Postpartum haemorrhage is defined as blood loss greater than 500ml following vaginal delivery or 1000ml following c-section. The leading cause is uterine atony which can be caused by factors like overdistension of the uterus or uterine fatigue. Prevention focuses on active management of the third stage of labor with uterotonics. Initial management of PPH involves ABCs, IV fluids, uterine massage, additional uterotonics like oxytocin, ergometrine, or misoprostol. If bleeding persists, further interventions may include bimanual compression, arterial embolization, compression sutures, or hysterectomy. Secondary PPH occurs after 24 hours and is usually due to retained placental
Third stage complications of labour- post partum hemorrhage in obstetrics and...sreya paul
management of postpartum hemorrhage in obstetrics and gynecology,bleeding can lead to death of mother after delivery. it is a very serious problem that need immediate interventions
Third stage complications of labour- post partum hemorrhage in obstetrics and...sreya paul
management of postpartum hemorrhage in obstetrics and gynecology,bleeding can lead to death of mother after delivery. it is a very serious problem that need immediate interventions
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
Blood loss of >/ 500 ml within 24 hours of vaginal birth or 1000 ml after caesarean section or any blood loss sufficient to compromise haemodynamic instability
MINOR PPH- 500- 1000ml blood loss
MAJOR PPH- > 1000ml Blood loss
MASSIVE PPH- >2000ml Blood loss
PPH Postpartum hemorrhage, affecter the delivery of fetus vaginal bleeding you can see with in 24 hours this primary PPH, secondary PPH will be up 28 of delivery.
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.
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.
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
complcations of third stage of labour, includes PPH, Inversion of uterus, retained placenta, placenta accreta, increta, percreta, amniotic fluid embolism
Blood loss of >/ 500 ml within 24 hours of vaginal birth or 1000 ml after caesarean section or any blood loss sufficient to compromise haemodynamic instability
MINOR PPH- 500- 1000ml blood loss
MAJOR PPH- > 1000ml Blood loss
MASSIVE PPH- >2000ml Blood loss
PPH Postpartum hemorrhage, affecter the delivery of fetus vaginal bleeding you can see with in 24 hours this primary PPH, secondary PPH will be up 28 of delivery.
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.
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.
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
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
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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
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
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!
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.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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.
2. Postpartum Haemorrhage
Traditional Definition
Blood loss of > 500ml. following vaginal delivery
Blood loss of >1000ml. following cesarean delivery
Functional Defination: Excessive bleeding that makes a
patient symptomatic ( e.g lightheadedness, vertigo,
syncope) and/or results in signs of hypovolemia( e.g
hypotension, tachycardia oliguria)
A 10% decrease in postpartum HB conc from prepartum
levels
Incidence
About 5% of all deliveries
10. Prevention
Be prepared
Active management of the third stage
- Prophylactic oxytocin with delivery of anterior shoulder
or immeidately after delivery
10 U IM or 5 U IV bolus
10-20 U/L N/S IV run rapidly at 100-150 ml/hr
- Early cord clamping and cutting
- Palpate the uterine fundus and confirm the uterus is
contracted
- Controlled cord traction (gentle) with suprapubic
countertraction
- Uterine massage after delivery of the placenta, as
approriate
- If placenta has not delivered after 15 minutes, infuse
oxytocin at 20 units/L of cristalloid at 100-150ml/hr
- Consider oxytocin infusion after placental delivery
11. Diagnosis – Is this a PPH?
Consider predisposing factors
Observe vaginal loss
Express blood from vagina following C/S
REMEMBER
- Blood loss is consistently underestimated
- Ongoing trickling can lead to significant blood
loss
- Blood loss is generally well tolerated to a point
12. Diagnosis – What is the cause?
Assess the fundus
Inspect the lower genital tract
Explore the uterus
- retained placental fragments
- uterine rupture
- uterine inversion
Assess coagulation
14. Management – ABC’s
Talk to and assess woman
Get HELP
Monitor vital signs
Remember that compensatory responses to blood loss in
these patients are excellent & may give you a false
sense of security
Large bore 2 IV access: active fluid resuscitation
Crystalloid – lots!
CBC, cross match and consider coagulation studuies
Elevate the legs to increase return of blood to the heart
Foley catheter
15. Management – Assess the fundus
Simultaneous with ABC’s
Atony is the leading cause of PPH
Uterine massage
If boggy – bimanual massage
Rules out uterine inversion
May feel lower tract injury
Evacuate clot from vagina and/or cervix
May consider manual exploration at this time
16. Management – Oxytocin
5 units IV bolus
20 units per L N/S IV wide open
10 units intramyometrial given
transabdominally
17. Manual Exploration: Is there a need?
No need for routine manual exploration
Risks:
- Infections
- Hemorrhages
- Pain
18. If no response to:
Uterine massage
Bimanual massage
Oxytocin
19. Proceed to Manual Exploration
Manual exploration is need to :
Rule out uterine inversion
Palpate cervical injury
Remove retained placenta or clot from
uterus
Rule out uterine rupture or dehiscence
20. Management – Additional Uterotonics
Ergometrine – caution in hypertension
- o.25 mg IM or 0.125mg IV
- Intervals of 5 mins maximum dose 1.25mg
Hemabate (carboprost tromethamine) – asthma
is relative contraindication
- 15 methyl – prostaglandin F2alpha
- O.25mg IM or intramyometrial
- Intervals of 15 – 90 mins maximum of 8 doses
(2mg)
21. Management – Additional Uterotonics
Cytotec (misoprostol) caution in asthma
- 800/1000 micrograms pr; 200 mcg po +
400mcg sublingual; & 200mcg po +
400mcg sL + 400mcg pr
Duratocin (carbetocin-long acting oxytocin
agonist)
- 100 micrograms IM or 100 micrograms IV
over 1 min.
