The document discusses isoimmune disease and Rh incompatibility. It defines isoimmune disease as an immune disease caused by antigens from another person. Rh incompatibility occurs when a mother is Rh-negative and the baby is Rh-positive, potentially causing hemolytic disease in the baby. The document outlines the major blood group systems, Rh factor, causes and pathogenesis of Rh incompatibility, methods of detection and treatment including intrauterine transfusions and exchange transfusions. It also discusses nursing management and risk factors for intrauterine fetal demise.
This topic contains definition, meaning, classification, pathophysiology, clinical menifestations, metabolic and general changes, management of obstetrical shock
This topic contains definition, meaning, classification, pathophysiology, clinical menifestations, metabolic and general changes, management of obstetrical shock
Rh Incompatibility in Pregnancy. Rh incompatibility occurs when a pregnant woman whose blood type is Rh-negative is exposed to Rh-positive blood from her fetus, leading to the mother's development of Rh antibodies
Obstetrics and Gynecological Nursing
The PPT contains detailed information about Abnormal uterine action, its classifications, causes, sign and symptoms and management.
Rh incompatibility is a condition that occurs during pregnancy if
a woman hasRh-negative blood and
her baby has Rh-positive blood.
"Rh-negative" and "Rh-positive" refer to
whether your blood has Rh factor. Rh factor is a protein on red blood cells. If
you have Rh factor, you're Rh-positive. If you don't have it, you're
Rh-negative. Rh factor is inherited (passed from parents to children through
the genes). Most people are Rh-positive.
Whether you have Rh factor doesn't affect your general health.
However, it can cause problems during pregnancy.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Rh Incompatibility I Hemolytic Disease of the NewbornSwatilekha Das
Rh Incompatibility I Hemolytic Disease of the Newborn-
Hi All,
I am Swatilekha Das, B.Sc, M.Sc Nurse and working as Assistant Professor of Nursing in a Nursing college. I worked as Clinical Instructor, nursing educator, nursing trainer, Nursing Tutor at hospitals, nursing schools and colleges.
ABOUT THIS ppt-
In this ppt I discussed about definition of rh incompatibility, cause, pathophysiology, diagnostic tests, treatment and screening and prevention of Rh incompatibility.
To know about it check the ppt till end.
I hope you enjoy this ppt and if you do then please click on the like button and share the with your friends too . Don't Forget to follow to see more such ppt. Thank you for checking the ppt.
@All Rights Reserved..
Rh Incompatibility in Pregnancy. Rh incompatibility occurs when a pregnant woman whose blood type is Rh-negative is exposed to Rh-positive blood from her fetus, leading to the mother's development of Rh antibodies
Obstetrics and Gynecological Nursing
The PPT contains detailed information about Abnormal uterine action, its classifications, causes, sign and symptoms and management.
Rh incompatibility is a condition that occurs during pregnancy if
a woman hasRh-negative blood and
her baby has Rh-positive blood.
"Rh-negative" and "Rh-positive" refer to
whether your blood has Rh factor. Rh factor is a protein on red blood cells. If
you have Rh factor, you're Rh-positive. If you don't have it, you're
Rh-negative. Rh factor is inherited (passed from parents to children through
the genes). Most people are Rh-positive.
Whether you have Rh factor doesn't affect your general health.
However, it can cause problems during pregnancy.
Please find the power point on Hyperemesis gravidarum and its managemen. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Rh Incompatibility I Hemolytic Disease of the NewbornSwatilekha Das
Rh Incompatibility I Hemolytic Disease of the Newborn-
Hi All,
I am Swatilekha Das, B.Sc, M.Sc Nurse and working as Assistant Professor of Nursing in a Nursing college. I worked as Clinical Instructor, nursing educator, nursing trainer, Nursing Tutor at hospitals, nursing schools and colleges.
ABOUT THIS ppt-
In this ppt I discussed about definition of rh incompatibility, cause, pathophysiology, diagnostic tests, treatment and screening and prevention of Rh incompatibility.
To know about it check the ppt till end.
I hope you enjoy this ppt and if you do then please click on the like button and share the with your friends too . Don't Forget to follow to see more such ppt. Thank you for checking the ppt.
