massive growth in revenue and job openings.
Could this growth lead to a “Roaring Twenties”? As quickly as the U.S. economy contracted, experiencing a 9.1% drop in economic output relative to the business cycle in Q2 2020, the largest in recorded history, it has rebounded beyond expectations. This surprising growth seems to be fueled by the U.S. government’s aggressive fiscal and monetary policies, and an increase in consumer spending as mobility restrictions are lifted. Unemployment rates between June 2020 and June 2021 decreased by 5.2%, while the demand for labor is increasing, coupled with increasing wages to incentivize Americans to rejoin the labor force. Schools and businesses are expected to fully reopen soon. In parallel, vaccination rates across the country and the world continue to rise, with full vaccination rates of 50% and 14.8% respectively.
However, it is not completely smooth sailing from here. According to M Capital Group, the main risks that threaten the continued growth of the U.S. economy are inflation, unsettled trade relations, and another wave of Covid-19 mutations that could shut down the world again. Have we learned from the past year of COVID-19 and adapted our economy accordingly?
“In order for the U.S. economy to continue growing, whether there is another wave or not, the U.S. needs to focus on diversifying supply chains, supporting business investment, and maintaining consumer spending,” says Grace Feeley, a research analyst at M Capital Group.
While the economic indicators are positive, the risks are coming closer to manifesting and threatening such growth. The new variants spreading throughout the world, Delta, Lambda, and Gamma, are vaccine-resistant and muddy the predictions made about the economy and health of the country. These variants bring back the feeling of uncertainty that has wreaked havoc not only on the stock market but the mindset of people around the world. MCG provides unique insight on how to mitigate these risks to possibly ensure a bright economic future.
3. Implantation and the establishment of pregnancy
The CL
supports the
pregnancy for
approximately
8 weeks
4. A transvaginal ultrasound scan
(TVUSS) can detect an early
intrauterine gestational sac, the first
sign of a normal pregnancy, at
around 5 weeks’ gestation.
A few days later a circular yolk sac can
be seen within the gestational sac
and the embryonic fetus can usually be
identified after 5.5 weeks’ gestation.
The fetal heartbeat may be visible as
early as 6 weeks’ gestation.
9. UK— Loss of an intra uterine pregnancy before 24 weeks of
gestation
WHO— Expulsion of fetus or embryo weighing 500g or less and
The gestational limit is less than22 weeks of pregnancy
The ending of the fetus before the fetus becomes viable
[depends on the NICU(26wks)]
10. • Chromosomal abnormalities. M.c 50% of cases
• Infections.
• placental abnormalities
• Uterine abnormalities/ fibroids
• Maternal extremes age
• Advanced paternal age
• Previous miscaurriage
• Drugs/chemicals.
11.
12. [1] Expectant management
allows for the avoidance of surgery. After a spontaneous
miscarriage where the pain and bleeding resolve, a repeat
ultrasound scan is not required to confirm completion. Women
may be advised to take a urinary pregnancy test after 3 weeks.
13. [2] Medical management
used in an outpatient setting to allow women to miscarry at home.
It involves the administration of a single, or repeated, vaginal or
sublingual dose of the prostaglandin E analogue misoprostol.
Some centres use pretreatment with the progesterone antagonist
mifepristone (if over 9 weeks’ gestation).
**Women undergoing medical management of miscarriage need to
understand that they may need surgical treatment if medical treatment
fails (10% failure rate) or if they bleed heavily.
14. [3] Surgical management
is preferred if there is persistent excessive bleeding or haemodynamic
instability, or if women favour this option.
It can be done by manual vacuum aspiration under local anaesthetic in an
outpatient clinic setting if the woman is not compromised. More
commonly it is done as a day case under general anaesthesia.
**However, surgical evacuation has its drawbacks including risks such as
uterine perforation, postoperative pelvic infection and cervical trauma and
subsequent cervical incompetence
15. • Recurrent miscarriage is defined as the loss of three or more
consecutive pregnancies and it affects 1% of couples.
• Risk factors include both advancing maternal and paternal
age, obesity, balanced chromosomal translocations, uterine
structural anomalies and antiphospholipid syndrome (APS).
