The document summarizes the structure, function and abnormalities of the placenta and amniotic fluid. Some key points:
- The placenta develops from fetal and maternal tissues and is complete by 12 weeks. It has both fetal and maternal surfaces separated by the intervillous space filled with maternal blood.
- It functions to transfer gases, nutrients, and waste between mother and fetus through complex mechanisms like diffusion, transporters and barriers.
- Abnormalities can include extra lobes (succenturiate placenta) or a thin membranous structure (membranous placenta) which can increase risks for the pregnancy.
- Amniotic fluid originates from fetal urine
Haemorrhage is a major cause of maternal morbidity and mortality throughout the world. Antepartum haemorrhage is defined as the bleeding from or within the genital tract after 28th week of pregnancy but before the birth of the baby. Causes may be placental, extra placental or unexplained Major causes of APH are two: placenta previa and abruptio placenta. h Placenta previa is 4 types. Placentography (USG) confirms the diagnosis .Abruptio placenta should be differentiated placenta previa Placenta previa can be diagnosed by—(i) Ultrasonography (preferred), (ii) Clinically. Transvaginal ultrasound classify placenta previa: (a) within 2 cm or (b) > 2 cm from the undilated internal cervical os. Vaginal examination for the diagnosis of placenta previa should not be done as it provokes severe hemorrhageImaging modalities (Doppler USG, MRI) have reduced the need of double set up examination and the risk of bleeding thereof as they can make the improved diagnosis of placenta previa, accreta and abruption. h Placental abruption is diagnosed mainly clinically and supported by laboratory, USG or MRI. h Complications of placenta previa and abruptio placenta affect both the mother and the fetus. Management of placenta previa and abruptio placenta depends upon the severity of the problem and also on the duration of pregnancy.
Presentation on this topic is available on link 👇
https://youtu.be/d_JgNiYv7eU
This topic contains detail about genital prolapse in pregnancy, It's definition, incidence, types, stages, causes, risk factors, clinical features, effect of prolapse, effect on pregnancy, effect during labour and puerperium, prevention, treatment and nursing management during pregnancy, labour and puerperium.
Placenta , memberanes and amniotic fluidDr anil kumar
Placenta is a hemochoreal. It is deciduate. It develops from trophoblasts.5/6 of placenta is fetal origin and 1/6 is maternal origin.It act as semipermiable memberane to exchange substances between fetus and mother.
Amniotic fluid if less in volume is called oligohydramnios .If excee,called polyhydramnios.
Oligohydramnios is associated with IUGR,renal agenesis and posterior urethral valve .
Polyhydramnios is associated with anencephly, meningocele, sacral agenesis ,diabetes in mother etc
Haemorrhage is a major cause of maternal morbidity and mortality throughout the world. Antepartum haemorrhage is defined as the bleeding from or within the genital tract after 28th week of pregnancy but before the birth of the baby. Causes may be placental, extra placental or unexplained Major causes of APH are two: placenta previa and abruptio placenta. h Placenta previa is 4 types. Placentography (USG) confirms the diagnosis .Abruptio placenta should be differentiated placenta previa Placenta previa can be diagnosed by—(i) Ultrasonography (preferred), (ii) Clinically. Transvaginal ultrasound classify placenta previa: (a) within 2 cm or (b) > 2 cm from the undilated internal cervical os. Vaginal examination for the diagnosis of placenta previa should not be done as it provokes severe hemorrhageImaging modalities (Doppler USG, MRI) have reduced the need of double set up examination and the risk of bleeding thereof as they can make the improved diagnosis of placenta previa, accreta and abruption. h Placental abruption is diagnosed mainly clinically and supported by laboratory, USG or MRI. h Complications of placenta previa and abruptio placenta affect both the mother and the fetus. Management of placenta previa and abruptio placenta depends upon the severity of the problem and also on the duration of pregnancy.
Presentation on this topic is available on link 👇
https://youtu.be/d_JgNiYv7eU
This topic contains detail about genital prolapse in pregnancy, It's definition, incidence, types, stages, causes, risk factors, clinical features, effect of prolapse, effect on pregnancy, effect during labour and puerperium, prevention, treatment and nursing management during pregnancy, labour and puerperium.
Placenta , memberanes and amniotic fluidDr anil kumar
Placenta is a hemochoreal. It is deciduate. It develops from trophoblasts.5/6 of placenta is fetal origin and 1/6 is maternal origin.It act as semipermiable memberane to exchange substances between fetus and mother.
Amniotic fluid if less in volume is called oligohydramnios .If excee,called polyhydramnios.