@All Rights Reserved..
immunological tolerance can be divided into two parts. they are central tolerance and peripheral tolerance. this slide contains information on development of central tolerance which include both B cell and T cell central tolerance.
Kell blood group system most important blood group system following to ABO and Rh blood group system, particularly RhD as far as immunogenicity is concerned and Its clinical importance.
Blood groups,blood transfusion,hazards,blood bankRanadhi Das
Austrian Karl Landsteiner(1901) discovered –
Human blood possess different antigenic and immune properties
Blood clumping was an immunological reaction.
Nobel Prize in Physiology and Medicine in 1930.
Adriano Sturli and Alfred von Decastello who were working under
Landsteiner discovered type AB a year later in 1902.
Janský is credited with the first classification of blood into the four types
(A, B, AB, O)in 1907, which remains in use today
It consists of slides about blood, various blood groups , pre-transfusion testing , blood products , conditions where blood transfusion is indicated and the various complications of blood transfusion in the field of oral and maxillofacial surgery.
A blood group also called a Blood Type
Classification of blood is based on the presence or absence of inherited antigenic substances on the surface of red blood cells (RBCs)
These antigens may be proteins, carbohydrates, glycoproteins, or glycolipids, depending on the blood group system.
The ABO blood group system is the most important blood type system (or blood group system) in human blood transfusion.
ABO blood types are also present in some other animals for example rodents and apes such as chimpanzees, bonobos and gorillas.
How to Make a Field invisible in Odoo 17Celine George
It is possible to hide or invisible some fields in odoo. Commonly using “invisible” attribute in the field definition to invisible the fields. This slide will show how to make a field invisible in odoo 17.
Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
Embracing GenAI - A Strategic ImperativePeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
This Gasta posits a strategic approach to integrating AI into HEIs to prepare staff, students and the curriculum for an evolving world and workplace. We will highlight the advantages of working with these technologies beyond the realm of teaching, learning and assessment by considering prompt engineering skills, industry impact, curriculum changes, and the need for staff upskilling. In contrast, not engaging strategically with Generative AI poses risks, including falling behind peers, missed opportunities and failing to ensure our graduates remain employable. The rapid evolution of AI technologies necessitates a proactive and strategic approach if we are to remain relevant.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
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
Palestine last event orientationfvgnh .pptxRaedMohamed3
An EFL lesson about the current events in Palestine. It is intended to be for intermediate students who wish to increase their listening skills through a short lesson in power point.
Honest Reviews of Tim Han LMA Course Program.pptxtimhan337
Personal development courses are widely available today, with each one promising life-changing outcomes. Tim Han’s Life Mastery Achievers (LMA) Course has drawn a lot of interest. In addition to offering my frank assessment of Success Insider’s LMA Course, this piece examines the course’s effects via a variety of Tim Han LMA course reviews and Success Insider comments.
Read| The latest issue of The Challenger is here! We are thrilled to announce that our school paper has qualified for the NATIONAL SCHOOLS PRESS CONFERENCE (NSPC) 2024. Thank you for your unwavering support and trust. Dive into the stories that made us stand out!
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.
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
3. TERMINOLOGY
• Iso - immune – means immune disease
in which the antibodies are produced as
a result of antigens from another person.
• Autoimmune – in which the antigens
come from the same person.
5. •The differences in human blood are due to the
presence or absence of certain protein molecules
called antigens and antibodies.
•The antigens are located on the surface of the
RBCs and the antibodies are in the blood plasma.
•Individuals have different types and
combinations of these molecules.
•The blood group you belong to depends on what
you have inherited from your parents.
DIFFERENT BLOOD GROUPS
6. • There are more than 20 genetically determined
blood group systems known today
Eg. ABO System,Rh-System, MNS System, Kell
System, Lewis System
•The AB0 and Rhesus (Rh) systems are the most
important ones used for blood transfusions.
•Not all blood groups are compatible with each other.
Mixing incompatible blood groups leads to blood
clumping or agglutination, which is dangerous for
individuals.
Cont…
7. CLASSIFICATION OF BLOOD
GROUPS
Major Blood Grouping System:
ABO blood group system
Rh blood group system
because they cause major transfusion reaction.
