Obstetric sepsis
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This document discusses the identification and management of sepsis in pregnant women. It notes that the altered physiology in pregnancy must be considered when identifying and treating sepsis. The goals of management are to address both the maternal and fetal health, and intensive care unit involvement may be indicated. Unique aspects of caring for pregnant women with sepsis include monitoring for aortocaval compression, the potential for pulmonary and organ edema given lowered circulating blood volume, lower tolerated blood pressures while monitoring end organ perfusion, and increased risk of desaturation and difficult airways. Early recognition and treatment of worsening hypoxemia and hypotension is important to avoid compromising the health of the mother and baby.
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This document provides information from a lecture on preterm birth and its modern management. It begins with polling questions on topics like the percentage of preterm births in the US and trends over time. It then defines preterm birth and its subdivisions. It discusses risks of prematurity like infant death and long-term complications. It notes that since 2006, the US preterm birth rate has dropped for the sixth consecutive year. However, the US rate remains the highest among industrialized nations. The document explores factors that may be contributing to the decline in preterm births and reviews evidence on the effects of prenatal care. It also examines current understanding of the pathology underlying preterm labor and discusses progesterone and 17-alpha hydroxyprogesterone cap
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Not all maternal deaths are preceded by an identifiable collapse, and not all maternal collapses result in death. Maternal collapse occurs any time during pregnancy, up to 42 days following delivery and is an acute event involving cardiorespiratory systems and/or brain, resulting in impaired consciousness or death.1
Maternal deaths are generally quantified as a maternal mortality ratio (MMR), expressed as the number of maternal deaths per 100,000 women giving birth. It includes deaths that occur due to complications of the pregnancy (direct deaths), and those resulting from worsening of other disease processes due to the pregnancy (indirect deaths). Deaths that occur from causes completely unrelated to pregnancy or birth are termed When faced with an acute maternal collapse, it is helpful to think of potential causes as falling into five categories, or the 5 Hs for simplicity:4
Head including eclampsia, stroke, epilepsy, vasovagal
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Hypoxia including pulmonary embolus, pulmonary oedema, anaphylaxis, asthma
Haemorrhage including abruption, uterine atony, genital tract trauma, uterine rupture, uterine inversion, ruptured aortic aneurysm
wHole body and Hazards amniotic fluid embolus, hypoglycaemia, trauma, anaesthetic complications, drug reactions (illicit or prescribed), sepsis
The likelihood of any one of these being causative will obviously depend somewhat on the timing of the collapse – early or late pregnancy, intrapartum, immediately postpartum, remotely postpartum.
Maternal cardiac arrest represents a small subset of women affected by maternal collapse. The incidence is approximately 1 in 30,000 ongoing pregnancies, with a high likelihood of death for both the mother and the fetus. The vast majority of us will never need to attend a maternal cardiac arrest, and doing so is uniquely stressful. For these reasons, it is important to have a framework in mind of how to deal with a maternal cardiac arrest, and to have practised the response to this situation.
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• Several other risk factors for maternal death are recognised. These include:
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• Obesity
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• Pre-existing mental health issues, substance use and domestic violence, all of which may be exacerbated by pregnancy and the puerperium
• Medical co-morbidities, particularly asthma, autoimmune diseases, inflammatory and atopic disorders, haematological disorders, essential hypertension, infections and musculoskeletal disorders
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Maternal deaths are generally quantified as a maternal mortality ratio (MMR), expressed as the number of maternal deaths per 100,000 women giving birth. It includes deaths that occur due to complications of the pregnancy (direct deaths), and those resulting from worsening of other disease processes due to the pregnancy (indirect deaths). Deaths that occur from causes completely unrelated to pregnancy or birth are termed When faced with an acute maternal collapse, it is helpful to think of potential causes as falling into five categories, or the 5 Hs for simplicity:4
Head including eclampsia, stroke, epilepsy, vasovagal
Heart including myocardial infarction, arrhythmia, cardiomyopathy, thoracic aortic dissection
Hypoxia including pulmonary embolus, pulmonary oedema, anaphylaxis, asthma
Haemorrhage including abruption, uterine atony, genital tract trauma, uterine rupture, uterine inversion, ruptured aortic aneurysm
wHole body and Hazards amniotic fluid embolus, hypoglycaemia, trauma, anaesthetic complications, drug reactions (illicit or prescribed), sepsis
The likelihood of any one of these being causative will obviously depend somewhat on the timing of the collapse – early or late pregnancy, intrapartum, immediately postpartum, remotely postpartum.
Maternal cardiac arrest represents a small subset of women affected by maternal collapse. The incidence is approximately 1 in 30,000 ongoing pregnancies, with a high likelihood of death for both the mother and the fetus. The vast majority of us will never need to attend a maternal cardiac arrest, and doing so is uniquely stressful. For these reasons, it is important to have a framework in mind of how to deal with a maternal cardiac arrest, and to have practised the response to this situation.
incidental deaths, and are not included in calculation of the MMR.
