1. Preeclampsia is defined as new onset hypertension and proteinuria after 20 weeks of gestation. It affects 5-10% of pregnancies globally and contributes to maternal deaths.
2. It is classified as mild or severe preeclampsia depending on blood pressure and presence of organ dysfunction. Risk factors include primiparity, obesity, and prior preeclampsia.
3. The pathogenesis involves defective placentation leading to an imbalance of angiogenic factors and endothelial dysfunction. This causes organ damage through vasospasm and reduced perfusion. Complications can affect the brain, liver, kidneys and other organs in both mother and fetus.
Dr Anil Arora address the liver diseases that are specific during pregnancy. The presentation contains case discussions on diagnosis, treatments & take home messages
HYPERTENSION IN PREGNANCY SOGON FINAL ONE.pptAdeniyiAkiseku
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Hypertensive disorders are the most common medical complication of pregnancy
It complicates up to 10% of pregnancies
It is a leading cause of maternal and perinatal morbidity and mortality worldwide
Rates are rising because of the older, more obese obstetric population with medical issues
Dr Anil Arora address the liver diseases that are specific during pregnancy. The presentation contains case discussions on diagnosis, treatments & take home messages
HYPERTENSION IN PREGNANCY SOGON FINAL ONE.pptAdeniyiAkiseku
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Hypertensive disorders are the most common medical complication of pregnancy
It complicates up to 10% of pregnancies
It is a leading cause of maternal and perinatal morbidity and mortality worldwide
Rates are rising because of the older, more obese obstetric population with medical issues
Global launch of the Healthy Ageing and Prevention Index 2nd wave â alongside...ILC- UK
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The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Global launch of the Healthy Ageing and Prevention Index 2nd wave â alongside...ILC- UK
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The Healthy Ageing and Prevention Index is an online tool created by ILC that ranks countries on six metrics including, life span, health span, work span, income, environmental performance, and happiness. The Index helps us understand how well countries have adapted to longevity and inform decision makers on what must be done to maximise the economic benefits that comes with living well for longer.
Alongside the 77th World Health Assembly in Geneva on 28 May 2024, we launched the second version of our Index, allowing us to track progress and give new insights into what needs to be done to keep populations healthier for longer.
The speakers included:
Professor Orazio Schillaci, Minister of Health, Italy
Dr Hans Groth, Chairman of the Board, World Demographic & Ageing Forum
Professor Ilona Kickbusch, Founder and Chair, Global Health Centre, Geneva Graduate Institute and co-chair, World Health Summit Council
Dr Natasha Azzopardi Muscat, Director, Country Health Policies and Systems Division, World Health Organisation EURO
Dr Marta Lomazzi, Executive Manager, World Federation of Public Health Associations
Dr Shyam Bishen, Head, Centre for Health and Healthcare and Member of the Executive Committee, World Economic Forum
Dr Karin Tegmark Wisell, Director General, Public Health Agency of Sweden
Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patientâs body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
Welcome to Secret Tantric, Londonâs finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the cityâs most beautiful masseuses.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
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R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
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M Capital Group (âMCGâ) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, âDespite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.â
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (âMTIâ) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
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Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
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QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
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From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
2. DEFINITION
⢠Hypertension in pregnancy is defined as a systolic blood pressure (bp)
>/ 140 mmhg and / or diastolic BP >/90 mmhg. The measurement
confirmed bt two or more readings in 4 hours apart.
3. PREVALENCE
⢠Hypertension and pre eclampsia contributes 5-10% of pregnancies
globally and 7-8% in india.
⢠Hypertensive disorders contribute 5% of maternal deaths in india.
4. CLASSIFICATION
⢠ACOG CLASSIFICATION OF HYPERTENSION IN PREGNANCY
1. GESTATIONAL HYPERTENSIOM
2. PRE ECLAMPSIA AND ECLAMPSIA
3. CHRONIC HYPERTENSION
4. PRE ECLAMPSIA SUPERIMPOSED ON CHRONIC HYPERTENSION
5.
