1) Pregnancy induced hypertension (PIH) refers to gestational hypertension, preeclampsia, and eclampsia that can occur during pregnancy. The document outlines the signs, symptoms, classifications, risk factors, management, and nursing responsibilities for PIH conditions.
2) Preeclampsia is diagnosed in a pregnant woman after 20 weeks gestation with new onset hypertension and proteinuria. Severe preeclampsia requires immediate delivery of the baby and mother.
3) Eclampsia occurs when a woman with preeclampsia experiences seizures in addition to her other symptoms. It is a medical emergency treated with magnesium sulfate and delivery of the baby.
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.
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.
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.
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
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.
Many women experience some minor disorders during pregnancy.
Every system of the body may be affected during pregnancy. These disorders, however , are not minor to the pregnant woman.
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
Title: Sense of Smell
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 primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
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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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
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.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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.
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
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Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
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
1. NURSING MANAGEMENT OF PREGNANCY
INDUCED HYPERTENSION (PIH)
PRESENTED BY:
LAMNUNNEM HAOKIP
MSC (N) 2ND YEAR
SNSR,SU
2. DISORDERS SYMPTOMS ONSET
Gestational
hypertension
Blood pressure elevated > 140/90 mm
Hg
After 20 weeks gestation
Preeclampsia
Blood pressure elevated >140/90
mmHg and +1 or greater proteinuria on
dipstick
After 20 weeks pregnancy
Eclampsia
Preeclampsia with neurologic
symptoms/seizures
After 20 weeks pregnancy
Chronic
hypertension
Pre-existing hypertension Exists prior to pregnancy
Preeclampsia/eclam
psia superimposed
on chronic
hypertension
Blood pressure increases >30 mm Hg
systolic or >15 mm Hg diastolic from
baseline with onset of significant
proteinuria
>20 weeks pregnancy
CLASSIFICATIONS OF PIH
3. ETIOLOGY
• Nulliparity
• Pre-eclampsia in a previous pregnancy
• Maternal age >35 years or<18 years
• Family history of PIH
• Chronic HTN
• Chronic Renal Disease
• Inherited Thrombophilia
• DM
4. CLINICAL
SCENARIO
Q. A 29-year old primigravida at 28 weeks of gestational age has a blood
pressure reading of 150/100 mm Hg obtained during a routine visit. Her
baseline blood pressure during the pregnancy was 120/70 mm Hg. The
patient denies having headache, blurry vision, nausea, vomiting or
abdominal pain. Her repeat BP is 160/100 mm Hg and urinalysis is 1+ for
protein by dipstick.
What is the most likely diagnosis?
PRE-ECLAMPSIA
5. Identification of Pre-eclampsia:
BP measurement
Peripheral Edema
Excessive weight gain
High risk history
Urine protein analysis
Evaluation of severity
• Headache
• Blurring vision
• Epigastric pain
• Decreased urine output
• Breathlessness
• Assess the fetal well being
6. Investigations done to look for end organ
changes
• CBC – Platelet count < 1 lac/mm3
• LFT – elevated SGOT and SGPT (2 times above normal)
• KFT – Serum Creatinine >1.1 mg/dl
If anytime, any end organ changes seen or the BP is shooting up
beyond 160/110 mm Hg. (sever PE)
7. The definitive management for Pre-eclampsia?
Termination of pregnancy.(37 completed).
Baseline workup and investigations.
Watch for development of severe PE.
Watch for fetal growth and well being.
8. Q. A 25-year old nulliparous woman at 30 weeks comes for ANC check-up
in OPD. Her BP is 170/110 mm Hg and urinalysis shows 2+ by dipstick.
There is no complaint of headache, vision change, pain or decreased urine
output. The FHS is 140 bpm.
What is the diagnosis?
SEVERE PRE-ECLAMPSIA
9. Management of severe
PE
• Admit the woman
• Baseline investigations and follow
• Control the BP and monitoring
• Watch for S/S of impending Eclampsia
• Evaluate the well being of the baby. (<34 weeks)
• Steroids for fetal lung maturity.(Inj. Betamethasone 2 doses of 12 mg IM 24
hours apart). Reassess on daily basis.
• If the gestation is >34 weeks, termination of pregnancy if no S/S of
impending eclampsia.
10. Q. A female with 35 week gestation, presents in emergency with
complaint of headache and blurring of vision since morning. Her BP is
170/120 mm Hg. Her urine analysis is 3+ by dipstick. How is the patient
managed?
Admit and observe.
Admit, control BP and continue pregnancy till term.
Admit, start MgSO4 and antihypertensive and terminate the pregnancy.
Start antihypertensive and follow in OPD.
