OBSTETRICS & GYNAECOLOGICAL NURSING
physiology and management of third stage of labour-introduction
labour
stages of labor
physiology
management of third stage of labour.
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Breast problems after delivery and their management.sunil kumar daha
Please find the power point on Breast problems after delivery and their management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
Placenta previa is a condition in which the placenta lies very low in the uterus and covers all or part of the cervix. The cervix is the opening to the uterus that sits at the top of the vagina. Placenta previa happens in about 1 in 200 pregnancies.
Placenta praevia risk factors include a previous delivery, age older than 35 and a history of previous surgeries, such as a caesarean section (C-section) or uterine fibroid removal.
The main symptom is bright red vaginal bleeding without pain during the second-half of pregnancy. The condition can also cause severe bleeding before or during delivery.
Limited physical activity is recommended. A C-section is often required in severe cases.
Breast problems after delivery and their management.sunil kumar daha
Please find the power point on Breast problems after delivery and their management. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
This topic contains definition, incidence, varieties, causes, risk factors, dangers, diagnosis, prognosis, prevention and management of inversion of uterus.
Definition-
The destructive operations are designed to diminish the bulk of the fetus so as to facilitate easy delivery through the birth canal
types
Craniotomy
Eviceration
Decapitation
Cleidotomy
CRANIOTOMY
Definition
It is an operation to make a perforation on the fetal head to evacuate the contents followed by extraction of the fetus
DECAPITATION
Definition
It is a destructive operation whereby the fetal head is severed from the trunk and the delivery is completed with the extraction of the trunk and that of the decapitated head per vaginam
CLEIDOTOMY
Definition
The operation consist of reduction in the bulk of the shoulder girdle by division of one or both the clavicles
Indications
Dead fetus with shoulder dystocia
Procedure
The clavicles are divided by the embryotomy scissors or long straight scissors introduced under the guidance of left two fingers placed inside the vagina
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
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
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Active Management of Third Stage of LaborAzael Haward
This short presentation gives a short overview of AMTSL, showing its evolution, advantages and illustrated steps.
AMTSL its a single important step you can do to reduce maternal death secondary to Post partum Hemorrhage.
DEFINITION OR MEANING OF MENSTRUAL (REPRODUCTIVE) CYCLE:-
Menstruation (Greek word, men-month) is monthly uterine bleeding out flowing through vagina into vulva for 4-5 days every 28 days (24-35 days)during reproductive life of a woman from menarche to menopause.
The Menstrual cycle of 28 days starts on day of onset of menstruation and ends at day 28 on start of next mens.
The cycle consists of a series of changes taking place concurrently in the ovaries and uterine lining, stimulated by changes in blood concentration of hormones.
General Physiological changes during puerperiumPRANATI PATRA
introduction
Estrogen and progesterone levels decrease markedly after expulsion of the placenta, reaching their lowest levels 1 week into the postpartum period.
The estrogen levels in non lactating women begin to increase by 2 weeks after birth, and higher by postpartum day 17.
If trauma to the urethra and bladder occur during the birth process, the bladder wall becomes edematous, often with small areas of hemorrhage.
Birth-induced trauma increased bladder capacity and the effects of anesthesia combine to cause a decrease in the urge to void.
introduction
anatomy and physiologic changes-UTERUS: At the end of third stage of labour, the uterus is in the midline , about 2cm below the level of umbilicus and weight 1000g
INTRODUCTION
DEFINITION
TYPES
CAUSES
MANAGEMENT-Management of 3rd stage bleeding
Actual management
MANAGEMENT OF 3RD STAGE BLEEDING
Steps of management
1. Placental site bleeding-
To palpate the fundus and massage the uterus to make it hard. The massage is to be done by placing four fingers behind the uterus and thumb in front.
To start crystalloid solution (NS or RL) with oxytocin (1L with 20 units) at 60 drops per minute and to arrange for blood transfusion if necessary.
Oxytocin 10 unit IM or methergine 0.2 mg is given intravenously.
To catheterize the bladder.
To give antibiotics (Ampicillin 2gm and Metronidazole 500mg IV)
2. Management of traumatic bleed
The uterovaginal canal is to be explored under general anesthesia after the placenta is expelled and haemostatic sutures are placed on the offending sites.