6. GESTATIONAL HYPERTENSION
⢠When hypertension ( BP of 140/90 mmhg or more) develops for the
first time after 20 weeks gestation, documented on two occasions at
least 4 hours apart in previously normotensive woman, and there is
no proteinuria, or signs of end organ dysfunction, it is called
gestational hypertension.
⢠As the disease progresses it may be reclassified into
⢠Pre eclampsia , if protienuria or no new signs of end organ damage
⢠Chronic hypertension: if hypertension persists 12 weeks after delivery
⢠Transient hypertension: if blood pressure is normal by 12 weeks after
delivery
7. PRE ECLAMPSIA
⢠Pre eclampsia syndrome is a new onset hypertension (>140/90 mmhg) on 2
occasions, 4 hours apart, that develop after 20 weeks gestation and is associated
with
⢠Protienuria or
⢠Evidence of multiorgan dysfunction with or without protienuria.
⢠Protienuria is defined as :
⢠A value of >/300 mg or more in 24 hour urine sample or
⢠Spot urine protein: creat ratio of >/0.3 or
⢠A value of 30 mg/dl protien in a random urine sample or
⢠A urine dipstick reading of >/1+ in a single random urine sample if the other
quantative methods are not available.
⢠A cut off >/2+ is reccomended by acog.
8. PROTIENURIA
⢠Protienuria is defined as :
⢠A value of >/300 mg or more in 24 hour urine sample or
⢠Spot urine protein: Creat ratio of >/0.3 or
⢠A value of 30 mg/dl protien in a random urine sample or
⢠A urine dipstick reading of >/1+ in a single random urine sample if the
other quantative methods are not available.
⢠A cut off >/2+ is reccomended by acog.
10. NON SEVERE PREECLAMPSIA
⢠The BP is >140/90 mmhg but less than <160/110 mmhg . this is confirmed
by repeat examination 4 hours apart.
⢠Protienuria is usually present.
⢠In some women , proteinuria may be absent, but one or more features of
end- organ involvement are usually present:
⢠Platelet count:<100,000/cumm
⢠Serum creatinine >1.1 mg/dl
⢠Liver transaminase twice the upper limit of normal
⢠Pulmonary edema
⢠Cereberal or visual symptom- headache, blurring of vision,and scotoma
11. SEVERE PREECLAMPSIA
⢠It is diagnosed when :
1.The BP >160/110 mmhg
2. There is protienuria and/ or
3. There is evidence of multiorgan involvement
The essential difference between non severe and severe pre eclampsia
is the blood pressure. Non severe pre eclampsia can progress rapidly to
severe pre eclampsia.
12. RISK FACTORS
⢠Primiparity
⢠Age,18 years
⢠Advanced maternal age (>35 years)
⢠High body mass index (>30 kg/m2)
⢠Multiple pregnancy
⢠Hydatidiform mole
⢠Maternal medical problems: diabetes, hypertension,renal
disease,connective tissue disorder, antiphospholipid syndrome
⢠Past or family history of preeclampsia
13. ETIO PATHOGENESIS
⢠Complex multifactorial etiology
⢠Many theories have been put forward
⢠often referred to as a âDisease of Theoriesâ
⢠It is a late manifestation of a multifactorial, multisystem disease, initiated
very early in pregnancy, suggesting an inadequate maternal response to
pregnancy.
