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.
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.
A Partograph is a graphical record of progress during labor.
Progress is measured by cervical dilatation against time in hours, as well as by providing a record of the important conditions of the mother and fetus that may arise during the process
Partogram is a useful tool for the assessment and management of labour. This presentation describes the method to plot partogram and means how to assess prolonged labour by using it.
This presentation includes all the events , its sign and symptoms about IOL as well as management of women in the first stage of labor and how to assess the women in labor with the help of partograph.
Partogram by dr alka mukherjee dr apurva mukherjee nagpur m.s. indiaalka mukherjee
The partograph or partogram has been established as the “gold standard” labor monitoring tool universally. It has recommended by the World Health Organization (WHO) for use in active labor The function of the partograph is to monitor the progress of labor and identify and intervene in cases of abnormal labor.
Even though the partograph has been utilized for over four decades in obstetric practice, reports of obstructed labor and its serious maternal and fetal sequelae have questioned the efficacy of the partograph at times. Moreover, evidence of efficacy of partograph is equivocal as suggested by a Cochrane review However, some of the trials studied in this Cochrane review have limitations with respect to the settings, population studied and conduct of labor. The partograph is an “easy-to-use” tool, but if not used correctly it will affect the final outcome.
In this context, we aim to decipher the efficacy and the utility of the partograph in the contemporary conduct of childbirth across all resource settings and health-care personnel and to suggest solutions to further enhance its efficacy in the optimizing labor outcomes.
The development of partograph provided health workers a pictorial overview of labor which can identify pathological labor to allow early intervention.
Most guidelines for normal human labor progress are derived from Friedman’s clinical observations of women in labor. In 1954, he introduced the concept of partogram by graphically plotting cervical dilatation against time. The curve obtained was a sigmoid curve. He divided the first stage of labor into latent phase and active phase. Active phase was further divided into acceleration, maximum slope and deceleration. From his observations, he obtained the following values
WHO has recommended use of the partograph, a low-tech paper form that has been hailed as an effective tool for the early detection of maternal and fetal complications during childbirth. Yet despite decades of training and investment, implementation rates and capacity to correctly use the partograph remain low in resource-limited settings. Nevertheless, competent use of the partograph, especially using newer technologies, can save maternal and fetal lives by ensuring that labor is closely monitored and that life-threatening complications such as obstructed labor are identified and treated. To address the challenges for using partograph among health workers, health-care systems must establish an environment that supports its correct use. Health-care staff should be updated by providing training and asking them about the difficulties faced at their health center. Then only the real potential of this wonderful tool will be maximally utilized
This presentation explains the basic concepts involved in CTG such as how to read it and how it works and the terms associated with it and a machine manufacture by Philips known as the Avalon FM30 : Fetal monitor
Partograph is a composite graphical recording of progress of labour and salient condition of mother and fetus. For progress of labor and conditions of the mother and the fetus. It was developed and extensively tested by the world health organization (WHO)
Similar to Partograph- Made easy for undergraduates (20)
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
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
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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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
2. What is Partograph or Partogram ?
• Is a tool which graphically represents key
events during labour.
• The partograph is an inexpensive and
accessible tool that can effectively monitor
the progress of labour
4. It helps the
care provider
•to identify slow progress
in labour early,
to initiate
appropriate
interventions
•to prevent prolonged
and obstructed labour.
Why should we use a partograph ?
5. First Obstetrician to describe the progress of labour
graphically
• E.A. Friedman was the first
obstetrician to describe the
progress of labour graphically in
1954.
• He reported the change in cervical
dilatation occurring in labour.
• The progress was recorded in
centimetres of dilatation per hour.
• The resulting graph was an S-
shaped curve.
6. Types of partographs:
• Philpott and Castle developed a
partograph, a practical tool for recording
all intrapartum details, not just cervical
dilatation
• Since the 1990's, WHO
• has published three different types of the
partograph
8. B. The modified WHO
partograph for use
in hospitals was
published in 2000
No latent phase
Active labour starts
from 4 cm
9. C. simplified partograph
by WHO
This version simplifies the partograph for
use at primary level.
Colour codes (green, yellow and red)
help the user to identify normal
labour (green) and distinguish it from
slow progress (yellow: watch out;
red: danger).
10. Why latent phase is removed
• Latent phase is most often a "retrospective diagnosis".
• Having a arbitrary time limit for latent phase of 8 h increases the
risk of incorrect diagnosis of labour and could thus increase the risk
of non-indicated interventions and morbidity.
• On the other hand, the risks of "prolonged latent phase" in the
presence of intact membranes and no other complications is almost
minimal.
• Lastly, the "transfer" from latent to active phase (broken line) by
health workers was reportedly a major source of confusion and
error in partography.
11. Observations charted on the Partograph
A) The Progress of labour
• Cervical dilatation
• Descent of fetal head
• Uterine contractions – duration,
frequency
B) Fetal condition
• Fetal heart rate
• Membranes and liquor
• Moulding of the fetal skull
C) Maternal condition
• Pulse/ BP / Temp
• Urine – volume, acetone, protein
• Drugs & IV Fluids
• Oxytocin regime
12. Starting a Partograph
A partograph should be started only when
a woman is in active phase of labour-
• Cervical dilatation must be 4 cms or more
13. Starting a Partograph
• 1st part is patient particulars.
