This document provides guidelines for antenatal screening in India. It recommends screening in the first, second, and third trimesters to assess risk factors, detect fetal abnormalities, and monitor fetal well-being. In the first trimester, it suggests screening for chromosomal anomalies through nuchal translucency measurement, biochemical markers, and non-invasive prenatal testing. Second trimester screening includes the quadruple marker test, anomaly scan, and screening for conditions like gestational diabetes. Third trimester screening focuses on fetal growth, amniotic fluid levels, fetal movement assessment, and cardiotocography to monitor fetal heart rate. The guidelines aim to optimize antenatal care through a systematic, multi-stage screening process
Adbhut matratva is a unique modification of the normal antenatal care.............we now propogate care from PRECONCEPTION to POST PARTUM including a HOLISTIC APPROACH
Adbhut matratva is a unique modification of the normal antenatal care.............we now propogate care from PRECONCEPTION to POST PARTUM including a HOLISTIC APPROACH
Prenatal Testing, deteksi kelainan bawaan sejak dalam kandunganHendrik Sutopo
Pengenalan mengenai prenatal diagnosis.
Memberikan gambaran sekilas mengenai cara-cara untuk mengetahui kelainan bawaan sejak janin dalam kandungan.
lebih ditujukan untuk kalangan medis.
Non Invasive Prenatal Testing (NIPT)
Baseline serum chemistry in 1st trimesterRohit Jain
ppt on "baseline serum chemistry in 1st trimester" by Dr.Rohit Jain,Assistant Professor,Obstetrics and Gynecology Department,Civil Hospital,BJ Medical College,Ahmedabad
Common Lab Investigations in pregnancy specific to each TrimesterDrNisheethOza
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.
Introduction
Pregnancy is a normal physiological process and any intervention that is offered to the pregnant or expectant mother should have known benefits and should be acceptable to the woman
Screening in pregnancy is the process of surveying a population of women with markers and defined screening cut-off levels, to identify those at higher risk for a particular disorder
All pregnant women, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies
Prenatal Testing, deteksi kelainan bawaan sejak dalam kandunganHendrik Sutopo
Pengenalan mengenai prenatal diagnosis.
Memberikan gambaran sekilas mengenai cara-cara untuk mengetahui kelainan bawaan sejak janin dalam kandungan.
lebih ditujukan untuk kalangan medis.
Non Invasive Prenatal Testing (NIPT)
Baseline serum chemistry in 1st trimesterRohit Jain
ppt on "baseline serum chemistry in 1st trimester" by Dr.Rohit Jain,Assistant Professor,Obstetrics and Gynecology Department,Civil Hospital,BJ Medical College,Ahmedabad
Common Lab Investigations in pregnancy specific to each TrimesterDrNisheethOza
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.
Introduction
Pregnancy is a normal physiological process and any intervention that is offered to the pregnant or expectant mother should have known benefits and should be acceptable to the woman
Screening in pregnancy is the process of surveying a population of women with markers and defined screening cut-off levels, to identify those at higher risk for a particular disorder
All pregnant women, regardless of age, should be offered, through an informed counselling process, the option of a prenatal screening test for the most common clinically significant fetal aneuploidies
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
- 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
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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!
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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.
