The document discusses India's Medical Termination of Pregnancy Act passed in 1971 to legalize abortion and reduce unsafe abortions. The act specifies the indications for legal termination, who can perform terminations, places it can be done, and consent requirements. Terminations can be done by registered medical practitioners up to 12 weeks gestation with one doctor's consent and up to 20 weeks with two doctors' consent. Various medical and surgical methods for first and second trimester termination are outlined, along with complications that can occur. The objectives of the act are to improve maternal health by preventing unsafe abortions and reducing mortality and morbidity.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
ou should know that an abortion which does not fulfil the conditions is considered a crime under the general law on crimes in India. Abortion of under 4 to 5-month pregnancy - The punishment for getting an illegal abortion is jail time of up to 3 years and/or fine.
Termination of second trimester pregnancies by dr alka mukherjee nagpur m.s. ...alka mukherjee
The second trimester termination of pregnancy is increasing because of increased determination of the sex linked genetic, metabolic disorders. Various surgical and medical methods have been tried for the second trimester MTP with varying success and induction abortion interval. Prostaglandins are associated with not only a high success rate but also with a short induction abortion interval. Misoprostol a newer synthetic prostaglandin E1 has proven its efficacy as an abortifacient for second trimester MTP since 1987. It is superior to all other available prostaglandins as it is stable at room temperature, requires no refrigeration, is cost effective, has fewer side effects, is a potent uterotonic and cervical ripening agent, free from bronchoconstrictive effect. It can be used by both the oral as well as vaginal route and in concurrence with other drugs as well. Mifepristone, (RU 486, a substitute 19- norethisterone derivative) by blocking the progesterone receptors causes estrogen dominance and results in intrauterine fetal death. At the same time it sensitizes the uterus to the activity of the prostaglandin. Thus, a combination of the two can significantly improve the efficacy of the misoprostol for the termination of second trimester termination of the pregnancy.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
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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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
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
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NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
ABDOMINAL TRAUMA in pediatrics part one.drhasanrajab
Abdominal trauma in pediatrics refers to injuries or damage to the abdominal organs in children. It can occur due to various causes such as falls, motor vehicle accidents, sports-related injuries, and physical abuse. Children are more vulnerable to abdominal trauma due to their unique anatomical and physiological characteristics. Signs and symptoms include abdominal pain, tenderness, distension, vomiting, and signs of shock. Diagnosis involves physical examination, imaging studies, and laboratory tests. Management depends on the severity and may involve conservative treatment or surgical intervention. Prevention is crucial in reducing the incidence of abdominal trauma in children.
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
1. INTRODUCTION
Medical terminationof pregnancy is refers as the inductionof abortion.
The inductionof abortionmay be legal & illegal. There are many countries
in the globe where the abortionis not yet legalised. Inindiathe abortion
was legalisedby “medical terminationof pregnancy Act”of 1971, &has
beeninforcedin the april 1972
DEFINITION
Deliberate terminationof pregnancy either by the medical & surgical
methodbefore the viability of the fetus is calledinductionof abortion.
MEDICAL TERMINATION OF PREGNANCY ACT 1971
The Indian abortionlaws falls under the Medical Terminationof
Pregnancy (MTP) Act, which was enactedby the Indian parliament in the
year 1971 withthe intentionof reducing the inccidence of illegal abortion
and consequent meternal mortality andmorbidity. The MTP Act came
intoeffect from1st
april 1972 and was amendedin the years 1975 and
2002.
Recently, the supreme court permittedarape survivor tothe terminate
her pregnancy at 24 weeks, Whichis beyond the permissible 20 weeks
limit prescribedunder the medical terminationof pregnancy Act, 1971.
MTP ACT LOGO
2. LEGAL ABORTION
• Terminationis performedby the medical practitioners(assistedinat least
25mtp& degree inOBG) by the act.
• Terminationis done at the place approvedunder the act.
• Terminationdone for condition& withinthe gestationweek prescribed
by the act.
• The abortionhas to be reportedtothe director of healthservice of the
state.