Oligohydramnios is associated with IUGR,renal agenesis and posterior urethral valve .
Polyhydramnios is associated with anencephly, meningocele, sacral agenesis ,diabetes in mother etc
The placenta is a large organ that develops during pregnancy.Blood from the mother passes through the placenta, filtering oxygen, glucose and other nutrients to your baby via the umbilical cord.
The placenta is a large organ that develops during pregnancy.Blood from the mother passes through the placenta, filtering oxygen, glucose and other nutrients to your baby via the umbilical cord.
an overview of placenta and membranes. Whether you're a medical professional, researcher, student, or simply intrigued by the wonders of human biology, this presentation promises to provide valuable insights into the marvels of the placenta and membranes.
DEVELOPMENT OF PLACENTA,PLACENTA AT TERM , DECIDUA,PLACENTAL MEMBRANE , PLACENTAL CICULATION,PLACENTAL ENDOCRINE SYNTHESIS,ABNORMAL PLACENTA,FUNCTIONS.
abruption. This is when the placenta partly or completely peels away from the inner wall of the uterus before delivery. With placental abruption, the developing baby might not get enough oxygen and nutrients. The pregnant person might have back or stomach pain and bleeding from the vagina. Placental abruption can lead to an emergency in which a baby needs to be delivered early.
Placenta previa. This condition happens when the placenta partly or totally covers the cervix. Placenta previa is more common early in pregnancy. It might get better on its own as the uterus grows.
Placenta previa can cause serious vaginal bleeding during pregnancy or delivery. Treatment depends on various factors. They include the amount of bleeding, whether bleeding stops, how far along the pregnancy is and the placenta's position. If placenta previa continues late into the pregnancy, a healthcare professional likely will recommend a C-section.
Placenta accreta. Most often, the placenta separates from the wall of the uterus after childbirth. With placenta accreta, part or all of the placenta stays firmly attached to the uterus. This condition happens when the blood vessels and other parts of the placenta grow into the uterine wall. This can cause serious blood loss during delivery.
Sometimes, the placenta invades well into the muscles of the uterus or grows through the uterine wall. If this happens, a healthcare professional likely will recommend a C-section followed by surgery to remove the uterus. This is called a C-hysterectomy.
The placenta is attached to the wall of the uterus. Most often, it attaches to the top, side, front or back of the uterus. Rarely, it might attach in the lower area of the uterus. When this happens, the placenta may block the passage that connects the uterus to the vagina, called the cervix. If the placenta is near the opening of the cervix, it's known as a low-lying placenta. If it partly or totally covers the opening of the cervix, it causes a condition called placenta previa.
What affects the health of the placenta?
Various factors can affect the health of the placenta, including:
Age of the pregnant person. Some conditions that affect the placenta are more common in older people, especially after age 40.
Water breaking before labor. During pregnancy, the developing baby is surrounded and cushioned by a fluid-filled layer of tissue called the amniotic sac. If the sac leaks or breaks before labor starts, it's known as the water breaking. This raises the risk of problems with the placenta.
High blood pressure. This condition can cause less blood to reach the placenta.
Being pregnant with twins or other multiples. Being pregnant with more than one baby might raise the risk of some conditions related to the placenta.
Blood-clotting conditions. Typically, blood hardens into a clump to help control bleeding from cuts. This process is called clotting. Sometimes, blood clots form inside the body and lead to medical problems. Conditions that ca
The placenta is formed gradually during the first three months of pregnancy, while, after the fourth month, it grows parallel to the development of the uterus. Once completed, it resembles a spongy disc 20 cm in diameter and 3 cm thick.
The placenta is a temporary organ that connects the developing foetus via the umbilical cord to the uterine wall to allow nutrient uptake, thermo-regulation, waste elimination, and gas exchange via the mother's blood supply; to fight against internal infection; and to produce hormones which support pregnancy. The placenta functions as a fetomaternal organ with two components: the fetal placenta which develops from the same blastocyst that forms the fetus, and the maternal placenta , which develops from the maternal uterine tissue. The placenta is expelled from the body upon birth of the fetus.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
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Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
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NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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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
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DISSERTATION on NEW DRUG DISCOVERY AND DEVELOPMENT STAGES OF DRUG DISCOVERYNEHA GUPTA
The process of drug discovery and development is a complex and multi-step endeavor aimed at bringing new pharmaceutical drugs to market. It begins with identifying and validating a biological target, such as a protein, gene, or RNA, that is associated with a disease. This step involves understanding the target's role in the disease and confirming that modulating it can have therapeutic effects. The next stage, hit identification, employs high-throughput screening (HTS) and other methods to find compounds that interact with the target. Computational techniques may also be used to identify potential hits from large compound libraries.