⢠The most favored recent theory about etiopathogenesis talks about a two-
stage theory
⢠Stage I âdefective Placental invasion of maternal blood vessels in first
trimester
⢠Stage II- toxic consequences of stage I leading to vascular spasm and
endothelial damage
15. Pathogenesis
⢠Defective placental invasion leads to an imbalance between
angiogenic(PIGF) and anti-angiogenic factors(soluble fts-like tyrosine
kinase 1(sFlit-1) + releases of toxic cytokines in circulation
⢠Along with immunological, environmental and genetic factors-
⢠Leads to vasospasm and endothelial damage in the blood vessels all
over the vascular tree
⢠Vaso spasm ď reduced organ perfusion
⢠Endothelial damage ď platelet aggregation ď thrombocytopenia
20. Clinical features
⢠Primigravida, elderly gravida (>40years)
⢠Obese
⢠Diabetic
⢠H/O PE in a previous pregnancy , F/O HT
⢠Symptoms ď of headache, blurring of vision epigastric pain
⢠Signs ď BP > 140/90 â150/100 mm of Hgď Mild PE
⢠BP > 160/110mm of Hgď Severe PE
⢠Pedal edema, puffy face, pallor, Brisk DTR
⢠Abdominal wall edema
⢠Obstetric examination ---FGR, reduced liquor
22. Principles of Management
⢠Pre-pregnancy counselling
⢠Prevention
⢠Early detection
⢠Treatment â
⢠Aims of treatment-
⢠Control of Blood pressure
⢠Prevention of complications
⢠Monitor fetal growth/well-being
⢠Judicious timely delivery
23. Pre-pregnancy counselling
⢠Identify High-risk women
⢠Normalise BP
⢠Treat thyroid disorder
⢠Optimize weight
⢠Treat anaemia
⢠Investigate for CKD
⢠Investigate for ALPA syndrome âespecially in women with H/O-
⢠RPL
⢠Early onset, severe PE
⢠BOH
⢠H/O placental abruption
24. Tests for Early detection of PE
⢠Detailed history
⢠High free beta HCG in DUAL marker test, high PAPP-A
⢠High inhibin A, Activin A in Quadruple test
⢠Persistent diastolic notch in uterine artery Doppler after 14 weeks
⢠Role over test
⢠sFlt-1/ PIGF ratio
25. Prevention
⢠Routine supplementation with calcium, magnesium, omega-3 fatty
acids, or antioxidant vitamins is ineffective.
⢠Calcium+ Vit D reduces the risk of developing preeclampsia
⢠Low-dose aspirin 150mg at bedtime is effective for women at
increased risk of preeclampsia from 11 weeks to 36weeks
⢠Low-dose aspirin is effective for women at highest risk from previous
severe preeclampsia, diabetes, chronic hypertension, or renal or
autoimmune disease
⢠LMWH in women with Biochemically detected APLA syndromeâto be
stared in first trimester after appearance of cardiac activity
26. Treatment
⢠The ultimate cure is DELIVERY.
⢠Assess gestational age
⢠Assess cervix
⢠Fetal well-being
⢠Laboratory assessment
⢠Rule out severe disease
27. Treatment mild PE
⢠Admission for BP charting, investigation
⢠OPD treatment âfrequent visits âevery visit âmeasure BP, Weight , Urinary
protein assess fetal growth
⢠Dietary salt restriction has no effect
⢠Bedrest has no effect
⢠Start antihypertensive drugs only if BP is persistently at 150/100
⢠Investigate periodically to see the worsening of the disease
⢠Fetal monitoring by USG, Doppler, and Biophysical profile
⢠Deliver at term
⢠Gestational hypertension (HT without proteinuria ) deliver at 38Weeks
28. Severe PE (BP > 160/110)
⢠Admission
⢠Investigate âCBC, LFT, RFT, Coagulation, urinary proteins, and fundoscopy.
