maternity guidline 2.pptx
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This document outlines guidelines for managing obstetric emergencies including placenta previa, postpartum hemorrhage (PPH), and eclampsia. For placenta previa, it recommends conservative care or cesarean section depending on gestational age and bleeding severity. For PPH, it lists drug therapies like misoprostol and tranexamic acid, as well as uterine balloon tamponade. For eclampsia, it provides a management protocol including administering magnesium sulfate, controlling blood pressure, monitoring the patient and fetus, and expedited delivery depending on gestational age.
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Overview and medical management of pph
PPH is a leading cause of maternal mortality. It can occur after vaginal or cesarean delivery. Uterine atony accounts for over 80% of cases. Initial management involves calling for help, uterine massage, IV access, rapid fluid resuscitation, and administration of uterotonic drugs like oxytocin, carboprost, and misoprostol. If bleeding continues, examination to check for lacerations or retained products is needed. Blood transfusion may be required based on Hb, platelets, fibrinogen levels. Secondary interventions include additional uterotonics, tamponade, or laparotomy for uncontrolled bleeding. Prompt recognition and treatment following protocols is key to reducing morbidity from PPH.
The use of algorithms & emergency boxes in obstetric emergency
1. Communicate the emergency and alert all necessary staff.
2. Resuscitate the patient with oxygen, IV fluids, and blood products to restore circulation and oxygen-carrying capacity.
3. Continuously monitor vital signs and investigate laboratory values every 15 minutes to guide resuscitation efforts. Stop the bleeding through techniques like bimanual compression, uterotonic drugs, balloon tamponade, or surgical interventions if needed.
Post Partum Hemorrhage in ED
Obstetric emergency which can kill instantly !! - PPH presenting to ED, so what is the role of Emergency Dept ? The most basic presentation of Obstetric emergency and how to tackle it? Being an emergency physician, obstetrics is always challenging! Keep yourself updated with Obstetric emergency.
Post partum Haemorrhage
1. Postpartum haemorrhage (PPH) is defined as blood loss greater than 500 ml within 24 hours of delivery. It can be primary (within 24 hours) or secondary (24 hours to 12 weeks).
2. Causes of PPH include uterine atony, retained placenta, genital tract trauma, and coagulation disorders. Uterine atony accounts for 75-90% of cases.
3. Management involves communication, resuscitation, monitoring, arresting the bleeding. Resuscitation focuses on airway, breathing, circulation, transfusions and fluid resuscitation. Arresting bleeding uses uterotonics, tamponade, compression sutures,
post partum haemorrhage.ppt how to access
Postpartum haemorrhage is a leading cause of maternal mortality. It is defined as bleeding over 500ml after childbirth. The main causes are an atonic uterus, retained placenta or tissue, and tears. Risk factors include advanced maternal age, previous bleeding, and multiple gestation. Rapid evaluation and treatment is critical to prevent shock. Initial management includes IV fluids, uterotonic drugs, massage, and identifying the cause. For an atonic uterus, oxytocin is first-line treatment followed by ergometrine or misoprostol if needed. For retained placenta, controlled cord traction and manual removal are attempted. Secondary PPH occurs after 24 hours and is usually due to infection.
Pre-eclampsia @MAk.pptx
A 34-year-old pregnant woman is diagnosed with preeclampsia. Nursing assessments for preeclampsia include monitoring blood pressure, urine output, neurological status, and fetal heart rate and movements. Interventions focus on preventing convulsions using magnesium sulfate, controlling blood pressure, and planning for delivery within 24 hours. Close monitoring of the woman and fetus is required throughout pregnancy, delivery, and the postpartum period to ensure a safe outcome.
Blood Products 2018
This document discusses blood products and massive transfusion protocols. It describes various blood components like packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. It outlines indications for transfusing different blood products based on hemoglobin, platelet count, coagulation tests. For massive transfusion, it recommends transfusing red blood cells, plasma, and platelets in a 1:1:1 ratio to achieve therapeutic goals. It also discusses disseminated intravascular coagulation (DIC) management and complications of massive transfusion like infections, circulatory overload, and metabolic disturbances.
