Multiple pregnancy is used to describe the development of more than one fetus in the uterus at the same time. It is a high risk pregnancy. Careful supervision and proper monitoring is needed for prevention of further complications.
Multiple pregnancy is used to describe the development of more than one fetus in the uterus at the same time. It is a high risk pregnancy. Careful supervision and proper monitoring is needed for prevention of further complications.
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
In ectopic pregnancy, implantation occupies at a site other than the endometrium. Ectopic pregnancies are responsible for approximately 10 percent of all maternal mortality. The prognosis for future reproduction is poor. Only one half of women having an ectopic pregnancy are eventually delivered of a liveborn infant. Various factors contribute to ectopic pregnancies, the most common being infection. Unlike intrauterine spontaneous abortions, genetic factors are not paramount in the etiology of ectopic pregnancy.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Uterine Rupture
Deepa Mishra
Assistant Professor (OBG)
Introduction
Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth
Symptoms while classically including increased pain, vaginal bleeding, or a change in contractions are not always present.
Disability or death of the mother or baby may result.
Definition
Uterine rupture is giving way of gravid uterus or dissolution in the continuity of uterine wall anytime after 28 weeks of gestation with or without expulsion of the fetus.
Incidence
Rates of uterine rupture during vaginal birth following one previous C-section, done by the typical technique, are estimated at 0.9%
Rates are greater among those who have had multiple prior C-sections or an atypical type of C-section.
In those who do have uterine scarring, the risk during a vaginal birth is about 1 per 12,000
Risk of death of the baby is about 6%
Etiology
Risk Factors
Previous cesarean section
Myomectomy
Dysfunctional labor
Labor augmentation by oxytocin or prostaglandins
High parity
First pregnancy- very rare
Types of uterine rupture
Complete Rupture
All the layers including peritoneum are torn and the uterine contents escape into the peritoneal cavity.
Usually results in death
Incomplete Rupture
Visceral peritoneum is intact and usually the fetus remains in the uterine cavity
Sign & Symptoms
Uterine dehiscence and abdominal pain and vaginal bleeding
Deterioration of fetal heart rate
Loss of fetal station on manual vaginal exam
Hypovolemic shock due to intrabdominal bleeding
Chest pain between the scapulae, pain during inspiration due to irritation of blood below the perineum
Cessation of uterine contractions
Palpation of fetus outside the uterus
Signs of abdominal pregnancy
Post term pregnancy
Diagnosis
Signs of obstructed labor with dehydration, exhaustion, tachycardia raised temperature tonic contraction , pathological retraction ring
Absent fetal heart sound
On PV hot, dry vagina with a large caput over the presenting part
Prevention
Early diagnosis and management of CPD mal presentation and obstructed labor
Proper selection of cases for vaginal delivery
Carefull monitoring of oxytocin infusion specially in multipara
Avoid intra uterine manipulation no version in single fetus
Instrumental delivery after cervical dilatation
Immediate CS in obstructed labor
Hospital delivery for high risk cases
ECV should be avoided during general anaesthesia
Careful manual removal of placenta
Treatment
Resuscitation with adequate hydration and blood transfusion
Laprotomy
Hysterectomy
Repair
Complication
Rupture uterus with haemorrhage, shock and sepsis
Fetal loss is high in spontaneous and traumatic rupture
Mortality is low in LSCS scar rupture
Некоторые физические законы в контексте автоматизации тестированияCOMAQA.BY
Мы проговорим подмножество из 6 наиболее релевантных автоматизации тестирования «законов» из разных областей науки в хронологическом порядке, а также их следствия для IT, рассмотренные через QA/QC призму. Затем попытаемся связать все воедино в единую «научную» картину мира автоматизации. И, конечно же, подготовим море «раздаточных материалов» для дальнейшего изучения, более глубокого понимания и практического применения в нашей ежедневной работе. Материал базируется на многолетнем опыте «управленческой» и «преподавательской» деятельности докладчика и будет полезен всем: от молодого специалиста до IT-«мастодонта», хотя бы как способ систематизации практического опыта. Беседа пойдет, пусть и через «околонаучную» призму, но «на пальцах», гарантированно будет понятна и полезна самому широкому кругу слушателей, будет направлена на «понимание» IT-процессов, основу сознательного успеха в отрасли.
