The document discusses postpartum hemorrhage (PPH) and strategies for managing the third stage of labor to prevent PPH. It notes that the third stage of labor begins after delivery and ends with delivery of the placenta, taking on average 15-20 minutes. Active management of the third stage, involving administration of uterotonics and controlled cord traction within 5-10 minutes, is preferred over passive management and helps decrease bleeding, PPH risk, and maternal mortality. The placenta can separate via the Schultze or Duncan method. Uterine contractions are key to separation, and oxytocin is used if the placenta does not separate on its own.
NURSING MANAGEMENT OF THIRD AND FOURTH STAGE OF LABOUR.docx.pptxAyushi958023
In this ppt you will learn about Nursing management of third stage of labor(expected and active management) and Nursing management fourth stage of labor.
NURSING MANAGEMENT OF THIRD AND FOURTH STAGE OF LABOUR.docx.pptxAyushi958023
In this ppt you will learn about Nursing management of third stage of labor(expected and active management) and Nursing management fourth stage of labor.
Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and before the birth of the baby. The most important causes of APH are placenta praevia and placental abruption
Under the topic of (APH) I talked about the most common causes of (APH) which are placental causes, including Placental Abruption, Placenta Previa and Vasa previa and I depended on the most famous obstetric and gynecological books, Like:
1-An evidence-based text for MRCOG, THIRD EDITION. 2016
2-Bedside Obstetrics and Gynecology (2010)
3-Differential_Diagnosis_in_Obstetrics and gynecology
And other books
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.
Antepartum hemorrhage (APH) is defined as bleeding from or into the genital tract, occurring from 24+0 weeks of pregnancy and before the birth of the baby. The most important causes of APH are placenta praevia and placental abruption
Under the topic of (APH) I talked about the most common causes of (APH) which are placental causes, including Placental Abruption, Placenta Previa and Vasa previa and I depended on the most famous obstetric and gynecological books, Like:
1-An evidence-based text for MRCOG, THIRD EDITION. 2016
2-Bedside Obstetrics and Gynecology (2010)
3-Differential_Diagnosis_in_Obstetrics and gynecology
And other books
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.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
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
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
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
2. Third stage of labor
Begins after delivery of baby and ends at the delivery of placenta
Plays crucial role in PPH
If third stage is managed properly, PPH can be prevented
Average duration of third stage => 15-20 mins
If third stage duration 30 mins or more => Prolonged third labor/retained
placenta
3. Third stage can be managed by
Passively
• Duration = 15-20 mins
• Waiting for spontaneous expulsion
of placenta
• Chances of PPH & Maternal
mortality are more
• Since human placenta is deciduate,
it has to shed off after delivery
Actively
• Duration = 5-10 mins
• If Active management of third labor
= 5-10 mins, then:
Decrease in bleeding
Decrease chance of PPH
Decrease Maternal mortality
Active Management is the preferred method of third stage
management and is the best method to prevent PPH
4. Delivery of Placenta is the main event in third stage delivery and it occurs by two methods
Schultze method:
Placenta starts separating from centre
Retroplacental clot is formed
(haemostatic – blood loss is less)
Bleeding is evident only after entire
placenta is separated
Shiny fetal side of placenta comes first
Most common method
Duncan method:
Placenta starts separating from
periphery
No retroplacental clot formed (blood
loss is more)
Bleeding is evident as soon as
placenta separates
Dull maternal side of placenta which
comes first
Less common method
5. General points
Most important factor responsible for placental separation is uterine contractions
In all cases of Retained placenta, 1st management is increase uterine contractions by giving oxytocin
(Methergin, prostaglandins are not recommended)
If even after giving oxytocin, placenta is not getting separated, then, manual removal of placenta is done in
OT under general anaesthesia
Line of separation of placenta lies along Zona Spongiosa
Living liqature:- Middle layer of myometrium, has fibres in criss cross manner in which blood vessels are
there in between them (when uterus contracts, blood vessels constricted)
Height of uterus immediately after delivery is just below the umbilicus (~-20 weeks of pregnancy)
Signs of placental separation:
1. Sudden rush of blood per vagina
2. Suprapubic bulge
3. Height of uterus increases slightly
4. Apparent lengthening of cord (permanent)
Most important – Feel the placenta in vagina > lengthening of cord
6. Steps in Active Management of Third
Stage of Labor (AMTSL)
1. Administer u
No more than one prior low transverse caesarean section
Clinically adequate pelvis
No other uterine scars or previous rupture
Physician immediately available throughout active labour to monitor
labour and for emergency LSCS if required
Availability of anesthetist for emergency LSCS
7. ABSOLUTE CONTRAINDICATION FOR
VBAC
Prior classic, T shaped incision or other transmural uterine surgery
Contracted pelvis
Medical or obstetric complication that preclude vaginal delivery
Patient refusal
Inability to immediately perform caesarean section because of unavailable
surgeon or anaesthetist, inadequate staff or facility
Previous rupture or scar dehiscence
Non reassuring fetal status
Previous 2 LSCS
8. Factors influencing VBAC
1. PREVIOUS VAGINAL DELIVERY
Those woman who gave birth vaginally atleast once are 9-28 times
more likely to have a successful VBAC and the success rate is 83-95%
2. PRIOR VBAC
It is the single best predictor for successful VBAC with an
approximately 87-90% planned VBAC success rate
3. LARGE FOR GESTATIONAL AGE/ MACROSOMIA
Successful VBAC with suspected macrosomia infants > 4000gm often
have a vaginal delivery rate of only 50-60%.
