This document discusses intrauterine fetal death, including its definition, causes, diagnosis, investigations, complications, prevention, and management. Some key points:
- Intrauterine fetal death refers to fetal deaths occurring during pregnancy or labor after 28 weeks of gestation. Common causes include pregnancy complications like preeclampsia and abruption, medical conditions in the mother, fetal abnormalities, and infections.
- Diagnosis involves absence of fetal movement, uterine changes, and ultrasound or X-ray findings. Investigations aim to confirm diagnosis and determine the cause of death.
- Complications can include psychological issues, infection if membranes rupture, and blood coagulation disorders if the fetus is retained for over two weeks.
Discover the critical insights you need to understand and combat pre-eclampsia in this engaging presentation. My expertly curated slides offer a comprehensive overview of this pregnancy-related condition, covering its causes, symptoms, risk factors, diagnosis, treatment options, and preventative measures. Don't miss this opportunity to gain a deeper understanding of pre-eclampsia and protect the health of expectant mothers and their babies.
Discover the critical insights you need to understand and combat pre-eclampsia in this engaging presentation. My expertly curated slides offer a comprehensive overview of this pregnancy-related condition, covering its causes, symptoms, risk factors, diagnosis, treatment options, and preventative measures. Don't miss this opportunity to gain a deeper understanding of pre-eclampsia and protect the health of expectant mothers and their babies.
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
Placental abruption is premature separation of placenta from the uterus/ in other words separates before childbirth.
It occurs most commonly around 25 weeks of pregnancy characterized by vaginal bleeding, lower abdominal pain, and dangerously low blood pressure
This presentation focuses on common obstetrics emergencies. These include early pregnancy complications such as miscarriages and ectopic pregnancy. As well as abdominal pain. Other include haemorrhage, hypertensive state, and sepsis.
Placental abruption is premature separation of placenta from the uterus/ in other words separates before childbirth.
It occurs most commonly around 25 weeks of pregnancy characterized by vaginal bleeding, lower abdominal pain, and dangerously low blood pressure
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 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.
How to Split Bills in the Odoo 17 POS ModuleCeline George
Bills have a main role in point of sale procedure. It will help to track sales, handling payments and giving receipts to customers. Bill splitting also has an important role in POS. For example, If some friends come together for dinner and if they want to divide the bill then it is possible by POS bill splitting. This slide will show how to split bills in odoo 17 POS.
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”.
Synthetic Fiber Construction in lab .pptxPavel ( NSTU)
Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
Students, digital devices and success - Andreas Schleicher - 27 May 2024..pptxEduSkills OECD
Andreas Schleicher presents at the OECD webinar ‘Digital devices in schools: detrimental distraction or secret to success?’ on 27 May 2024. The presentation was based on findings from PISA 2022 results and the webinar helped launch the PISA in Focus ‘Managing screen time: How to protect and equip students against distraction’ https://www.oecd-ilibrary.org/education/managing-screen-time_7c225af4-en and the OECD Education Policy Perspective ‘Students, digital devices and success’ can be found here - https://oe.cd/il/5yV
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
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.
2. Def: embraces all foetal deaths occurring
both during pregnancy,before or after 28/40
(antepartum) and during labour (intrapartum)
Before 28/40 usually called abortion and
missed if retained
For practical purposes ,we refer to
antepartum death beyond 28/40 usually MSB
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3. Aetiology
20-30 % unknown
Pregnancy complications
– PE-spasm of uteroplacental circulation leads to
reduction of placental blood flow and placental
insufficiency
– APH- both PP and abruption produce acute
placental insufficiency. Abruption causes more
deaths than PP because of its association with
PE
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4. Pre-existing medical diseases and acute illnesses
during pregnancy
– Chronic HTN-it produces placental insufficiency and usually
less lethal ,unless PE supervens
– Chronic nephritis-continuation beyond viability is rare and
foetal death occurs due to massive placental infarction
– DM- actual cause of death not clear.Atherosclerotic
changes in pelvic blood vessels may lead to plcental
insufficiency and fetal death.Associated factors
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5. – Such as PE,hydramnios,congenital malformation and
maternal ketosis may be responsible
– Syphilis- causes death by spirochaete affecting placenta
and foetus
– Hyperpyrexia-acute fever of mother over 39.4 centigrade
can kill fetus directly
– Severe anaemia –may cause foetal death through maternal
