An obstetrical emergency is a suddenly developing life-threatening condition related to pregnancy or delivery that requires urgent medical intervention to prevent maternal death. Common emergencies include hemorrhage, hypertensive disorders, abdominal issues, umbilical cord prolapse, shoulder dystocia, amniotic fluid embolism, and postpartum psychosis. Prompt recognition and treatment are essential to prevent maternal mortality from conditions like ruptured uterus, preeclampsia, eclampsia, and excessive bleeding.
This PPT describes the common obstetrical emergency and its nursing management in a simple way. Content will be helpful to all healthcare professionals to revise, refresh and to update.
PPH.Presented by
Ahmed Mukhtar Ali Mohammed
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
This PPT describes the common obstetrical emergency and its nursing management in a simple way. Content will be helpful to all healthcare professionals to revise, refresh and to update.
PPH.Presented by
Ahmed Mukhtar Ali Mohammed
M.B.B.Ch., M.Sc Obstetrics and GynecologyAssistante lecturer of Obstetrics and Gynecology
Faculty of Medicine, Zagazig University
Ahmad mukhtar
MD.,M.B.B.Ch., M.Sc Obstetrics and GynecologyConsultant and Lecturer of Obstetrics and Gynecology, Faculty of
MEDICINE, Zagazig University.
"Nursing is based on an art and science that mould the attitudes, intellectual competencies, and technical skills of the individual nurse into the desire and ability to help people, sick or well, cope with their health needs." – Abdellah
ORGANIZATION: According to L. White, "Organization is the arrangement of personnel for facilitating the accomplishment of some agreed purpose through allocation of functions and responsibilities.“
Definition of Professional Organization:
A professional Organization is an organization, usually nonprofit that exists to a particular profession, to protect both public interests and the interests of professionals.
The whole number of people or inhabitants in a country or region” -(Webster’s dictionary)
In sociology, population refers to a collection of human beings.
Scaled down teaching used by a student teacher in a controlled condition of a teacher in order to attain proficiency in a particular teaching skill is called micro teaching
The research approach indicates the basic procedure for conducting research.
Research approach is the technique which the researcher uses to structure a study in order to gather and analyze information relevant to the research question .
A disruptive condition that occurs in response to adverse influences from the internal or external environments
A condition in which the person responds to changes in the normal balanced state
A biological, psychological, social or chemical factor that causes physical or emotional tension and may be a factor in the etiology of certain illnesses.
Most of us have probably become angry on occasion. Let us hope the moment passed quickly, we apologized and moved on. However, anger that is not under control can be extremely harmful, even lethal. It is vital to learn early how to control this emotion.
Stages of labour and alternative therapiesSaima Habeeb
Birth is a normal, healthy part of a woman’s life. This unexplainable happiness is usually accompanied by severe pain due to contractions.
Labour is a health state that most women aspire to, at some point in their lives. The first thought that comes to the mind of an expecting woman regarding her delivery is the pain of labour.
Labour is a normal physiological process, which while should be an occasion for rejoicing
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
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
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
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
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
3. One life is lostOne life is lost
in the process ofin the process of
creating anothercreating another
becausebecause
it is obstetrical emergencyit is obstetrical emergency
which when unrecognizedwhich when unrecognized
and mishandledand mishandled
leads to Maternal deathleads to Maternal death
4. DefinitionDefinition
A suddenly developing severe lifeA suddenly developing severe life
threatening condition that isthreatening condition that is
related to pregnancy or deliveryrelated to pregnancy or delivery
which requires urgent medical orwhich requires urgent medical or
surgical therapeautic interventionsurgical therapeautic intervention
in order to prevent the likely deathin order to prevent the likely death
of woman.of woman.
5. An obstetrical emergencyAn obstetrical emergency::
may occur anytime during pregnancy,may occur anytime during pregnancy,
delivery, or up to 6 weeks after child birth.delivery, or up to 6 weeks after child birth.
may occur suddenly without any warning.may occur suddenly without any warning.
is life threatening.is life threatening.