2. EXPERT GROUP
DR NARENDRA MALHOTRA
DR MALAARORA
DR RANJANA KHANNA
DR ABHA RANI SINHA
DR PRAGYA MISHRA
DR NAVNEET MAGON
DR GANPAT SAWANTA
3. Reference Material
• New WHO guidelines on antenatal care –
Systematic review BJOG 2016;123:519-28
• Guidelines by Government of western
Australia
• SOGC guideline on Prenatal Screening
• RCOG / NICE Guidelines
5. Why Screen ?
1.Triage mothers to High Risk & Low Risk
2.Prevent Maternal Complications
3.Screen the fetus for
• Chromosomal errors
• Structural Defects
• Growth abnormalities
4.Decide the time and mode of safe
delivery
6. ADD SCREENING FOR N.C.D.HERE
THE PYRAMID OF ANTENATAL CARE
Post delivery continued screening
7. Routine Antenatal Care 1990s…….
Early scan to diagnose
pregnancy & dating
22-24 wks
Fetal defects
Anomaly scan
8. Routine Antenatal Care 2005
11-14 wks
Fetal defects
20-23 wks
P I P I P
The great
Ob syndrome
9. Routine Antenatal Care 2010
11-13+6 wks
Fetal defects
Chemical markers Major
Cardiac defects
Uterine artery Doppler
20-23 wks
Anomaly scan
10. FOGSI OLD CHECK LIST OF 2009,MODIFIED IN 2017 AT FOGSI T.O.G.
15. Body Mass Index – If high
•Prevent further weight gain
•Institute Life style modifications
•Medical Therapy – Metformin
•Nutrition Therapy – High fibre diet
•Daily Exercise
•Prepare for safe delivery
17. Blood Pressure
• Hypertension – BP in both arms
Sitting position
Dissappearance of korotkov
• Hypotension – increase sodium/ potassium intake
• Screening test for PIH
Placental Growth Factor (PlGF)
S Flt
s endoglin
Uterine artery doppler flow indices
18. Screening for Anaemia
• Complete Blood count
• Peripheral Smear
• If Microcytic Hypochromic
Iron studies – Ferritin / Total Iron / TIBC
Haemoglobin Electrophoresis
• If Normocytic / Macrocytic
Serum Vitamin B12
Serum / Red cell Folate
Reticulocyte count
19. Blood group & Rhesus Antibodies
• If Rhesus Negative
• Partners Blood group – If negative –
• If positive – Indirect Coombs test
• If positive – Cordocentesis & fetal blood
transfusion with Rh negative blood at
periodic intervals
• Deliver at 34 weeks
20. Endocrine Screening
• Thyroid function test
• If abnormal, thyroid antibodies
• In PCO – screen for GDM early (HbA1C)
• If galactorrhea – Prolactin
• Serum Vitamin D
• Relaxin ?
21. Infection Screen
• Complete blood count /ESR
• Rubella antibodies
• Urine routine & microscopy
• Mid stream urine culture
• High Vaginal / Endo cervical swab /Wet Prep /
Vaginal pH / Chlamydia antibodies
(SOLVS + FVU PCR)
• HIV / Hep B / Hep C / VDRL
23. Various Integrated screening in
strategies (1st and 2nd trim)
Main strategies:
• Fully Integrated
• Step-wise sequential
• Contingent screening
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29. Screening in the 1st trimester
• Time window: 8 - 14 weeks
• Ultrasound Marker:
• NT
• Biochemical markers:
• PAPP-A
• Fb-hCG
• Marker combination:
• Combined test: NT, PAPP-A, Fb hCG
30. Screening for Trisomy 21 at 11- 14 weeks
2-stage (contingency) screening- UK system
USG (N.T.) AND DUAL MARKER FOR ALL
Fetal NT and
free BhCG and
PAPP-A at 12 wks
Very high risk
Very low risk
CVS
Reassure
Borderline
risk
Further
screening
Nasal bone
DV, TR
31. Screening for Trisomy 21 at 11- 14 weeks for
India
2-stage (contingency) screening proposed
RISK ESTIMATE BY ONLY USG N.T. AND OTHER MARKERS
Fetal NT
Nasal bone and
ductus venosus
tricuspid
regurgitation at 12
wks
Very high risk
Very low risk
CVS
Reassure
Borderline
risk
Further
screening
Free B hCG
PAPP-A
THIS WILL SAVE
TIME
MONEY
OPTIMUM USE OF OUR
SKILL
DOUBLE MARKER
TEST
Scan 20w NIPT
32. • MA+ NIPT(OPTIONAL)
• Dual Marker
• NT + NB + TR + DV
First
trimester
• Quad Marker
• Genetic Sonogram
Second
trimester
Integrated1
st and2nd trimesterscreening
DR – 97%
FPR – 2.5%
33. SO PROPOSAL IS INDIAN
CONTINGENT SCREEN
OR
INTEGRATED FIRSTAND
SECOND TRIMESTER
SCREEN
COMBINED FIRST TRIMESTER SCREEN
FOR RISK ESTIMATE…….
