1) The document describes the position of the fetus in the uterus, including lie, presentation, attitude, and position.
2) It then explains the mechanism of labor, including the steps of labor for an occiput lateral position: engagement, descent, flexion, internal rotation, crowning, extension, restitution, and expulsion of the shoulders and trunk.
3) Key points are that the fetus is usually in a longitudinal lie with cephalic presentation, and the mechanism of labor involves a series of movements that adapt the fetal head to navigate the birth canal.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
VACUUM DELIVERY - OBSTETRICS AND GYNAECOLOGY-
DEALS WITH THE DELIVERY OF HUMAN BABY BY VACUUM IN SPECIAL OBSTETRIC CONDITIONS.
VACUUM is an instrumental device designed to assist delivery by creating a vacuum between it and the fetal scalp.
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
The ability of the fetus to successfully negotiate the pelvis during labor involves changes in the position of its head during its passage in labor. The mechanisms of labor, also known as the cardinal movements, are described in relation to a vertex presentation, as is the case in 95% of all pregnancies.
A detailed view of National Control Programme for Diabetes, 1987 and the changes in the programme.. for nursing students.
From Community health nursing..
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.
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.
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
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
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
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
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.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
2. z
Goals
Position of fetus in uterus :- Lie, presentation,
presenting part, attitude, denominator, position.
Mechanism of labor :- definition
Steps of labor of occipito lateral position :-
engagement, descent, flexion, internal rotation,
crowning, extension, restitution, internal rotation
of shoulder & external rotation of head, expulsion
of shoulder & trunk
4. z
LIE
Relationship of the
long axis of the
fetus to the long
axis of centralized
uterus or maternal
spine.
Longitudinal –
99.5%
Transverse, oblique
or unstable – 0.5%
5. z
PRESENTATION
Part of the fetus which occupies lower pole of the uterus (pekvic brim).
Cephalic (head) -96.5%
Breech / podalic (feet) – 3%
Shoulder – 0.5%
PRESENTING PART
Part of the presentation which overlies the internal os & felt by
examining finger through cervical opening.
Cephalic presentation – vertex 96%, brow & face 0.5%
Breech – fetal legs. Complete breech – flexed. Frank breech –
extended. Footling – foot.
6. z
ATTITUDE
Relation of the different parts of fetus
to one another.
Universal attitude – flexion.
During later months – head, trunk &
limbs of fetus maintain attitude of
flexion on all joints – form ovoid
mass, corresponds to ovoid uterus.
Extension may occur – deflexed
vertex, brow or face
Legs may extend in breech
Diagrammatic representation of a
fetus in flexed attitude
P–V—Vertico-podalic diameter;
A–A—Bisacromial diameter;
T–T—Bitrochanteric diameter
8. z
DENOMINATOR
Arbitrary bony fixed point on presenting part, comes in relation
with various quadrants of maternal pelvis.
Occiput in vertex, mentum (chin) in face, frontal eminence in
brow, sacrum in breech & acromion in shoulder.
POSITION
Relation of denominator to different quadrants of pelvis. Pelvis is
divided into equal segments of 450 – 8 positions.
Anterior or posterior or oblique - left or right.
First vertex – LOA, second – ROA, third – ROP. Fourth – LOP.
9. z
The position and relative frequency of the vertex at
the onset of labor
10. z
Causes of preponderance of longitudinal
lie and cephalic presentation
Fetus in attitude of flexion, a shape of an ovoid – long vertico-podalic axis, 25cm at
term.
Fetus accommodates comfortably along the long axis of ovoid shape of the uterine
cavity at term – longitudinal lie.
Cephalic presentation – majority. Due to :-
Gravitation – head being heavier comes down
Adaptation – smallest circumference of flexed head, 27.5cm & circumference of
complete breech (flexed), 32.5cm. Cephalic & podalic poles comfortably
accommodated in narrow lower pole & wider fundal pole of uterus respectively.
12. z
DEFINITION
Series of movements that occur on the head in the process of adaptation, during
journey through the pelvis.
Principle movements take place in the head and rest of fetal trunk involved in
participation or initiation of movement.
Mechanism :- in normal labor, head enters brim more commonly through available
transverse diameter (70%) & less commonly through one of the oblique diameters.
Position – occipitolateral or oblique occipitoanterior. LOA common than ROA.
Engaging antero-posterior diameter of head – SOB 9.5cm or SOF 10cm (in slight
deflexion). Engaging transverse diameter is biparietal 9.5cm.
13. z
STEPS OF LABOR FOR OL POSITION
Engagement
Descent
Flexion
Internal rotation
Crowning
Extension
Restitution
External rotation of head & internal rotation of shoulders
Expulsion of the trunk
14. z
ENGAGEMENT
Primigravidae – before onset of labor. Multiparae – late first stage with rupture of
membranes.
Due to lateral inclination of head, sagittal suture (SS) does not strictly correspond to
transverse diameter of inlet – deflected anteriorly towards symphysis pubis (SP) or
posteriorly towards sacral promontory (SPr).
This Deflection – asynclitism. Mild degree is common. Severe degree asynclitism –
cephalopelvic disproportion.
If SS lie ant., SP; post. Parietal Bone (PB) presenting part - post. Asynclitism or post.