Requires urgent action.Requires urgent action.
The patient must be taken to a hospital orThe patient must be taken to a hospital or
first referral unit without any delayfirst referral unit without any delay..
6. Realize that every pregnancy faces theRealize that every pregnancy faces the
risks, even when the previous onesrisks, even when the previous ones
have been normalhave been normal
Every pregnant woman even if she is wellEvery pregnant woman even if she is well
nourished and well educated, can developnourished and well educated, can develop
sudden life threatening complications thatsudden life threatening complications that
require quality obstetric care.require quality obstetric care.
7. RememberRemember
Excessive bleeding during child birth is dangerousExcessive bleeding during child birth is dangerous
If quantity of blood lost is more than which can be heldIf quantity of blood lost is more than which can be held
in cupped palm, it is excessivein cupped palm, it is excessive
Continuous flow of blood, whether or not placenta isContinuous flow of blood, whether or not placenta is
delivered, is dangerousdelivered, is dangerous
Excessive blood loss, fast &feeble pulse, cold &clammyExcessive blood loss, fast &feeble pulse, cold &clammy
skin are signs of impending loss of consciousnessskin are signs of impending loss of consciousness
If baby is not delivered within 12 hours of L/P, is anIf baby is not delivered within 12 hours of L/P, is an
emergencyemergency
If placenta does not come out within 30 minutes ofIf placenta does not come out within 30 minutes of
delivery of baby, is an emergencydelivery of baby, is an emergency
11. LacerationsLacerations
First thing to be ruled out in bleeding postFirst thing to be ruled out in bleeding post
partum woman with a firm uteruspartum woman with a firm uterus
Careful examination of the entire genital tractCareful examination of the entire genital tract
Rarely results in massive blood lossRarely results in massive blood loss
May be life threatening if extends to the retroMay be life threatening if extends to the retro
peritoneumperitoneum
12. Atony (PPH)Atony (PPH)
Most common cause ofMost common cause of
significant blood losssignificant blood loss
due todue to retained placentaretained placenta
or its bitsor its bits
Generally responds toGenerally responds to
uterine massage anduterine massage and
uterotonic drugsuterotonic drugs
(oxytonics).(oxytonics).
13.
14. AbruptionAbruption
Delivery is generally indicted unless the fetus isDelivery is generally indicted unless the fetus is
very premature and both the mother and fetusvery premature and both the mother and fetus
are stableare stable
Renal failure is the most common cause ofRenal failure is the most common cause of
maternal mortalitymaternal mortality
Couvelaire uterus results dueCouvelaire uterus results due
to retroplacental clotsto retroplacental clots
Restriction of physical activityRestriction of physical activity
No vaginal doucheNo vaginal douche
15. PreviaPrevia
Transvaginal ultrasound is highly accurate inTransvaginal ultrasound is highly accurate in
making diagnosismaking diagnosis
Preterm delivery frequently needed due toPreterm delivery frequently needed due to
excessive blood lossexcessive blood loss
or fetal compromiseor fetal compromise
16. AccretaAccreta
Most frequently seen now when a woman with aMost frequently seen now when a woman with a
previous c/section has placenta overlying theprevious c/section has placenta overlying the
uterine scaruterine scar
Placenta is adhered to uterine wallPlacenta is adhered to uterine wall
Manual removal isManual removal is
difficult and needdifficult and need
prompt hysterectomyprompt hysterectomy
17. InversionInversion
Usually occurs when the placenta is fundallyUsually occurs when the placenta is fundally
implantedimplanted
Occurs due to mismanagement of 3Occurs due to mismanagement of 3rdrd
stage ofstage of
labour,excessive cord traction, combining fundallabour,excessive cord traction, combining fundal
pressure and cord traction, applying fundalpressure and cord traction, applying fundal
pressure on atonic uterus, pathologically adheredpressure on atonic uterus, pathologically adhered
placenta, fetal macrosomia, short cord,placenta, fetal macrosomia, short cord,
precipitate labour.precipitate labour.