MTP Act specifies
1. The Indications for legal Terminations
2. Who can Terminate
3. The Place where it can be terminated
4. Last but most important Consent requirement
INDICATIONS
METERNAL CAUSES
• Mentally illness
• Severe cardiac disease
• Malignant hypertension
• Malignancy in breast or cervical
• Rubellavirus infaction
• Hyperemesisgravidarum
3. FETAL CAUSES
• Mentally &physically illness
• Severe neural tube defect
• Chromosomal (down syndrome)
• Handicapped
• Mall presentation
SOCIEO ECONOMIC STATUS
• Prevent grave injury tothe physical and mental healthof the pregnant
woman
• Unplanned pregnancy withlow socieoeconomic status
HUMANTARIAN
• Pregnancy is result of the rape
• Failure of contraceptive device
MTP Act: Objectives
MTP Act
• Aims to improve the maternal healthscenarioby preventing large
number of unsafe abortions and consequent highincidence of maternal
mortality & morbidity.
• Legalizes abortionservices.
• Promotes access tosafe abortionservices towomen.
Offers protectiontomedical practitionerswhootherwise wouldbe
penalizedunder the IndianPenal code (sections 315-316)
4. MTP Act, Rules & Regulations
MTP Act is an Act of Parliament providing an Overviewof Safe abortions
and delegating authority toCentral &State government.
Rules are framedby the Central Government but must be ratifiedby each
house of Parliament.
Regulations are framedby the State Government &relate toissues
involving opinions, reporting andmaintaining secrecy.
PLACE FOR MTP
Place establishedandmaintainedby government.
Non government institutioncanperform, they obtainlicence fromCMO
of district.
Experience of RMP- Up to 12 weeks of gestation only
Before the commencement of act experience minimum3 years.
Who is registeredinstate medical register- 6 month of house surgeon-
shipin gynaecology.
Or experience of working indepartment of gynarcology- 1 year.
A Practitioner whohas assistedRMP in25 cases of Medical terminationof
pregnancies, at least 5 of whichhave beenperformedindependently ina
hospital establishedor maintainedby government or a training institute
approvedfor this purpose by the Government.
Experience and TrainingRequired by a RMP– Up to 20
weeks
PG Degree or Diplomain OBG.
5. Completed6 months as House Surgeonin OBG
At least one year experience indept of OBG at any hospital that has all
facilities
FIRST TRIMESTER TERMINATION OF PREGNANCY
METHOD OF FIRST TRIMESTER ABORTION:
Mifepristone (RU-486) andMisoprostol-
Mifepristone (200mg) ananalog of progestin (norethindrone) acts as an
antagonist, blocking the effect of natural progesterone.
Additionof low dose prostaglandins (800mg) (PGE1) improves the
efficiency of first trimesterabortion. It is effective upto63 days and is
highly successful whenusedwithin49 days of gestation.
Methotrexate and Misoprostol-
Methotrexate 50mg/m2 IM (before 56 days of gestation) followedby 7
days later misoprostol 800ug vaginally is highly effective.
Misoprostol may have to be repeatedafter 24 hours if it fails.
Methotrexate andmisoprostol regimenis less expensive but takes longer
time than Mifepristone andMisoprostol.
SURGICAL METHODS OF FIRST TRIMESTER ABORTION
MENSTRUAL REGULATION:
It is the aspirationof the endometrial cavity within14 days of missed
periodin a woman withprevious normal cycle.
The operationis done as an out patient or an office procedure.
It is done withaseptic precautions.
6. After introducing the posterior vaginal speculum, the cervix is steadied
withan allis force
Scecond trimester of pregacy
MEDICAL METHODS:
PROSTAGLANDINS:
They act on the cervix andthe uterus.
ThePGE(dinoprostone, sulprostone, gemeprost, misoprostol) andPGF
(carboprost) analogues are commonly used.
PGEs are preferredas they have more selective actiononthe
myometriumand less side effects
2.Mifepristone and prostaglandins:
Mifepristone 200mg oral, followed36-48 hours later by misoprostol.
800ug vaginal;thenmisoprostol 400ug oral every 3 hours for 4 doses is
used.
Success rate of abortionis 97% and median inductiondelivery interval is
6.5 hours.
Pretreatment withmifepristone reduces the induction- abortioninterval
significantly comparedtouse of misoprostol alone.
3.PROSTAGLANDIN F2 (CARBOPROST):-
-250mg IM every 3 hours for a maximum 100 dose can be used.
4.OXYTOCIN:
Highdose oxytocinas a single agent can be usedfor secondtrimester
abortion.
7. It is effective in80% of cases.
It can be usedwithintravenous normal saline along withany of the
medications usedeither intra-amniotic space inanattempt toaugment
the abortionprocess.
