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This document discusses fetal death, including common causes, symptoms, diagnosis, maternal complications, and counseling patients. Fetal death occurring between 20 weeks of gestation and delivery is termed intra-uterine fetal death. Common causes include hypertensive disorders, diabetes, infections, cord accidents, and genetic anomalies. Diagnosis is made when ultrasound shows no fetal heart tone or movement. This can lead to disseminated intravascular coagulation in the mother. Patients experiencing fetal death should be counseled and delivered to prevent complications.
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Hp mar06 rqectopic
This document presents 4 multiple choice questions related to ectopic pregnancy. It begins by describing a case of a woman presenting with abdominal pain and irregular menstrual bleeding, asking what the most appropriate diagnostic test would be. It then presents a case of a woman at 7 weeks pregnant with an ultrasound finding of a mass near the ovary but no intrauterine pregnancy, asking for the most likely diagnosis. The third question asks about the most appropriate treatment for a hemodynamically stable patient with an unruptured ectopic pregnancy. The fourth question asks about the most common etiologic factor for ectopic pregnancy. The document provides answers and explanations for each question.
Early pregnancy bleeding .ppt by Dr. Rabirra
1. Ectopic pregnancy is implantation of a fertilized egg outside the uterus, usually in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, tubal surgery, or ectopic pregnancies.
2. Clinical presentations include delayed menstruation, lower abdominal pain, and vaginal bleeding or spotting. With tubal rupture, severe sharp pain occurs.
3. Ectopic pregnancies are classified based on location, most commonly in the fallopian tube ampulla or isthmus. Diagnosis involves history, ultrasound, and beta-hCG blood tests.
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD, Mob: 7289915430, w...
This document discusses post-dated pregnancy and intra-uterine fetal death (IUFD). It defines IUFD as the death of a fetus in the uterus and lists various potential causes including pregnancy complications, fetal issues, and idiopathic causes. The document outlines methods for diagnosing IUFD such as symptoms, signs, investigations including ultrasound and biophysical profile, and management approaches including expectant management, induction of labor, and fetal surveillance. It also discusses post-dated pregnancy risks and recommendations for induction of labor at or beyond 41 weeks gestation.
Infertility2
The document discusses outcome measurement for assisted reproductive technology (ART). It introduces various ART procedures and study design considerations for ART studies. Key points include defining success based on equivalence or non-inferiority to comparators rather than superiority, using deliveries/initiated cycles as the gold standard outcome measure, and considering safety endpoints like ovarian hyperstimulation syndrome and multiple pregnancies. The future of ART outcome measurement may involve improving biological surrogate outcomes like aneuploidy rates through technologies like preimplantation genetic diagnosis.
Diagnostic approach and management of extrauterine pregnancy
An ectopic pregnancy is a pregnancy that develops outside a woman's uterus. This happens when the fertilized egg from the ovary does not reach or implant itself normally in the uterus. Instead, the egg develops somewhere else in the abdomen. The products of this conception are abnormal and cannot develop into fetuses. Urine pregnancy test is often done by women itself once amenorrhea is present about 2 weeks of expected menstrual period, however, pregnancy blood test such Beta – human Chorionic Gonadotropin (BhCG) and ultrasound examination are the best tool of diagnosis. The most common place that ectopic pregnancy occurs is in one of the fallopian tubes, a so-called tubal pregnancy. These are the tubes that transport the egg from the ovary to the uterus. Ectopic pregnancies also can be found on the outside of the uterus, on the ovaries, or attached to the bowel. Most serious complication of an ectopic pregnancy is intra-abdominal hemorrhage. In the case of a tubal pregnancy, for example, as the products of conception continue to grow in the fallopian tube, the tube expands and eventually ruptures. This can be very dangerous because a large artery runs on the outside of each Fallopian tube. If the artery ruptures, the woman can bleed severely. Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy and is the leading cause of pregnancy-related deaths in the first trimester of pregnancy in the USA. In Albania, we face difficulties not only in application of high technology of ultrasound machine in public health sector but unfortunately we are unable to perform BhCG in public health sector laboratories, such making not only challenge and even delay but an expensive process of diagnosis of this medical problem. In conclusion, since ectopic pregnancy is an abnormal pregnancy, and comes with high risk of serious complication, early diagnosis of pregnancy location and its management is crucial in preventing medical complication.