Minor Blood Grouping System:
MNS blood group system
p blood group system
because they cause minor transfusion reaction.
Familial Blood Grouping System:
Kell, Daffy, Lutheran, Lewis, Deigo, and Many
more.
8. According to the ABO blood
typing system there are four
different kinds of blood types: A,
B, AB or O (null).
ABO blood grouping system
9. Landsteiner Law
• It was given by Karl Landsteiner in 1900.
• It states that ; If an agglutinogen is
present on the RBC of an individual, the
corresponding agglutinin must be absent
in the plasma of that individual and vice-
versa.
• This law is only applicable to ABO blood
grouping system.
10. Blood group A
If you belong to the blood
group A, you have A
antigens on the surface of
your RBCs and B
antibodies in your blood
plasma.
Blood group B
If you belong to the blood
group B, you have B
antigens on the surface of
your RBCs and A
antibodies in your blood
plasma.
ABO BLOOD GROUPING SYSTEM
11. Blood group AB
If you belong to the blood group
AB, you have both A and B
antigens on the surface of your
RBCs and no A or B antibodies
at all in your blood plasma.
Blood group O
If you belong to the blood group O
(null), you have neither A or B
antigens on the surface of your RBCs
but you have both A and B antibodies
in your blood plasma.
13. Blood
Group
Antigens Antibodies Can give
blood to
Can
receive
blood from
AB A and B None AB AB, A, B, O
A A B A and AB A and O
B B A B and AB B and O
O None A and B AB, A, B, O O
14. Blood group O is called
"universal donor"
because it has no antigens
on RBC.
Blood group AB are called
"universal
receivers“ because it has
no anti- bodies in the
plasma.
16. • The Rhesus factor gets its name from
experiments conducted in 1937 by scientists
Karl Landsteiner and Alexander S. Weiner.
• Their experiments involved rabbits which,
when injected with the Rhesus monkey's red
blood cells, produced an antigen that is
present in the red blood cells of many
humans.
17. •The genotype is determined by the inheritance of 3
pairs of closely linked allelic genes situated on
chromosome 9 named as
D/d,
C/c,
E/e
……….. (Fisher- Race theory)
18. • A condition that occurs during pregnancy if
a blood and her
blood. Mother’s body create Rh
antibodies against the baby’s blood.
• Also known as haemolytic disease of the
fetus and newborn(HDFN).
Oct-15 18Rhesus Incompatibility
19. • First demonstrated in rhesus monkey
• Blood groups are classified as Rh
positive and Rh negative
20. • The Rh factor , Rh+ and Rh- usually refers
specifically to the presence or absence of antigen-
D
•There are two alleles, or genetic variants , of this
antigen: D and d.
•A person who is Rh- has two recessive traits, dd.
Anyone who has at least one D-DD or Dd-is Rh+
21. • A person's Rh type is generally most relevant
with respect to pregnancies
• If the pregnant woman and her husband are
Rh negative, there is no reason to worry about
Rh incompatibility
22. •If she is Rh negative and her husband is Rh
positive,the baby will inherit the father's blood
type ,creating incompatibility between mother
and her fetus.
•If some of the fetal blood gets into mother's
blood stream, her body will produce antibodies.
•These antibodies could pass back through the
placenta and harm the developing baby's red
blood cells, causing very mild to very serious
anemia in the fetus.
23. Pathogenesis
Oct-15 Rhesus Incompatibility 23
1. Rh-ve mother carrying Rh+ve
fetus
2. Entry of fetus Rh+ve RBC into
maternal circulation
3. Development of Rh antibodies
by the mother
24. • Usually placenta acts as barrier to fetal blood entering
maternal circulation. However, sometimes during
pregnancy or birth,fetomaternal haemorrhage (FMH)
can occur. The woman’s immune system reacts by
producing anti-D antibodies that cause sensitisation
25.
26. •In subsequent pregnancies antibodies can cross placenta
and destroy fetal erythrocytes. The haemolytic disease of
fetus and new born caused by Rh isoimmunisation can
occur during the first pregnancy, but usually sensitisation
during the first pregnancy or birth leads to extensive
destruction of fetal RBC during subsequent pregnancies
28. Sign &symptom of Rh incompatibility:
• Rh incompatibility can cause symptoms ranging
from very mild to fatal.