Following hit identification, the hits are optimized to improve their efficacy, selectivity, and pharmacokinetic properties, resulting in lead compounds. These leads undergo further refinement to enhance their potency, reduce toxicity, and improve drug-like characteristics, creating drug candidates suitable for preclinical testing. In the preclinical development phase, drug candidates are tested in vitro (in cell cultures) and in vivo (in animal models) to evaluate their safety, efficacy, pharmacokinetics, and pharmacodynamics. Toxicology studies are conducted to assess potential risks.
Before clinical trials can begin, an Investigational New Drug (IND) application must be submitted to regulatory authorities. This application includes data from preclinical studies and plans for clinical trials. Clinical development involves human trials in three phases: Phase I tests the drug's safety and dosage in a small group of healthy volunteers, Phase II assesses the drug's efficacy and side effects in a larger group of patients with the target disease, and Phase III confirms the drug's efficacy and monitors adverse reactions in a large population, often compared to existing treatments.
After successful clinical trials, a New Drug Application (NDA) is submitted to regulatory authorities for approval, including all data from preclinical and clinical studies, as well as proposed labeling and manufacturing information. Regulatory authorities then review the NDA to ensure the drug is safe, effective, and of high quality, potentially requiring additional studies. Finally, after a drug is approved and marketed, it undergoes post-marketing surveillance, which includes continuous monitoring for long-term safety and effectiveness, pharmacovigilance, and reporting of any adverse effects.
2. Placenta
• Human placenta develops from two
sources
Fetal component- Chorionic frondosum
Maternal component- decidua basalis
• Placental development begins at 6 weeks
and is completed by 12 th week
4. Placenta at Term- Gross Anatomy
• Fleshy
• Weight-500gm
• Diameter- 15-20 cm
• Thickness-2.5 cm
• Spongy to feel
• Occupies 30% of the uterine wall
• Two surfaces- Maternal and fetal
• 4/5th of the placenta is of fetal origin and 1/5 is of
maternal origin
5. Fetal surface of the placenta
• Covered by smooth and
glistening amnion
overlying the chorion
• Umbilical cord is attached
at or near its centre
• Branches of the umbilical
vessels are visible
beneath the amnion as
they radiate from the
insertion of the cord
6. Maternal surface of the placenta
• Rough and spongy
• Maternal blood gives
it dull red colour
• Remanants of the
decidua basalis gives
it shaggy appearance
• Divided into 15-20
cotyledons by the
septa
7. • Margins of the placenta are formed by fused chorionic
and the basal plate
• Placenta is attached to the upper part of the uterine body
either at the posterior or anterior wall
• After delivery ,placenta separates with the line of
separation being through decidua spongiosum
(intermediate spongy layer of the decidua basalis
8. Structure of the placenta
• Placenta is limited by the
amniotic membrane on
the fetal side and by the
basal plate on the
maternal
• Between these two lies
the intervillous space
filled with maternal blood
and stem villi with their
branches
9. • Amniotic membrane-
single layer of cubical
epithelium loosely attached to
adjacent chorionic plate and
does not take part in placental
formation
• Chorionic plate- forms the
roof of the placenta
• From outside inwards consists
of
Syncitotrophoblast
Cytotrophoblast
Extraembryonic mesoderm
with branches of umbilical
vessels
10. • Basal Plate- forms the
floor From outside
inwards it consist of
Compact and spongy
layer of decidua basalis
Layer of Nitabuch
Cytotrophoblastic shell
Syncytiotrophoblast
Basal plate is perforated by
the spiral arteries allowing
entry of maternal blood into
intervillous space
11. • Layer of Nitabuch - is a fibrinous layer formed
at the junction of cytotrohoblastic shell with
decidua due to fibrinoid degeneration of
syncitotrohoblast
• It prevents excessive penetration of the decidua
by the trophoblast
• Nitabuch membrane is absent in placenta
accreta and other morbidly adherent placentas
12. Intervillous space:
Numerous branch villi
arising from the stem villi
project into this space
It is lined internally on all
sides by the
syncytiotrophoblast and is
filled with maternal blood
13. Stem (Anchoring villi )
Arise from the chorionic plate
and extend to the basal plate
Fetal cotyledon (60-100 ) –
derived from one major primary
stem villus and is the structural
unit of placenta
Maternal cotyledon (15-20 )
contains 3-5 fetal cotyledons
Villus is the functional unit of