There is absolute risk of 3.6% for uterine rupture. Discourage VBAC
attempts in those gestations with EFW-4250gm or more.
9. 4. INDICATION FOR PRIOR CESAREAN SECTION
Non recurrent causes – Breech, Fetal distress
Success rate was less for –Dystocia, Failure to progress.
5. MATERNAL OBESITY
As the maternal weight increases (BMI>30), the rate of VBAC
success decreases
10. 6. OTHER FACTORS
At or after 40 weeks of gestation
Previous preterm caesarean section
Advanced maternal age
ALL THESE ARE ASSOCIATED WITH A DECREASED LIKELIHOOD OF
PLANNED VBAC SUCCESS
11. Monitoring of labour with a previous
caesarean section.
Establish IV line
Blood for cross-matching to be sent
Clear fluids are to be allowed. Fluid replacement same as normal labour
Maternal monitoring –PR every half hourly, BP-2 hourly till she progresses
to established labour
Oxytocin can be used for induction/augmentation of labour after
amniotomy. Titration of dose has to be done with careful fetal and
maternal monitoring
Record FHR continuously
Record progression of labour in partogram
12. Signs of scar dehiscence
Unexplained maternal tachycardia
Pain at incision site
Deceleration of FHR on CTG – Prolonged deceleration or variable decelerations
that are persistent and severe is the most specific sign of uterine rupture
Meconium stained liquor
Scar tenderness
Fresh bleeding PV
Sudden cessation of uterine contractions or there is receding of presenting
part on PV examination
Fetal parts palpable superficial on Per abdomen examination
Hematuria
13. Complications in pregnancy with previous
caesarean section
UTERINE RUPTURE
Complete rupture
When all layers of uterine wall are separated . It includes extrusion of
intrauterine contents into the abdominal cavity
Incomplete /Partial rupture or Scar dehiscence
Uterine muscle is separated but visceral peritoneum is intact. This includes
extrusion of intra uterine contents into the broad ligament
14. Symptoms of uterine rupture
Pain in lower abdomen/ incision site (Ranging from mild to severe and
sometimes a tearing sensation)
Shoulder pain
Uterine contraction often diminishes in intensity and frequency
Dizziness and weakness
Gross hematuria
15. Signs of uterine rupture
Tenderness over the whole abdomen
Distension of the abdomen
Uterine contour not well maintained
Fetal parts more superficially palpated
Fetal heart sound absent
Bleeding Pv, hematuria may or may not be present
Receding of the presenting part on PV examination
16. Management of uterine rupture
Exploratory laparotomy followed by repair or hysterectomy.
REPAIR THE UTERINE DEFECT - it is technically feasible if:
- hemostasis can be achieved
- the patients need to retain fertility
CESAREAN HYSTERECTOMY - It is required:
- If extension into broad ligament vessels
- Uncontrolled uterine bleeding
- The presence of placenta accreta
17. Maternal mortality and morbidity
The vast majority of maternal deaths in women with prior caesarean
section arise due to medical disorders
-THROMBOEMBOLISM
- PRE ECLAMPSIA
- SURGICAL COMPLICATIONS
- UTERINE RUPTURE
No statistically significant difference between planned VBAC
(17/10,000)and ERCS (44/10,000)
Maternal mortality is higher in women with unsuccessful VBAC
18. Perinatal mortality and morbidity
Planned VBAC carries a 2-3/10,000 additional risk of birth related perinatal
death when compared with ERCS
VBAC is estimated with 10/10,000 risk of antepartum still birth beyond 39
weeks of gestation and 4/10,000 risk of delivery related perinatal death
VBAC reduces the risk of TTN/RDS in fetus.