Hypertensive disorder in pregnancy
Hypertensive disorders are a leading cause of maternal and neonatal morbidity and mortality worldwide. Preeclampsia is characterized by new onset hypertension and proteinuria after 20 weeks of gestation and can progress to eclampsia with seizures. It is diagnosed when blood pressure is ≥140/90 mmHg on two occasions at least 4 hours apart accompanied by ≥300mg protein in 24 hour urine or a urine protein creatinine ratio of >0.3. Treatment involves blood pressure control with medications like labetalol, nifedipine and magnesium sulfate to prevent seizures. Delivery is usually required to resolve preeclampsia though timing depends on gestational age and maternal/fetal stability. Close monitoring of mother and
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Overview and medical management of pph
PPH is a leading cause of maternal mortality. It can occur after vaginal or cesarean delivery. Uterine atony accounts for over 80% of cases. Initial management involves calling for help, uterine massage, IV access, rapid fluid resuscitation, and administration of uterotonic drugs like oxytocin, carboprost, and misoprostol. If bleeding continues, examination to check for lacerations or retained products is needed. Blood transfusion may be required based on Hb, platelets, fibrinogen levels. Secondary interventions include additional uterotonics, tamponade, or laparotomy for uncontrolled bleeding. Prompt recognition and treatment following protocols is key to reducing morbidity from PPH.
The use of algorithms & emergency boxes in obstetric emergency
1. Communicate the emergency and alert all necessary staff.
2. Resuscitate the patient with oxygen, IV fluids, and blood products to restore circulation and oxygen-carrying capacity.
3. Continuously monitor vital signs and investigate laboratory values every 15 minutes to guide resuscitation efforts. Stop the bleeding through techniques like bimanual compression, uterotonic drugs, balloon tamponade, or surgical interventions if needed.
Post Partum Hemorrhage in ED
Obstetric emergency which can kill instantly !! - PPH presenting to ED, so what is the role of Emergency Dept ? The most basic presentation of Obstetric emergency and how to tackle it? Being an emergency physician, obstetrics is always challenging! Keep yourself updated with Obstetric emergency.
Post partum Haemorrhage
1. Postpartum haemorrhage (PPH) is defined as blood loss greater than 500 ml within 24 hours of delivery. It can be primary (within 24 hours) or secondary (24 hours to 12 weeks).
2. Causes of PPH include uterine atony, retained placenta, genital tract trauma, and coagulation disorders. Uterine atony accounts for 75-90% of cases.
3. Management involves communication, resuscitation, monitoring, arresting the bleeding. Resuscitation focuses on airway, breathing, circulation, transfusions and fluid resuscitation. Arresting bleeding uses uterotonics, tamponade, compression sutures,
post partum haemorrhage.ppt how to access
Postpartum haemorrhage is a leading cause of maternal mortality. It is defined as bleeding over 500ml after childbirth. The main causes are an atonic uterus, retained placenta or tissue, and tears. Risk factors include advanced maternal age, previous bleeding, and multiple gestation. Rapid evaluation and treatment is critical to prevent shock. Initial management includes IV fluids, uterotonic drugs, massage, and identifying the cause. For an atonic uterus, oxytocin is first-line treatment followed by ergometrine or misoprostol if needed. For retained placenta, controlled cord traction and manual removal are attempted. Secondary PPH occurs after 24 hours and is usually due to infection.
Pre-eclampsia @MAk.pptx
A 34-year-old pregnant woman is diagnosed with preeclampsia. Nursing assessments for preeclampsia include monitoring blood pressure, urine output, neurological status, and fetal heart rate and movements. Interventions focus on preventing convulsions using magnesium sulfate, controlling blood pressure, and planning for delivery within 24 hours. Close monitoring of the woman and fetus is required throughout pregnancy, delivery, and the postpartum period to ensure a safe outcome.
Blood Products 2018
This document discusses blood products and massive transfusion protocols. It describes various blood components like packed red blood cells, platelets, fresh frozen plasma, and cryoprecipitate. It outlines indications for transfusing different blood products based on hemoglobin, platelet count, coagulation tests. For massive transfusion, it recommends transfusing red blood cells, plasma, and platelets in a 1:1:1 ratio to achieve therapeutic goals. It also discusses disseminated intravascular coagulation (DIC) management and complications of massive transfusion like infections, circulatory overload, and metabolic disturbances.
Hypertensive disorder in pregnancy
Hypertensive disorders are a leading cause of maternal and neonatal morbidity and mortality worldwide. Preeclampsia is characterized by new onset hypertension and proteinuria after 20 weeks of gestation and can progress to eclampsia with seizures. It is diagnosed when blood pressure is ≥140/90 mmHg on two occasions at least 4 hours apart accompanied by ≥300mg protein in 24 hour urine or a urine protein creatinine ratio of >0.3. Treatment involves blood pressure control with medications like labetalol, nifedipine and magnesium sulfate to prevent seizures. Delivery is usually required to resolve preeclampsia though timing depends on gestational age and maternal/fetal stability. Close monitoring of mother and
Sepsis Treatment
The document discusses sepsis treatment bundles which include early goal directed therapy, corticosteroids, antibiotics, ARDSnet ventilator management, stress ulcer prophylaxis, deep vein thrombosis prophylaxis, and Drotrecogin alpha. It provides details on the components, goals, and guidelines for each bundle element aimed at improving outcomes for patients with sepsis.