• Mildest form- Rh incompatibility:
1-Hemolysis (Destruction of the red blood cells)
with the release of free hemoglobin into the
infant's circulation.
2- Jaundice (Hemoglobin is converted into,bilirubin
which causes an infant to become yellow.
31. Severe form- Rh
incompatibility
1- Hydrops fetalis (Massive fetal
red blood cell destruction).
2- It causes Severe
anemiaFetal heart
failure Death of the infant
shortly after delivery.
32. 2- Total body swelling.
3- Respiratory distress (if the infant has been delivered)
4- Circulatory collapse.
5- Kernicterus. (Neurological syndrome in extremely
jaundiced infants)
6- It occurs several days after delivery and is
characterized initially by...
A) Loss of the Moro reflex.
B)Poor Feeding.
C) Decreased activity
33. LATER
• At last it may lead to death of the child
immediately after its birth
34.
35. 1-There are no any physical symptoms can be seen
in rh incompatibility.
2-If the woman just found out she is pregnant,she
should undergo blood-type test. This test
determines her blood type and Rh factor.
3-Blood test that will determine whether she is Rh
positive or Rh negative
DETECTION OF Rh INCOMPATIBILITY:
36. Treatment
• Intrauterine transfusion
• Elect time of delivery
• Exchange transfusion after delivery
• Phototherapy after delivery
• Top-up transfusion
(Hb falls below 7g/dl, prophylactic :oral folate)
Oct-15 36Rhesus Incompatibility
37. Intrauterine transfusion
• The fetus can die in utero from severe anaemia
and hydrops before he can be delivered.
• An intrauterine transfusion can prolong the life
in utero of a fetus to a gestation where the risks
of prematurity are estimated as being less than
those of the Rh disease. This can be done by an:
1. Intraperitoneal transfusion guided by
ultrasound.
2. Umbilical vein transfusion guided by
ultrasound.
Oct-15 Rhesus Incompatibility 37
38. • Rh-negative blood is either transfused
under ultrasound control. Repeat as
necessary, according to amniotic optical
density, or fetal haematocrit. The
intravenous route is becoming increasingly
the preferred method.
39. Choose time of induction and best
method of delivery
• Balance the risks of prematurity (too soon) with
that of worsening Rh disease (too late).
• Consider the risks of vaginal delivery and be
prepared for a lower segment Caesarean section
(LSCS).
• Usually done only after 34 weeks of gestation.
• The paediatric team should be in close and a
senior paediatrician present at the delivery
• fresh Rh-negative blood available.
Oct-15 Rhesus Incompatibility 39
40. Resuscitation and Exchange transfusion
• Good resuscitation is
essential. In an anaemic.
premature infant, lung
disease is common. It can
be due to:
Surfactant deficiency at
very early delivery.
Pulmonary oedema from
anaemia and
hypoproteinaemia.
Hypoplastic lungs
secondary to pleural
effusions.
• In severe Rh haemolytic
disease of the newborn, an
umbilical artery catheter
should be inserted as soon
as possible to assess and
control PaO2 and pH.
• Central venous pressure
should be measured.
Drain pleural effusions and
ascites at resuscitation.
Oct-15 Rhesus Incompatibility 40
41. Indication for exchange
Transfusion:
1. Early: Decision mainly based
on cord haemoglobin
(in addition consider history of
previously affected babies).
• Cord haemoglobin <12g/dl.
• Strongly positive Coombs’
test.
• Cord bilirubin >85mmol/l.
2. Late: Usually done for
hyperbilirubinaemia.
• The aims:
Treat anaemia.
Washes out IgG antibodies.
Decreases degree of
haemolysis.
Removes bilirubin.
Prevents kernicterus.
Oct-15 Rhesus Incompatibility 41
Resuscitation and Exchange transfusion
42. Phototherapy
• Placing newborn baby under a halogen or
fluorescent lamp with their eyes covered.
• Lowers the bilirubin levels in the baby’s blood
through photo-oxidation.
• During phototherapy, intravenous hydration is
required.