Doté d’un style contemporain et élégant, ce bâtiment de 19 logements s’intègre parfaitement dans cet environnement hétéroclite. Résidence à taille humaine, AMBRE propose de beaux appartements en majorité traversant allant du T1 au T4, répartis sur 5 niveaux. Clairs et spacieux, les appartements bénéficient d’un aménagement intérieur soigné et d’une belle luminosité naturelle. AMBRE se veut sobre grâce à l’utilisation de matériaux de qualité : briquettes de parement gris perle, habillage métallique, garde-corps vitrés, bardage zinc pour les lucarnes de toit, ardoises naturelles, autant d’éléments valorisant l’architecture. Les huisseries en bois exotique apportent la touche noble aux parties communes. Côté jardin, les appartements s’ouvrent au soleil et à la végétation pour privilégier le cadre de vie. Le bâtiment est tournée de façon à aller chercher la meilleure orientation possible et préserver l’intimité des résidents. Témoin de la qualité de la construction et des matériaux utilisés, la résidence AMBRE répond à la norme RT 2012 pour limiter la consommation d’énergie.
Détails des logements disponible
LHG has been working with upstreaming key components of the RDK over the last 3 years. This demo shows the RDK media framework (RMF) running on 96Boards platforms such as HiKey and DB410C.
This presentation was prepared by me, Dr. P. Chizororo, to help fellow professionals understand one of the most common malpresentations, Breech presentation. Visit my YouTube channel, Nexus Medical Media for all pre-clinical subjects
BREECH PRESENTATION obstetrics and gynacology mbbs final yearsarath267362
BREECH PRESENTATION obstetrics and gynacology mbbs final year
presentation , pregnancy
final year mbbs
normal labor
breech labor complications
management
BREECH
tdmc kerala
The incidence of multiple gestation continues to increase, and now accounting for more than 3% of all live births.
Twin pregnancies and higher-order multiple births comprise an increasing proportion of the total pregnancies in the developed world due to the expanded use of fertility treatments and older maternal age at childbirth.
Multiple gestation is associated with:
Increase in neonatal morbidity and mortality rates.
Increase in maternal complications at least two folds.
The number of triplet, quadruplet, and higher-order multiple births peaked in 1998 and has dropped slightly recently, most likely because of limits in the number of embryos transferred and because of the availability and acceptance of multifetal pregnancy reduction (MFPR) procedures.
Prematurity, monochorionicity, and growth restriction pose the main risks to fetuses and neonates in multiple gestations.
The mean duration of pregnancy is 35.3 weeks for twin gestations, 31.9 weeks for triplets, and 29.5 weeks for quadruplets.
Stillbirth rates increase from 6.8 /1000 for singletons to 16.1 for twins and to 21.5 for triplets, and infant mortality rates increase from 5 to 23.4 and to 51.2 /1000 births, respectively.
Infants of multiple gestations comprise almost one quarter of very-low-birth-weight infants.
The incidence of severe handicap among neonatal survivors of multiple gestation is also increased: 34.0 and 57.5 /1000 twin and triplet survivors, respectively, compared with 19.7 /1000 singleton survivors.
Maternal morbidity is significantly increased in mothers with multiple gestations and is apparently related to the number of fetuses.
Multiple gestations are associated with significantly higher risks for:
Hypertension
Placental abruption
Preterm labor (78%)
Preeclampsia (26%);
HELLP syndrome (9%) (hemolysis, elevated liver enzymes, low platelets)
Anemia (24%)
Preterm premature rupture of membranes (pPROM) (24%)
Gestational diabetes (14%)
Acute fatty liver (4%)
Chorioendometritis (16%)
Postpartum hemorrhage (9%)
Twins can be dizygotic (DZ), resulting from the fertilization of two separate ova during a single ovulatory cycle.
DZ twins have dichorionic-diamniotic (DCDA) placentas, although these may fuse during pregnancy.
Monozygotic (MZ), resulting from a single fertilized ovum that subsequently divides into two separate individuals.
In MZ twins, the timing of egg division determines placentation (تكون المشيمة):
Diamniotic, dichorionic (DCDA) placentation occurs with division prior to the morula stage (within 3 days post fertilization).
Diamniotic, monochorionic (MCDA) placentation occurs with division between 4-8 days postfertilization.
Monoamniotic, monochorionic (MCMA) placentation occurs with division between 8-12 days postfertilization.
Division at or after day 13 results in conjoined twins.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
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.
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.
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.