22. If bogginess or haemorrhage continues
Consider abdominal aortic compression that is a
life saving intervention when there is a heavy
bleeding (whatever the cause)
- Circulating blood volume is restricted to the
upper part of the body and thereby to the vital
organs
- BP is kept up
- Blood is prevented from reaching the
bleeding are in the pelvis
- Volume is conserved
23. If bogginess or haemorrhage continues
Other emergency therapies:
tamponade with esophageal catheter,
emergency embolization, emergency
laparotomy with pelvic vessel ligation or
hysterectomy
24. Tamponade
Uterine packs-pack entire uterine cavity
with gauze. Thought to be dangerous &
ineffective by most obstetrians.
Should give i.v antibiotics
Regardless of form of tamponade used Hb
& urine output shd be closely monitored
Important esp. with the gauze pack bse a
large amt of blood can collect behind the
pack.
25. Arterial embolisation
Done by an interventional radiologist
Patient haemodynamically stable
Selective procedure done with single
bleeding vessel & it can be occluded
With diffuse bleeding area/single bleeding
vessel cant b identified-large artery
feeding multiple smaller vessels in
bleeding area is occluded
26. Laparatomy
Incision – midline vertical
Retractor –self retaining for adequate
lateral exposure
If descrete vessel bleeding –clamp it-ligate
with appropriate suture material
Atony or bleeding adjacent to the uterus &
difficult to control –do uterine atery
ligation
27. Uterine vessel ligation
Bilateral ligation(o’ leary stitch) becoming first line
procedure to control bleeding
Advs.
(1)uterine arteries easily accessible vs internal illiac artery
(2) procedure > successful
(3)field of dissection generally not near the ureters & illiac veins
Procedure:
identify the ureter
No. 0 chromic catgut/polyglycolic acid suture on a large curved
needle
Needle passed thru lateral aspect of lower uterine seg. As close to
the cervix as possible, then back thru the broad ligament just
lateral to the uterine vessels tied to compress the vessels
If above not successful vessels of the utero-ovarian arcade are
ligated just distal to the cornua by passing a suture thru the
myometrium just medial to the vessels
28. Compression sutures
B-lynch suture; a pair of vertical brace no.
2 chromic sutures are secured around the
uterus, appearing as suspenders,to
compress together the ant & post uterine
walls.
29. Internal iliac artery ligation
Techinically difficult
Usually successful in < half of patients in which
its attempted
Need adequate exposure
Peritoneum over common iliac artery opened &
dissected down to bifurcation of external &
internal iliacs
Then areolar sheath covering internal iliac is
incised longtudinally & a right-angle clamp is
carefully passed beneath the artery.
30. Internal iliac ligation cont’d
Careful not to perforate contiguous large
veins esp internal iliac vein.
Non-absorbable suture is inserted into
open clamp, jaws closed,suture carried
around vessel & vessel ligated.
NB: Pulsations in external iliac if present
before tying the ligature shd be present
after as well.
31. Internal iliac atery ligation cont’d
Mechanism of action here is an 85% reduction
in pulse pressure in the arteries distal to the
ligation.
This converts an arterial pressure system into
one with pressures close to those in the venous
circulation which are more amenable to
hemostasis via simple clot formation.
Bilateral ligation doesn’t seem to interfere with
subsequent reproduction
NB: HYSTERECTOMY-Last option
32. Management – Bleeding with firm uterus
Explore the lower genital tract
Requirements -appropriate analgesia
-good exposure and lighting
Surgical repair of vaginal and cervical
lacerations
May temporize with packing
33. Management – Continued uterine bleeding
Consider currettage
Correct possible coagulopathy – PTT, fibrinogen
If coagulation is abnormal
- Correct with clotting factors, platelets and
PRBC’s, cryoprecipitate
If coagulation is normal
- Rule out uterine rupture or inadequate
incision repair
- Consider uterine ligation, hysterectomy.
34. Management
ABC – ENSURE that you are always ahead
with your resuscitation
All obstetrical providers should have
access to medications to treat PPH
Consider need for more expert help
35. conclusion
Be prepared
Practise prevention
Assess the loss
Assess maternal loss
Resuscitate vigorously and appropriately
Diagnose the cause
Treat the cause
36. Secondary PPH
Occurs in approx 1% cases
Aetiology:
Retained placental fragments
Intrauterine infection(often coexists with the above)
Submucous fibroid
Lacerations and haematomas
Trophoblastic disease(a very rare but important
cause)
Chronic uterine inversion
37. management
Intravenous crystalloid
X-match blood
Intravenous antibiotics if any signs of sepsis
Under anaesthesia try to remove any placental
tissue
Follow this with cautious curettage
NB: Any tissue shd always be sent for
histopathological diagnosis-keeping in mind the
very rare case of trophoblastic disease