placenta
Total surface of the villi for
exchange varies between 4-14
sq meters
14. Placental barrier or membrane
Maternal and fetal blood
are separated by
placental membrane
or barrier (0.025 mm
thick )
• Endothelial lining of
fetal vessels
• Connective tissue of
the villi
• Basement membrane
• Cytotrophoblast
• Syncytiotrophoblast
15. Placental Function
Transfer of gases ,nutrients and waste
products , namely
• Respiratory function
• Nutritive function
• Excretory function
Endocrine and enzymatic function
Barrier function
Immulogical function
16. Factors affecting the transfer
between mother and the fetus
• Physical properties of the substance- molecular
weight, lipid solubility, ionised substances
• Area and functional integrity of the placental
membrane
• Rate of blood flow
• Concentration gradient of the substance on
either side of the exchange membrane
17. Mechanism involved in the transfer
of substances
• Simple diffusion-O2 and CO2
• Facilitated diffusion ( carrier mediated ) –glucose
,vitamins
• Active transfer ( against concentration gradient )-ions
• Endocytosis- invagination of cell membrane to form
intracellular vesicle
• Endocytosis-Release of substances in the vesicles to
extracellular space eg IgG immunoglobulin
18. Respiratory function
• Although fetal respiratory movement occurs, no
active exchange of gases takes place
• Intake of oxygen and output of carbon dioxide
take place by simple diffusion across the fetal
membrane
• O2 delivery to the fetus is at the rate of 8 ml/kg
which is achieved by cord blood flow of 160-
320ml/min
19. Excretory function
• Waste products from the fetus such as
urea, uric acid, cretinine are excreted to
the maternal blood by simple diffusion
20. Nutritive function
Fetus obtains its nutrients from the maternal blood
• Glucose- transferred to the fetus by facilitated diffusion
• Lipids for fetal growth and development has dual origin. They are
transferred across the fetal membrane or synthesised in the fetus
• Amino acids are transferred by active transport
• Water and electrolytes- Na, K ,Cl cross by simple diffusion, Ca , P,
and Fe cross by active transport
• Water soluble vitamins are transferred by active transport but the fat
soluble vitamins are transferred slowly
21. Barrier Function
• Placental membrane is thought to be a protective barrier for the
fetus against harmful agents in the maternal blood
• Substances with large molecular weight or size like insulin or
heparin are transferred minimally
• Only IgG ( not IgA or Ig M )antibodies and antigens can cross the
placental barrier
• Most drugs can cross the placental barrier and some can be
teratogenic
• Various viruses, bacteria, protozoa can cross the placenta and affect
the fetus in utero
22. Immunological function
• Inspite of foreign paternally inherited
antigens in the fetus and placenta, there is
no graft rejection due to immunological
protection provided by the placenta
23. Endocrine and Enzymatic function
• Placenta secretes various hormones – Protein
hormones like HCG, human placental
lactogen,pregnancy specific beta 1
glycoprotein,,pregnancy associated plasma protein,
steroidal hormones like estrogen and progestrone
• Enzymes secreted are diamine oxidase-which activates
the circulatory pressor amines,oxytocinase which
neutralizes oxytocin, phospholipase A2 which
synthesizes arachidonic acid
24. Placental abnormalities
Placenta
succenturiata (3%)
• One or more small lobe or
cotyledon of placenta may be
placed at a varying distance
from the main placental margin
• A leash of vessels connecting
the main to the small lobe
traverse through the
membranes
• Accessory lobe is developed
from activated villi on the
chorionic laeve
25. Clinical significance-
If succenturiate lobe is retained
following birth of placenta it may lead
to
PPH
Subinvolution
Uterine sepsis
Poly formation
Treatment- exploration of the uterus
and removal of the lobe
26. Circumvallate placenta
Development-
• Due to smaller chorionic
plate than the basal plate
• The chorionic plate does
not extend into the
placenta margin
• The amnion and chorion
are folded and rolled back
to form a ring leaving a
rim of uncovered
placental tissue
27. Morphology
• Fetal surface has a central
depressed zone surrounded by
a usually complete thickened
white ring made up of double
fold of amnion and chorion
• Branching vessels radiate from
the cord insertion upto ring
only
• Area outside the ring is thicker,
elevated and rounded
28. Clinical significance
• There are more chances of –
• Miscarriage
• Hydrorrhoea gravidarum
• Antepartum haemorrhage
• Preterm delivery
• Fetal growth restriction
• Retained placenta or membrane
29. Placenta marginata