Normal and abnormal delivery 2018
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- Children conceived through ART have an increased risk of birth defects compared to naturally conceived children, though the absolute risks are small.
- Studies have found possible associations between ART and rare imprinting disorders like Beckwith-Wiedemann and Angelman syndromes, though the evidence is still tentative.
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Recommended
Hp mar06 rqectopic
This document presents 4 multiple choice questions related to ectopic pregnancy. It begins by describing a case of a woman presenting with abdominal pain and irregular menstrual bleeding, asking what the most appropriate diagnostic test would be. It then presents a case of a woman at 7 weeks pregnant with an ultrasound finding of a mass near the ovary but no intrauterine pregnancy, asking for the most likely diagnosis. The third question asks about the most appropriate treatment for a hemodynamically stable patient with an unruptured ectopic pregnancy. The fourth question asks about the most common etiologic factor for ectopic pregnancy. The document provides answers and explanations for each question.
Early pregnancy bleeding .ppt by Dr. Rabirra
1. Ectopic pregnancy is implantation of a fertilized egg outside the uterus, usually in the fallopian tubes. Risk factors include previous pelvic inflammatory disease, tubal surgery, or ectopic pregnancies.
2. Clinical presentations include delayed menstruation, lower abdominal pain, and vaginal bleeding or spotting. With tubal rupture, severe sharp pain occurs.
3. Ectopic pregnancies are classified based on location, most commonly in the fallopian tube ampulla or isthmus. Diagnosis involves history, ultrasound, and beta-hCG blood tests.
POST DATED PREGNANCY AND INTRA-UTERINE FETAL DEATH, IUFD, Mob: 7289915430, w...
This document discusses post-dated pregnancy and intra-uterine fetal death (IUFD). It defines IUFD as the death of a fetus in the uterus and lists various potential causes including pregnancy complications, fetal issues, and idiopathic causes. The document outlines methods for diagnosing IUFD such as symptoms, signs, investigations including ultrasound and biophysical profile, and management approaches including expectant management, induction of labor, and fetal surveillance. It also discusses post-dated pregnancy risks and recommendations for induction of labor at or beyond 41 weeks gestation.
Infertility2
The document discusses outcome measurement for assisted reproductive technology (ART). It introduces various ART procedures and study design considerations for ART studies. Key points include defining success based on equivalence or non-inferiority to comparators rather than superiority, using deliveries/initiated cycles as the gold standard outcome measure, and considering safety endpoints like ovarian hyperstimulation syndrome and multiple pregnancies. The future of ART outcome measurement may involve improving biological surrogate outcomes like aneuploidy rates through technologies like preimplantation genetic diagnosis.
Diagnostic approach and management of extrauterine pregnancy
An ectopic pregnancy is a pregnancy that develops outside a woman's uterus. This happens when the fertilized egg from the ovary does not reach or implant itself normally in the uterus. Instead, the egg develops somewhere else in the abdomen. The products of this conception are abnormal and cannot develop into fetuses. Urine pregnancy test is often done by women itself once amenorrhea is present about 2 weeks of expected menstrual period, however, pregnancy blood test such Beta – human Chorionic Gonadotropin (BhCG) and ultrasound examination are the best tool of diagnosis. The most common place that ectopic pregnancy occurs is in one of the fallopian tubes, a so-called tubal pregnancy. These are the tubes that transport the egg from the ovary to the uterus. Ectopic pregnancies also can be found on the outside of the uterus, on the ovaries, or attached to the bowel. Most serious complication of an ectopic pregnancy is intra-abdominal hemorrhage. In the case of a tubal pregnancy, for example, as the products of conception continue to grow in the fallopian tube, the tube expands and eventually ruptures. This can be very dangerous because a large artery runs on the outside of each Fallopian tube. If the artery ruptures, the woman can bleed severely. Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy and is the leading cause of pregnancy-related deaths in the first trimester of pregnancy in the USA. In Albania, we face difficulties not only in application of high technology of ultrasound machine in public health sector but unfortunately we are unable to perform BhCG in public health sector laboratories, such making not only challenge and even delay but an expensive process of diagnosis of this medical problem. In conclusion, since ectopic pregnancy is an abnormal pregnancy, and comes with high risk of serious complication, early diagnosis of pregnancy location and its management is crucial in preventing medical complication.