Eclampsia labor room protocol by dr alka mukherjee dr apurva mukherjee nag...
Eclampsia is a uniquely pregnancy-related disorder that manifests as new onset of generalized tonic colonic seizures. It typically occurs after 20 weeks of concluded gestation, although it may occur sooner with plural gestations or molar pregnancies, and may additionally occur in the 6-week postpartum window. It represents the severe end of the preeclampsia spectrum. Preeclampsia spectrum includes symptoms of the central nervous system (CNS), for example, severe headaches or vision changes, and may involve hepatic abnormalities (such as elevated liver transaminases with right upper quadrant/epigastric discomfort), elevated blood pressures, and also may include thrombocytopenia, renal abnormalities, and pulmonary edema. In developed countries, resultant maternal mortality may be as high as 1.8%, and in the developing countries, it may be as high as 14%.The etiology of the disorder remains elusive. The placenta seems to have a prime role in its etiology. An increase in placental mass, as in plural pregnancies, increases the risk for the preeclampsia-eclampsia spectrum, as does placental edema that occurs in pregnancies complicated by fetal hydrops. Molar pregnancies that impact placental architecture also have a higher risk of the complication. In the developed countries, the incidence of preeclampsia has been described to be between 1.5 to 10 cases in 100,000 deliveries. The condition is more prevalent in the developing countries. The risk factors of preeclampsia are similar to those of preeclampsia and include nulliparity, non-white, low socioeconomic backgrounds, plural pregnancies, and extremes of maternal age. Additionally, it is associated with and an array of maternal medical conditions such as chronic hypertension, chronic renal disease, and autoimmune disorders. Obesity and maternal diabetes are also recognized as increasingly important etiologies. Fetal conditions such as fetal hydrops have been associated with preeclampsia. Women known to have preeclampsia may develop eclamptic, generalized, tonic-clonic seizures that conclude with no persistent neurologic deficit, meaning they do not deserve diagnostic evaluation beyond that performed for preeclampsia. A preeclampsia workup would include an evaluation of renal function, liver function, complete blood count, and imaging of fetoplacental unit. Obstetric ultrasound imaging of the fetus includes an assessment of fetal growth as well as fetal health (biophysical profile and as indicated umbilical artery cord Doppler studies), including fetal heart rate stri Clinical monitoring for placental abruption is heightened and is maternal monitoring for evolving complications such as pulmonary edema or renal dysfunctionNeuroimaging should be considered if:
• There are persistent neurologic deficits
• The loss of consciousness is prolonged
• The onset of seizures is 48 hours beyond delivery
• An eclamptic seizure occurs before 20 weeks
• Recurrent seizures in spite of adequate magnesium sulfate
Protocol obs-edited
The document provides protocols and guidelines for the Department of Obstetrics including definitions, classifications, investigations, and management guidelines for various obstetric conditions. It covers protocols for pre-eclampsia and eclampsia, liver diseases in pregnancy, deep venous thrombosis in pregnancy, preterm labour, preterm PROM, breech presentation, APH, induction of labour, normal labour and delivery, PPH, umbilical cord prolapse, Rh prophylaxis, and GDM. The department aims to provide high quality, empathetic and research-based care through comprehensive training and by reviewing and creating protocols according to population needs.
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Antepartum hemorrhage (APH) refers to bleeding after 20 weeks of pregnancy. Causes include placenta previa, placental abruption, and cervical issues. Anesthetic considerations for delivery include preparing for potential hemorrhage, choosing regional or general anesthesia depending on the urgency and maternal status, and strategies to minimize blood loss such as uterotonics. Complications of massive hemorrhage like coagulopathy and Sheehan's syndrome also require management. The goal is to anticipate blood loss and be prepared for potential life-threatening issues from APH.
Dysfunctional uterine bleeding
This document discusses abnormal uterine bleeding (AUB), also known as dysfunctional uterine bleeding (DUB). It defines normal menstruation and various types of abnormal bleeding patterns. The majority of AUB occurs during the reproductive years when hormone levels are unstable. While around 80% of AUB cases have no anatomical cause, about 50% are due to fibroids or polyps. Treatment options discussed include medical therapies like NSAIDs, hormones, and IUDs, as well as surgical procedures like endometrial ablation and hysterectomy. However, the document notes that medical treatments are not always effective and have side effects, while hysterectomy is an expensive last resort for many without pathological conditions.