USG + Doppler
⢠Anti hypertensives
⢠MGSO4 for prevention of eclampsia
⢠IF > 37 weeks ď deliver âIOL
⢠If 34-37weeks ď Antihypertensive ,MGSO4 + IOL
⢠If less than 34 weeks
⢠Steroids for fetal lung maturity
⢠Monitor FWB by Doppler +USG + NST
⢠IOL and delivery
29. Mode of delivery
⢠Vaginal delivery is preferred
⢠Pt in labour âAugment labour
⢠Poor bishop âinduce labor
⢠Caesarean section
⢠For obstetric indication
⢠Fetal distress
⢠Deranged fetal Doppler
⢠Eclampsia âpoor bishop score
30. Mild PE Expectant treatment{BP 140/90-
150/100}
⢠Maternal monitoring ;
⢠Frequent ANC visits
⢠Measure BP twice weekly
⢠Obtain lab tests weekly: CBC, Platelets, AST, ALT, LDH , uric acid , creatinine
⢠Urinary protein by urine protein creatinine ratio/24-hour urinary protein
⢠Fetal monitoring
⢠NST Biweekly,
⢠AFI weekly or twice weekly
⢠Biophysical profile weekly
⢠USG for fetal biometry every three weeks
31. Management in Severe PE
⢠Admit in LR
⢠If gestation 37weeks or more â
⢠Investigate, obstetric assessment â
⢠Antihypertensives
⢠MGSO4 for eclampsia prevention
⢠Induce labor ---Deliver
⢠34-37 weeks
⢠obstetric assessment
⢠Deliver
⢠<34 weeks
⢠Steroids +IOL after 48hours
⢠<32weeks
⢠Steroids + MGSO4 for neuroprotection
⢠Deliver after 48 hours
32. Severe Preeclampsia
â˘Indications for delivery irrespective of gestational
age-
⢠Uncontrolled HT
â˘Development of complication
â˘Severe FGR with Doppler changes
â˘IUFD
33. Antihypertensive
⢠Start antihypertensives if BP is persistently 140/100-150/100mm of Hg
⢠Labetalol is the drug of choice
⢠Start at 100-200 mg TDS can be increased to 800 mg TDS
⢠Very high BP (160/110 mm of Hg)
⢠IV labetalol 20mmg IV ď 40mg IV --80mg IV --80 mg every 10-15 minutes (maximum 220 mg
in 24 hours)
⢠20 mg /hr IV infusion
⢠BP monitoring every 15-20 minutes
⢠Other antihypertensives â
⢠Nifedipine, alpha-methyl dopa, hydralazine, Nitro-glycerine (NTG)
⢠Avoid ace inhibitors âcause fetal malformations if taken in the first trimester
⢠Fetal renal damage in the second, and third trimesters
34. MGSO4 in severe PE
⢠Prevention and /or treatment of eclampsia in severe PE or impeding eclampsia
⢠Offers Maternal and fetal neuroprotection
⢠Acts on neuro-muscular junction
⢠Indication
⢠Severe PE
⢠Impending eclampsia â(severe headache, blurring of vision, epigastric pain , brisk DTR)
⢠Eclampsia
⢠MHSO4 regimes IV/IM injections
⢠Pritchardâs - 14
⢠Dhaka
⢠Zuspan
35. Pritchard regime âmost commonly used
⢠Loading dose :
⢠4gram IV diluted as 20 % solution IV slowly
⢠+ 10gram IM injection (5 grams in each buttock)
⢠Maintenance dose:
⢠5 gram IM every 4 hours in alternate buttocks to be continued for 24 hours after delivery
⢠Monitoring :
⢠Urine output -30ml/hour
⢠Respiratory rate
⢠DTR
⢠Toxicity
⢠Absent DTR
⢠Respiratory paralysisâneeding Intubation and mechanical ventilation
⢠Antidote
⢠Calcium gluconate- 10 ml of 10% solution iv slowly over 10 minutes
36.
37. Management in labour
⢠Frequent monitoring of BP, Respiration, Pulse
⢠Routine monitoring of Progress of labour
⢠FHR monitoring by CTG
⢠Maintain hydration nutrition
⢠Cut short 2nd stage
⢠AMTSL
⢠Avoid methyl ergometrine
⢠Careful monitoring of 4th stage of labour
38. Post partum management
⢠After delivery continue MGSO4 for 24 hours
⢠Continue anti-hypertensive for 1 week
⢠Monitor vitals, urine output , look out for complications
⢠Counsel for contraception
⢠Foll0w-up for chronic HT