Obstetrical emergencies are life-threatening conditions that occur during pregnancy, labor, or delivery. Vasa previa is a condition where blood vessels from the umbilical cord cross the cervix without a protective covering, which can cause fetal hypoxia. Symptoms include painless vaginal bleeding. Diagnosis is via ultrasound and examination after delivery. Treatment involves c-section between 35-37 weeks. Amniotic fluid embolism occurs when amniotic fluid enters maternal circulation, triggering an anaphylactic response. It can cause pulmonary issues, hypotension, and coagulopathies. Obstetric shock results from acute, generalized tissue hypoperfusion and can have multiple causes like hemorrh
Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
BIRTH INJURIES IN NEWBORN: Definition of birth injuries , statistics, etiology, classification of birth injuries , head injuries: cephalhematoma and Caput succedaneum, skull fractures
, nerve injuries: erb's palsy and klumpke's palsy, bone injuries: clavicular and long bone fracture , intra-abdominal and soft tissue injuries, management and prevention of birth injuries
Emergencies that occur in pregnancy or during or after labor and delivery.
main emergencies are
Ectopic Pregnancy
Uterine Inversion
Obstetrical Shock
Cord Prolepses
Amniotic Fluid Embolism
Postpartum Hemorrhage
BIRTH INJURIES IN NEWBORN: Definition of birth injuries , statistics, etiology, classification of birth injuries , head injuries: cephalhematoma and Caput succedaneum, skull fractures
, nerve injuries: erb's palsy and klumpke's palsy, bone injuries: clavicular and long bone fracture , intra-abdominal and soft tissue injuries, management and prevention of birth injuries
This topic contains definition, meaning, classification, pathophysiology, clinical menifestations, metabolic and general changes, management of obstetrical shock
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.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
This topic contains definition, meaning, classification, pathophysiology, clinical menifestations, metabolic and general changes, management of obstetrical shock
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.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
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Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
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Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
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)
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3. VASA PREVIA
It is an abnormality of the cord that occurs when one or more blood vessels from the umblical
cord or placenta cross the cervix but it is not covered by Wharton’s jelly.
This condition can cause hypoxia to the baby due to pressure on the blood vessels.it is a life
threatening condition.
It occurs in 1 in 2500 births.
4. ETIOLOGY
These vessels may be from either
Velamentous insertion of umblical cord
placental lobe joined to the main disk of the placenta.
Low-lying placentas
Previous delivery by C-section
5. SYMPTOMS
Sudden onset of painless
vaginal bleeding, especially
in their second and third
trimesters.
The baby’s blood is a
darker red color due to the
naturally lower oxygen
levels of a fetus.
If very dark burgundy
blood is seen when the water
breaks, this may be an
indication of vasa previa
6. Diagnosis
The classic triad of the vasa praevia is
antenatal sonography with color-flow Doppler reveals a
vessel crossing the membranes over the internal cervical os.
The diagnosis is usually confirmed after delivery on
examination of the placenta and fetal membranes.
membrane rupture
painless vaginal
bleeding
fetal bradycardia
7. TREATMENT
o Baby can be delivered by C- section between the 35th and 37thweek of pregnancy
o Hospitalization throughout third trimester is also recommended .
o Steroids are sometimes used to mature the lungs of the fetus if fetus is immature.
8. AMNIOTIC FLUID EMBOLISM
This rare but catastrophic condition occurs when amniotic fluid enters the
maternal circulation by uterus and placental site. The presence of amniotic
fluid in
maternal circulation trigger an
anaphylactic response.
9. The body respond in 2 phases.
The initial phase is one of pulmonary vasospasm causing hypoxia, hypotension, pulmonary
edema and cardiovascular collapse.
The second phase sees the development of left ventricular failure, with hemorrhage and
coagulation disorders and further uncontrollable hemorrhage.
10. CAUSES
Ruptured membranes
Ruptured uterine or cervical veins
Abdominal trauma
Amniocentesis.
A maternal age of 35 years or older
Caesarean or instrumental vaginal delivery
Polyhydramnios
Cervical laceration or uterine rupture
Placenta previa or abruption
Eclampsia
Fetal distress
11. SIGNS AND SYMPTOMS
Sudden shortness of breath
Excess fluid in the lungs
Sudden low
blood pressure
Sudden
circulatory
failure
Life-threatening problems with blood clotting (disseminated intravascular
coagulopathy)
Altered
mental status
Nausea or
vomiting
Chills
Rapid heart
rate
Fetal distress
SeizuresComa
12. TREATMENT
Administer oxygen to maintain normal saturation. Intubate if necessary.
