Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Fourth stage of labor: The hour or two after delivery when the tone of the uterus is reestablished as the uterus contracts again, expelling any remaining contents. These contractions are hastened by breastfeeding, which stimulates production of the hormone oxytocin.
The second stage of labor begins when the cervix is completely dilated (open), and ends with the birth of your baby. Contractions push the baby down the birth canal, and you may feel intense pressure, similar to an urge to have a bowel movement. Your health care provider may ask you to push with each contraction.
Please find the power point on Gestational Diabetes Mellitus (GDM) . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
One of the most important steps to giving birth to a healthy child is taking care of yourself first. Your child’s health starts with yours and is heavily influenced by your medical history, your family’s health history along with a combination of a healthy diet and exercise plan.
Dr Anil Arora address the liver diseases that are specific during pregnancy. The presentation contains case discussions on diagnosis, treatments & take home messages
Common Lab Investigations in pregnancy with reference to Anaemia, Leukocytosi...DrNisheethOza
There are no standardized guidelines/protocols for conducting common laboratory investigations during pregnancy. Here is an attempt to educate Pregnant ladies in this important aspect of their healthcare.
ATOSIBAN Update In Preterm Labor Dr. Sharda Jain Lifecare Centre
PRETERM BIRTH
As defined by the WHO,
Preterm is defined as babies born alive before 37 weeks of
pregnancy are completed.
Sub-categories of preterm birth:
Extremely preterm (<28><32><34><37 weeks).
Children's basic illnesses - a primer for mothersRAJESH EAPEN
Children's basic illnesses , primer for mothers, cough, cold, hand washing, temperature reading, nose bleeds, vomiting, diarrhea, fractures, ear infections, eye injury, sprains
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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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
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MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
2. NICE/RCOG GUIDELINES – JUNE
2010
Pregnancy is a normal physiological
process & any interventions offered should
have known benefits & be acceptable to the
pregnant women
Current models of ante-natal care originated in
the early 20th century.
The pattern of visits recommended at that time
(monthly until 30 wks, then fortnightly to 36 wks
and then weekly until delivery) is still
recognisable today
3. AIMS OF ANTENATAL CARE
Monitoring the progress of pregnancy
with minimum interference
Guidance to the expectant mother
Early detection of any deviation from
normal
Institution of corrective measures
wherever possible
Preparation of the mother for labour &
delivery
4. PRENATAL CARE
The ideal initial prenatal care visit occurs before
conception with a pre-conceptive visit.
A pre-conceptive visit allows modification of
behavioral choices, medication, and optimizing
medical concerns before conception.
5. FIRST VISIT – 10 WEEKS
ANC BEGINS AS SOON AS PREGNANCY IS
CONFIRMED
CONFIRMATION OF PREGNANCY – UPT
HISTORY TAKING
GENERAL & SYSTEMIC EXAMINATION
INVESTIGATIONS – Hb, RBS, Ur, Blood Group, HIV,
VDRL, HbsAg , Sickling Test
USG –Confirming viability & number
Estimation of GA & EDD (10–13wks)
6. Advice - Do’s And Dont’s
DIET
WORK & EXERCISE – Continue working till the end & moderate
exercise
COMMON SYMPTOMS – Morning
sickness, Heartburn, LBA, Frequency, Vg Discharge, Constipation
SEXUAL INTERCOURSE – safe
MEDICATIONS – Folic acid & calcium
ALCOHOL INTAKE - <1-2 UK units/wk (1 u= half a pint of ordinary
strength lager/beer, or one shot [25 ml] of spirits. One small [125
ml] glass of wine =1.5 UK units)
SMOKING – Quit-LBW, IUGR
DRIVING & TRAVEL – Car (seat belts) & Air travel (36wks), travel
abroad & related vaccinations
8. SCREENING FOR MATERNAL
DISEASES
ANEMIA – Booking – 11 gm%
28wks – 10.5 gm%
No need for routine Iron supplements
SICKLE CELL DISEASE - Sickling test
ALLO-ANTIBODIES - ICT - Routine anti-D
prophylaxis at 28 & 36 wks to all non-sensitised
pregnant women
Women should be screened for atypical red cell
allo antibodies (Kidd, Duffy, Anti-C) in early
pregnancy & at 28 weeks, regardless of their
rhesus D status
9. SCREENING FOR FETAL ANOMALIES
DOWN’S SYNDROME- Nuchal Thickness -
performed end of first trimester (13w0d-13w6d) –
increased >6 mm
COMBINED TEST – NT + HCG + PAPP-A (11w-
13w6d)
TRIPLE/QUADRUPLE TEST 15-20wks.