Postpartum_Hemorrhage_By_dr.Redwan.pptx
Postpartum haemorrhage (PPH) is a major cause of maternal mortality. The main causes are uterine atony (80%), trauma (20%), and coagulopathy (rare). Clinical PPH is blood loss >500mL after vaginal delivery or >1000mL after c-section. Treatment involves monitoring vitals, IV fluids, uterotonics like oxytocin and misoprostol, bimanual compression, and blood transfusion. For refractory cases, procedures like balloon tamponade, ligation of uterine arteries, or hysterectomy may be needed. Prevention focuses on risk assessment, active management of third stage of labor, and treatment of secondary PPH if bleeding reoccurs after 24
Pph drill
Dr. Monika Madaan discusses postpartum hemorrhage (PPH), a leading cause of maternal mortality. PPH is defined as blood loss over 500ml after delivery. Risk factors include placenta previa/accreta, coagulopathy, overdistended uterus, grand multiparity, abnormal labor, and previous PPH history. Active management of the third stage of labor can help prevent PPH. Treatment involves resuscitation, fluid replacement, administering uterotonics and other drugs, uterine tamponade, compression sutures, devascularization, and hysterectomy if needed. New developments include tranexamic acid and recombinant factor VII. Proper documentation and debriefing are also
Pregnancy Induced Hypertension & Preeclampsia
Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
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This document discusses hypertensive disorders of pregnancy, which complicate 5-10% of pregnancies. It defines various types of hypertensive disorders including gestational hypertension, chronic hypertension, preeclampsia, eclampsia, and preeclampsia superimposed on chronic hypertension. It outlines diagnostic criteria and management guidelines for each disorder. Key points covered include definitions, risk factors, complications, treatment and delivery timing based on gestational age. The goal of management is to ensure the safety of the mother and fetus.
HYPERTENSION IN PREGNANCY
This document discusses the classification, diagnosis, and management of hypertensive disorders that can occur during pregnancy. It describes four main types: gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It provides details on evaluating and monitoring patients with these conditions, indications for delivery, and guidelines for different antihypertensive medications. The management of severe preeclampsia, HELLP syndrome, and eclampsia is covered, including magnesium sulfate administration and expectations for maternal and fetal stabilization and delivery.
Post partum haemorrhage
Dr. Suguna R. Kumar discusses postpartum hemorrhage (PPH), which is the leading cause of maternal mortality in India. PPH is defined as blood loss over 500mL after a vaginal delivery or 1000mL after a cesarean section within 24 hours. Active management of the third stage of labor (AMTSL) including oxytocin administration after delivery, delayed cord clamping, and uterine massage has been shown to reduce PPH occurrences by 60% and need for further treatment by 80%. Management of PPH involves IV access, fluid resuscitation, uterotonic drugs like oxytocin and misoprostol, bimanual uterine compression, and potential surgical interventions if bleeding does not
Surviving sepsis recommendations (1)
1. Sepsis is defined as infection plus systemic manifestations of infection. Severe sepsis is sepsis plus organ dysfunction, while septic shock is sepsis-induced hypotension despite fluid resuscitation.
2. Initial management of septic shock includes administering broad-spectrum antibiotics within 1 hour, fluid resuscitation of at least 30 mL/kg of crystalloids, and vasopressors like norepinephrine to maintain a mean arterial pressure of 65 mmHg or higher.
3. Other recommended treatments include source control, glucose control with insulin to keep blood glucose under 180 mg/dL, stress ulcer prophylaxis as needed, and early enteral nutrition over total parenteral nutrition.
Pph
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide, accounting for 34% of deaths in developing countries. PPH is defined as blood loss of 500ml or more following a vaginal birth or 1000ml or more following a caesarean section. Early identification of at-risk patients and active management of the third stage of labour can help prevent PPH. Diagnosis involves communication, resuscitation with fluids and blood products, monitoring, and investigating the cause of bleeding. Treatment focuses on bimanual compression, uterotonic drugs, surgical haemostasis procedures if conservative measures fail, and consideration of recombinant factor VII.
OBSTETRIC EMERGENCY EDITED.pptx
This document discusses obstetric emergencies and red alerts. It defines various hypertensive disorders in pregnancy like gestational hypertension, chronic hypertension, pre-eclampsia, severe pre-eclampsia, and eclampsia. It also discusses management of antepartum hemorrhage, placenta previa, abruptio placenta, postpartum hemorrhage, and maternal collapse. Treatment protocols for magnesium sulfate therapy, antihypertensive drugs, and prophylaxis against postpartum hemorrhage are also provided.