Normal and abnormal delivery 2018
This document discusses normal versus abnormal modes of delivery, specifically focusing on cesarean section rates. It provides statistics on global and Lebanese cesarean section rates, noting that Lebanese rates have risen dramatically in recent decades to over 40% currently. The document explores various factors contributing to increasing cesarean rates, such as financial incentives, malpractice concerns, and lack of labor preparation. It also reviews potential adverse effects of cesarean section on infant health outcomes like respiratory issues, microbiome disturbance, and increased risk of obesity and metabolic disorders. Solutions proposed to reduce unnecessary cesarean sections include implementing national guidelines, improving prenatal education, and promoting vaginal birth after cesarean.
The Theory and Pratice of Human Reproduction
This document summarizes several studies on the health outcomes of children conceived through assisted reproductive technologies (ART) such as in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI). Some key findings include:
- Children conceived through ART have an increased risk of birth defects compared to naturally conceived children, though the absolute risks are small.
- Studies have found possible associations between ART and rare imprinting disorders like Beckwith-Wiedemann and Angelman syndromes, though the evidence is still tentative.
- Overall, studies found that pregnancy outcomes after ICSI were similar to IVF, and neonatal outcomes and health of ICSI children were comparable to IVF children. However,
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On this call, Dr. Skakkebaek presented his concerns about increasing trends in male reproductive disorders, including the significant global increase in incidence of germ cell tumors. He and colleagues from all over the world demonstrated that over half of all young men's semen quality does not meet the reference standard of the World Health Organization. Dr. Skakkebaek presented evidence linking testicular cancer, poor semen quality, childlessness, and rapidly decreasing fertility rates. He showed how there is little doubt that environmental factors, most likely associated with modern lifestyles, have - in a broad sense - had an adverse influence on male reproductive health. He and his group are examining a fundamental role that exposure to endocrine-disrupting chemicals may play in these trends, trends that in a few decades will result in decreasing populations in industrialized countries, and believes collaborative research is required to identify the causes of these adverse trends.
Sources: http://healthandenvironment.org/partnership_calls/18355
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INTRAUTERINE GROWTH RESTRICTION
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Dr Nidhi Outcome of IVF | Jindal IVF Chandigarh
The document discusses various risks associated with pregnancies resulting from assisted reproductive technologies (ART) like IVF. It notes that ART pregnancies have slightly higher risks of early pregnancy loss, ectopic pregnancy, multiple pregnancies, gestational diseases, birth defects, and poorer perinatal outcomes. However, it also states that some of these risks may be due to underlying infertility issues rather than the ART procedures themselves. The document advocates for close monitoring of ART pregnancies and suggests more research is needed to fully understand all risk factors.
ABORTION ( PART- 1)
Abortion is the expulsion or extraction from its mother of an embryo or fetus weighing 500g or less when it is not capable of independent survival . there are many types of abortion. for this yo u read this ppt and also be ready to watch its next part. so read it and get information about miscarriage. it is an important topic in obstetrics. stay tuned.
Ectopic pregnancy.presentation slides pt
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tubes. Risk factors include previous pelvic infections caused by bacteria like Chlamydia and gonorrhea, as well as a history of prior ectopic pregnancy or tubal surgery. Clinical features may include abdominal pain, vaginal bleeding, and shoulder pain. Diagnosis is confirmed through ultrasound and beta-hcg blood tests. Treatment depends on whether the tube has ruptured, but may include surgery or medication with methotrexate. Differential diagnoses include threatened or incomplete abortion, corpus luteum cyst, infections like salpingitis, and appendicitis.
The Outcome of Fetuses Diagnosed with Congenital Cystic.pdf
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- 13 infants (30.9%) were symptomatic at birth while 29 (69.1%) were asymptomatic. Symptomatic infants were more likely to have associated antenatal complications and less likely to have resolution of the fetal CCAM lesion.
- The majority (61%) of symptomatic infants required surgery compared to just one (3.4%) asymptomatic infant. However, most infants remained symptom-free during the 1st year of life. Death only occurred in symptomatic infants.