STEPS OF MANUAL REMOVAL OF PLACENTA
The patient is placed in lithotomy position. With all aseptic measures, the bladder is catheterized.
One hand is introduced into the uterus in cone shaped manner following the cord. While introducing the hand, the labia are separated by the fingers at the other hand.
Counter pressure on the uterine fundus is applied by the hand placed over the abdomens. The abdominal hand should steady the fundus and guide the movement of the fingers inside the uterine cavity till the placenta is completely separated.
Taking-In Phase
It takes 2-3 days, during which time the mother’s first concern is with her own needs (sleep and food).
The woman reacts passively, mostly dependent on others to meet her needs.
She is quite talkative during this phase about every detail of her labor and delivery experience
Taking-Hold Phase (Taking Responsibility as a Mother)
It starts the 3rd day postpartum
She progresses from the passive individual to the one who is in command of the situation.
This phase lasts about 10 days.
Once the mother has taken control of her physical being and accepted her role as a mother, she is able to extend her energies to her mate and other children.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Letting-go Phase
This generally occurs when the mother returns home.
In this phase there are two separations that the mother must accomplish.
One is to realize and accept physical separation from the infant. The other is to relinquish her former role as a childless person and accept the enormous implications and responsibilities of her new situation.
Physical Assessment is necessary to identify individual needs or potential problems
Explain to pt purposes of the examination.
Obtain her consent.
Record your findings and report results to the mother.
Ensure privacy and environment where the mother can lie on her back with her head supported.
Ensure bladder is empty & lay patient supine with legs flexed.
The midwives hands should be clean and warm
AMNIOINFUSION--
definition-An amnioinfusion is a technique of instilling an isotonic fluid {such as a normal saline or lactated ringer’s solution} into the amniotic cavity during labor to relieve umbilical cord compression and alleviate fetal distress from severe prolonged variable decelerations in the presence of oligohydramnios.
INDICATIONS
Fetal heart rate abnormalities
APGAR scores for those with low scores
Asphyxia during time of birth
Decreasing the rates of cesarean birth related with FHR problem
PROCEDURE
The amnio infusion procedure involves the use of an intrauterine pressure catheter (IUPC), or a single or double lumen type of IUPC.
The IUPC has been designed to attain an accurate monitoring of uterine contractions among women in the intrapartum period.
It has a special port from which the saline fluid or lactated ringer’s solution is being injected, passing through the tubing and going its way into the uterus.
An IUPC is inserted through standard technique once the membranes ruptures, and then it is attached to intravenous extension tubing. If IUPC is not available, a pediatric nasogastric tube can be used instead.
Lactated ringer’s solution without dextrose is infused into the amniotic cavity; normal saline can be an acceptable fluid alternative
Assisting Physician with Amnioinfusion
Explain the procedure to the patient.
Assist in dorsal recumbent position. Assist with draping and exposing vaginal area.
Connect IUPC tubing to IV fluid, flush
Connect the catheter to the monitor cable
Assist physician with insertion of double lumen IUPC and connect IV tubing to the amnioport to begin amnioinfusion.
The placenta is said to be retained when it is not expelled from the uterus even 30 minutes after the delivery of the baby
Manual placenta removal is a procedure to remove a retained placenta from the uterus after childbirth.
Mannual removal of placenta is done under GA.
Patient placed in lithotomy position
Bladder is catheterized
newborn assessment-
intriduction-Definition of neonatal period:
A period from birth 4 weeks postnatal.
The exam will cover the following:
Record date and time of exam
General assessment and measurements
Skull bones
Face
Mouth & palate
Nose
Ears
Eyes
Chest
Abdomen
Arms
Hands
Legs
Feet
Genitals
Anus
Spine
Skin
reflxes-
Obsterics and Gynaecology-
introduction-Preventive obstetrics is the concept of prevention or early detection of particular health deviations through routine periodic examinations and screening .
The concept of preventive obstetrics concerns with the concepts of the health & wellbeing of the mother her baby during the antenatal,intranatal & postnatal period.
The goal of the preventive obstetrics is the delivery of a healthy infant by a healthy mother at the end of a healthy pregnancy.
Pregnancy & child birth normal physiological
process that change from conception to
delivery.