anoxaemia
– Chorioamnionitis-especially due to beta haemolytic
streptococcus
– Other rare causes-
hepatitis(viral),toxoplasmosis,HSV,CMV,Mumps
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6. Foetal causes
– Congenital malformation –incompatible with
independent existence
– RH-incompatibility –excessive haemolysis
produces foetal anaemia,anoxia and heart failure
– Postmaturity-cause unexpected death during
pregnancy due to placental insufficiency,worse in
labour
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7. Recurring mishaps in subsequent pregnancies
consider DM,RH incompatibilty,chronic
nephritis,thrombophilia,antiphospholipid syndrome
Morbid pathology-as dead fetus is sorrounded by
sterile liquor it undergoes an aseptic destructive
process known as maceration.Epidermis first to be
involved having,blistering and peeling off of the
skin.Appears 12-24 hours after death then other
organs –ligments,brain matter other vicera
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8. Diagnosis
Symptom –absence of foetal movements
Signs-retrogression of positive breast
changes after variable period of fetal death
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9. Per abdomen
– Gradual retrogression of the HOF
– Uterine tone is diminished and uterus feels
flaccid.Braxton-Hicks contraction is not easily felt
– Foetal movement not easily felt during palpation
– FHS not heard even by doppler
– Egg-shell crackling feel of the foetal head ,if
elicited is almost pathognomonic
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10. Investigations
Straight X-ray abdomen show varying degree
of
– Spalding sign –usually appears 7days after death
– Hyperflexion of the spine
– Crowding of ribs shadow-Bhudda`s sign
– Appearance of gas shadow(Robert`s sign) in the
chambers of the heart and great vessels appear
as early as 12 hours
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11. Ultrasound scan-the evidences are
– Lack of foetal motions (including cardiac) during
a 10 minute period
– Gradually ,oligohydramnios and collapsed cranial
bones are evident
Confirmation of diagnosis is made on repeated clinical
exams at intervals of one week supplemented by scan
or radiology
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12. Investigations protocol in IUD
Investigation protocol are directed
– To confirm the diagnosis by radiology or
sonography
– Estimate blood fibrinogen level perodically
,specially if the fetus is retained more than 2
weeks
– Find cause of death
– Blood tests consist of RH typing,VDRL,post
prandial sugar UE,creatinine
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13. Urine exam for casts and pus cells.Naked
eye exam of placenta and cord,swab from
placenta for bacteriology,virology including
histology and exam of baby including
autopsy may give clue as to cause of death
Cytogenetic study by karyotyping of baby is
helpful in presence of congenital
malformation or IUGR
X-ray bones might detect some skeletal abn
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14. Complications
– Psychological upset often a problem
– Infection –so long as the membranes are
intact,infection is unlikely but once membranes
rupture infection ,specially by gas forming
organisms like CL.welchi may occur
– Blood coagulation disorders-if retained for more
than 2 weeks(as occurs in 10-20%) there is
possibility of DIC
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15. – During labour –uterine inertia,retained placenta and PPH
Prevention-while can not be prevented ,following
guidelines help reduce incidence
– Regular ANC –prevent ,detect at the earliest and institute
effective therapy likely to cause foetal death
– To screen out the “at risk mothers” ,to monitor carefully for
the assessment of foetal well being and terminate the
pregnancy at the earliest evidence of foetal compromise
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16. Management
Expectant attitude(non-interference)
– Psychological morbity is high but is a safe
practice-assure
– 80% spontaneous expulsion in 2 weeks,if not
admit .
– Fibrinogen estimation done every week if not
twice if retained longer than 4 weeks Falling level
of up to 150mg% should be arrested by controlled
infusion of heparin
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17. Interference indicated :
– Psychological upset of the patient –common
– Manifestation of uterine infection
– Falling fibrinogen level-fibrinogen level should be
elevated well above the critical level before
interference
– Tendency of prolongation of pregnancy beyond 2
weeks
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18. Early termination is now favoured ,since
induction is more so give options!
Methods of induction
– Termination should always be done by medical
induction
Oxytocin infusion in ascalating doses up to 40 units
Prostaglandins
Prostaglandins then oxytocin
Mifepristone(RU486) then prostaglandins
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19. Suppression of lactation
What happens to lactation?
– Do no express
– Wear tight bra
– Medical suppression with dopamine agonists
such bromocriptine,carbegoline
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20. Will it happen again?
Need sympathetic handling
Allow grieving process
Name the child,take pictures
Help arrange funeral
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