Postoartum Hemorrhage
Uterine atony, retained placenta, and blood clotting issues are the main causes of postpartum hemorrhage (PPH), the leading cause of maternal mortality worldwide. A study conducted questionnaires on PPH prevalence, causes, and treatments among Egyptian university students. Most participants knew someone who experienced PPH. The most common reported causes were anemia, uterine atony, and clotting problems. Blood transfusion was the most common reported treatment. The study concluded there is low PPH awareness and an increasing trend, calling for better education and healthcare to manage risks and reduce mortality.
Palm coein clasification
The document discusses the new FIGO classification system for abnormal uterine bleeding (AUB). It introduces the PALM-COEIN system which provides a standardized terminology and classification. The system categorizes AUB into structural causes (polyps, adenomyosis, leiomyoma, malignancy) and non-structural causes (coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, not yet classified). It provides guidelines for evaluation and outlines the notation system for documenting multiple contributing factors to a patient's AUB. The standardized classification aims to improve management of AUB internationally through a unified terminology and focus on appropriate treatment concepts.
Recurrent Implantation Failure
May occur very early on during the attachment or migration stages (No objective evidence e.g. –ve hCG)
May also occur at a later stage (+ve hCG) but process becomes disrupted
Definition: Refers to the failure of the embryo to reach a stage when an intrauterine gestational sac is recognized by ultrasonography.
Implantation failure can apply to patients undergoing ART and patients trying to conceive without any fertility treatment.
It is a separate entity from RPL
Orvieto et al - 3 failed IVF-ET cycles with good quality embryos transferred .
Zeyneloglu et al. - 3 unsuccessful IVF specifically with two embryos of high quality
Simon and Laufer - embryo & endometrium can both play an active role in RIF
Coughlan et al. suggest a more complete working definition taking into account maternal age, number of embryos transferred, and number of cycles completed.
They define RIF as the failure of clinical pregnancy after 4 good quality embryo transfers, with at least three fresh or frozen IVF cycles, and in women under the age of 40
RIF is a complex problem with a wide variety of etiologies / mechanisms/ treatment options.
Recommendations vary depending on the source of their problem. Perhaps the best and yet most complex answer is personalized medicine, a personal approach to each patient depending on her unique set of characteristics.
It would help to establish a set of standardized tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
This can be implemented when we have well designed studies that will help us to establish new protocols.
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Chorioamnionitis is a serious complication of pregnancy and a major cause of maternal and perinatal morbidity and mortality world over. This PowerPoint provides the basics of chorioamnionitis with emphasis on its etiologic role in fetal and neonatal infections.
Electronic fetal monitoring
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2) It reviews the rationale for EFM and evidence that it reduces neonatal seizures but not cerebral palsy in low-risk pregnancies.
3) The document covers the basic pathophysiology of fetal heart rate including physiological control, hypoxic response, and interpretation of EFM tracings.
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Abortion is defined as the spontaneous or induced termination of pregnancy
before fetal viability. Many prefer miscarriage for spontaneous loss.
abortion as
loss or termination of a pregnancy with a fetus aged younger than 20 weeks’
gestation or weighing <500 g.
Of all miscarriages, approximately half are euploid abortions, that is, carrying a normal chromosomal complement.
Most common abnormalities are
trisomy, found in 50 to 60 percent;
monosomy X, in 9 to 13 percent; and
triploidy, in 11 to 12 percent
A prominent miscarriage risk is associated with poorly
controlled diabetes mellitus, obesity, thyroid disease, and systemic lupus
erythematosus. In these, inflammatory mediators may be an underlying theme
to pregnancy loss.
For women undergoing cancer treatment, direct therapeutic radiation can
cause miscarriage.
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Uterine atony, retained placenta, and blood clotting issues are the main causes of postpartum hemorrhage (PPH), the leading cause of maternal mortality worldwide. A study conducted questionnaires on PPH prevalence, causes, and treatments among Egyptian university students. Most participants knew someone who experienced PPH. The most common reported causes were anemia, uterine atony, and clotting problems. Blood transfusion was the most common reported treatment. The study concluded there is low PPH awareness and an increasing trend, calling for better education and healthcare to manage risks and reduce mortality.
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May also occur at a later stage (+ve hCG) but process becomes disrupted
Definition: Refers to the failure of the embryo to reach a stage when an intrauterine gestational sac is recognized by ultrasonography.
Implantation failure can apply to patients undergoing ART and patients trying to conceive without any fertility treatment.