Patient presents with shock, hemorrhage andPatient presents with shock, hemorrhage and
abdominal pain.abdominal pain.
19. InversionInversion
Don’t attempt to deliver placenta until thereDon’t attempt to deliver placenta until there
have been signs of separationhave been signs of separation
Raise the foot endRaise the foot end
Prompt replacement is generally easier.Prompt replacement is generally easier.
Halothane or nitroglycerine are effective agentsHalothane or nitroglycerine are effective agents
to relieve pain.to relieve pain.
Uterotonics (oxytocins) then needed toUterotonics (oxytocins) then needed to
contract the uteruscontract the uterus
Instillation of 4-5 liters warm saline intoInstillation of 4-5 liters warm saline into
introits and then sealing with hand or softintroits and then sealing with hand or soft
ventouse capventouse cap..
20. Prompt replacement by pushing the fundusPrompt replacement by pushing the fundus
with palm of hand along vagina andwith palm of hand along vagina and
lifting the uterus towards umblicuslifting the uterus towards umblicus
21. Rupture of uterusRupture of uterus
Frequently the result of uterine scar disruptionFrequently the result of uterine scar disruption
Commonly occurs in patients who had previousCommonly occurs in patients who had previous
c/section,the multiparous woman receivingc/section,the multiparous woman receiving
oxytocins, mother who is subjected tooxytocins, mother who is subjected to difficultdifficult
forcep/vacuum operationforcep/vacuum operation, or internal uterine, or internal uterine
manipulation.manipulation.
Incidence has increased with the increase ofIncidence has increased with the increase of
c/sectionsc/sections
Perforation of non pregnant uterusPerforation of non pregnant uterus
can lead to rupture of uteruscan lead to rupture of uterus
in subsequent pregnanciesin subsequent pregnancies
(Howe-1993, Usta etal-2007)(Howe-1993, Usta etal-2007)
22. Rupture of uterus R/TRupture of uterus R/T
VACUUM/FORCEP DELIVERY IN PASTVACUUM/FORCEP DELIVERY IN PAST
23. Rupture of uterus R/TRupture of uterus R/T
previous caesarean sectionprevious caesarean section
25. Ruptured UterusRuptured Uterus
Uterine wall thins too much around cervix as fetusUterine wall thins too much around cervix as fetus
growsgrows
Uterine wall rupturesUterine wall ruptures
Fetus released into abd/cavityFetus released into abd/cavity
Mortality to mother usuallyMortality to mother usually
5% to 20%5% to 20%
Infant mortality over 50%Infant mortality over 50%
Fetal deaths are reportedFetal deaths are reported
(Flannely etal-1993, Phelan-1990).(Flannely etal-1993, Phelan-1990).
29. Assessment FindingsAssessment Findings
Previous uterine rupturePrevious uterine rupture
Abdominal traumaAbdominal trauma
Large fetusLarge fetus
Born more than 2 childrenBorn more than 2 children
Prolonged or difficult laborProlonged or difficult labor
Tearing or shearing sensation in abdomenTearing or shearing sensation in abdomen
Constant severe abdominal painConstant severe abdominal pain
NauseaNausea
Signs of shockSigns of shock
Vaginal bleeding (minor, or heavy)Vaginal bleeding (minor, or heavy)
Cessation of noticeable uterine contractionsCessation of noticeable uterine contractions
Palpation of infant in abdominal cavityPalpation of infant in abdominal cavity
30. Rupture of uterus-managementRupture of uterus-management
Immediate c/section to deliver live babyImmediate c/section to deliver live baby
Surgical repair usually satisfactorySurgical repair usually satisfactory
Hysterectomy option depends on theHysterectomy option depends on the
extend of traumaextend of trauma
Preservation of uterus has reported inPreservation of uterus has reported in
successful future pregnanciessuccessful future pregnancies (O’Connor(O’Connor
&Gaughan-1993)&Gaughan-1993)
31. Sexual AssaultSexual Assault
EpidemiologyEpidemiology
~1 in 5 women will be raped in their lifetime~1 in 5 women will be raped in their lifetime
Estimated that as few as 1 in 3 cases are reportedEstimated that as few as 1 in 3 cases are reported
Recent study showed of 372 victims, only 7% hadRecent study showed of 372 victims, only 7% had
genital injuries. Majority had facial/extremity injuriesgenital injuries. Majority had facial/extremity injuries
Rape is a crime of powerRape is a crime of power
ManagementManagement
Provide for patient’s physical and psychological wellProvide for patient’s physical and psychological well
being firstbeing first
Non-judgmentalNon-judgmental
Encourage preservation of evidenceEncourage preservation of evidence
Provide supportive care as necessaryProvide supportive care as necessary
32.