Parietal presentation. Common in prmigravidae. Post. lateral flexion to glide ant. PB.
If SS lie post., SPr.; ant. PB presenting part – ant. Asynclitism or ant. Parietal
presentation. Common in multiparae. Ant. lateral flexion to glide post. PB.
15. z
Head brim relation prior to engagement—
(A) Anterior parietal presentation,
(B) Head in synclitism,
(C) Posterior parietal presentation
A B C
After flexion, head enters brim & synclitism occurs. In 25% cases.
16. z
DESCENT
If no undue bony or soft tissue obstruction – continuous process.
Slow & insignificant in 1st stage & pronounced in 2nd stage & complete with expulsion of
fetus.
Primigravidae – practically no descent in 1st stage with prior engagement. Multiparae –
starts with engagement
Head expected to reach pelvic floor till cervix is fully dilated
Factors:-
Uterine contraction & retraction
Bearing down efforts
Straightening of fetal ovoid specially after rupture of the membranes.
17. z
FLEXION
Some degree noticeable at beginning of the labor. Complete flexion –
uncommon.
Factors:- due to resistance offered by :-
Unfolding cervix, Walls of the pelvis and Pelvic floor
Precedes internal rotation or coincides.
Necessary for descent – reduces the shape and size of the plane of
advancing diameter of the head
Two arm lever theory:- fulcrum & 2 arms:-
Fulcrum – occipito-allantoid joint of head (joins the head to body)
Short arm – condyles to occipital protuberance & Long arm – condyles to chin
On Resistance – short descend & long arm ascend = flexion
18. z
Lever action producing flexion of the
head reducing the engaging diameter of the head from—
(A) Occipitofrontal to (B) Suboccipito bregmatic
19. z
INTERNAL ROTATION OF THE HEAD
No further descent without it. Descent accompanies internal rotation.
Theories:-
Slope of pelvic floor :- 2 halves of levator ani form a gutter, direction of fibres is
backwards & towards midline.
During each contraction, head, occiput, in well flexed position, stretches levator ani.
After contraction, elastic recoiling of levator ani, brings occiput forward toward
midline. Repeats until occiput placed anteriorly. K/a rotation by law of pelvic floor
(Hart’s rule).
Pelvic shape :- forward inclination of side walls of cavity, narrow bispinous diameter,
long anteroposterior diameter of outlet – put long axis of head in maximum available
diameter, AP diameter.
Law of unequal flexibility :- internal rotation due to inequalities in flexibility of
component parts of fetus.
20. z
Cont..
OL position – ant. rotation by 2/8th of a circle of occiput
Oblique ant position – 1/8th of a circle forward, place occiput behind symphysis pubis.
Prerequisites for Ant. Internal rotation :- well flexed head, efficient uterine contraction,
tone of levator ani muscles & favourable shape of midpelvic plane.
Level of internal rotation varies – cervix, favourable but less frequent. Mostly at pelvic
floor.
Torsion of neck :- inevitable phenomenon during internal rotation.
If the shoulders remain in AP diameter, neck has to sustain torsion of 2/8th of a circle
which fails – some amount of rotation of shoulders in same direction of 1/8th of circle –
place shoulder in oblique diameter and 1/8th left behind.
Shoulders occupy left oblique diameter in LOL position & right in ROL
Oblique occipitoanterior position – no movement of shoulders as neck sustains
only1/8th of a circle.
21. z
CROWNING
After internal rotation, further descent occurs until subpcciput
lies under pubic arch.
Maximum diameter of head – biparietal diameter stretches vulval
outlet without recession of head even after contraction is over –
k/a crowning of head.
22. z
EXTENSION
Delivery of the head – extension through “couple of force” theory.
Driving force pushes head – downward direction
Resistance by pelvic floor – upward & forward direction
Downward & Upward neutralize. Forward thrust help in extension.
Successive parts of the head to be born through stretched vulval
outlet – vertex, brow & face.
Following release of the chin through stretched perineum, head drops
down, brings chin close to maternal anal opening.
23. z
Lateral view showing mechanism of labor in
left occipitolateral position
(A and B) Posterior
parietal presentation,
posterior lateral flexion
of the head and
engagement.
(C and D) Internal
rotation of the head with
movement of the
shoulders;
descent and delivery of
the head by extension
24. z
RESTITUTION
Visible passive movement of the head due to untwisting of the
neck sustained during internal rotation.
Head rotates through 1/8th of circle in direction opposite to
internal rotation.
Occiput points to maternal thigh corresponding to original lay.
25. z
INTERNAL ROTATION OF SHOULDERS
& EXTERNAL ROTATION OF THE HEAD
Movement of rotation of the head visible
externally due to internal rotation of the
shoulders.
Ant. Shoulder rotates toward symphysis
pubis from oblique diameter – external
rotation of head by 1/8th in same direction of
restitution.
Now shoulders in AP diameter. Occiput
points maternal thigh corresponding to
original lay during engagement.
26. z
BIRTH OF SHOULDERS & TRUNK
After shoulders in AP diameter – further descent – anterior shoulder
escapes below symphysis pubis first.
Lateral flexion of spine – post. shoulder sweeps over perineum.
Lateral flexion - Rest of the trunk expelled out
Anterior shoulder Posterior shoulder