It is a separate entity from RPL
Orvieto et al - 3 failed IVF-ET cycles with good quality embryos transferred .
Zeyneloglu et al. - 3 unsuccessful IVF specifically with two embryos of high quality
Simon and Laufer - embryo & endometrium can both play an active role in RIF
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It would help to establish a set of standardized tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
This can be implemented when we have well designed studies that will help us to establish new protocols.
Chorioamnionitis Dr Simon Byonanuwe
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2) It reviews the rationale for EFM and evidence that it reduces neonatal seizures but not cerebral palsy in low-risk pregnancies.
3) The document covers the basic pathophysiology of fetal heart rate including physiological control, hypoxic response, and interpretation of EFM tracings.
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Abortion is defined as the spontaneous or induced termination of pregnancy
before fetal viability. Many prefer miscarriage for spontaneous loss.
abortion as
loss or termination of a pregnancy with a fetus aged younger than 20 weeks’
gestation or weighing <500 g.
Of all miscarriages, approximately half are euploid abortions, that is, carrying a normal chromosomal complement.
Most common abnormalities are
trisomy, found in 50 to 60 percent;
monosomy X, in 9 to 13 percent; and
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Prenatal care
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Intra uterine insemination for unexplained infertility
1. Intrauterine insemination (IUI) involves placing processed semen into the uterine cavity around ovulation and can increase conception rates for unexplained infertility compared to timed intercourse.
2. For unexplained infertility, IUI with or without ovarian stimulation is a first-line treatment option that is simple, cost-effective and less invasive than IVF.
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This slide will highlight the most important theoretical and practical concept regarding abortion. In this slide preparation the definition, types, clinical presentation, the magnitude and prevalence, types of abortion in different settings, managing of abortion based presentation are presented.
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3) While IVF has helped many couples conceive, it also carries risks like multiple births, preterm delivery, and ovarian hyperstimulation syndrome. Success rates have improved over time but depend on factors like a woman's age and the clinic's
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iufdsdc.ppt
- 1. Fetal Death
- 2. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies APGO Educational Topic 21 A. Describe the common causes of fetal death in each trimester. B. Describe the symptoms, physical findings and diagnostic methods to confirm the diagnosis of fetal death. C. Describe the maternal complications of fetal death, including DIC. D. Counsel the patient experiencing death of the fetus.
- 3. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Fetal Death Intra-Uterine Fetal Death (IUFD) Fetal death after 20 weeks EGA but before the onset of labor. Complicates 1% of pregnancies. Shift from expectant management to active management.
- 4. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Common Causes Unknown or indeterminate in approx 50% of cases. http://pathologyoutlines.com/images/placentatrueknot.jpg True Knot
- 5. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Common Causes Hypertensive Diseases (Pre-E, Eclampsia) Diabetes Mellitus Erythroblastosis Fetalis Umbilical Cord Accidents (true knot, prolapse) Congenital Anomalies Infections (Fetal or Maternal) Hemorrhage (Abruption) Thrombophilias (antiphospholipid antibodies)
- 6. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Infection - TORCH Toxoplasmosis Rubella CMV HSV Parvo-virus Listeria
- 7. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Gestational HSV Infection http://www.nature.com/jp/journal/v22/n1/images/7210584f1.jpg
- 8. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Patient Presentation Subjective decreased fetal movements Uterus FH is small for EGA No fetal heart tones with doppler Will still have pos hCG Ultrasound No Fetal Movement No Fetal Cardiac Activity
- 9. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Diagnostic Methods for IUFD http://www.slredultrasound.com/ThermalImages/Pelvic/IUFD1.jpg No FCA No movement
- 10. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Maternal Complications Disseminated Intravascular Coagulopathy Decreased platelets Decreased fibrinogen Increased PT/PTT (Clotting times) Clinical bleeding / oozing from all sites Decreasing H/H RX involves DELIVERY, pRBC’s, FFP, PLATELETS, Supportive Management
- 11. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Maternal Complications 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)
- 12. 2009-2010 USUHS MSIII Ob/Gyn Clerkship Self Directed Studies Management = Delivery Attempt for SVD Expectant vs. Active management Active Management Cytotec Pitocin Pain Management PCA (Pt Controlled Analgesia) Epidural