• Investigation of recurrent miscarriage should involve testing
for antiphospholipid antibodies and imaging of the uterus.
Products of conception in subsequent miscarriages should be
sent for cytogenetic analysis and, where testing reports an
unbalanced structural chromosomal abnormality, parental
peripheral blood karyotyping of both partners should be
performed. Aspirin and low-dose heparin can reduce the
miscarriage rate in women with APS by 50%.
16. • implantation of a pregnancy outside the normal uterine cavity
• Most common site is fallopian tube
17.
18. Tubal pregnancy
approximately 98% of ectopic pregnancy implant in the fallopian
tube, the implantation may be within the fimbrial end[5%],
ampullary section[80%], isthmus[12%]
Cornual pregnancy
Rare situation where implantation has occurred in a horn of a
bicornuate uterus
Ovarian ectopic pregnancy
Contraceptive device and fertility treatment are risk factors
Do laparscopy to save ovary
19. Heterotopic pregnancy
presence of multiple gestations, with one being present in the
uterine cavity and the other outside the uterus.
Abdominal ectopic pregnancy
Implantation on to any organ within the peritonial cavity
Scar pregnancy
Life threatening condition because of the occurrence of
abnormally adherent placenta with subsequent heavy bleeding
and the high risk of uterine rupture with related morbidity and
mortality
20. Ectopic pregnancy rates have been linked to trends in pelvic
inflammatory disease, specifically Chlamydia trachomatis
infection
Other risk factors:
• previous ectopic pregnancy .
• previous tubal surgery.
• Functional alterations in the Fallopian tube due to smoking.
and increased maternal age.
• Additional risk factors include previous abdominal surgery
(e.g. appendicectomy, caesarean section).
• Fertility treatment.
• endometriosis.
21. • History and examination
• TVUSS:
identification of an intrauterine pregnancy (intrauterine
gestation sac, yolk sac +/− fetal pole) on TVUSS effectively
excludes the possibility of an EP in most patients except in
those patients with rare heterotopic pregnancy. The presence of
moderate to significant free fluid during TVUSS is suggestive of
a ruptured EP.
• Quantitative B-hcg
• Laparscopy findings
22.
23. • In up to 40% of women with an EP the diagnosis is not made
on first attendance and they are labelled as having a ‘pregnancy
of unknown location’ (PUL).
• A PUL is a working diagnosis defined as an empty uterus with
no evidence of an adnexal mass on TVUSS (in a patient with a
positive pregnancy test).
• The mainstay of investigation of a PUL is consecutive
measurement of serum hCG concentrations.
• An endometrial biopsy can occasionally be helpful when hCG
levels are static.
• All PUL must be investigated to determine the location of the
pregnancy.
25. Intramuscular methotrexate is a treatment option for patients with
minimal symptoms,
and adnexal mass<40 mm in diameter
and a current serum hCG concentration under 3,000 IU/l.
methotrexate treatment serum hCG is usually routinely measured on days 4, 7 and 11, then
weekly
thereafter until undetectable (levels need to fall by 15% between day 4 and 7, and continue to
fall with treatment).
The few contraindications to medical treatment include: (1) chronic liver, renal or
haematological disorder; (2) active infection; (3) immunodeficiency; and (4) breastfeeding.
There are also known side-effects such as stomatitis, conjunctivitis, gastrointestinal upset and
photosensitive skin reaction, and about two-thirds of patients will suffer from non-specific
abdominal pain.
It is important to advise women to avoid sexual intercourse during treatment and to avoid
conceiving for 3 months after methotrexate treatment because of the risk of teratogenicity.
26. The standard surgical treatment approach is laparoscopy.
Laparotomy is reserved for severely compromised patients or where
there are no endoscopic facilities.
The operation of choice is removal of the Fallopian tube and the EP
within (salpingectomy), or in some cases a small opening can be made
over the site of the EP and the EP extracted via this opening
(salpingostomy), Salpingostomy is recommended only if the
contralateral tube is absent or visibly damaged, and it is associated
with a higher rate of subsequent EP.