This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
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, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
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.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Malpresentations are all presentations of
fetus other than vertex. Face presentation, brow presentation, shoulder presentation and breech presentation are common malpresentations.
This ppt is made by Mr. arkab khan pathan under guidance of Mrs. RAKHI GOAR. this ppt contain the detail and all the lecture notes of HEG.
THANK YOU.
Arkab khan
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Fetal malpositioning & malpresentation can pose a serious threat to maternal & fetal well being. The document discusses the risks, complication, and management of some of the common malpresentation & malpositioning.
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 the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
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
Global launch of the Healthy Ageing and Prevention Index 2nd wave – alongside...ILC- UK
The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
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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CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
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.
1. DR. S.N. BERA & M. DASH
M.K.C.G MEDICAL COLLEGE ORISSA
2. An abnormal position of the vertex rather than an
abnormal presentation.
In a vertex presentation when occiput is placed
posteriorly over the sacro -illiac joint or directly over
sacrum, it is called occipito -posterior position.
3.
4. When the occiput is placed over right sacro-illiac
joint , Right occipito-posterior(ROP)/3RD position of
vertex.
When the occiput is placed over left sacroilliac joint,
Left occipito -posterior(LOP).also called 4th position of
vertex.
when it points towards sacrum, is called Direct
occipito-posterior .
5.
6. INCIDENCE
At the onset of labour ,the incidence of O-P is about
10% & is much less in late second stage of labour.
ROP is 5 times more common than LOP
Presence of sigmoid colon on the left & dextro-
rotation of the uterus favours ROP.
7.
8. CAUSES
MATERNAL-
shape of inlet- Anthropoid/android pelvis
more than 50% cases because the wide occiput can be
comfortably placed in wider posterior segment of pelvis.
9.
10. FETAL-Marked deflection of head favours posterior
position. It occurs due to
High pelvic inclination.
placenta previa
pelvic tumours
Primary brachycephaly
UTERINE –Abnormal uterine contraction
11. Diagnosis: –
Inspection :-
- Abdomen looks flat below the umbilicus.
Palpation :-
Fundal height :- corresponds with period of
amenorrhoea.
Fundal grip :- breech.
13. Lateral grip :-Foetal back is felt on rt. Flank of
mother in ROP & in left flank, in LOP.
Fetal limbs are felt easily as knob like structure
anteriorly.
14.
15. Pelvic grip :-Head is not engaged.
-Cephalic prominance (sinciput) is not felt so
prominent as found in well flexed occipito –anterior.
-In direct occipito – posterior the small sinciput is
confused with breech.
16. -Auscultation :
FHS is best heard in flank in direct occipito –
posterior / R.O.P.
-but difficult in L.O.P.
17. Vaginal examination :-
1. Finding depends upon degree of flexion of head.
2. Confirmation made during 2nd stage of labour:-
a. Sagittal suture:- occupies any of the oblique diameter
of pelvis.
b. posterior fontanelle :-felt near the sacro-iliac joint.
c. anterior fontanelle :- felt near the ilio-pectineal
eminence.
18. Sometimes the position is not recognized until there is
delay in the second stage of labour.
The diagnosis by vaginal examination may be difficult due
to the formation of caput succedaneum over the presenting
part.
In this case the fingers may be passed higher to feel the free
margin of the ear which will point to the occiput.
19. MECHANISM OF LABOUR The head engages through right oblique diameter in
ROP & left oblique diameter in LOP.
The engaging transverse diameter of head is biparietal
(9.5cm)
Anterior-posterior diameter is either
suboccipitofrontal (1ocm) or occipitofrontal (11.5cm).
20. IN FAVOURABLE CASES(90%)
Good uterine contraction results in good flexion of
head. normal descent occur up to pelvic floor.
Occiput rotates 3/8th of a circle(135degree) anteriorly
to lie behind symphysis pubis. shoulders rotate about
2/8th of circle to occupy oblique diameter.
Rest of the mechanism is like that of right
occipitoanterior in ROP & left occipitotanterior in
LOP.
22. UNFAVOURABLE CASES(10%)
non rotation or malrotation
Certain cases occiput fails to rotate-
Deflexion of the head
Weak uterine contraction
Flat sacrum
Prominent ischial spine
Convergent side walls
Weak pelvic floor muscles
Big baby
Early drainage of liquor
24. 3 types results
Incomplete forward rotation –occiput rotates 1/8th of
circle sagital suture comes to lie in bispinous diameter
results in Deep transverse arrest. It occurs in mild
deflexion of head.
Nonrotation –both sinciput & occiput reaches pelvic
floor at same time & sagital suture lies in oblique
diameter results in Oblique posterior arrest. It occurs
inmoderate deflexion of head.
25. Malrotation - the sinciput touches pelvic floor first
resulting in anterior rotation of sinciput 1/8th of circle
putting occiput to sacral hollow called Persistent
Occiput -posterior Position of vertex. It occurs in
extreme deflexion. Also called occipito -sacral
position.