Oct-15 Rhesus Incompatibility 42
44. Prevention and Prophylaxis
• Anti-D immunoglobulin to all Rh-negative women
at 28 and 34 weeks routinely-RAADP Or give anti-
D immunoglobulin
if she has a:
Therapeutic abortion.
Spontaneous abortion/ectopic pregnancy.
Amniocentesis.
Any bleeding in pregnancy/threatened miscarriage.
External Cephalic Version.
After delivery at any gestation within 72Hours.
Oct-15 44Rhesus Incompatibility
45. NURSING MANAGEMENT
DIAGNOSIS
Risk for injury from breaking down products of RBCs
in greater numbers than normal and functional
immaturity of the liver.
Goals
• Will receive appropriate therapy to accelerate
bilirubin excretion.
• Will experience no complications from phototherapy.
• Will experience no complications from exchange
transfusin.
46. • Interrupted family process R/T infant with
potentially adverse physiologic response.
• Family will receive emotional support.
• Family will be prepared for home care of the
neonate.
47. • NURSING CARE for Rh incompatibility DURING
PHOTOTHERAPY
1. Remove clothing to proper skin exposure.
2.Turn infant frequently to expose all skin area.
3. Record and report jaundice and blood levels of
bilirubin.
4. Record and report if any change in body
temperature
48. 5. Cover and check eyes with eye patches to
prevent eye injury.
-Be sure the eyes close before applying eye patch
to prevent corneal irritation.
-Should be loose enough to avoid pressure.
-Eye patches should be changed every 8houly and
eye care given.
6.Nurse should expect the infant’s stools to be
green and the urine dark because of photo
degradation products.
49. 7. Serum bilirubin and hematocrit should be
monitored during therapy and for 24 hours
following therapy.
8.In case of breast milk jaundice stop breast
feeding temporarily.
9. Maintain feeding intervals to prevent
dehydration.
55. Introduction
• In addition to cases in which a fetus dies during
delivery as a result of asphyxia (oxygen
deprivation if the umbilical cord becomes
twisted) or difficult labor.
• Others can die in utero before labor starts.
followed by expulsion of the fetus from the
uterus within a few days.
• However, in rare instances the dead fetus is not
expelled from the uterus at once, but is retained
for several weeks.
56. • Fetal death refers to the spontaneous death of
a fetus at any time during pregnancy, although
the term is often used interchangeably with
‘stillbirth’.
• A stillbirth is a death that occurs after 20
weeks of gestation.
57. Definition of IUFD
Intrauterine fetal death: is the clinical term for
the death of a baby in the uterus, during
pregnancy and before birth. The term is
usually used for pregnancy losses that
happen after the 20th week of gestation.
58. Epidemiology
•In the present investigation the epidemiological
factors responsible for intrauterine fetal deaths
after 20 week of gestation were studied.
•A retrospective study of 16882 pregnancies
registered and managed in the Department of
Obstetrics and Gynecology, in united state
59. Continue…..
One hundred and three cases of intrauterine
fetal deaths were registered and treated
expectantly out of 16882 total pregnancies
registered during the four year study period.
The stillbirth rate was 6.1 per 1000 total births.
63. Cont….
• Depression, Anxiety, Psychosocial
• Anxiety with future pregnancies
• May have repeat losses (depending on causes)
• Bleeding ---> can lead to DIC but may only
require blood product replacement
• Pain, Infection (similar to any other delivery)
64. Risk factors
•Multiple pregnancy
•Advanced maternal age
•History of fetal demise (IUFD)
•Maternal infertility
•Maternal haemoconcentration
•Maternal colonization with certain pathogens
•Small for gestational age infant
•Obesity
•Paternal age
•African American race
65. Clinical features
• Absence of fetal movement
• Vaginal bleeding
• Abdominal pain
• Small uterus than the duration of pregnancy
• Sometimes secretion of colostrum occur few
days after death of fetus in uterus.
66. Diagnosis of IUFD
• In most patients, the only symptom is decreased
fetal movement. An inability to obtain fetal heart
tones upon examination suggests fetal demise;
however, this is not diagnostic and death must be
confirmed by diagnostic tests .
