The document discusses various obstetrical operations including forceps delivery, vacuum delivery, c-section, and episiotomy. It describes the types of forceps used, indications for their use, prerequisites, and procedures. Complications of forceps delivery are also outlined. Similarly, the document discusses vacuum extractor procedures, indications, contraindications and complications. Cesarean section definitions, indications, preoperative preparation, intraoperative care, postoperative care and complications are summarized. Lastly, the document covers episiotomy including indications, advantages, disadvantages, procedures for performing and suturing an episiotomy, as well as post-care.
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Please find the power point on Vacuum delivery. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Please find the power point on Vacuum delivery. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Pathophysiology of Normal Labour by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management and pathophysiology of Normal Labour . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
THIRD STAGE OF LABOUR AND ITS MANAGEMENT.pdfDolisha Warbi
definition, duration, events, (placenta separation, descend of placenta, expulsion of placenta , the Schultz mechanisms, Mathew Duncan mechanisms, signs of separation, expectant management, active management, complexion , examination of placenta and its membrane, complication.
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...alka mukherjee
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
Pathophysiology of Normal Labour by Sunil Kumar Dahasunil kumar daha
Please find the power point on Management and pathophysiology of Normal Labour . I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
THIRD STAGE OF LABOUR AND ITS MANAGEMENT.pdfDolisha Warbi
definition, duration, events, (placenta separation, descend of placenta, expulsion of placenta , the Schultz mechanisms, Mathew Duncan mechanisms, signs of separation, expectant management, active management, complexion , examination of placenta and its membrane, complication.
Umbilical cord prolapse by dr alka mukherjee dr apurva mukherjee nagpur m.s. ...alka mukherjee
The umbilical cord is a flexible, tube-like structure that, during pregnancy, connects the fetus to the mother. The umbilical cord is the baby's lifeline to the mother. It transports nutrients to the baby and also carries away the baby's waste products. It is made up of three blood vessels – two arteries and one vein.
Umbilical cord prolapse is a complication that occurs prior to or during delivery of the baby. In a prolapse, the umbilical cord drops (prolapses) through the open cervix into the vagina ahead of the baby. The cord can then become trapped against the baby's body during delivery. Umbilical cord prolapse occurs in approximately one in every 300 births.
An umbilical cord prolapse presents a great danger to the fetus. During the delivery, the fetus can put stress on the cord. This can result in a loss of oxygen to the fetus, and may even result in a stillbirth.
The most common cause of an umbilical cord prolapse is a premature rupture of the membranes that contain the amniotic fluid. Other causes include:
• Premature delivery of the baby
• Delivering more than one baby per pregnancy (twins, triplets, etc.)
• Excessive amniotic fluid
• Breech delivery (the baby comes through the birth canal feet first)
• An umbilical cord that is longer than usual
Diagnosis of a prolapsed umbilical cord can be in several ways.
During delivery, the doctor will use a fetal heart monitor to measure the baby's heart rate. If the umbilical cord has prolapsed, the baby may have bradycardia (a heart rate of less than 120 beats per minute).
The doctor can also conduct a pelvic examination and may see the prolapsed cord, or palpate (feel) the cord with his or her fingers.
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
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CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
8. TYPES OF FORCEPS
Outlet forceps delivery, where the forceps are applied when the fetal head
has reached the perineal floor and its scalp is visible between contractions.
Low forceps delivery, when the baby's head is at +2 station or lower. There is
no restriction on rotation for this type of delivery.
Midforceps delivery, when the baby's head is above +2 station. There must
be head engagement before it can be carried out.
9.
10. INDICATIONS OF FORCEPS APPLICATION
MATERNAL FETAL MATERNAL AND FETAL
Impairment of ability
to push.
Heart disease
Pulmonary
compromise
Intrapartum infection
Umbilical cord
prolapse
Premature separation
of placenta
Non – reassuring fetal
heart pattern
Prolonged second stage of
labour( more than 3 hours
and more than three hours
without regional anesthesia
in nulliparous women)
In parous women more than
2 hours with and more than
one hour without regional
anesthesia.
11. CONTRAINDICATIONS FOR FORCEP
APPLICATION
Any contraindication to vaginal delivery.