33. Emergency Care in haemorrhageEmergency Care in haemorrhage
Monitor vitalsMonitor vitals
Maintain patent AirwayMaintain patent Airway
Ensure adequate circulationEnsure adequate circulation
Treat for shockTreat for shock
Replace and save blood soaked padsReplace and save blood soaked pads
Save all tissueSave all tissue
Provide emotional supportProvide emotional support
Control bleedingControl bleeding
Never place anything into vaginaNever place anything into vagina
Sanitary napkin over vaginaSanitary napkin over vagina
Immediate transport in left lateral recumbentImmediate transport in left lateral recumbent
34. Hypertensive disordersHypertensive disorders
Preeclampsia/EclampsiPreeclampsia/Eclampsi
HTN, edema, proteinuriaHTN, edema, proteinuria
Cause unknownCause unknown
Eclampsia is above plus seizuresEclampsia is above plus seizures
Occur from 20Occur from 20thth
week to 7 daysweek to 7 days
post partumpost partum
Have been reported up to 26 daysHave been reported up to 26 days
Most frequent in last trimesterMost frequent in last trimester
Women in 20’s first time pregnancyWomen in 20’s first time pregnancy
At risk mothers:At risk mothers:
DiabetesDiabetes
Heart diseaseHeart disease
Renal problemsRenal problems
HypertensionHypertension
All gravid pt’s with HTN should be evaluatedAll gravid pt’s with HTN should be evaluated
35. Signs & Symptoms-PreeclampsiaSigns & Symptoms-Preeclampsia
HypertensionHypertension
EdemaEdema
Excessive weight gainExcessive weight gain
Extreme swelling of face, hands, and feetExtreme swelling of face, hands, and feet
HeadacheHeadache
Sensitivity to lightSensitivity to light
Visual difficultiesVisual difficulties
Pain in upper abdomenPain in upper abdomen
Apprehension and shakinessApprehension and shakiness
36. EclampsiaEclampsia
During seizure placenta can separate from uterineDuring seizure placenta can separate from uterine
wallwall
Death can also result fromDeath can also result from
Cerebral hemorrhageCerebral hemorrhage
Respiratory arrestRespiratory arrest
Renal failureRenal failure
Circulatory collapseCirculatory collapse
37.
38. Preeclampsia/EclampsiaPreeclampsia/Eclampsia
ManagementManagement
Supportive for preeclampsiaSupportive for preeclampsia
If EclampticIf Eclamptic
Versed/diazepam 2.5-5 mg IV/IMVersed/diazepam 2.5-5 mg IV/IM
Magnesium 2 gm IV over 5-10 minMagnesium 2 gm IV over 5-10 min
Rapid transfer for deliveryRapid transfer for delivery
Suction (if necessary)Suction (if necessary)
If seizure begins, positive pressure ventilationIf seizure begins, positive pressure ventilation
Transport in a calm and quiet manner as possibleTransport in a calm and quiet manner as possible
Complications of Preeclampsia/EclampsiaComplications of Preeclampsia/Eclampsia
Spontaneous hepatic/splenic hemorrhageSpontaneous hepatic/splenic hemorrhage
End-organ failureEnd-organ failure
AbruptioAbruptio
Fetal compromiseFetal compromise
39.
40.