FOLLOWED BY COMBINED 2ND
TRIMESTER RISK SCREENING
37. 1LOW LEVELS PREDICT PRE ECCLAMPSIA
2 LOW RISK NO FURTHER TEST (1 : 1000)
INTERMEDIATE RISK (100 : 999) TO PROCEED TO SECOND TRIMESTER SCREENING VS NIPT
HIGH RISK (1 : 99) TO GO FOR CVS / NIPT
ANTENATAL CHECKLIST
First Trimester Recommended Preferable
weight BMI
Blood pressure Mean Arterial Pressure
Haemoglobin Complete blood count/ Peripheral smear /
Hb Electrophoresis / HPLC
Blood group ABO & Rh (both partners)
Urine routine MSU culture
VDRL/ Hep B / HIV HCV / Rubella IgG
TSH Thyroid function test / Thyroid Antibodies
Vitamin D
DIPSI test 75gms 2 hours blood sugar Hb A1C / OGTT/ 6 point blood sugar test
Dating scan + NT
Double marker (free beta
HCG + PAPP A1 )
(Contingent Screen2
Cervical length
Uterine artery Doppler
NIPT
Placental Growth Factor
(PLGF)
Per speculum exam Pap Smear, Bacterial vaginosis &
Chlamydia screen
40. CERVICAL LENGTH SCREENING
ROUTINE TO PREVENT PRETERM
LABOUR AND FOR GUIDELINE FOR
CX STITCH
• ASYMPTOMATIC SINGLETON PREGNANCYATVS CL <25
MM IN SECOND TRIMESTER
• SCREEN AT 11-13 WEEKSAND THEN AT 22-22 WEEKS
RECENT EVIDENCE SAYS CX STITCH DOES NOT HELP AND
PROGESTERONE MAY BE THE ONLY TREATMENT OPTION
HERE.ROUTINE MCDONALD STITCH PRACTISE SHOULD BE
INDIVIDUALISED
46. Screening for GDM
• HbA1C
• DIPSI one step screen 75 gms 2
hour
• Cut off of 140 mg/dl
• At 24 to 28 weeks
• Repeat at 32 weeks in high risk
women i.e Polyhydramnios /
previous GDM / Parents &
siblings diabetic
47. Screening for PIH
• Blood Pressure
• Water Retention – edema / rapid
weight gain
• Micro albuminuria
• Spot test – Urine Protein /Creatinine
ratio
• Ratio of PlGF / sFlt
• LDH raised in HELLP Syndrome
• Renal artery doppler
48. Vaccination
• Tetanus Toxoid – ONE DOSE
• Tdap –SECOND DOSE AT 24 WEEKS
• Influenza vaccine 24 weeks onwards
• hpB can be given if not immunised
• Targetted Vaccine in case of travel to
endemic areas
• Post partum – HPV vaccine
53. INFECTION SCREEN
• GBS – Is routine screening required prior to
delivery ?
• Pelvic assessment – Does it improve your
decision for normal delivery ?
• Pelvic relaxation techniques / exercises like
walking / squatting / butterfly
56. Cardiotocography
• Non Stress test vs Oxytocin Stress test
• When to start ? Post viability period 30
weeks
• How often to do ? Once a week
• What are the omnious signs –
Lack of BTB variation
Variable deaccelerations of cord
compression
Late deacceleration of fetal hypoxia
• Supplement with ST waveform analysis
• Fetal cord blood pH during labour
58. Recording
•Every kick / roll is 1 movement
•Count 10 movements everyday
•Should be around 6 in 1 hour
•If < 6 movements in 2 hours
•Call doctor & come for CTG / USS
assessment
59. About baby’s movements
An active baby is usually a healthy baby. You
will feel your baby stretch, kick, roll and turn
every day. Some babies are more active than
others. All babies have periods of sleep during
which they are not as active. You will get to
know your baby’s pattern of movements and
when your baby is most active.
You should feel your baby’s movements
throughout the day, each day from 28 weeks of
pregnancy until the baby is born.
When during my pregnancy should I count
my baby’s movements?
Your health care provider may ask you
to count your baby’s movements once
every day.
If you think there is a decrease in your
baby’s movements this is an important sign that
your baby may not be well. Count your baby’s
movements to be sure that you feel at least 6
movements in 2 hours.
Reference:
Society of Obstetricians and Gynaecologists of Canada (2007).
Fetal Health Surveillance : Antepartum and Intrapartum Consensus
Guideline. Journal of Obstetrics and Gynaecology Canada. 29(9).
FETAL MOVEMENT
COUNT CHART
PLEASE BRING THIS CHART WITH YOU EACH
TIME YOU SEE THE DOCTOR/MIDWIFE
IMPORTANT PHONE NUMBERS:
DOCTOR:
MIDWIFE:
HOSPITAL:
DUE DATE:
OTHER INSTRUCTIONS:
For 24-hour nurse advice and health information call
Health Link Alberta:
1-866-408- LINK (5465)– Toll Free
In Calgary call 403-943- LINK (5465)
In Edmonton call 780-408-LINK (5465)
ADDRESS:
NAME:
HS0001-132 (2012/11)
How do I count my baby’s movements?