5.MODE OF ACTION:
Myometrial oxytocinreceptor concentrationincreases maximum(100-
200 fold) during labour.
Oxytocinacts throughreceptor andvoltage mediatedcalciumchannels to
initiate myometrial contractions.
SURGICAL METHOD
HYSTEROTOMY
Hysterotomy is anoperative procedure of extracting the productsof
conceptionout of the womb before 28th
week by cutting throughthe
anterior wall of the uterus.
The operationis usually done through the abdominal route.
The operationis rarely done these days these days for the purpose of
MTP.
Complications:
Hemorrhage and shock
Peritonitis
Intestinal obstruction
COMPLICATION OF MTP
IMMEDIATE:-
8. Injury to the cervix (cervical lacerations)
Uterine perforationduring D and E
Haemorrhage and shock due to trauma, incomplete abortion, atonic
uterus or rarely coagulationfailure
Thrombosis or embolism
Remote
Gynecological
Obstetrical
Gynecological complications include-
Menstrual disturbances
Chronic pelvic inflammation
Obstetrical complications include-
Ectopic pregnancy (three-foldincrease)
Pretermlabour
Dysmaturity
Rupture uterus
CONCLUSION
In india abortionwas legalizedby “Medical terminationof pregnancy Act”
of 1971.
It has beeninforcedinthe 1st
april 1972.
It was amended in the year 1975.
9. The government is intentionof reducing the incidence of illegal abortion.
Reducing the meternal moratality andmorbidity.
24 week abortion – 2 RMP.
12 week gestationabortion – 1 RMP
BIBLIOGRAPHY
The textbook of obstetrics and gynecology (D.C.Dutta’s) 7th
addition.
https://www.slideshare.net
10. 1. Medical termiation of pragnancy act was passed in –
a) 1984
b) 1975
c) 1981
d) 1971 ans. ( d )
2. A registered medical practioner may terminate pragnancy if it is –
a) Not less than 20 week old
b) Not more than 20 week old
c) Not more than 12 week old
d) None of the above ans. ( d )
3. Medical termination of pregnancy act 1971 was passed with
ojectives –
a) Termination of certain pregnancy by any one
b) Termination of certain pragnancy by rmp
c) Termination of certain pragnancy by pharmasist
d) Termination of pragnancy by nurse ans. ( b )
4. 12 week pragnancy can be terminated with the consentof –
a) 1 rmp
b) 2 rmp
c) 3 rmp
d) Non of the above ans. ( a )
5. Minimum 2 rmp may given consent of termination of pregnancy when it is-
a) More than 12 week old
b) More than 20 week old
c) More than 18 week old
d) More than 10 week old ans. ( b )
6. A rmp may terminate pregnancy if –
a) He has complited 3 month of house surgery
b) 6 month of house surgery
c) 1 month of house surgery
d) 12 month of house surgery ans. ( b )
11. 7. Pregnancy may be terminated by at –
a) Any other place
b) Hospital approved by state government
c) Any hospital
d) None ans. ( b )
8. The admission gesiter and its maintainance is regulated is under mtp
regulation –
a) 1971
b) 1972
c) 1973
d) 1975 ans. ( d )
9. Hospital or place for termination approved if –
a) Mci
b) Di
c) Dco
d) Cmo of district ans. ( d )
10. What is mean by guardiance –
a) A person having the care of a minor or lunatic
b) A person having the care of a major or lunatic
c) A person having the care of a major or minor
d) None of the above ans. ( a )
11.Termination record is maintain for –
a) 1 year
b) 5 year
c) 2 year
d) 20 month ans. ( b )
12.Mtp act constitued by –
a) Central government
b) State government
c) Pci
d) Mci ans. ( a )
12. 13.If fail to comply the regulation of mtp act which amount taken as
punishment –
a) 500
b) 2000
c) 1000
d) 10000 ans. ( c )
14.If any persondoing mtp is not rmp can punished with imprisoment of –
a) 2 – 7 year
b) 1 year
c) 5 – 10 year
d) None of the above ans. ( a )
15. Which drug used in first trimester –
a) Mifepristone and misoprostol
b) Methotraxte and misoprostol
c) Prostaglandin
d) Oxytocin ans. ( a,b )
16.Which drug used in second trimester –
a) Mifepristone and misoprostol
b) Methotraxte and misoprostol
c) Prostagladin
d) Oxytocin ans. ( c,d )