Initiate cardiopulmonary resuscitation (CPR) if the patient arrests. If she does not respond to
resuscitation, perform a cesarean delivery.
Treat hypotension with crystalloid and blood products.
Consider pulmonary artery catheterization in patients who are hemodynamically unstable.
Continuously monitor the fetus.
13. OBSTETRIC SHOCK
Shock is a critical condition and a life threatening medical emergency.
Shock results from acute, generalized, inadequate perfusion of tissues,
below that needed to deliver the oxygen and nutrients for normal
function.
15. STAGES OF SHOCK
Stage1 Compensated
-- fall in BP and
cardiac output is
compensated by
adjustment of
homeostatic
mechanism.
Stage2
Decompensate--
Maximal
compensatory
mechanism are
acting but tissue
perfusion is reduced.
Vital organ (cerebral,
renal, myocardial)
function reduced.
Stage3
Irreversible--Vital
organ perfusion
badly impaired.
Acute tubular
necrosis, severe
acidosis, decreased
myocardial
perfusion and
contractility the
profound decrease
in perfusion leads to
cellular death &
Organ failure.
17. MANAGEMENT
Active management of shock should start as soon as it is suspected
Resuscitation follows
ABC
An Airway--Patent airway is assured and high pressure oxygen (15 l/min) using mask/intra tracheal intubation and anesthesia machine.
B Breathing--Ventilation checked and supported if needed.
C Circulation
1. Insert two wide bore cannulas
2. Restore blood volume and reverse hypotension with crystalloids/colloids.
3. Initial request for 4-6 units of blood should be sent. O Rh negative blood may be transfused.
18. Monitor the response to therapy - Pulse, BP, SPO2, urine output & its ph.
Position of patient - Head down and left lateral tilt to avoid aortocaval compression which may
further worsen the hypotension.
19. UTERINE INVERSION
Uterine inversion is a potentially fatal childbirth complication with a maternal survival rate
of about 85%.
It occurs when the placenta fails to detach from the uterus as it exits, pulls on the inside
surface, and turns the organ inside out.
20. ETIOLOGY
The exact cause of uterus inversion is unclear.
The most likely cause is strong traction on the umbilical
cord, particularly when the placenta is in a fundal location,
during the third stage of labor.
22. GRADES OF INVERSION
INCOMPLETE
INVERSION - the top
of the uterus (fundus)
has collapsed, but the
uterus hasn’t come
through the cervix.
COMPLETE
INVERSION - the
uterus is inside-out and
coming out through the
cervix.
PROLAPSED
INVERSION - the fundus
of the uterus is coming out
of the vagina.
TOTAL INVERSION -
both the uterus and vagina
protrude inside-out (this
occurs more commonly in
cases of cancer than
childbirth)
23. DIAGNOSIS
Prompt diagnosis is crucial and possibly lifesaving. Some of the signs of uterine inversion could include:
The uterus protrudes from the vagina.
The fundus doesn’t seem to be in its proper position when the doctor palpates (feels) the mother’s abdomen.
The mother experiences greater than normal blood loss.
The mother’s blood pressure drops (hypotension).
The mother shows signs of shock (blood loss).
Scans (such as ultrasound or MRI) may be used in some cases to confirm the diagnosis.
24. TREATMENT
Treatment options vary, depending on the individual circumstances and the preferences of the hospital staff, but could include:
Attempts to reinsert the uterus by hand.
Administration of drugs to soften the uterus during reinsertion.
Flushing the vagina with saline solution so that the water pressure ‘inflates’ the uterus and props it back into position (hydrostatic correction).
Manual reinsertion of the uterus while the woman is under general anaesthetic.
Abdominal surgery to reposition the uterus if all other attempts to reinsert it have failed.
Antibiotics to reduce the risk of infection.
Intravenous liquids.
Blood transfusion.
Intravenous administration of oxytocin to trigger contractions and stop the uterus from inverting again.
Emergency hysterectomy (surgical removal of the uterus) in extreme cases where the risk of maternal death is high.
Close monitoring in intensive care for a few days, if necessary.