Massive PPH
management of massive post par-tum hemorrhage is a very challenging & crucial.management with blood transfusions & drugs will reduce the mortality & morbidity.
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This document provides information on the clinical presentation, investigation, and treatment of malaria. It discusses how malaria commonly presents with symptoms like fever, chills, sweats, and headaches. It also covers severe complicated malaria and its symptoms. For investigation, it recommends examining blood films under microscopy, using rapid diagnostic tests, and PCR. It provides treatment guidelines for uncomplicated and severe falciparum malaria, including recommended drugs and dosages. It also discusses specific treatment considerations for populations like pregnant women, those with hepatic or renal impairment, children, and prevention through chemoprophylaxis.
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1. This document discusses early post-kidney transplant care, which focuses on the first 3 months when acute events like rejection and infections are most likely to occur.
2. Prior to transplantation, patients undergo evaluations to ensure medical optimization and rule out active infections. During admission, immunosuppressants and monitoring of vitals and urine output are emphasized.
3. Complications in the early post-transplant period include acute tubular necrosis, acute rejection, and infections which are managed through immunosuppression, fluid balance, and treatment of the underlying condition. Maintaining adequate urine output and graft function is the goal.
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This document discusses the physiology of coagulation and various anticoagulant and thrombolytic agents. It covers the intrinsic and extrinsic pathways of coagulation and the mechanisms of several common anticoagulants including heparin, low molecular weight heparins, warfarin, and direct thrombin and factor Xa inhibitors. It also addresses considerations for reversing anticoagulation with protamine or newer antidotes and managing patients on anticoagulants who require surgery or procedures.
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The document discusses sepsis treatment bundles which include early goal directed therapy, corticosteroids, antibiotics, ARDSnet ventilator management, stress ulcer prophylaxis, deep vein thrombosis prophylaxis, and Drotrecogin alpha. It provides details on the components, goals, and guidelines for each bundle element aimed at improving outcomes for patients with sepsis.
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Eclampsia is a uniquely pregnancy-related disorder that manifests as new onset of generalized tonic colonic seizures. It typically occurs after 20 weeks of concluded gestation, although it may occur sooner with plural gestations or molar pregnancies, and may additionally occur in the 6-week postpartum window. It represents the severe end of the preeclampsia spectrum. Preeclampsia spectrum includes symptoms of the central nervous system (CNS), for example, severe headaches or vision changes, and may involve hepatic abnormalities (such as elevated liver transaminases with right upper quadrant/epigastric discomfort), elevated blood pressures, and also may include thrombocytopenia, renal abnormalities, and pulmonary edema. In developed countries, resultant maternal mortality may be as high as 1.8%, and in the developing countries, it may be as high as 14%.The etiology of the disorder remains elusive. The placenta seems to have a prime role in its etiology. An increase in placental mass, as in plural pregnancies, increases the risk for the preeclampsia-eclampsia spectrum, as does placental edema that occurs in pregnancies complicated by fetal hydrops. Molar pregnancies that impact placental architecture also have a higher risk of the complication. In the developed countries, the incidence of preeclampsia has been described to be between 1.5 to 10 cases in 100,000 deliveries. The condition is more prevalent in the developing countries. The risk factors of preeclampsia are similar to those of preeclampsia and include nulliparity, non-white, low socioeconomic backgrounds, plural pregnancies, and extremes of maternal age. Additionally, it is associated with and an array of maternal medical conditions such as chronic hypertension, chronic renal disease, and autoimmune disorders. Obesity and maternal diabetes are also recognized as increasingly important etiologies. Fetal conditions such as fetal hydrops have been associated with preeclampsia. Women known to have preeclampsia may develop eclamptic, generalized, tonic-clonic seizures that conclude with no persistent neurologic deficit, meaning they do not deserve diagnostic evaluation beyond that performed for preeclampsia. A preeclampsia workup would include an evaluation of renal function, liver function, complete blood count, and imaging of fetoplacental unit. Obstetric ultrasound imaging of the fetus includes an assessment of fetal growth as well as fetal health (biophysical profile and as indicated umbilical artery cord Doppler studies), including fetal heart rate stri Clinical monitoring for placental abruption is heightened and is maternal monitoring for evolving complications such as pulmonary edema or renal dysfunctionNeuroimaging should be considered if:
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Antepartum hemorrhage (APH) refers to bleeding after 20 weeks of pregnancy. Causes include placenta previa, placental abruption, and cervical issues. Anesthetic considerations for delivery include preparing for potential hemorrhage, choosing regional or general anesthesia depending on the urgency and maternal status, and strategies to minimize blood loss such as uterotonics. Complications of massive hemorrhage like coagulopathy and Sheehan's syndrome also require management. The goal is to anticipate blood loss and be prepared for potential life-threatening issues from APH.