• Labor should be induced as soon as possible after
diagnosis. Patient responses vary in regard to this
recommendation; some wish to begin induction
immediately, while others wish to delay induction
for a period of hours or days until they are
emotionally prepared.
68. • Blood test because it comes negative within a
week after the death of the fetus.
• The secretion of estriol it is a type of estrogen
produced by an active placenta in the
mother’s urine falls sharply.
69. Treatment & management
• Explain the problem to the woman and her
family. Discuss with them the options of
expectant or active management.
• Medical induction of labor: Medicine is used
to start labor and fetus delivered naturally.
70.
71. Pain management
• Pain management in patients undergoing
induction of labor for fetal death is usually easier
to manage than in patients with live fetuses.
• Higher doses of narcotics are available to the
patient and often a morphine is sufficient for
successful pain control. Should a patient desire
superior pain control to intravenous narcotics,
epidural anesthesia should be offered.
72.
73. NURSING MANAGEMENT
Diagnosis
Anticipatory grieving related to fetal loss
Intervention
• To give the patient time to gather support
from her family and to fathom the reality of
the situation.
• Provide psychological support.
• Provide counseling to the mother as well as
family.
74. Nursing health care guidelines at home
• Teach the patient to be aware of the signs and
symptoms that could indicate postpartum
complications:
• Pain in the calf of the leg; increase in vaginal
bleeding; foul odor of vaginal discharge; fever;
burning with urination; persistent mood charge;
or a hard, reddened area on the breast.
75. • Explain that the patient should not have
intercourse or drive a car until after the
postpartum check.
• Encourage participation in a bereavement
support group, even if the patient and
significant other seem to be coping with the
loss.
• They may be able to help other couples cope.
81. STAGES
• Stage I (Hyperplasia)
- 4 to 20 weeks
- Rapid mitosis
- Increase of DNA content
82. Cont…
• Stage II (Hyperplasia & Hypertrophy)
- 20 to 28 weeks
- Declining mitosis.
- Increase in cell size.
83. Cont…
• Stage III ( Hypertrophy)
- 28 to 40 weeks
- Rapid increase in cell size.
- Rapid accumulation of fat, muscle and
connective tissue.
• 95% of fetal weight gain occurs during last 20
weeks of gestations.
86. Cont…
•Alcohol 12-fold increase risk of IUGR
•Drugs Beta- Blockers(Atenolol in
second trimster, Anticoagulants,
Anticonvulsants( phenytoin)
•Hypoxemia
•Infections UTI, Malaria, TB, Genital
Infections
87. Cont …
• Small stature/ low pre-pregnancy weight
• Teen pregnancy
• Primi gravida
• Grand multiparity
88. FETAL FACTORS
• A Chromosome Defect-
In second trimester 20% SGA fetuses
have chromosomal abnormality
Triploid is most common under 26 wks.
Trisomy-18 is common after 26 wks .
Other are 21(Down’s syndrome), 16, 13,
xo (turner’s syndrome).
89. Cont….
• Exposure to an infection-
• German measles (rubella), cytomegalovirus,
herpes simplex, tuberculosis, syphilis, or
toxoplasmosis, TB, Malaria, Parvo virus
90. Cont…
• birth defects
• (cardiovascular, renal, anencephally, limb
defect, etc).
• A primary disorder of bone or cartilage.
• A chronic lack of oxygen during development
(hypoxia
• Placenta or umbilical cord defects.
91. PLACENTAL FACTORS
• Uteroplacental Insufficiency Resulting
From -.
–Improper / inadequate trophoblastic
invasion and placentation in the first
trimester.
–Lateral insertion of placenta.
–Reduced maternal blood flow to the
placental bed.
92. Cont…
• Fetoplacetal Insufficiency Due To-.
–Vascular anomalies of placenta and cord.
–Decreased placental functioning mass-.