• Several other risk factors for maternal death are recognised. These include:
• Maternal age 35 and older
• Obesity
• Lower socioeconomic status
• Pre-existing mental health issues, substance use and domestic violence, all of which may be exacerbated by pregnancy and the puerperium
• Medical co-morbidities, particularly asthma, autoimmune diseases, inflammatory and atopic disorders, haematological disorders, essential hypertension, infections and musculoskeletal disorders
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- A "Sepsis Six" pregnancy-specific bundle (cultures, lactate, urine output monitoring, oxygen, IV fluids, antibiotics) aims to aid early recognition and treatment.
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- Risk factors include multiparity, advanced maternal age, twins, preeclampsia, hypertension, and African descent.
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This document discusses recurrent pregnancy loss and provides information on definitions, incidence, causes, investigations, and guidelines. Some key points:
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Peripartum cardiomyopathy (ppcm)
This document discusses peripartum cardiomyopathy (PPCM), defined as heart failure occurring during the last month of pregnancy or up to 5 months postpartum without an identifiable cause. Key points:
- Incidence is 0.05-0.06% of pregnancies but higher in some African countries due to postpartum salt consumption.
- Risk factors include multiparity, advanced maternal age, twins, preeclampsia, hypertension, and African descent.
- Causes are mostly idiopathic but may include viral infection or autoimmune response.
- Prognosis is variable with 50-60% recovering by 6 months postpartum but others have persistent or worsening dysfunction. M
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Peripartum cardiomyopathy expliane din lucid language.
includes all latest information ,trials , drugs used,
Overview of IUGR FGR
Fetal growth restriction (FGR), formerly called intrauterine growth restriction (IUGR), refers to a condition in which an unborn baby is smaller than it should be because it is not growing at a normal rate inside the womb.
Mild FGR usually doesn't cause long-term problems. In fact, most babies who have it catch up in height and weight by age 2. But severe FGR can seriously harm a baby before and after birth. The extent of the problems depends on the cause and how severe the growth restriction is. It also depends on what point in the pregnancy it starts.
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Premature Labour
Premature labour, also known as preterm labour, occurs when a woman goes into labour before 37 weeks of gestation. It accounts for 5-10% of all deliveries and is a major cause of neonatal mortality and morbidity. The causes are often multifactorial and can include demographic factors, reproductive history, uterine factors, and infections. Management depends on factors such as gestational age, fetal well-being, and availability of neonatal intensive care and may involve tocolysis, corticosteroids, antibiotics, and monitoring for signs of infection.
Prematurity & and its complication on different organs, Dr Iraguha Bandora Yv...
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The document discusses preterm birth and summarizes key information. It defines a preterm baby as one delivered before 37 weeks of gestation. Worldwide, preterm birth complicates 5-18% of births, with rates of 5-9% in Europe and 12-13% in the USA. Prematurity is associated with short and long term complications affecting multiple organ systems. Prevention strategies aim to reduce preterm birth through screening and treating at-risk women. Treatment includes steroids, antibiotics, tocolysis and neonatal care to improve outcomes.Postterm-Pregnancy-DrAZ.ppt
Postterm pregnancy refers to pregnancy extending beyond 42 weeks of gestation. It is associated with increased risks to the fetus and neonate, including higher rates of perinatal mortality, meconium staining of amniotic fluid, and fetal hypoxia. While postterm pregnancy itself is not pathological, the post-maturity syndrome describes pregnancies complicated by intrauterine growth restriction and other issues. Monitoring of postterm pregnancies should include biophysical profile assessments including amniotic fluid measurement and non-stress tests. Management options include induction of labor at 41 weeks to reduce risks, or conservative management with close surveillance for women opting not to induce.
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Management of mild covid infection in pregnancy
The document provides guidelines for managing mild COVID-19 infection in pregnancy. It discusses the clinical presentation of mild infection, recommendations for home isolation and monitoring, and guidance on antepartum, intrapartum, postpartum care and breastfeeding. Key points include managing asymptomatic cases through teleconsultation, monitoring for danger signs requiring admission, and making delivery decisions based on obstetric rather than COVID-19 status alone.
Clinical study of Eclampsia and outcome in a tertiary care centre
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
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Placental abruption is the premature separation of the placenta from the uterine wall after 20 weeks of gestation. It can cause bleeding, uterine and back pain, and fetal distress. Risk factors include increased age, preeclampsia, smoking, and prior abruption. It is classified as revealed, concealed, or mixed depending on if bleeding is obvious. Complications include maternal shock, renal failure, and fetal death. Diagnosis involves history, exam, and ultrasound. Management depends on maternal and fetal stability, and may involve resuscitation, monitoring, steroids, or delivery. The goal is to prolong pregnancy if possible or deliver based on maternal or fetal indications.