Cervix not fully dilated and fully effaced.
CPD/ CP
Inability to determine the presentation and position of the fetal head
Unsuccessful trial of vacuum extraction
12. PRE-REQUISITES FOR FORCEPS APPLICATION
F: Favourable head position and station
O: Open os
R: Ruptured Membranes
C: Contraction present and consent
E: Engaged head, Empty Bladder
P: Pelvimetry
S: Stirrups / Lithotomy Position
13. PROCEDURE
INTRODUCTION OF THE BLADES
The patient is anesthetized and the
perineum is carefully prepared.
The two fingers are introduced into the
vaginal canal followed by the blade of each
side. The blade should be jellified.
Once both the blades are localized, the
operator locked the forceps for further
procedure.
14.
15. LOCKING OF THE FORCEP
With proper application, the forceps locks easily or with minor
manipulation.
Make sure that there is no injuries to the cervix and surrounding
tissues.
16. TRACTION
Traction should be applied using
traction handle only and not by holding
the shaft of the blade.
The force exerted should be from the
wrist. The traction should be done
during a contraction so that minimal
force needs to be exerted.
The direction of traction should be in
the direction of the birth canal.
19. VACUUM/VENTOUSE EXTRACTOR
• The vacuum extractor like the obstetric forceps, is a method of getting hold of
the fetal head while it is still in the birth canal.
WORKING
The obstetric forceps applied around the head gives force theoretically to the
base of the skull, while in ventouse, the extractor grips the scalp and it is
almost true to say that the baby is pulled out by its hair.
20.
21. CONTRAINDICATIONS OF VENTOUSE
• Ant presentation other than vertex
• Preterm fetus
• Suspected fetal coagulation disorder
• Suspected fetal macrosomia
• Unengaged fetal head
• Obvious CPD
• Patient’s refusal
• Haemophilia
22. PROCEDURE FOR VENTOUSE APPLICATION
STEP 1:
The cup is placed against the fetal head nearer to the occiput with the
‘knob’ of the cup pointing towards the occiput.
A vacuum of 0.2 kg/cm2 is induced by the pump slowly, taking at least
2 minutes.
The pressure is gradually increased at the rate of 0.1 kg/cm2/min
until effective vacuum of 0.8 kg/cm2 is achieved in about 10 minutes.
23. STEP 2: Traction
Traction must be at the right angle to the cup
Should be synchronous with the uterine contractions
Traction is released in between contraction
Traction should be made using one hand along with the axis of the birth
canal. The fingers on the other hand are to be placed against the cup to
note the correct angle of traction, rotation and advancement of the
head.
24. contd
Operative vaginal delivery should be abandoned when there is no
descent of the head. The traction should not exceed 30 minutes on no
account.
As soon as delivered, the vacuum is reduced by opening the screw-
release valve and the cup is then detached.
27. DEFINITION
• It is an operative procedure whereby the foetuses after the end of
the 28th weeks are delivered through an incision on the abdominal
and uterine walls.
28. INDICATIONS
ABSOLUTE INDICATIONS RELATIVE INDICATIONS
Vaginal delivery is not possible:
• Central placenta previa
• CP or CPD
• Pelvic mass
• Advanced carcinoma cervix
• Vaginal obstruction
Vaginal delivery may be possible but risks to
the mother and/or to the baby are high:
• CPD/previous CS
• Non reassuring FHS
• Dystocia, Malpresentation
• BOH, Hypertensive disorder
Common Indications
Primigravida
• Failed induction, Previous LSCS, CPD, Dystocia,
Malpresentation
Multigravida
• Previous LSCS
• APH
• Malpresentation
29. Preoperative preparation
• Abdomen is scrubbed, hair clipped
• Ranitidine 150 mg is given orally the night before and is repeated 1
hour before surgery to raise the gastric pH
• Stomach to be emptied
• FHS to be checked regularly
• Cross match blood when average blood loss is anticipated
30. Intraoperative care
• Help and support in positioning during spinal/epidural anesthesia
• FHS monitored and document in clinical record
• Support mother with surgery
• Support with neonatal resuscitation
• Facilitate skin to skin contact
• New-born assessment
31. Postoperative care: First 24 Hours – 0 day
• First 6-8 hours is important, check vitals, bleeding etc.