41. Acute abdomen in PregnancyAcute abdomen in Pregnancy
Acute abdominal pain can be due to:-Acute abdominal pain can be due to:-
Ectopic Pregnancy (EP)Ectopic Pregnancy (EP)
Ovarian cystOvarian cyst
AppendicitisAppendicitis
UTIUTI
Abruptio placentaeAbruptio placentae
Degenerating fibroidDegenerating fibroid
CholecystitisCholecystitis
Renal colicRenal colic
pancreatitispancreatitis
42. Ectopic Pregnancy (EP)Ectopic Pregnancy (EP)
Implantation of zygote outside the uterusImplantation of zygote outside the uterus
95% occur in the fallopian tube95% occur in the fallopian tube
Tubal rupture may occur due to:Tubal rupture may occur due to:
Coital traumaCoital trauma
Manipulation during examManipulation during exam
Gestational age (9-16 wks)Gestational age (9-16 wks)
SpontaneousSpontaneous
Represents ~2% of pregnanciesRepresents ~2% of pregnancies
Leading cause of maternal death in the first trimesterLeading cause of maternal death in the first trimester
Any female of childbearing age with acuteAny female of childbearing age with acute
abdominal pain is said to have an ectopic pregnancyabdominal pain is said to have an ectopic pregnancy
until proven otherwiseuntil proven otherwise
45. Assessment HistoryAssessment History Previous ectopic pregnanciesPrevious ectopic pregnancies
History of PIDHistory of PID
Missed menstrual cyclesMissed menstrual cycles
Sudden, sharp, or knife-like abdominal pain localized onSudden, sharp, or knife-like abdominal pain localized on
one sideone side
Vaginal spottingVaginal spotting
Pain radiating to one or both shouldersPain radiating to one or both shoulders
Tender, bloated abdomenTender, bloated abdomen
Palpable mass in abdomenPalpable mass in abdomen
Weakness or dizziness when sitting or standingWeakness or dizziness when sitting or standing
Decreased BP. (late sign)Decreased BP. (late sign)
Increased heart rateIncreased heart rate
ShockShock
Bluish discoloration around naval (late sign)Bluish discoloration around naval (late sign)
Urge to defecateUrge to defecate
46. Ectopic Pregnancy (EP)Ectopic Pregnancy (EP)
ManagementManagement
Pertinent historyPertinent history
Missed mensesMissed menses
Sexually activeSexually active
Previous EP, STD, surgery, etc.Previous EP, STD, surgery, etc.
Lower quadrant pain/tendernessLower quadrant pain/tenderness
Avoid aggressive palpation/repeated examAvoid aggressive palpation/repeated exam
Vital signsVital signs
Orthostatic as appropriateOrthostatic as appropriate
High flow OHigh flow O22
Treat for shockTreat for shock
PositionPosition
IV accessIV access
Surgical intervention usually requiredSurgical intervention usually required
47. Ovarian cystOvarian cyst
Constitutes an emergency if it undergoes torsionConstitutes an emergency if it undergoes torsion
Pain at onset-unilateral, intermittent & colicky.Pain at onset-unilateral, intermittent & colicky.
Then constant & severeThen constant & severe
Back pain when cystBack pain when cyst
compresses behindcompresses behind
the uterusthe uterus
May be febrileMay be febrile
Cyst may ruptureCyst may rupture
and lead to peritonitisand lead to peritonitis
Needs prompt surgicalNeeds prompt surgical
interventionintervention
48. AppendicitisAppendicitis
Leads to spontaneous abortion and prematureLeads to spontaneous abortion and premature
labourlabour
presents w/ pain-periumblical (rt side) andpresents w/ pain-periumblical (rt side) and
tendernesstenderness
May rupture-peritonitisMay rupture-peritonitis
Needs prompt surgeryNeeds prompt surgery
49. UTIUTI
abrupt onset withabrupt onset with
-chills, rigors and high fever,-chills, rigors and high fever,
-low back ache, flank pain-low back ache, flank pain
-dysuria, sometimes haematuria-dysuria, sometimes haematuria
Detected from urine testDetected from urine test
Needs full hydrationNeeds full hydration
Needs antibiotic therapyNeeds antibiotic therapy
Care in feverCare in fever
50. Prolapsed CordProlapsed Cord
Umbilical cord presents firstUmbilical cord presents first
Etiology-Etiology- long cordlong cord
Cord wrapped around neckCord wrapped around neck
(may be multiple times)(may be multiple times)
malpresentationsmalpresentations
Be aware ofBe aware of twins!!!!twins!!!!