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
Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
ADVANCED BIOPHARMACEUTICS & PHARMACOKINETICS : UNIT 5
APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMS By - AKANKSHA ASHTANKAR
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
7. Dizygotic twins (fraternal)
• Most common represents 2/3 of cases.
Fertilization of more than one egg by more
than one sperm.
• Non identical ,may be of different sex. Two
chorion and two amnion.
• Placenta may be separate or fused. “each
fetus is contained within a complete amniotic-
chorionic membrane “
9. Monzygotic twins
• Constitutes 1/3 of twins These twins are multiple
gestations resulting from cleavage of a single,
fertilized ovum.
• The timing of cleavage determines the
placentation of the pregnancy.
• Constant incidence .
• Not affected by heredity.
• Not related to induction of ovulation.
13. Important notes:
• 1- Monozygotic twins having same sex &
blood group.
• 2- Process of formation of chorion is earlier
than formation of amnion.
• 3-Dizygotic twins must be
dichorionic/diamniotic.
• 4- There is no dichorionic/ monoamniotic.
17. • Super fecundation: is fertilization of two ova
produced in the same menstrual cycle by two
spermatozoa deposited in two separate acts
of coitus.
• Superfoetation: is fertilization of two ova
produced in two different menstrual cycles by
two separate spermatozoa. Actually, this
cannot occur in human as ovulation is
suppressed once pregnancy occurs.
18. Maternal Physiological Adaptation
Increase blood volume and cardiac output.
Increase demand for iron and folic acid.
Maternal respiratory difficulty.
Excess fluid retention and edema.
Increase attacks of supine hypotension.
19. Lie and presentation
• Commonest lie – longitudinal (90%) but
malpresentation are quite common.
• Both vertex (50%)
• First vertex and second breech (30%)
• First breech and second vertex (10%)
• Both breech (10%)
• First vertex and second transverse and so on...
20. Diagnosis
History
* Family history of multiple pregnancy (wife
and/ or husband).
* Recent intake of ovulatory drugs.
* Increased foetal movement.
21. Diagnosis
*Inspection
More enlargement of the abdomen.
Palpation:
* Fundal level: higher than that corresponds to the
period of amenorrhoea.
* Fundal, umbilical and first pelvic grips: can detect
multiple foetal poles. At least, 3 poles should be
palpated to diagnose twin pregnancy.
* Foetal limbs: felt as multiple knobs.
22. Diagnosis
• Auscultation
* Foetal heart sounds: are heard with maximum
intensity in 2 separate points by 2 observers
with a minimum difference of 10 beats per
minute.
* Arnaux sign: occasionally, the superimposition
of two foetal heart sounds produces a
galloping rhythm.
23. Diagnosis
Ultrasonography
• Diagnosis of twins:
*At 7th week: two separate gestation sacs can be
identified.
*At 8th week: separate foetal bodies can be detected.
* At 12th week: separate heads can be distinguished.
*If routine scanning of all pregnant women is carried out
at 16 weeks twins should rarely be missed.
26. DIAGNOSIS OF MULTIPLE PREGNANCY
Positive family history mainly on maternal
side.
Positive history of ovulation induction.
Exaggerated symptoms of pregnancy.
Marked edema of lower limb.
Discrepancy between date and uterine size.
Palpation of many fetal parts.
27. INVESTIGATION
• Number of sacs. [ before 10 weeks ]
2 sacs – dichorionic
Single sac - monochorionic
• Placenta
• Sex
• Intertwin membrane
thicker and more echogenic in dichorionic
.
28. • Twin peak / Lambda sign
- characteristic of dichorionic pregnancies
- chorionic tissue between 2 layers of
intertwin membrane at the placental origin
• T Sign – in monochorionic , no chorionic tissue
• If no membrane is seen in between –
monochorionic monoaniotic
31. Maternal Complications - Antepartum
Hyperemesis – increased β- hCG
Hydramnios – monoamniotic pregnancies, Twin
transfusion syndrome, major cause of prematurity
Pre- eclampsia – 3 times commoner compared to
singleton
Pressure symptoms
Anaemia – increased plasma volume expansion ,
fetoplacental demand for iron increased.
APH – Placenta praevia , Abruptio placenta.
32. Fetal Complications
Antepartum Intrapartum
1.Prematurity 1.PROM
2.IUGR 2.Cord Prolapse
3.Single fetal demise 3.Abruption in second
twin
4.Twin to Twin transfusion
syndrome
4.Interlocking (rare)
5.Vanishing Twin/abortion
6.Cong.anomalies
7.Conjoined twins
33. FETAL COMPLICATIONS
Perinatal mortality: 6 times
Morbidity: 2- 3 times
Mono chorionic - morbidity/mortality twice as that of dichorionic.