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This document discusses abnormal uterine bleeding (AUB), also known as dysfunctional uterine bleeding (DUB). It defines normal menstruation and various types of abnormal bleeding patterns. The majority of AUB occurs during the reproductive years when hormone levels are unstable. While around 80% of AUB cases have no anatomical cause, about 50% are due to fibroids or polyps. Treatment options discussed include medical therapies like NSAIDs, hormones, and IUDs, as well as surgical procedures like endometrial ablation and hysterectomy. However, the document notes that medical treatments are not always effective and have side effects, while hysterectomy is an expensive last resort for many without pathological conditions.
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Postpartum haemorrhage (PPH) is a major cause of maternal mortality. The main causes are uterine atony (80%), trauma (20%), and coagulopathy (rare). Clinical PPH is blood loss >500mL after vaginal delivery or >1000mL after c-section. Treatment involves monitoring vitals, IV fluids, uterotonics like oxytocin and misoprostol, bimanual compression, and blood transfusion. For refractory cases, procedures like balloon tamponade, ligation of uterine arteries, or hysterectomy may be needed. Prevention focuses on risk assessment, active management of third stage of labor, and treatment of secondary PPH if bleeding reoccurs after 24
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Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
Pregnancy hypertension
This document discusses hypertensive disorders of pregnancy, which complicate 5-10% of pregnancies. It defines various types of hypertensive disorders including gestational hypertension, chronic hypertension, preeclampsia, eclampsia, and preeclampsia superimposed on chronic hypertension. It outlines diagnostic criteria and management guidelines for each disorder. Key points covered include definitions, risk factors, complications, treatment and delivery timing based on gestational age. The goal of management is to ensure the safety of the mother and fetus.
HYPERTENSION IN PREGNANCY
This document discusses the classification, diagnosis, and management of hypertensive disorders that can occur during pregnancy. It describes four main types: gestational hypertension, preeclampsia, chronic hypertension, and preeclampsia superimposed on chronic hypertension. It provides details on evaluating and monitoring patients with these conditions, indications for delivery, and guidelines for different antihypertensive medications. The management of severe preeclampsia, HELLP syndrome, and eclampsia is covered, including magnesium sulfate administration and expectations for maternal and fetal stabilization and delivery.
Post partum haemorrhage
Dr. Suguna R. Kumar discusses postpartum hemorrhage (PPH), which is the leading cause of maternal mortality in India. PPH is defined as blood loss over 500mL after a vaginal delivery or 1000mL after a cesarean section within 24 hours. Active management of the third stage of labor (AMTSL) including oxytocin administration after delivery, delayed cord clamping, and uterine massage has been shown to reduce PPH occurrences by 60% and need for further treatment by 80%. Management of PPH involves IV access, fluid resuscitation, uterotonic drugs like oxytocin and misoprostol, bimanual uterine compression, and potential surgical interventions if bleeding does not
Surviving sepsis recommendations (1)
1. Sepsis is defined as infection plus systemic manifestations of infection. Severe sepsis is sepsis plus organ dysfunction, while septic shock is sepsis-induced hypotension despite fluid resuscitation.
2. Initial management of septic shock includes administering broad-spectrum antibiotics within 1 hour, fluid resuscitation of at least 30 mL/kg of crystalloids, and vasopressors like norepinephrine to maintain a mean arterial pressure of 65 mmHg or higher.
3. Other recommended treatments include source control, glucose control with insulin to keep blood glucose under 180 mg/dL, stress ulcer prophylaxis as needed, and early enteral nutrition over total parenteral nutrition.
Pph
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality worldwide, accounting for 34% of deaths in developing countries. PPH is defined as blood loss of 500ml or more following a vaginal birth or 1000ml or more following a caesarean section. Early identification of at-risk patients and active management of the third stage of labour can help prevent PPH. Diagnosis involves communication, resuscitation with fluids and blood products, monitoring, and investigating the cause of bleeding. Treatment focuses on bimanual compression, uterotonic drugs, surgical haemostasis procedures if conservative measures fail, and consideration of recombinant factor VII.