Objectives
To promote , protect and maintain the health of the mother during pregnancy.
To detect “high risk” cases and give them special attention
To foresee complications and prevent them.
To remove anxiety and dread associated with delivery
OBSTETRICS & GYNAECOLOGICAL NURSING-
MINOR AILMENT DURING PREGNANCY-
INTRODUCTION-Many women experience some minor
disorder during pregnancy.
These disorder should be treated adequately as they may escalate and become life-threatening.
DEFINITION-“The minor complaints of pregnant women that occur due to physiological alterations of hormones and other causative factors which can be managed without medical interventions.”
- Every system of body may affected by pregnancy.
OBSTETRICS & GYNAECOLOGICAL NURSING
GENETIC COUNSELLING DURING PREGNANC
INTRODUCTION-
COUNSELLING-Counselling is consultation, mutual interchange of opinions, deliberating together.A process in which the counsellor assist the counselee .
Provides concrete, accurate information about inherited disorders.
Provides information about prognosis and follow up.
Discuss ways in which disease can be prevented.
DIALYSIS-
INTRODUCTION-
PPURPOSE-Nephrotoxins
Cystic kidney diseases
Diabetics
Nephro pathy
Hypertension
contraindication
1.people with extremely serious diseases, low blood pressure or shock, should avoid it.
2.people got serious blood poisoning should not be take it
3.people who have take operation within 3days should not take it
4.people with severe anemia or bleeding tendency should not
5.People with malignant tumor
TYPES OF DIALYSIS
{1} HEMODIALYSIS
{2} PERITONEAL DIALYSIS
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
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
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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.
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physiology and management of third stage of labour
1.
2. Physiological process
Normal labour: spontaneous in onset, at term,
vertex presentation, natural termination without
any complications affecting health of mother &/or
newborn
Three stages of labour
3. First stage : onset of true labour pains to full dilatation
of cervix
Second stage: full dilatation of cervix to expulsion of
fetus from birth canal
Third stage: after expulsion of fetus to expulsion of
placenta & membranes (afterbirths)
5. After expulsion of fetus to expulsion of placenta &
membranes (afterbirths)
Duration :15 min.
Placental separation
Placental expulsion
6. Separation of placenta is brought about by contraction
and retraction.
Reduces the size of placental area.
Placenta begins to tear off the uterine wall.
At the area of separation a clot forms.
7.
8.
9.
10. Contraction & retraction of Upper Uterine Segment
Placenta forced to lie in LUS/upper vagina
Voluntary contraction of abdominal muscles
Expulsion of placenta
11. 1. Effective retraction of
uterine muscles :
Living ligatures
2. Thrombosis of torn
sinuses
3. Myotamponade:
apposition of walls of
the uterus
Mechanisms to control bleeding
12.
13.
14. Constant watch.
A hand is placed over the fundus
Look for 3 classic signs of placental separation
15.
16.
17. 3. Change in shape of uterine fundus from discoid to
globular with elevation of fundal height
18.
19. Modified Brandt Andrews method
Left hand: palmar surface of fingers placed above pubic
symphysis. Body of uterus pushed upwards & backwards
Right hand: cord traction in downward & backward
direction
Uterus feels hard, contracted
20.
21.
22.
23.
24.
25.
26.
27. Massage the uterus
Examination of placenta ,membranes, cord
Inspect vulva, vagina & perineum
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40. Most crucial
Life threatening complications
PPH(postpartum haemorrhage)
Retained placenta
Inversion of uterus
Pulmonary embolism
41. Care for at least an hour after delivery.
The mother should receive cleansing body
wash,mouth wash and perineal care. She
should be encouraged to empty bladder and
bedpan offered.
Blood pressure , pulse,uterine contaction
,and bleeding should be checked every
15mts.
42. The baby’s general wellbeing and security
of the cord clamp needs to be checked. as
the baby will chill after birth thoroughly dry
and wrap the baby.
Mothers intended to breastfeed may be
encouraged. Early breastfeeding causes a
reflex release of oxytocin from the posterior
pituitary and stimulates the uterus to
contract.
43.