• Small placenta, abruptio placenta,
placenta previa, post term pregnancy
95. Environmental Causes of IUGR
• High altitude - lower environmental oxygen
saturation
• Toxins
96. Types of IUGR
• Symmetric IUGR
(33 % of IUGR Infants)
• Asymmetric IUGR
(55 % of IUGR)
• Combined type IUGR
(12 % of IUGR)
97. SYMMETRICAL
• Height, weight, head circ proportional
• Early pregnancy insult:
• Commonly due to congenital infection, genetic
disorder, or intrinsic factors
• Reduced no of cells in fetus
• Normal ponderal index
• Low risk of perinatal asphyxia
• Low risk of hypoglycemia
98. PONDERAL INDEX
• The ponderal index is used determine those
infants whose soft tissue mass is below
normal for their stage of skeletal
development.
Ponderal Index = birth weight x 100
crown-heel length
99. Cont…
• Typical values are 20 to 25.
• Those who have a ponderal index below the
10th % can be classified as SGA
• PI is normal in symmetric IUGR.
• PI is low in asymmetric IUGR
100. ASSYMETRICAL
• Later in pregnancy:
• Commonly due to utero placental
insufficiency, maternal malnutrition, hypoxia,
or extrinsic factors
• Low ponderal index
• Cell number remains same but size is small
• Increased risk of asphyxia
• Increased risk of hypoglycemia
101. • Growth restriction in the stage of hypertrophy
• Brain sparing effect
• Head growth remains normal but abdominal
girth slows down
102.
103.
104.
105. Newer Classification
1. Normal Small Fetuses-
• Have no structural abnormality, normal
umbilical artery & liquor but wt., is less.
• They are not at risk and do not need any special
care.
106. Abnormal Small Fetuses- have chromosomal
anomalies or structural malformations. They
are lost cases and deserve termination as
nothing can be done.
Growth Restricted Fetuses- are due to impaired
placental function. Appropriate & timely
treatment or termination can improve
prospects.
111. • Signs of recent wasting
- soft tissue wasting
- diminished skin fold thickness
- decrease breast tissue
- reduced thigh circumference
• Signs of long term growth failure
- Widened skull sutures, large fontanelles
- shortened crown – heel length
- delayed development of epiphyses
112. DIAGNOSIS OF IUGR
• History
• Risk factors
• Last menstrual period - most precise size of
uterus
• Time of quickening (detection of fetal
movements)
• Examination
• Maternal serum screening
113. Uterine Artery Doppler Velocimetry
- Notching of the waveform /reduce EDF
associated 3-fold increase in risk of FGR.
• Combination of un-explain elevated maternal AFP
is powerful predictor of adverse perinatal
outcome (FGR)
• Increase AFP combine with echogenic bowel is
strong predictor of FGR
114. • DOPPLER OF THE UMBILICAL ARTERY
• Reduced end diastolic flow.
• Absent end diastolic flow
• Reversed end diastolic flow( severe cases)
115.
116.
117.
118. Problems
• Hypoxia
- Perinatal asphyxia
- Persistent pulmonary hypertension
- meconium aspiration
• Thermoregulation
- Hypothermia due to diminished
subcutaneous fat and elevated
surface/volume ratio
119. Metabolic
- Hypoglycemia
- result from inadequate glycogen stores.
- diminished gluconeogenesis.
- increased BMR
- Hypocalcemia
- due to high serum glucagon level, which
stimulate calcitonin excretion
120. • Hematologic
- hyperviscosity and polycythemia due to
increase erythropoietin level sec. to hypoxia
• Immunologic
- IUGR have increased protein catabolism and
decreased in protein, prealbumin and
immunoglobulins, which decreased humoral
and cellular immunity.
121. • Fetal distress,
• Hypoxia, Acidosis and Low Apgar Score at
birth.
Increased perinatal morbidity and mortality
• Grade 3-4 intraventricular haemorrhage
• Necrotizing enterocolitis
122. • BIOPHYSICAL
• HC:AC
• Brfore 32 wks more than 1
• 32—34 wks app 1
• FEMUR LENGTH
• FL:AC IS 22at all gest wks from 21 wks to term
• More than 23.5 indicate IUGR
130. • Bronchopulmonary dysplasia
• Metabolic disturbances and hypoglycemia
• Polycytemia
• Hypothermia
• Impaired cognitive function and cerebral
paresis
131. MEDICAL MANAGEMENT
• ASPIRIN THERAPY
• Other forms of treatment that have been
studied are
• nutritional supplementation,
• zinc supplementation,
• fish oil,
• hormones and
• oxygen therapy
132. NURSING MANAGEMENT (During Pregnancy)
Diagnosis
• Impaired nutritional status less then body
requirement related to malnutrition.