12. NURSING
MANAGEMENT
MILD PRE-ECLAMPSIA
Rest
Diet: no added salt
Monitoring of the mother and fetus: Monitor blood pressure twice daily every
4 – 6 hours and urine examination. Fetal growth and well being have to be
monitor.
If gestation <37 weeks: DBP settles and proteinuria becomes insignificant, the
patient may be allow to continue pregnancy.
If gestation >37 weeks, after ensuring fetal maturity, labour is induced.
13. SEVERE PREECLAMPSIA:
Anti hypertensive drugs is to be given.
Tab. Labetalol – 100 mg orally BD per day.
Tab. Nifedipine 10 mg orally, can be titrated according to the BP level.
Tab. Hydralazine 10-25 mg bid, orally, Tab. Methyldopa 250 – 500 mg tid,
qid, Orally.
For quick control of HTN in severe pre-eclampsia, Inj. Labetalol 10 – 20 mg
can be given.
14.
15. Q. 8 months pregnant woman is wheeled into the emergency with
seizures. Her relatives inform that she had been complaining of severe
headache and blurring of vision since morning.
What is the diagnosis? How will we managed?
Stabilization
Airway
ECLAMPSIA
Termination of
pregnancy
16. Dangers of Eclampsia
• Aspiration pneumonia
• Pulmonary edema
• Placental abruption
• Cardiopulmonary arrest
• Renal failure
Massive cerebral haemorrhage
Q. What is the most common cause of sudden death in a woman with
eclampsia?
Intracranial haemorrhage.
17. ECLAMPSIA CAN OCCUR DURING:
• Antepartum
• Intra-partum
• Postpartum
Q. Which is the most dangerous?
18. ECLAMPSIA
Magnesium Sulphate (MgSO4) is the drug of choice for treating
convulsions.
Pritchard regime (MgSO4)
Loading dose :
4g 20% MgSO4 should be given IV over 5 – 10 minutes (not less than 3
minutes.)
Maintenance dose :
10g of 50% MgSO4 solution deep IM injection into alternate buttocks(5g on
left and 5g on right buttock) every 4 hrs.
19.
20. Zuspan regime
• Loading dose : 4 – 6 g diluted in 100 mL NS, slow IV infusion over 15 – 20
minutes.
• Maintenance dose: 1 – 2 gm / hour in 100 mL of IV infusion.
MONITORING DURING MgSO4 THERAPY:
Respiratory rate
Knee jerk
Urine output
Antidote of MgSO4: Inj. Calcium Gluconate 10 mL. IV
Therapeutic MgSO4 levels: 4 – 7
mEq/L
Loss of knee jerk: 10 mEq/L
Respiratory paralysis: 12 mEq/L
Cardiac arrest: 15 mEq/L
22. TIMING OF DELIVERY
Severe pre-eclampsia is usually treated consecutively till the end of the
36th weeks to ensure reasonable maturation of the fetus. Indications of
termination before 36th weeks include:
Aggravation of the pre-eclamptic feature.
HTN persists
Acute fulminating pre-eclampsia
23. METHOD OF DELIVERY:
Vaginal delivery may be commenced in vertex presentation by –
Amniotomy + Oxytocin
PGs, if cervix is not favourable.
Caesarean section is indicated in:
Oxytocin test fails
Failure of induction of labour
CPD
24. INTRAPARTUM CARE:
Close monitoring of the fetus and mother vitals
Proper analgesia
Anti-hypertensives may be given if needed
2nd stage of labour may be shortened by forceps delivery.
POST PARTUM CARE:
Continue observation of the mother for 48 hours
Drugs are continued in a small dose for 48 hours.
25. COMPLICATIONS
• Injuries
• Cerebral haemorrhage
• Hyperpyrexia
• Renal failure
• Pulmonary edema: Furosemide 40 mg IV followed by 20 mg of mannitol.
• Puerperal infection and puerperal psychosis.
28. BIBLIOGRAPHY/REFEREN
CE
• Annamma Jabob. A comprehensive textbook of Midwifery and Gynaecological
Nursing, Fourth edition.pp 724-741.
• Lily Podder. Fundamentals of Midwifery and Obstetrical Nursing. ELSEVIER.pp 374-
381.
• DC Dutta’s textbook of Obstetrics. Hiralal Konar 8th Edition.Jaypee The Health
Sciences Publisher.pp 573-585.
• DAVIS’S DRUG GUIDE for Nurses TWELFTH EDITION. Pp 806-808,869-870.
• Mosby’s 2020. Nursing Drug Reference. Skidmore, Third South Asia Edition. Pp
801-803,732-734.