• Get into a comfortable position – lying on
your side or sitting. Place one or both of your
hands on your abdomen.
• Count each time that you feel your baby
move. If you feel many movements all at
once, count each movement that you feel.
• Write down the date and the time that you
start counting on the fetal movement chart.
• Make a mark on the chart each time your baby
moves.
• Stop counting when you have counted 6
movements.
• Write down the time you stopped counting.
• Do not count for more than 2 hours
What if I don’t feel 6 movements in 2 hours?
Count your baby’s movements once a day. You
should feel 6 or more movements in 2 hours.
If you count fewer than 6 movements in 2 hours
do not wait. Go to the hospital or birthing unit.
Your baby’s heart rate and movements will be
checked using a fetal monitor. This is called a
non-stress test or NST.
If you live too far from a hospital or birthing
unit, immediately contact your health care
provider for advice.
60. TWEAK Screening for alcoholism
• T – Tolerance (No of drinks one can hold)
• W- Worry about drinking
• E – Eye opener
• A- Amnesia
• K/C – Cut down on drinking
• To screen for fetal alcohol syndrome
61. • Antepartum fetal surveillance is the assessment of
fetal well being in utero before the onset of labor
• Early detection of fetus at risk so that timely
management to prevent further deterioration
• Also find out normal fetuses and avoid unnecessary
interventions
• Very high negative predictive value
• Very low positive predictive value
62. FETUS AT RISK
• PRE TERM
• POST TERM
• IUGR
• THICK MECONIUM
WITH SCANTY
FLUID
• INTRAUTERINE
INFECTION
• INTRAPARTUM
BLEEDING
FETUS AT
RELATIVE RISK
INJUDICIOUS USE OF
OXYTOCIN
EPIDURAL IN A CASE WITH
SOME COMPROMISE
DIFFICULT INSTRUMENTAL
DELIVERY/ MACROSOMIA/
MALPRESENTATION
ACUTE EVENTS (CORD
PROLAPSE, ABRUPTION,
SCAR RUPTURE)
SUSPICIOUS/ ABNORMAL
ADMISSION TEST
66. • Hydrops fetalis
• Fetal infections
• PREGNANCY RELATED CONDITIONS
• Preeclampsia
• Multiple pregnancy
• Post term pregnancy
• Decreased fetal movements
• Abnormal placentation
• Placental abruption
67. • Oligohydramnios
• Polyhydramnios
• Unexplained stillbirth in a previous pregnancy
• Cholestasis of pregnancy
• PROM
• Poorly controlled Gestational Diabetes mellitus
68. The Various Methods of Antepartum
Fetal Surveillance
1) Clinical assessment by uterine growth
2) Fetal movement count by the mother
3) Ultrasound for fetal growth
4) Non stress test and cardiotocography
5) Vibroacoustic stimulation test
6) Contraction stress test
7) Nipple stimulation test
8) Biophysical profile
9) Modified biophysical profile
10) Doppler studies
11) Fetal lung maturation studies
12) Placental grading
70. SCREENING IN PREGNANCY
At booking (Recommended 3ANC) [Preferable 5]
General Physical exam Heart / Lungs / Breast /
Abdomen
In all trimesters
• Maternal weight /BMI
• Blood Pressure / Mean Arterial Pressure
• Urine dipstick (albumin sugar)
71. 1LOW LEVELS PREDICT PRE ECCLAMPSIA
2 LOW RISK NO FURTHER TEST (1 : 1000)
INTERMEDIATE RISK (100 : 999) TO PROCEED TO SECOND TRIMESTER SCREENING VS NIPT
HIGH RISK (1 : 99) TO GO FOR CVS / NIPT
ANTENATAL CHECKLIST
First Trimester Recommended Preferable
weight BMI
Blood pressure Mean Arterial Pressure
Haemoglobin Complete blood count/ Peripheral smear /
Hb Electrophoresis / HPLC
Blood group ABO & Rh (both partners)
Urine routine MSU culture
VDRL/ Hep B / HIV HCV / Rubella IgG
TSH Thyroid function test / Thyroid Antibodies
Vitamin D
DIPSI test 75gms 2 hours blood sugar Hb A1C / OGTT/ 6 point blood sugar test
Dating scan + NT
Double marker (free beta
HCG + PAPP A1 )
(Contingent Screen2
Cervical length
Uterine artery Doppler
NIPT
Placental Growth Factor
(PLGF)
Per speculum exam Pap Smear, Bacterial vaginosis &
Chlamydia screen