• A thin fibrous ring is present at the margin
of the chorionic plate where the fetal
vessels appear to terminate
30. Membranous placenta
• The whole of the chorion is covered by
functioning villi and thus placenta appears
as thin membranous structure on
ultrasonography
31. Chorioangioma
• Are the most common benign tumors of
the placenta and are hamartomas of
primitive chorionic mesenchyme
• Small tumors may be asymptomatic but
large tumors may be associated with
hydroamnios and antepartum
haemorrhage
32. Amniotic fluid
• It is the fluid in the amniotic sac surrounding the fetus
• Origin – both mother and fetus
Transudation from maternal circulation across the
placental surface and fetal membranes
Active secretion from amniotic epithelium
Transudation across surface of umbilical cord and fetal
placental circulation
Contribution from fetal urine
Tracheobronchial secretion
Transfer across fetal skin
33. • Volume- varies according to the
gestational age
• Measures
• 12 weeks – 50 ml
• 20 weeks- 400 ml
• 36 weeks- 800ml-1 liter
• At term - it reduces to apprx 700ml
35. Physical features
• Faintly alkaline
• Low specific gravity-1.010
• Becomes highly hypotonic to maternal
serum at term pregnancy
• Osmolarity of 250 mOsmol/liter is
suggestive of fetal maturity
36. Colour
• In early pregnancy it is colourless
• At term becomes pale straw coloured due
to preence of exfoliated lanugo and
epidermal cells from fetal skin
37. Abnormal appearance
• Greenish- due to presence of meconium
• Golden yellow-due to presence of bilirubin resulting from
fetal cell hemolysis due to Rh incompatibility
• Greenish yellow- in post maturity
• Dark maroon/ blood stained – due to altered blood in
accidental haemorrhage
• Prune juice/dark brown- in presence of retained dead
fetus
38. Functions of amniotic fluid
During pregnancy
• Act as a shock absorber to protect the fetus from external injury
• Maintains the fetal temprature
• Allows free movement and growth of fetus
• Prevents adhesion formation between the fetal parts and the
amniotic sac
• Has some nutritive value because of small amount of protein and
salt content
39. During Labour
• It forms hydrostatic wedge to help dilatation of cervix
• During uterine contractions , the amniotic fluid in the
intact membranes prevents interference with placental
circulation
• Provides pool for the fetus to excrete urine
• Protect the fetus from the ascending infections by its
bactercidal action
40. Clinical importance
• Study of amniotic fluid helps in knowing the well being
and maturity of fetus
• Intramniotic instillation of prostaglandins and hypertonic
saline can be used for induction of abortion
• Artificial rupture of membranes to drain liquor is a
method of induction and augmentation of labour
• Excess liquor (polyhydroamnios), less liquor known as
(oligohydroamnios ) can be estimated by ultrasound
measurement of amniotic fluid index (AFI )
41. Measurment of AF
• Measurement of AFI-
quantitative method of
measurement of amniotic
fluid by usg. Single
largest pocket is
measured in four
quadrants and added.
• Normal range is 5-24 cm
• Single deepest pocket
• Normal range is 2-8 cm
46. • Symptoms- breathlessness due to
mechnacial compression, edema of legs,
varicosities in legs,
• Signs-Abdomen is markedly distended,
skin is tense,shiny fundal height >POG,
48. During labour
Premature rupture of membranes
Cord prolapse
Uterine inertia
PPH
Puerperium
Subinvolution
Puerperal sepsis
Fetal Complications
• High perinatal mortality due to prematurity and congenital
malformations
49. Management
• Rule out fetal congenital anomalies
• Bed rest
• Amnioreduction- 1-1.5 liters of amniotic fluid is removed over 3
hours to relieve maternal distress
• Indomethacin therapy- impairs lung fluid production,enhances
absorption of amniotic fluid, decreases fetal urine
production,increases fluid movement across fetal membranes
• Dose – 1.5-3 mg/kg from 24-35 weeks for 2 weeks
• S/E- premature closure of patent ductus arterious
50. Oligohydroamnios
• Amniotic fluid is less than 200 ml at term or AFI < 5 cm
OR SDP< 2 cm
Etiology
• Fetal chromosomal anomalies
• Intrauterine infections
• Drugs- PG inhibitors, ACE inhibitors
• Renal agenesis or obstruction of the urinary tract
• IUGR associated with placental insufficency
• Amnion nodosum-failure of secretion by the cells of the
amnion
• Postmaturity
51. • Diagnosis
• FH<POG
• The uterus is full of fetus because of
scanty liquor
• Malpresentation is common
52. • Complications
Fetal
• Abortion
• Adhesions due to intramniotic adhesions
• Fetal pulmonary hypoplasia, cord compression
Maternal
• Prolonged labour due to inertia
• Increased operative interference due to
malpresentation