OBSTETRIC EMERGENCY EDITED.pptx
This document discusses obstetric emergencies and red alerts. It defines various hypertensive disorders in pregnancy like gestational hypertension, chronic hypertension, pre-eclampsia, severe pre-eclampsia, and eclampsia. It also discusses management of antepartum hemorrhage, placenta previa, abruptio placenta, postpartum hemorrhage, and maternal collapse. Treatment protocols for magnesium sulfate therapy, antihypertensive drugs, and prophylaxis against postpartum hemorrhage are also provided.
Massive PPH
management of massive post par-tum hemorrhage is a very challenging & crucial.management with blood transfusions & drugs will reduce the mortality & morbidity.
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This document provides information on the clinical presentation, investigation, and treatment of malaria. It discusses how malaria commonly presents with symptoms like fever, chills, sweats, and headaches. It also covers severe complicated malaria and its symptoms. For investigation, it recommends examining blood films under microscopy, using rapid diagnostic tests, and PCR. It provides treatment guidelines for uncomplicated and severe falciparum malaria, including recommended drugs and dosages. It also discusses specific treatment considerations for populations like pregnant women, those with hepatic or renal impairment, children, and prevention through chemoprophylaxis.
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1. This document discusses early post-kidney transplant care, which focuses on the first 3 months when acute events like rejection and infections are most likely to occur.
2. Prior to transplantation, patients undergo evaluations to ensure medical optimization and rule out active infections. During admission, immunosuppressants and monitoring of vitals and urine output are emphasized.
3. Complications in the early post-transplant period include acute tubular necrosis, acute rejection, and infections which are managed through immunosuppression, fluid balance, and treatment of the underlying condition. Maintaining adequate urine output and graft function is the goal.
Anticoagulants.ppt
This document discusses the physiology of coagulation and various anticoagulant and thrombolytic agents. It covers the intrinsic and extrinsic pathways of coagulation and the mechanisms of several common anticoagulants including heparin, low molecular weight heparins, warfarin, and direct thrombin and factor Xa inhibitors. It also addresses considerations for reversing anticoagulation with protamine or newer antidotes and managing patients on anticoagulants who require surgery or procedures.
Eclampsia and Maternal Transport
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What follows is a collection of snippets from the podcast. To hear the full interview and more, check out the podcast on all podcast platforms and at www.dsmsports.net
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“After being the most listed dog breed in the United States for 31
years in a row, the Labrador Retriever has dropped to second place
in the American Kennel Club's annual survey of the country's most
popular canines. The French Bulldog is the new top dog in the
United States as of 2022. The stylish puppy has ascended the
rankings in rapid time despite having health concerns and limited
color choices.”
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A presentation on the concept of Exemption of Profits of Start ups from Income Tax
Organizational Change Leadership Agile Tour Geneve 2024
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How MJ Global Leads the Packaging Industry.pdf
MJ Global's success in staying ahead of the curve in the packaging industry is a testament to its dedication to innovation, sustainability, and customer-centricity. By embracing technological advancements, leading in eco-friendly solutions, collaborating with industry leaders, and adapting to evolving consumer preferences, MJ Global continues to set new standards in the packaging sector.
How to Implement a Real Estate CRM Software
To implement a CRM for real estate, set clear goals, choose a CRM with key real estate features, and customize it to your needs. Migrate your data, train your team, and use automation to save time. Monitor performance, ensure data security, and use the CRM to enhance marketing. Regularly check its effectiveness to improve your business.
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Best practices for project execution and delivery
A select set of project management best practices to keep your project on-track, on-cost and aligned to scope. Many firms have don't have the necessary skills, diligence, methods and oversight of their projects; this leads to slippage, higher costs and longer timeframes. Often firms have a history of projects that simply failed to move the needle. These best practices will help your firm avoid these pitfalls but they require fortitude to apply.
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Dpboss Matka Guessing Satta Matta Matka Kalyan Chart Indian Matka Indian satta Matka Dpboss Matka Kalyan Chart Matka Boss otg matka Guessing Satta Innovation Management Frameworks: Your Guide to Creativity & Innovation
Innovation Management Frameworks: Your Guide to Creativity & InnovationOperational Excellence Consulting
[To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentations]
This PowerPoint compilation offers a comprehensive overview of 20 leading innovation management frameworks and methodologies, selected for their broad applicability across various industries and organizational contexts. These frameworks are valuable resources for a wide range of users, including business professionals, educators, and consultants.
Each framework is presented with visually engaging diagrams and templates, ensuring the content is both informative and appealing. While this compilation is thorough, please note that the slides are intended as supplementary resources and may not be sufficient for standalone instructional purposes.
This compilation is ideal for anyone looking to enhance their understanding of innovation management and drive meaningful change within their organization. Whether you aim to improve product development processes, enhance customer experiences, or drive digital transformation, these frameworks offer valuable insights and tools to help you achieve your goals.