• Name, Gravida, Para, Hosp. No.
• DOA, TOA
• Ruptured membrane, Hours
15. What is alert line ?
• an oblique line on the
Cervical Dilatation Area
of the partograph that
goes from 4 to 10 cm of
cervical dilatation
• Represents the rate of
cervical dilatation 1 cm
per hour. This rate is
considered to be the slowest
rate of cervical dilatation
among nulliparae in normal
labour.
16. What is action line ?
• An oblique line in the Cervical Dilatation Area of the partograph that
runs parallel and four hours to the right of the Alert Line
• If the cervical dilatation graph reaches or crosses the Action line, it
indicates dangerously slow progress of labour.
• In this case, full medical assessment must be performed and decision
must be made about the cause of the slow progress, and appropriate
action taken
18. left of or on the alert line
• Do not augment with oxytocin or intervene unless
complications develop
• ARM may be done at any time in the active phase
19. Between Alert and Action lines
In a Health Centre:
Transfer to hospital with facilities
for Cesarean section, unless
Cervix is almost fully dilated
ARM may be performed if
membranes are still intact and
observe labour for a short
period before transfer
In Hospital:
Perform ARM if membranes are
intact and continue routine
observations
20. At or Beyond Active Phase Action Line
Full medical assessment
Consider IV infusion/bladder
catheterization/analgesia
Options:
Delivery if fetal distress or
obstructed labour
Oxytocin augmentation if no
contraindication
Supportive therapy (only if
satisfactory progress is now
established and dilatation
could be anticipated at
1cm/hr or faster)
21. Descent of fetal head
It is measured in terms of fifths above the pelvic brim
• The width of the 5 fingers is a guide to the expression in fifths
of the head above the brim. A head that is mobile above the
brim will accommodate the full width of 5 fingers
• Plotted with “0” on the lower part of cervicograph.
22.
23. As the head descends, the portion of the head remaining above
the brim will be represented by fewer fingers
24. • It is generally accepted that the head is
engaged when the portion of the head above
the brim is represented by 2 fingers are less
27. Fetal Heart Rate
Listen
• Patient in left lateral position
• Just after the contraction has
passed its strongest phase
• For 1 full minute,
• every 30 min
• if abnormal every 15mins
• If abnormal over 3
observations, take action
Record
• At the top of the Partograph
• Every half hour
28. Fetal Heart Rate
FHR Interpretation
110-160 NORMAL
100-109
Or 161-180
Borderline- Be alert
>180 Fetal Tachycardia
<100 Fetal Bradycardia
& Fetal distress
Fetal Tachycardia is the initial sign of fetal distess
29. Membranes & Liquor
State of Liquor Record
• Membranes intact I
• Clear C
• Meconium M
• Absent A
• Blood Stained B
31. Fetal condition- Moulding
State of Moulding Record
• Bones are separated &
sutures felt O
• Bones are just touching
each other 1+
• Bones are overlapping 2+
• Bones are severely
overlapping and not
separable 3+
33. Drugs
Recorded at the foot of
the Partograph
• Oxytocin:
• IV Fluids
• Other Drugs: Drotin,
Epidosin, Tramadol,
Pethidine,
• Epidural
34. Oxytocin dose calculation
• One ampoule of oxytocin contains 5 Units of
drug.
• Dissolve in 500 ml NS.
• Conc. is 10 Unit per Litre (10 U/L).
• Half ampoule is dissolved in 500 ml NS
• Conc. Is 5 Unit per Litre (5 U/L)
35. Oxytocin dose calculation
• 15 drops is equivalent to 1ml of fluid.
• Suppose we have taken oxytocin@5 U/L
• Each Litre of fluid contains 5 unit drug
• Each Litre of fluid contains 5000 mili-unit (mU)
• Each ml of fluid contains 5 mili-unit (mU)
• Each 15 drops of fluid contains 5mU
• The rate is 15 drops per min to start with.
36. Maternal Condition
Recorded at the foot of the
Partograph
• Pulse: every half hour
• BP: every 4 hrs or more
frequently
• Temp: every 4 hrs or
more frequently
• Urine: Protein
,Acetone,Volume
37. Can the partograph be used only for normal ( vertex)
presentation ?
• Use of the partograph is not restricted to vertex
presentations.
• It can be used in all situations where vaginal birth can be
expected. For example, it can be used in monitoring progress of labour
in breech presentation. However in this situation, descent of the fetal
head and moulding are not assessed and recorded on the partograph.
• The partograph can also be used in face presentation.
• Vaginal birth is not anticipated with transverse lie and brow
presentation and hence the partograph is not used.
38. How should the labour progress be monitored in
second stage of labour ?
• The condition of mother and the fetus should be monitored
more frequently in the second stage of labour.
• The cervix is fully dilated and while no further recordings of
cervical dilatation are required,
• it is important to monitor other information e.g. frequency
and strength of uterine contractions, descent of the fetal
head, fetal heart rate, colour of amniotic fluid, medications
administered, etc.