• Fluid: sodium chloride or RL continued until 2 – 2.5L is infused.
• Oxytocic: 5 units IV is given and may be repeated
• Prophylactic antibiotic 2 – 3 days
• Ambulation to be attempted
• Breastfeeding
32. Day – 1
• Oral feeding in the form of lain or electrolyte water or raw tea is given.
• Active bowel sounds are observed by the end of the day
Day – 2
• Light solid diet of mother’s choice is given
• Bowel care is done
Day 5-6
• The abdominal skin stitches are removed
33. Complications
Intraoperative
• Extension of the uterine incision in one or both sides
• Uterine lacerations at the lower uterine incision
• Ureteral injury rare
• GI tract injury
35. Remote
• Gynaecological: Menstrual excess or irregularities, chronic pelvic pain
• General surgical: Incisional hernia, IO because of adhesion and bands
• Future pregnancy: Risk of scar rupture
Fetal:
• Iatrogenic prematurity and development of RDS.
36.
37.
38.
39. EPISIOTOMY
• An episiotomy is a surgical procedure where a small incision is made in
the area between vagina and anus (perineum) during childbirth.
40. INDICATIONS
• Delay due to rigid perineum, disproportion between fetus and vaginal
orifice.
• Fetal distress due to prolapsed cord in second stage.
• To facilitate vaginal or intra uterine manipulation Eg. Forceps, breach
delivery
• Preterm baby in order to avoid intracranial damage
• Previous 3rd degree repaired on the perineum.
41.
42. ADVANTAGES
• Fetal acidosis and hypoxia are reduced
• Over stretching of the pelvic floor is
lessened
• Bruising of the urethra is avoided.
• In sever pre – eclampsia or cardiac disease
to reduce the effort bearing down.
• A previous third degree tear which may
occur again because of the scar tissue
which does not stretch well is prevented
DISADVANTAGES
• Bartholin's duct may be served
• The levatorani muscle is weakened
• Bleeding is more profuse
• Suturing is more difficult
• The woman experiences subsequent
discomfort
43. Local analgesia for Episiotomy
• Lignocaine /lidocaine/ 0.5 percent of 10ml is safe and efficient. It takes
effect rapidly with in 1 & 2 minutes.
44. Timing of Episiotomy
The head should be well down on the perineum, low enough to keep it
stretched and thinned.
In breech presentation the posterior buttock would be distending the
perineum.
It must be made neither too soon nor too late
45. PROCEDURE/STEPS OF EPISIOTOMY
• Two fingers are placed in the vagina between the presenting part and the
posterior vaginal wall.
• The incision is made by the episiotomy scissors, one blade of which is placed
inside in between the fingers and the posterior vaginal wall and other on the
skin.
• The incision should be made at the height of uterine contraction. · Deliberate
cut is made starting from the Centre of the fourchette extending laterally
either to the right or to the left (medio lateral)
46.
47. Procedures of suturing episiotomy
• Timing of repair – Repair is done soon after expulsion of placenta.
Early repair prevents sepsis and excessive bleeding per vagina.
• Preparation – The patient is placed in lithotomy position. A good
light source from behind is needed. The perineum and wound area is
cleansed with antiseptic solution. Repair should be done under strict
aseptic precautions. A vaginal pack may be inserted and is placed high
up. The pack must be removed after the repair is completed.
48. • Interrupted chromic catgut sutures are placed by the curved round needle on
the vaginal wall starting from the apex of the wound upto the margins of the
hymen.
• Interrupted chromic catgut stitches are placed by the round body needle to
oppose the perineal muscles. The margins of the wound from the hymen upto
the fourchette are opposed by a few interrupted catgut sutures like that in the
first step.
• Interrupted chromic catgut sutures are placed to oppose the skin, perineal fascia
by the cutting curved needle. After the procedure perineum is cleaned. Sterile
pad is applied and patient is made comfortable in bed.
49.
50.
51. After care of Episiotomy
• Hot bath, clean wound care.
• If pus or fouls smelling discharge develop report to health personnel.
• Advise not to strain and avoid constipation