INCLUDED FRAMEWORKS/MODELS:
1. Stanford’s Design Thinking
2. IDEO’s Human-Centered Design
3. Strategyzer’s Business Model Innovation
4. Lean Startup Methodology
5. Agile Innovation Framework
6. Doblin’s Ten Types of Innovation
7. McKinsey’s Three Horizons of Growth
8. Customer Journey Map
9. Christensen’s Disruptive Innovation Theory
10. Blue Ocean Strategy
11. Strategyn’s Jobs-To-Be-Done (JTBD) Framework with Job Map
12. Design Sprint Framework
13. The Double Diamond
14. Lean Six Sigma DMAIC
15. TRIZ Problem-Solving Framework
16. Edward de Bono’s Six Thinking Hats
17. Stage-Gate Model
18. Toyota’s Six Steps of Kaizen
19. Microsoft’s Digital Transformation Framework
20. Design for Six Sigma (DFSS)
To download this presentation, visit:
https://www.oeconsulting.com.sg/training-presentationsZodiac Signs and Food Preferences_ What Your Sign Says About Your Taste
Know what your zodiac sign says about your taste in food! Explore how the 12 zodiac signs influence your culinary preferences with insights from MyPandit. Dive into astrology and flavors!
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maternity guidline 2.pptx
- 1. Guideline by the RCOG MONITOR / INVESTIGATE. STOP THE BLEEDING. RESUSCITATE. COMMUNICATE.
- 2. COMMUNICATE call 6 • Call experienced midwife • Call obstetric registrar & alert consultant • Call anaesthetic registrar , alert consultant • Alert haematologist • Alert Blood Transfusion Service • Call porters for delivery of specimens / blood
- 3. MONITOR / INVESTIGATE • Cross-match 6 units • Full blood count • Clotting screen • Continuous pulse / BP / • ECG / Oximeter • Foley catheter: urine output • CVP monitoring
- 4. Placenta Previa Management Severe bleeding Caesarean section Moderate bleeding Gestation >34 <34 Resuscitate Steroids Unstable Stable Resuscitate Mild bleeding Gestation <36 Conservative care >36
- 5. PPH
- 6. MANAGEMENT OF PPH Send Blood Samples
- 8. DRUG THERAPY FOR PPH Misoprostol 1000ugm use by rectum Tranexamic acid 1g/ml IV at 1ml per minute(administered over 10minutes) Second dose of 1g IV if bleeding continues after 30minutes.
- 16. Rush hydrostatic balloon catheter
- 19. Management protocol for Eclampsia • Management (carried out by a team): Turn the patient on her side Insure clear airway(section,mouth,gag) Maintain IV access. Stop fits mag.sul,diazepam Control Bp (hydralazine,Labetalol) Intake and output chart Investigation(urine,FBC, RFT, LFT, clotting profile, cross match) Monitor patient and her fetus After stabilization (Bp controlled, no convulsions, hypoxia controlled) deliver
- 20. . Loading dose Give MgSO4, 4g+ 20ml NS or sterile water I.V over 5-20 minutes Give 10g (i.e. 20ml of 50% solution) 5g in each buttock as deep I.M wih1ml of 2% lignocaine in the same syringe INTRAMUSCULAR REGIMEN Maintenance dose MgSO4 5 g (i.e. 10ml of 50% solution) + 1 ml lignocaine 2%, 4 hourly in alternate buttocks. Ringer lactate or normal saline 30 drops/min. or 1 litre in 6-8 hrs. Maternal glucocorticoid therapy at 24-34 wk for foetal lung maturation Expedited delivery? no?< 23 weeks: counseling for termination of pregnancy 23-32 weeks: steroids, antihypertensive medications, daily maternal and fetal evaluation, delivery at 34 weeks 32-33 weeks: amniocentesis immature fluid steroids, delivery in 48 hours N.P Hemolysis o abnormal peripheral smear o lactate dehydrogenase > 600 U/L Elevated liver enzymes o serum aspartate aminotransferase > 70 U/L o lactate dehydrogenase > 600 U/L low platelets o platelet count < 100,000/mm3 Blood Should be sent for : • Serum electrolytes • Liver function tests • Full Blood count • Clotting test • Group and save serum • Renal function tests / urine acid test0 Management protocol for Eclampsia
- 21. Eclampsia - anticonvulsant therapy Diazepam useful for status seizures mechanism of action facilitate the binding of GABA to its receptor benzodiazepine receptors dosage - 10 mg at a rate of 5 mg per min may be repeated at 10 to 15 minute intervals