CONTINGENT SCREENING measuring free β-
hCG & PAPP-A in all pts at 10 wks -those with low
risk are screened negative- remainder NT - 13 wks -
low risk are screened negative-others offered marker
assays & diagnostic tests.
ANOMALY SCAN - 18w 0d-20w 6d – Optional
10. TRIPLE MARKER TEST
Performed between the 15th & 18th wk.
AFP (fetus), HCG (placenta), and Estriol
(both)
High AFP levels - neural tube defects,
anencephaly, mistaken dates.
Low AFP & Estriol & High HCG -Trisomy 21
(Down) Trisomy 18 (Edwards) or any other type
of chromosome abnormality.
11. QUADRUPLE TEST
Pts registering in late 2nd trimester-22wks
AFP (fetal liver), Estriol (placenta+fetal
liver),HCG (placenta),Inhibin-A (placenta)
High AFP levels - open neural tube defect,
mistaken dates or twins.
Low AFP levels - high risk for Down syndrome.
High HCG and Inhibin-A levels - increased
risk Down syndrome.
Low Estriol - high risk for Down syndrome
12. SCREENING FOR INFECTIONS
Asymptomatic bacteriuria - persistent bacterial
colonisation of the urinary tract without symptoms.
After the initial screening, patients only need to be
screened for UTI infections if they are symptomatic
HIV – MTCT- more than 35% reduced to 5% with
ART with ZT(300mg)+NVP(200mg)+3TC(150mg)
twice daily-14 wks till BF & 6wks for infant after BF
The combination of ART, LSCS and avoiding breast
feeding can further reduce the transmission to 1%.
Latest guidelines – Continue ART + Breast feeding
13. SCREENING FOR INFECTIONS
HEPATITIS–B - Screening for HBsAg, new
sample-confirmatory testing & testing for e-markers
to know if baby will need Ig along with vaccine
postnatally
RUBELLA - susceptibility screening offered early to
identify women at risk of contracting rubella
infection and vaccinate in the postnatal period.
SYPHILLIS- TPHA if VDRL is positive
Mother-to-child transmission is associated with
neonatal death, congenital syphilis, stillbirth and
preterm birth
14. SCREENING FOR CLINICAL
CONDITIONS
GESTATIONAL DIABETES
RBS at booking - less than 130 mg/dl or 7.2 mmol/l
OGCT - 1 hr after 50 gm of glucose - 24wks – h/o
GDM–16wks-< 140mg/dl or 7.8 mmol/l
GTT– 75 gm of glucose and 03 days of diet rich in
carbohydrates.
Fasting – 104 mg/dl or 5.8 mmol/l
2 hr after glucose – 140 mg/dl or 7.8 mmol/l
A 2 hr 75 g OGTT is used as the gold standard
diagnostic test and is assumed to be 100%
sensitive and specific
15. PRE-ECLAMPSIA
Pre-eclampsia is a complex disorder with
widespread endothelial damage in all organs, thus
presenting signs and symptoms may be more varied
than just high BP & proteinuria
Blood pressure measurement and urinalysis
for protein–each visit.
Hypertension single diastolic BP of 110 mmHg or
any consecutive readings of 90 mmHg on more than
one occasion at least 4 hours apart.
Proteinuria 02 clean catch samples-4 hours apart
with 2+ proteinuria by dipstick are significant.
300 mg protein in a 24 hour sample
16. PLACENTA PREVIA
Low-lying placentae - not an uncommon finding
on early trimester scans
Most low-lying placentae detected at the routine
scan generally resolve by the time the baby is
born.
Only a woman whose placenta extends over the
internal cervical os should be offered another
trans-abdominal scan at 32 weeks.