Early ROMEarly ROM
ManagementManagement
Unwrap cordUnwrap cord
If unable, clamp and cut cordIf unable, clamp and cut cord
If oxytocin is going ,stop it.If oxytocin is going ,stop it.
51. Cord around neck causes fetalCord around neck causes fetal
distress anddistress and hypoxiahypoxia
if not removedif not removed
52. Prolapsed Cord- managementProlapsed Cord- management
Raise the cord by following measures:Raise the cord by following measures:
Cord is pinched off between the head and vaginal wallCord is pinched off between the head and vaginal wall
If cord lies outside, replace it gently to prevent spasm, wrap cordIf cord lies outside, replace it gently to prevent spasm, wrap cord
in moist sterile towel soaked with saline, then a warm dry towelin moist sterile towel soaked with saline, then a warm dry towel
to prevent heat loss and drying.to prevent heat loss and drying.
Insert sterile fingers into vagina to gently lift head or buttocks toInsert sterile fingers into vagina to gently lift head or buttocks to
decrease pressure on cord and keep it elevated till deliverydecrease pressure on cord and keep it elevated till delivery
GiveGive exaggerated Sims position (3), or knee chest position(1&2)exaggerated Sims position (3), or knee chest position(1&2)
to raise buttocksto raise buttocks
53. Prolapsed Cord- managementProlapsed Cord- management
Evidence shows that full bladder also helpsEvidence shows that full bladder also helps (Houghton-(Houghton-
2006, Katz etal-1988).2006, Katz etal-1988).
In these studies, self retained catheter is used to instill appIn these studies, self retained catheter is used to instill app
500-700ml of sterile saline into the bladder. The full500-700ml of sterile saline into the bladder. The full
bladder can relieve compression of the cord by elevatingbladder can relieve compression of the cord by elevating
the presenting part about 2cm above the ischial spinethe presenting part about 2cm above the ischial spine
until delivery by c/ section. The bladder would beuntil delivery by c/ section. The bladder would be
drained in OT immediately before delivery.drained in OT immediately before delivery.
In community case should be transported to the hospitalIn community case should be transported to the hospital
in knee chest position/ exaggerated Sims position andin knee chest position/ exaggerated Sims position and
keep on checking for pulsation in the cordkeep on checking for pulsation in the cord
54. Shoulder DystociaShoulder Dystocia
Failure of shoulders to traverse the pelvisFailure of shoulders to traverse the pelvis
spontaneously after birth of headspontaneously after birth of head
Predisposed in post dated and fetal macrosomiaPredisposed in post dated and fetal macrosomia
Risk factors in labourRisk factors in labour
Oxytocin augmentationOxytocin augmentation
prolonged labourprolonged labour
operative deliveryoperative delivery
• Blood loss >100mlBlood loss >100ml
• Maternal death fromMaternal death from
ut rupture/haemorrageut rupture/haemorrage
• Neonatal asphyxiaNeonatal asphyxia
55. Sh. Dystocia /managementSh. Dystocia /management
HELPERRHELPERR mnemonic to disimpact the shouldersmnemonic to disimpact the shoulders
HHelp-change mothers positionelp-change mothers position
EEpisiotomy need assessedpisiotomy need assessed
LLegs in McRoberts positionegs in McRoberts position
PPressure suprapubicallyressure suprapubically
EEnter introitus for internalnter introitus for internal
rotationrotation
RRemove posterior armemove posterior arm
RRoll the woman over and try againoll the woman over and try again
57. Vasa PraeviaVasa Praevia
Fetal vessel lies over the os infront of presenting partFetal vessel lies over the os infront of presenting part
Occurs in valementous/ succenturiate placentaOccurs in valementous/ succenturiate placenta
May rupture when memb ruptureMay rupture when memb rupture
and causes fresh vaginal bleedingand causes fresh vaginal bleeding