Post term pregnancy
Post-term pregnancy is defined as exceeding 40 weeks of gestation. It occurs in 5-10% of pregnancies, often due to inaccurate gestational age calculation. Both mother and baby are at increased risk of complications like dystocia, meconium aspiration, stillbirth. Management includes assessing gestational age accurately, monitoring the fetus, and inducing labor between 41-42 weeks to prevent risks of post-term pregnancy. Intrauterine fetal death is the death of a fetus before delivery. It can result from maternal, fetal or obstetric complications. Evaluation includes detailed history, examinations, and tests to determine the cause to help counsel patients and prevent future recurrence.
The antibiotic arms race: Getting the launch codes right.
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Maternal Mortality
Maternal mortality remains a significant issue worldwide, with over 500,000 deaths annually. Through initiatives like the Confidential Enquiries into Maternal Deaths system, Malaysia has significantly reduced its maternal mortality rate from 540/100,000 live births in 1950 to 28.1/100,000 in 2000. Postpartum hemorrhage is a leading cause of death in Malaysia, while medical conditions, sepsis, and hypertensive disorders also contribute substantially. Recommendations focus on increasing access to emergency care and transportation, improving provider training, and expanding family planning programs.
Neonatal septicemia
This document summarizes information about neonatal sepsis, including its definition, risk factors, symptoms, diagnosis, and treatment. Key points include: neonatal sepsis is a bloodstream infection common in preterm infants, with symptoms that are non-specific; diagnosis relies on clinical assessment combined with laboratory tests like blood cell counts and blood cultures; and treatment involves early, broad-spectrum antibiotics along with supportive care while monitoring for complications. The document also discusses challenges around diagnosing sepsis in newborns and potential immunotherapy approaches.
6 Neonatal Septicemia
Neonatal sepsis is a serious infection that can affect newborns, especially those born prematurely or with low birth weight. The immaturity of a newborn's immune system makes them highly susceptible to infection. Symptoms of neonatal sepsis are non-specific and can include poor feeding, temperature instability, and respiratory distress. Diagnosis relies on clinical signs and abnormal laboratory test results, as there is no single diagnostic marker. Treatment involves administering broad-spectrum antibiotics early while infection is considered, with supportive care and management of any complications.
ABORTION.ppt
This document defines abortion and miscarriage and discusses the classification, causes, risk factors, and management of spontaneous abortion. It defines abortion as the termination of a pregnancy before 20 weeks or when the fetus weighs less than 500g. The most common causes of early pregnancy loss are defective placentation, chromosomal abnormalities, and maternal age. Risk factors include prior pregnancy loss, infections, endocrine and anatomical factors, immunological issues like antiphospholipid syndrome, and exogenous agents. Spontaneous abortions are classified as threatened, inevitable, incomplete, complete, missed, or septic based on symptoms and examination findings. Management depends on the classification and may include observation, medication, or surgical evacuation.
HM 2012 session-VIII patient safety
This document provides an overview of patient safety initiatives and issues in hospitals. It discusses that 10% of hospital patients suffer adverse events, with medical errors causing around 100,000 deaths per year in the US. Common types of errors include overdoses and performing procedures on the wrong patient. The document then outlines the Patient Safety Friendly Hospital Initiative, which develops standards to assess patient safety in hospitals and has piloted the approach in 7 countries. It describes the five domains used to measure hospital performance on patient safety and provides examples of critical and core standards. The document concludes by offering recommendations on how hospitals can develop their own patient safety programs.
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
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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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
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Learning objectives:
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3. Describe the functions of the dorsal and respiratory groups of neurons
4. Describe the influences of the Pneumotaxic and Apneustic centers
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Obstetric sepsis
- 2. Why this is important? Learning Objectives Identification Management of sepsis Common infections Pregnancy-specific infections Unique considerations 2
- 3. Identification of sepsis in pregnant women Consideration of altered physiology in identification and management Management aims Indications for ICU involvement and specific aspects of care Realize the importance of both maternal and foetal considerations in management 3
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- 30. Have we not covered something? 30
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- 34. In Extra-uterine sepsis, foetal well-being largely determined by maternal status In Intra-uterine sepsis, lack of sensitivity and specificity in EFM findings 34
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- 37. Remember Aortocaval compression (week 20 onwards) Susceptibility to pulmonary and organ oedema (Low COP) Lower MAPs may be tolerated – monitor end- organ perfusion Prone to desaturation, plus airway may be difficult 37
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- 48. Worsening hypoxaemia and hypotension may severely compromise mother and baby Potential difficult airway management Early recognition and action mandated! 48
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