If the trans-abdominal scan is unclear, a trans-
vaginal scan should be performed.
17. MONITORING FETAL WELL BEING
Clinical Examination – Symphysis-Fundal height
– after 24wks (difference of more than 2 cms is
significant)
Daily Fetal Movement Count – DFMC–10/12 hrs
or 3 in one hr – one hr post meals.
Ultrasound – not accurate in assessing fetal growth
in later trimesters
Doppler Studies - in suspected IUGR
CTG/NST– valid only after 32 weeks
Biophysical Profile – Movement, tone, HR (NST),
Breathing, AFI – Normal score 8 or more
Modified Biophysical Profile – NST + AFI
18. VACCINATIONS
Tetanus Toxoid - 02 doses
Killed/Inactivated/Toxoids can be given .
Live vaccines are contraindicated
Not Given - BCG, Cholera, Japanese Encephalitis,
Measles , Mumps, Rubella, Typhoid, Varicella
Give only if essential as safety in pregnancy has
not been documented - Hepatitis A & E
Influenza
Meningococcal
OPV
Rabies
Diphtheria
Yellow fever
19. MANAGEMENT OF COMMON
SYMPTOMS IN PREGNANCY
NAUSEA & VOMITTING
More in primigravidas & multiple pregnancies
Cause - First/Increased exposure to HCG
No harm to fetus - Generally settles by 16-20wks
Diet - Avoid oily & spicy food
Small frequent meals
Home remedies – Ginger & lemon
Medications - T. Pyridoxine - twice daily
Severe cases – Inj. Metoclopramide
20. HEARTBURN
Effect of progesterone - reduced tone of
lower esophageal sphincter
Diet modifications – reduce spicy food & eat
small and frequent meals at short intervals
Postural modifications – avoid bending &
lying down immediately after meals
Medications–H2 receptor blockers - Ranitidine
Proton Pump Inhibitors - Omez ®
Antacids - Gelusil®
21. CONSTIPATION
Effect of Progesterone – Relaxes musculature
reduces tone & motility of smooth muscles
Diet modification – High fibre diet
Plenty of water
More fruits & vegetables
Medications – Mild Laxatives–Lactulose
Herbolax ®
Liquid Paraffin
22. VAGINAL DISCHARGE
Due to vascular congestion & increased activity
of cervical mucus secreting glands
No treatment required
Watch for – Change of colour
Foul Smell
Associated Pruritis
Painful or burning micturition
Above signs indicate infection in which case the
same will have to be treated accordingly
23. BACKACHE
Initially due to pelvic organ congestion & later
due to strained pelvic supports & exaggerated
lumbar lordosis
Lifestyle – as active as possible
Support- Lower back when sitting
Abdominal bump when lying down
Non-pharmacological - Back massage
- Hot fomentation
Drugs - Unrelenting cases - Analgesics
- Balms/gels for LA
24. HAEMORRHOIDS & VARICOSE
VEINS
Due to vascular congestion
Effect of Progesterone
No effective treatment in pregnancy
Avoid constipation
Diet advice – high fibre, plenty of water
Leg elevation & avoid prolonged periods of
standing
Compression stockings
Medications – Laxatives, creams & Flavinoids
Hirudoid cream
25. POST-DATISM
At 40 wks of gestation, only 58% of women had
delivered, 74% by 41 wks and 82% by 42 wks
Perinatal mortality & morbidity is increased if
duration of pregnancy is more than 42 wks.
Sweeping/Stripping of membranes – 41 wks –
likelihood of spontaneous onset of labour in 48
hrs
41-42 weeks – Twice weekly NST, USG for AFI
42 weeks – Induction of labour & delivery
26. INTERVENTIONS NOT ROUTINELY
RECOMMENDED
Repeated maternal weighing.
Breast or pelvic examination.
Iron or vitamin A supplements.
Routine Doppler ultrasound in low-risk pregnancies.
Ultrasound estimation of fetal size for suspected LGA
Routine screening for preterm labour.
Routine screening for cardiac anomalies using NT.
Routine fetal-movement counting.
Routine auscultation of the fetal heart.
Routine antenatal electronic cardio-tocography.
Routine ultrasound scanning after 24 weeks