Causes fetal exsanguinationCauses fetal exsanguination
unless fetus is born withinunless fetus is born within
a minutea minute
Needs immediate c/sectionNeeds immediate c/section
if in Ist stage and immediateif in Ist stage and immediate
vaginal delivery if in IInd stagevaginal delivery if in IInd stage
59. Amniotic Fluid Embolus-AFEAmniotic Fluid Embolus-AFE
Occurs when amniotic fluid enters the maternalOccurs when amniotic fluid enters the maternal
circulation as a result of:-circulation as a result of:-
Termination of pregnancyTermination of pregnancy
Abruptio placenta with open retroplacental vesselAbruptio placenta with open retroplacental vessel
Precipitate labour with lacerated open cervical vesselsPrecipitate labour with lacerated open cervical vessels
Amniocentesis with a traumatic tapAmniocentesis with a traumatic tap
Intrauterine manipulationIntrauterine manipulation
Mortality rates as high as 60-80%Mortality rates as high as 60-80%
Higher if meconium stainedHigher if meconium stained
Clinical PresentationClinical Presentation
Sudden onsetSudden onset
Cardiovascular collapseCardiovascular collapse
SeizuresSeizures
DICDIC
Death usually sudden (<1hr.)Death usually sudden (<1hr.)
62. Amniotic Fluid Embolus-AFEAmniotic Fluid Embolus-AFE
ManagementManagement
SupportiveSupportive
Emergency resuscitationEmergency resuscitation
OO22 by tight fitting maskby tight fitting mask
Positive pressure breathing by trachealPositive pressure breathing by tracheal
intubationintubation
Aminophyllin-200mg i/v slowlyAminophyllin-200mg i/v slowly
Treatment of shockTreatment of shock
Continuous assessment of urinary outputContinuous assessment of urinary output
Better outcome seen in early transferBetter outcome seen in early transfer
(Tuffnell-2002)(Tuffnell-2002)
63. Psychosis/ DepressionPsychosis/ Depression
Can occur at anytime during pregnancyCan occur at anytime during pregnancy
May be severe enough to present a significantMay be severe enough to present a significant
suicidal risksuicidal risk
Newborn care gets disturbedNewborn care gets disturbed
Patients at risk:-Patients at risk:-
previous severe neurosis or psychosis,previous severe neurosis or psychosis,
past pregnancy associated with depression,past pregnancy associated with depression,
exaggeration of lack of normal emotional responsesexaggeration of lack of normal emotional responses
to pregnancy,to pregnancy,
severely disturbed marital & family relationship,severely disturbed marital & family relationship,
physical handicap (imposes limitations),physical handicap (imposes limitations),
stillborn, neonatal death, malformed babystillborn, neonatal death, malformed baby
65. ManifestationsManifestations
EarlyEarly:-fatigue, exhaustion, irritability, frequent tearfulness,:-fatigue, exhaustion, irritability, frequent tearfulness,
insomnia, verbalization of feelings of worthless especiallyinsomnia, verbalization of feelings of worthless especially
concerning motherhood potentialconcerning motherhood potential
LateLate (recognized due to severity): suspiciousness,(recognized due to severity): suspiciousness,
confusion, delusions, disturbed thought process, refusal ofconfusion, delusions, disturbed thought process, refusal of
food, severe insomnia, hyperactivity,, suicidalfood, severe insomnia, hyperactivity,, suicidal
preoccupationpreoccupation
Management:Management:
Psychiatric consultationPsychiatric consultation
prompt therapy of any organic disorderprompt therapy of any organic disorder
Sedatives to induce sleep and control hyperactivitySedatives to induce sleep and control hyperactivity
Adequate patient supervisionAdequate patient supervision
Adequate diet and fluidsAdequate diet and fluids
66. Preterm Labour-PTLPreterm Labour-PTL
Incidence very high due to associated risk factorsIncidence very high due to associated risk factors
Premature baby needs emergency care who is usuallyPremature baby needs emergency care who is usually