- additional risk from TTS
Monoamniotic twins - 50% mortality.
Main cause of adverse outcome is
1. Prematurity
2. IUGR
Cerebral palsy, neurodevelopmental impairment, lower IQ scores.
Monochorionic twins: 1. TTTS
2 .Monoamniotic twinning
3. Conjoined twinning
4. Acardiac fetus
34. Management
• During pregnancy
* Frequent antenatal visits: to detect early any
complication mentioned before and manage it.
* Proper diet: with prophylactic supplementation of
iron and folic acid.
* Adequate rest: to improve placental blood flow
and avoid preterm labour.
* Prophylactic tocolytics or cerclage: is of no actual
benefit.
35. Management
• During labour
* Delivery should be in a hospital .
* A team of experienced obstetrician, assistant,
anaesthetist and neonatologist is necessary
for safety.
36. Management
Delivery of the first twin:
>If it is cephalic: proceed as normal usually
there is no problem.
> If it is breech: caesarean section is safer for
fear of locked twins, although vaginal delivery
may pass without this complication.
>Immediate clamping of the cord is essential
after delivery of the first twin to avoid
bleeding from a uniovular second twin.
37. Management
Delivery of the second twin: It depends upon its
presentation;
• Longitudinal lie (vertex or breech):
• Transverse or oblique lie:
38. Management
• Longitudinal lie (vertex or breech):
>Amniotomy is done during uterine contraction
which may be delayed up to 5 minutes.
>If delay is more than 5 minute, start oxytocin
drip.
>Delivery of the second twin is usually easy due
to dilatation of the maternal passages by
delivery of the first twin.
39. Management
>If there is foetal distress or cord prolapse,
rapid delivery is indicated by:
* breech extraction in breech presentation.
* Forceps delivery in engaged vertex
presentation.
* Vacuum extraction or rarely internal podalic
version and breech extraction may be
indicated in non-engaged head.
40. Management
• Transverse or oblique lie
• a. External cephalic or podalic version is done
then do amniotomy and deliver the foetus as
cephalic or by breech extraction respectively
or,
• b. Internal podalic version and breech
extraction under general or epidural
anaesthesia.
41. Management
• Caesarean section is indicated in:
> The first baby is transverse lie.
>Prolapsed pulsating cord or foetal distress in the
first stage.
> Retained second twin when it is;
a. transverse lie,
b. membranes are ruptured,
c. uterus is retracted
d. cervix is not fully dilated.
42. Management
• Caesarean section is indicated in
> Conjoined twins.
>Triplets or more are safer delivered by C.S.
> Other indications of C.S. as placenta praevia,
contracted pelvis, etc.
43. Midwifery Management
• Daily weight, abdominal girth monitoring.
• Assessment of nutrition and diet pattern and
modification.
• Health education related to diet, hygiene, and
care.
• Daily monitoring of fetal heart rate.
• Intake and output monitoring.
44. Nursing theory
• Orem’s self care theory
• Roy’s adaptation theory
• King’s goal attainment theory(safe
confinement)
• Paplau’s interpersonal theory ( postnatal)
• Nightingale’s environmental theory (Baby)
45. NURSING MANAGEMENT
• 1. Breathing difficulty related to growth of the
two foetuses.
• 2. Hyper emesis related to pressure exerted on
the stomach.
• 3. Fatigue related to exhaustion due to increase
number of vomiting.
• 4. Altered nutrition less than body requirement
related to less intake of food secondary to hyper
emesis.
• 5.Fluid volume deficit related to hyper emesis.
46. Cont..
• 6. Altered socialization related to
psychological upset due to multiple
pregnancy.
• 7. Anxiety related to outcome of pregnancy.
• 8. knowledge deficit related to the disease
condition, self care and posnatal care of the
baby.
• 9. Fear related to process of labour.
47. • 10.Ineffective coping mechanism related to
anxiety, fear due to outcome of pregnancy and
process of labour.
• 11. Increased operative inferences related to
number of fetus and position.
• 12. Risk of infection related to repeated per
vaginal examination.
• 13. Risk of trauma related to increased
operative inferences.
48. • 14.Risk of complications related to multiple
pregnancy.