26. In favourable circumstances in persistent
occipitoposterior position, spontaneous delivery
occurs as face to pubis. Descend of head occurs until
root of nose hinges under symphysis pubis. Delivery
of brow, vertex, occiput lastly face is born by
extension .Restitution ,external rotation &delivery of
trunk occurs normally.
27. COURSE OF LABOUR
Avg duration of both 1st& 2nd stage of labour is
increased.
FIRST STAGE-
engagement is delayed
persistence of deflexion of head
Driving force transmitted through the fetal axis is
not alignment with axis of inlet.
28. Early rupture of membrane occur.
Abnormal uterine contraction
SECOND STAGE-delayed due to long internal
rotation or malrotation , with at times, arrest of
head
THIRD STAGE-increased incidence of postpartum
hemorrhage & trauma to genital tract
29. MODE OF DELIVERY
Long anterior rotation of occiput -spontaneous or
assisted vaginal delivery occurs.(90%)
Short posterior rotation-spontaneous or assisted
vaginal delivery may occur as face to pubis. but there is
more chance of perineal tear
30. Non-rotation or short anterior rotation-spontaneous
vaginal delivery highly unlikely . May progress to
prolonged or obstructed labour.
31. MANAGEMENT OF LABOUR
Early diagnosis
Strict vigilance with watchful expectancy hoping for
descent &anterior rotation of occiput
Judicious & timely interference if needed
Early caeserean section
32. Management of the first stage of labour:
The 1st stage is managed as in a normal case.
Nothing can be done to correct the Malposition or to
influence the rotation of the head at this stage.
A partogram is done to monitor the :
1.Uterine contraction (frequency, duration and strength
).
2.Fetal heart.
3.Dilatation of the cervix.
33. If progressive cervical dilatation does not occur
augmentation with an oxytocin drip may be tried.
If still no progress obtained in a few hours
caesarian section (C/S) is performed.
Also if there is fetal distress C/S is done
34. Management of the 2nd stage of labour:
1.In most cases (70% ) provided that the uterine contractions
are strong and the woman is able to make good expulsive
efforts the occiput rotates forward and normal delivery
takes place.
2.In other cases (10% ) the baby may be delivered face-to-
pubes with out difficulty but there is a great risk of a
perineal tear.
35. 3.In about 20% of cases there is failure of the
presenting part to rotate and descend and such
cases delivered by C/S or rotation can be enhanced
by assistance .
36. Arrest In occipito-transverse or
oblique position
Ventouse- It is suitable in cases where the pelvis is
adequete & non-rotation of the occiput due to
weak contraction or lack of tone of pelvic floor .
37. Fate of OPP
OPP
Engaging diameter :- occipito-
frontal 11.5cm or sub-occipitofrontal
10cm.
Favorable (90%)
Unfavorable (10%)
3/8th rotation
occiput comes under
symphysis pubis (rt/lt
occipito anterior)
Normal vaginal delivery
Mild deflexion
Moderate deflexion
Severe deflexion
Occiput rotate by
1/8th circle
Deep
transverse
arrest
Non-rotation
Oblique
posterior
arrest
Occiput rotate
posteriorly by 1/8th
POPP/ occipito-
sacral position
Face to pubis
delivery
Arrest
41. Manual rotation & forcep
extraction
First head is rotated manually till the occiput is
placed behind symphysis . It is done with either by
whole hand method or half hand method. Then
forceps blades are applied.
The pelvis should be adequate,
Baby is of average size
There is good amount of liquor
42. Manual rotation and forceps delivery:
Should be done under pudendal block or general
anaesthesia.
The head is rotated with the fingers to a direct
anterior position.
43. The shoulder girdle of the fetus should be rotated
at the same time as the head by pressure through
the abdominal wall by external hand.
After rotation completed an obstetric forceps are
applied to complete the delivery.
44. Difficulties are-
Failure to grip head adequately due to lack of space.
Failure to dislodge head from impacted position
Inadequate anaesthesia
Wrong case selection
Complications-
Accidental slippage of head
Prolapse of cord
45. Forceps rotation&extraction
It is done by experts
Kielland’s forceps used.
Advantage over manual rotation
No chance of displacement of head
No accidental cord prolapse
Rotation can be done above or below the level of
obstruction
46. Caeserean section-if there is midpelvic contraction,I t
is much safer than rotation
Craniotomy- it is done in case of dead baby
47. Occipito sacral arrest
Below the
spine
Station of head
Above the
level of ischial
spine
C/S
Ventouse or
forceps with
deep
episiotomy
48. Deep transverse arrest:
Means arrest of labour when the fetal head has descended
to the level of the ischial spines and the sagittal suture lies
in the transverse diameter of the pelvis.
The occiput lies on one side of the pelvis and the sinciput
on the other side and the head is badly flexed.
49. It is only diagnosed during the 2nd stage of labour.
If the head is firmly fixed in the transverse
position obstructed labour will occur
50. Management of DTA
DTA or oblique posterior arrest
Assisted delivery
Pelvis adequate Inadequate pelvis
-Manual rotation of occiput to
anterior position followed by forceps
extraction
- vacuum delivery
- forceps rotation
Dead baby
Craniotomy
C/S