low birth weightlow birth weight
Final outcome of preterm labourFinal outcome of preterm labour
Delivery of a :-Delivery of a :-pretermpreterm
-premature-premature
--small babysmall baby
WHOWHO yet needed Mothersyet needed Mothers
womb to grow fullywomb to grow fully
67. Associated Factors of PTLAssociated Factors of PTL
hypertensionhypertension
anemiaanemia
84. Needs of premature babyNeeds of premature baby
-- oxygenoxygen
- Inj Vit K , antibiotics,- Inj Vit K , antibiotics,
steroidssteroids
-tube feeding/ i/v fluid-tube feeding/ i/v fluid
--position for easy--position for easy
breathing-15 degreebreathing-15 degree
(head turned to one side)(head turned to one side)
-suctioning using soft-suctioning using soft
suckersucker
-incubator or phototherapy-incubator or phototherapy
-warm environment-warm environment
-support to parents-support to parents
85. Keep the preterm baby well wrappedKeep the preterm baby well wrapped
and examine himand examine him
86. Things to RememberThings to Remember
Stay calmStay calm
Explain that you are trained to helpExplain that you are trained to help
Ensure mothers comfort,Ensure mothers comfort,
modesty & peace of mindmodesty & peace of mind
Be able to recognizeBe able to recognize
your limitationsyour limitations
87. Impact of obstetrical emergenciesImpact of obstetrical emergencies
Woman may die or develop disabilitiesWoman may die or develop disabilities
Children get orphaned due to maternal deathsChildren get orphaned due to maternal deaths
Motherless children die 10 times moreMotherless children die 10 times more
The care of children and other family members isThe care of children and other family members is
threatenedthreatened
Children are less likely to receive HC and educationChildren are less likely to receive HC and education
Girls in particular suffer. They drop out from schoolGirls in particular suffer. They drop out from school
to look after young siblingsto look after young siblings
88. What can be done to reduce Emergencies andWhat can be done to reduce Emergencies and
prevent maternal & fetal deathsprevent maternal & fetal deaths
Empower woman ( to increase awareness andEmpower woman ( to increase awareness and
confidence in seeking AN services without delay)confidence in seeking AN services without delay)
Enhance AN, health and nutrition interventionsEnhance AN, health and nutrition interventions
Ensure access to H/C facility (blood banks)Ensure access to H/C facility (blood banks)
Ensure skilled attendant during deliveryEnsure skilled attendant during delivery
Provide quality care of associated problemsProvide quality care of associated problems
Ensure rest/good sleep, personal/envir hygieneEnsure rest/good sleep, personal/envir hygiene
Avoidance of noxious substancesAvoidance of noxious substances
Avoidance of stress and physical exertionAvoidance of stress and physical exertion
89. Communities can do followingCommunities can do following
Ensure availability of obstetrical services to allEnsure availability of obstetrical services to all
womenwomen
Identify the nearest H facility with obs/ B/BIdentify the nearest H facility with obs/ B/B
servicesservices
Coordinate with hospitals and B/B so to makeCoordinate with hospitals and B/B so to make
blood available in emergencyblood available in emergency
Organize an emergency obs loan fund so that cashOrganize an emergency obs loan fund so that cash
is available in emergencyis available in emergency
organize an emergency transport systemorganize an emergency transport system
Identify all skilled birth attendantsIdentify all skilled birth attendants
Ensure that all H/W are skilled in identifying signsEnsure that all H/W are skilled in identifying signs
of emergency like heavy bleeding, convulsions,of emergency like heavy bleeding, convulsions,
delayed delivery, retained placenta etcdelayed delivery, retained placenta etc