VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Role of tranexamic acid in cesarean sectionAhmad Farouk
we aimed at Reaching the minimal blood loss during elective cesarean section in order to decrease patients' morbidity by using Tranexamic acid injection before operation time .
It is a composite graphical recording of cervical dilatation and descent of head against duration of labour in hours.
It also gives information about fetal and maternal condition that are all recorded on single sheet of paper.
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Role of tranexamic acid in cesarean sectionAhmad Farouk
we aimed at Reaching the minimal blood loss during elective cesarean section in order to decrease patients' morbidity by using Tranexamic acid injection before operation time .
Tranexamic Acid "Maxna" (by gul nawaz khan)Gul Nawaz
Details of blood, hemostasis, clotting factors, heavy menstrual bleeding, causes of heavy menstrual bleeding, treatment options of heavy menstrual bleeding and menorrhagia, mode of action of tranexamic acid.
WARNING: This talk will be ineffective if you have no sense of humour.
In Karim’s hilarious and wonderfully sarcastic way, he takes on the Tranexamic Acid debate which (bizarrely) continues to spark controversy.
CRASH 2 had over 20,000 enrolled patients and demonstrated a 15% mortality relative risk reduction by using tranexamic acid in trauma.
There remain some haters out there, including the authors of this amusing review paper who not only slam TXA but the way in which social media has distributed the results. After openly criticising discussion about CRASH 2 on FOAMed resources such as EMCRIT, St Emlyns and on Twitter in general, the papers author, Sophia Binz, calls for “professional and productive scientific debate” - PLEASE feel free to engage with the authors by discussion in the forum below and this shall be fed back in a professional and productive way.
In this talk Karim presents “The Tranexamic Acid Denier’s Handbook”, which describes the multiple strategies we can employ to deny the results of CRASH 2. He tells you how to deflect, how to disrespect the study, how to disrespect the results, how to disrespect the design, how to disrespect the ethics, disrespect the subjects, disrespect the investigators, how to be a scaremonger and finally how to publish (anything) to throw people off the scent.
Now you are empowered to deny the evidence and not use a cheap and effective drug that has been shown to save lives. Go for it!
Karim is currently being headhunted by the UN for his skills in diplomacy.
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!
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
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
Phone Us ❤85270-49040❤ #ℂall #gIRLS In Surat By Surat @ℂall @Girls Hotel With...
Medical Management of Post-partum Hemorrhage (PPH)
1. Medical Management of
Post-partum Hemorrhage (PPH)
Jitendra Patil
M. Pharma (Pharmacology)
2. BOTTOM LINE
Averting Maternal Death is based on having a
prepared mind, a prepared team & a full range of
possible therapies
PPH IS TRULY
AN EQUAL OPPORTUNITY KILLER
3. Our Best Estimate is A Gross
Underestimate
200,000 women die from
PPH each year**
*International College of Midwives, 2003
**FIGO, 2003
5. Post-Partum Hemorrhage (PPH) ……
• Bleeding after childbirth
• Life-threatening condition
• Blood loss > 500 ml during a vaginal delivery or > 1,000 ml
with a cesarean delivery.*
*http://emedicine.medspsce.com/article/796785-overview
6. Why is PPH a concern ?
• Important cause of maternal mortality
• Accounting for nearly one quarter of all maternal deaths
• India-The maternal mortality rate
560/100,000 live births & 35-56%
PPH accounts for 35-56% of
Maternal deaths in India.**
*http://emedicine.medspsce.com/article/796785-overview
worldwide.*
Human Reproduction Research Collaborating Center (ICMR), J N Medical College, Balgaum, KA, India.
7. Types of PPH
PPH can be divided into 2 types:
Primary postpartum hemorrhage: Occurs within 24 hours of
delivery
Secondary postpartum hemorrhage: Occurs 24 hours to 6
weeks after delivery.
Most cases (99%) of postpartum
hemorrhage are primary
http://www.rcog.org.uk/womens-health/clinical-guidance/prevention-and-management-postpartum-haemorrhage-green-top-52
8. Why bleeding occurs ?
…placental removal leaves a 20cm
diameter wound that continues to bleed
if uterine musculature does not contract
and stay contracted
11. How much time do we have ?
It is estimated that, if untreated,
Death occurs on average in:
2 hours from Postpartum Hemorrhage
12 hours from Antepartum Hemorrhage
2 days from Obstructed Labor
6 days from Infection
16. Active management of Third Stage of Labor
• Administering a uterus-contracting drug, e.g. Oxytocin,
Misoprostol within one minute of birth
• Applying controlled cord traction & counter traction to the
uterus
• Massaging the fundus of the uterus through the abdomen
• Monitoring for further signs of bleeding
17. Active Vs Expectant Management
Management of
Third Stage of
Labor
Blood Loss *
> 500 mls
Blood loss *
> 1000 mls
Expectant
(n=3126)
13.6% 2.6%
Active (n=3158)** 5.2% 1.7%
* Clinical estimation generally thought to be underestimates by about 34-50%
**Oxytocin, Ergometrine or both IM/IV
Prendiville, Elbourne, McDonald, The Cochrane Library issue 3, 2003
18. Management of PPH
First line of Therapy
Uterotonic agents
Oxytocin
Ergot-alkaloids (Ergometrine, Methyl Ergonovine)
Prostaglandins (Dinoprostone, Misoprostol)
Surgical Interventions e.g. artery ligation
Radiological embolisation
Haemostatic drugs e.g. Tranexamic acid
D C Dutta. Text book of Obstetrics.5th Edn. 2001.