Intervention
• To correct malnutrition by providing balanced
diet.
• To take extra calories from normal i.e. 300
calories extra.
• To provide nutritious foods, juices, fruits etc.
133. Diagnosis
• Decreased uteroplacental circulation related
to reduced blood flow to maternal surface or
placental cause.
Intervention
• Adequate bed red in left lateral position.
• Provide low dose of aspirin i.e. 50 mg daily.
• Prove o2 to mother at the rate of 2.5 L/min by
nasal prong for short term for prolongation of
pregnancy.
134. Diagnosis
• Decreased knowledge status of mother
related to IUGR, its complication to baby.
Intervention
• Provide knowledge to the mother.
• Provide health education to mother related to
self care as well as related to diet.
• Provide detailed information about her
condition of baby as well as complication for
baby.
135. NURSING MANAGEMENT FOR BABY
Risk for infection related to poor immunity
Goal
Care at neonatal intensive care unit
Intervention
• The NICU should be warm, free from excessive sound
smoothing light.
• Protection from infection should be ensured by aseptic
measures and effective hand washing.
• Rough handling and painful procedure should be
avoided.
• Baby should be placed on soft comfortable, “nestled”
and cushioned bed.
• Continuous monitoring of the baby’s clinical status are
vital aspects.
136. Decreased body temperature related to IUGR
Goal
Maintenance of stable body temperature
Intervention
• Baby should be received in a pre warmed radiant
warmer or incubator. Environmental temperature
should be maintained according to baby’s weight
and age.
• Baby’s skin temperature should be maintained 36.5
to 37.5 degree celcious.
• Baby birth weight of less than 1200gm should be
cared in the NICU incubator with 60 to 70 %
humidity, oxygen and thermo nutral environment
for better thermal control and prevent heat loss.
137. Decreased body weight of baby related to IUGR.
Goal
Maintenance of nutrition and hydration
Intervention
• Caloric needs of non-growing LBW babies during first
week of life are 60 kcal/ kg/ day on 7th is to be
stepped up gradually to 100 on 14th day and about
120-150 on 21st day, to maintain satisfactory
growth.
• Human milk is the first choice of nutrition for all LBW
babies. Colostrums, hind milk, foremilk, and preterm
milk help faster growth of baby.
• If breast milk is not available cows milk in proportion
of 1:1 (milk: water) for 1st month and 2:1 during
second month is an alternative substitute.
139. RESEARCH ARTICLE
TITLE - Study of causes and complications of intra
uterine fetal death (IUFD)
OBJECTIVES - This study were to study the causes of
Intra Uterine Fetal Death (IUFD), associated
complications and to suggest preventive measures.
METHODS - Study design: retrospective observational
study. This study was carried out over a period of 3
months (April 2014- June 2014) at a tertiary care
hospital. Inclusion criteria was all IUFD >20 weeks of
gestation.
140. RESULT
Out of 1850 total births during the study period
80 IUFD occurred. Hence proportion of IUFD
was 4.3%. In this study, Still Birth Rate (SBR) as
per WHO criteria (28 weeks) was 22.1 per 1000.
Registered patients were 24 (30%) whereas 56
(70%) were emergency admissions. Majority of
cases, 48 (60%) were multigravidae with past
obstetric history of abortion and IUFD in 13
(16.2%) and 9 (11.2%) respectively. In 31
(38.7%) no identifiable cause of IUFD was found
whereas cause was identified in 49 (61.3%).
141. Conclusions
Anemia, PIH, accidental haemorrhage were
leading causes of IUFD. Majority of women
who had IUFD were emergency admission
who had not received adequate antenatal
care. A significant proportion of IUFD is
preventable by health education to patients
and community for regular antenatal care,
about warning signs during antenatal period,
hospital delivery and early referral.
Editor's Notes
Rhesus disease gets worse with successive pregnancies.
Anti-D is given as prophylaxis and is useless once sensitization has occurred.