44. Labor is said to be normal if all are present except:
1. At term
2. Breech presentation
3. Spontaneous in onset
4. Healthy mother & neonate after delivery
45. Labor is said to be normal if all are present except:
1. At term
2. Breech presentation
3. Spontaneous in onset
4. Healthy mother & neonate after delivery
46. Regarding the third stage of labor, following is not
true:
1. Most crucial stage of labor
2. Duration is 15 minutes
3. Uterine inversion is most common complication
4. AMTSL is routine in all
47. Regarding the third stage of labor, following is not
true:
1. Most crucial stage of labor
2. Duration is 15 minutes
3. Uterine inversion is most common complication
4. AMTSL is routine in all
48. The uterotonic of choice for prophylaxis of PPH in
third stage of labor is
1. Syntometrine
2. Oxytocin
3. Misoprostol
4. carboprost
49. The uterotonic of choice for prophylaxis of PPH in
third stage of labor is
1. Syntometrine
2. Oxytocin
3. Misoprostol
4. carboprost
50. All are true in relation to AMTSL except:
10 IU of Oxytocin , IM
Uterine massage
Reduces the duration of third stage
Perform in only high risk cases
51. All are true in relation to AMTSL except:
1. 10 IU of Oxytocin , IM
2. Uterine massage
3. Reduces the duration of third stage
4. Perform in only high risk cases
52. Complications during third stage of labor are all except
1. PPH
2. Chronic Uterine inversion
3. Retained placenta
4. Amniotic fluid embolism
53. Complications during third stage of labor are all except
1. PPH
2. Chronic Uterine inversion
3. Retained placenta
4. Amniotic fluid embolism
54. The most frequently observed method of placental
separation :
1. Marginal separation
2. Central separation
3. None
4. both
55. The most frequently observed method of placental
separation :
1. Marginal separation
2. Central separation
3. None
4. both
56. The most important method to control uterine
bleeding following delivery
1. Myotamponade
2. Thrombosis
3. Contraction& retraction of uterine muscle
4. none
57. The most important method to control uterine
bleeding following delivery
1. Myotamponade
2. Thrombosis
3. Contraction& retraction of uterine muscle
4. none
58. Following are true regarding misoprostol, except
1. Low cost
2. Easy storage
3. Administered rectally
4. Drug of choice for AMTSL
59. Following are true regarding misoprostol, except
1. Low cost
2. Easy storage
3. Administered rectally
4. Drug of choice for AMTSL
60. Following is true regarding Oxytocin
1. Given as IV bolus dose
2. Thermolabile
3. Contraindicated in cardiac patient
4. Causes hypertension
61. Following is true regarding Oxytocin
1. Given as IV bolus dose
2. Thermolabile
3. Contraindicated in cardiac patient
4. Causes hypertension
62. Prevention of PPH, all are true except
1. Treatment of anemia in antenatal period
2. Practice AMTSL in all
3. Home delivery in high risk cases
4. In forceps delivery, explore uterovaginal canal
63. Prevention of PPH, all are true except
1. Treatment of anaemia in antenatal period
2. Practice AMTSL in all
3. Home delivery in high risk cases
4. In forceps delivery, explore uterovaginal canal
64.
65. The third stage of labour commences with the completed
delivery of the fetus and ends with the completed delivery
of the placenta and its attached membranes. The third
stage of labour begins once your baby is born, and ends
when you deliver the placenta and the empty bag of waters
attached to the placenta (membranes). It's normal for
there to be some bleeding during this stage of labour.
66. Shirish S Sheth,“Essential of Obstetrics”, 1stEditio
n, Chapter13, Antenatal Care,Jaypee Brothers Medi
cal Publishers, New Delhi,2004, page no.: 102 - 107.
Maya Devi Subedi,“Manual of Midwifery A”, 1stEd
ition, Chapter 11, AntenatalAdvice, Books and Stat
ioners, 2005, page no.: 157 - 165.
•Kamala Shova Napit,“Manual of Midwifery B”, 1st
Edition, Chapter 4,Management of First Stage of L
abour,published by Makalu Books and Stationers,2
005, page no.: 41 to 64.
67. Miles C Benamin ‘text book of obstetric and
gynaecology ’ 2nd edition page no ; 249-254
Dutta Dc ‘text book of obstetric & gynaecology ‘ 3rd
edition page no – 139-143