Second Line of Therapy
Cochrane Database of Systematic Reviews 2007, Issue 1. Art. No.: CD003249.
19. Oxytocin
• Oxytocin is a synthetic form of the nanopeptide produced in the
http://www.uspharmacist.com/content/d/in-service/c/28279/
posterior pituitary.
• It stimulates the (upper) active segment of the myometrium to
contract rhythmically, which constricts spiral arteries & decreases
blood flow through the uterus.
• Clinical response is rapid & occurs within 3 to 5 minutes.
• Oxytocin is dosed at 10 to 40 U/L .
• Side effects are very rare, but occasional causes nausea & vomiting.
• The only serious side effect is dilutional hyponatremia, which may
happen with prolonged use.
• Rapid IV infusion is associated with hypotension & tachycardia.
20. Carboprost
• It is synthetic prostaglandin analogue of PGF2α which enhance
uterine contractility and cause vasoconstriction
• IM dosing, initial: 250 mcg; if needed, may repeat at 15- to 90-
minute intervals; maximum total dose, 2 mg (8 doses).
• In 75% of cases, a successful clinical response is reached within 30 min.
• Clinical response may be enhanced with concomitant use of oxytocin.
• The reported side effects include nausea, vomiting, diarrhea,
http://www.uspharmacist.com/content/d/in-service/c/28279/
bronchospasm, & hypertension.
• The recommendation is that the drug be given with caution to
patients with hepatic or cardiovascular disease, asthma, or
hypersensitivity to the drug.
21. Methylergonovine Maleate
• Onset of action (tablet) is within 5 to 10 minutes
• Onset of the IM dose is 2 to 5 minutes
http://www.uspharmacist.com/content/d/in-service/c/28279/
• It is a semisynthetic ergot alkaloid.
• It causes generalized smooth-muscle contraction in which the
upper and lower segments of the uterus contract tetanically.
• It is available as 0.2mg tablets & is used 0.2mg 3 to 4 times/day in
the puerperium for 2 to 7 days.
• Side effects are very rare, but occasional causes nausea & vomiting.
• This drug should be used with extreme caution in patients with
hypertension or preeclampsia, especially if ephedrine (a
vasoconstrictive agent) is already given.
22. Misoprostol
*Med Res Rev. 1990 Apr-Jun;10(2):149-72
• Synthetic prostaglandin E1 analogue
• Initially developed for oral use
• Other routes of administration
Sub-lingual, Rectal, vaginal & Buccal
Approved for PPH
• India
• Bangladesh
• Nepal
• Russia
• Uganda
• Nigeria
• Ethiopia
• Somalia
• Ghana
• Kenya
- - Countries - -
24. Misoprostol Advantages
Thermostable
Affordable uterotonic agent compared with other
Ease of administration
Useful in poor resource sources – skilled workers
• Standard management# with 600mcg Misoprostol lowered
maternal mortality by 81%.**
• Oral Misoprostol was associated with significant ↓ in the rate
of acute PPH and mean blood loss. ***
#Standard management defined as delivery attendance by a village health worker without
*Int Congr Series 1279 (2005) 358–363
**Int J Gynaecol Obstet. 2010 Mar;108(3):289-94.
***Lancet.2006;368(9543):1248-53
administration of medication.
25. Clinical Guidance
The WHO recommends the use of Misoprostol in settings
where it is not possible to use Oxytocin or another injectable
uterotonic such as Ergometrine or an Oxytocin and
Ergometrine fixed-dose combination.
In the absence of personnel to offer active management of
the 3rd stage of labour, it is recommended that the trained
health worker should offer Misoprostol 600mcg orally
immediately after the birth of the baby.
WHO Statement regarding the use of misoprostol for postpartum haemorrhage prevention and treatment.
2009. Ref No: WHO/RHR/09.22
26. • Current data supports the use of Misoprostol in PPH.
• Safe & Effective treatment option in management of PPH.
• Oxytocin is a gold standard treatment in PPH.
• Increasing clinical evidences suggest Misoprostol as an
alternative to Oxytocin.
27. How should secondary PPH be treated?
Secondary PPH is often associated with endometritis. When
antibiotics are clinically indicated, a combination of Ampicillin
(Clindamycin if penicillin allergic) & Metronidazole is appropriate.
In cases of endomyometritis (tender uterus) or overt sepsis, then
the addition of Gentamicin is recommended.
Surgical measures should be undertaken if there is excessive or
continuing bleeding, irrespective of ultrasound findings.
A senior obstetrician should be involved in decisions &
performance of any evacuation of retained products of conception
as these women are carrying a high risk for uterine perforation.
RCOG guideline. 2009; Green top guideline 52: 1-24
28. How should secondary PPH be treated?
It is generally accepted that secondary PPH is often associated
with infection & conventional treatment involves antibiotics &
uterotonics.
In continuing haemorrhage, insertion of balloon catheter may be
RCOG guideline. 2009; Green top guideline 52: 1-24
effective.
A combination of Clindamycin & Gentamicin is appropriate; for
Gentamicin, daily dosing regimens are at least as effective as
thrice daily regimens; once uncomplicated endometritis has
clinically improved with intravenous therapy, there is no additional
benefit from extended oral therapy.
This antibiotic therapy does not contraindicate breastfeeding.
38. Recommendations for All Hospitals
• Use the BRASS drape in all deliveries
• Perform PPH drills on all shifts with each new
group of interns, residents and nurses
• Place large posters of B-Lynch brace suture
technique on wall of each OR
• Develop SWAT team approach with bleeding
>1000cc on responsive to simple therapy