This document provides information about a 33-year-old pregnant woman admitted to the hospital with mild preeclampsia at 36 weeks of gestation. It includes her medical history, symptoms, physical exam findings, lab results, diagnosis, and notes on preeclampsia and its management. The key details are that she presented with swelling in her lower limbs and a history of amenorrhea for 8 months, and was found to have elevated blood pressure and mild preeclampsia at 36 weeks of pregnancy.
Pre- eclampsia and eclampsia accounts for approximately 63000 maternal deaths worldwide .The maternal mortality rate is as high as 14% in developing countries
Case Study Report on PIH and Severe Pre eclampsiaRashmi Regmi
it is a case study report on PIH and Severe Pre eclampsia
I did when I was posted on Kist Medical TEaching Hospital for Midwifery Practicum
Prepared by:
Rashmi Regmi
B Sc Nursing
Manmohan Memorial Institute Of health Sciences
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Pre- eclampsia and eclampsia accounts for approximately 63000 maternal deaths worldwide .The maternal mortality rate is as high as 14% in developing countries
Case Study Report on PIH and Severe Pre eclampsiaRashmi Regmi
it is a case study report on PIH and Severe Pre eclampsia
I did when I was posted on Kist Medical TEaching Hospital for Midwifery Practicum
Prepared by:
Rashmi Regmi
B Sc Nursing
Manmohan Memorial Institute Of health Sciences
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Toxemia of pregnancy: Definition,risk factors,Clinical features,management of pre-eclampsia. Nursing students will understand toxemia of pregnancy .Jasleen Kaur
A comprehensive overview of hypertensive disorders in pregnancy with its complications and management. Mainly focused on gestational hypertension, preeclampsia and eclampsia.
Dr Anil Arora address the liver diseases that are specific during pregnancy. The presentation contains case discussions on diagnosis, treatments & take home messages
Discover the critical insights you need to understand and combat pre-eclampsia in this engaging presentation. My expertly curated slides offer a comprehensive overview of this pregnancy-related condition, covering its causes, symptoms, risk factors, diagnosis, treatment options, and preventative measures. Don't miss this opportunity to gain a deeper understanding of pre-eclampsia and protect the health of expectant mothers and their babies.
Similar to Pregnancy Induced Hypertension - Pre eclampsia (20)
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
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
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.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
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
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.
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
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
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
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.
2. Name: Mrs. Nagalakshmi B D
Age: 33 yrs
W/O: Mr. Harish
IP No.: 98870
Place : bangalore
Occupation : Housewife
Date of Admission :18/10/13
Date of surgery 18/10/13
3. Chief complaints :
h/o 8 months of amenorrhoea
h/o Swelling of B/l lower limbs since 15 days
HOPI :
Patient with 8 months of amenorrhea appreciating fetal
movements well, was apparently normal 15 days back, when
she started noticing swelling of both lower limbs, aggravated
by work , no diurnal or postural variation, present through
out day
No H/o headache, blurring of vision, epigastric pain,
bowel/bladder disturbances, fever, rashes, bleeding
4. Obstetric History: ML: 12 years NCM G2P1L1
1st Pregnancy: in 2006 , FTVD of live male baby of
weight 2.5kg at Bangalore hospital. No antenatal/
Intrapartum/Postpartum complications . Breast fed for
6 months . H/o using male barrier contraception .
2nd pregnancy: Present pregnancy, spontaneous
conception
5. 1st Trimester : Pregnancy diagnosed by UPT ; +ve after
5 week of LMP. Started on Folic acid supplementation .
Blood investigations and scan done on 17/4/13
showed SLIUG . No H/o fever, rashes, excessive
vomiting, pain abdomen, bleeding/spotting PV.
2nd trimester: Quickening felt at 4th month of
gestation. Continued folic acid. Started on
Iron/Calcium supplementation. Immunised with 2
doses of Inj.T.T. Scan on 14/6/13 showing SLIUG of
18+2 weeks at 18+2 weeks by LMP, fetal doppler
normal.
6. 3rd trimester: Appreciates fetal movements well,
continued iron/calcium/ folic acid. Patient had
increased readings of BP since 30 weeks .Tab.
Methyldopa 250 mg BD started.
now referred to hospital with above complaints for
further management
7. Menstrual History: PMC: 3-4/ 24-25 days, regular,
normal flow, no clots
LMP- 8/2/13 EDD- 15/11/13
POG- 36 wks
Past History : No H/o Diabetes/hypertension/
Tuberculosis/ epilepsy/ Thyroid disorders.
Family History: No H/o Diabetes/ Tuberculosis/
epilepsy/ Thyroid disorders.
8. O/E
Moderately built and nourished. conscious and
cooperative
Vitals :
PR 88/min and regular
BP 150/90 mmHg measured in sitting position
Afebrile
B/l pedal edema
No pallor ,icterus cyanosis ,clubbing or
lymphadenopathy
9. Facies No abnormality
Upper incisors no loose or protruding teeth
Nose both nares patent no nasal airflow obstruction
Mallampati Class 2
Thyromental distance >3fingers
Mouth opening adequate
Movement at atlanto occipetal joint normal
No obvious external pathology
10. RS : B/L air entry equal NVBS
CVS : S1S2 heard, no murmur
P/A-Uterus 32-34 size, relaxed, cephalic lower pole ,
non tense, non tender , FHS+ 148 bpm regular
PROVISIONAL DIAGNOSIS
33 yrs female, G2P1L1 with 36 wks of gestation with
SLIUG, with mild pre eclampsia
11.
12. In 2000, National High Blood Pressure Education Program
classified hypertensive disorders complicating pregnancy
as:
Gestational hypertension
Preclampsia- eclampsia
chronic hypertension
chronic hypertension with superimposed preeclampsia
13. Blood Pressure ≥ 140/90 on two or more occasions
- in a previously normotensive
patient
- after 20 weeks gestation
- without proteinuria
- returning to normal 12 weeks
after delivery
Almost half of these develop preeclampsia
syndrome
14. Blood Pressure ≥ 140/90 before 20 weeks of
gestation
Or
Persistence of hypertension beyond 12 weeks after
delivery
15. New-onset proteinuria ≥ 300 mg/24 hours in
chronc hypertensive women but no proteinuria
before 20 weeks gestation
A sudden increase in proteinuria or blood pressure
or platelet count <1 lakh/mm3 in women with
hypertension and proteinuria before 20 weeks’
gestation
16. New onset of hypertension & proteinuria in a previously
normotensive woman
after 20 weeks of gestation
Returning to normal after 12 weeks of delivery.
Edema not a part of diagnosis now.
Eclampsia :
New onset of seizures or unexplained coma during
pregnancy or postpartum period in patients with pre-
existing preeclampsia and without pre-existing
neurological disorder
17. The NHBPEP has recommended that clinicians
consider the diagnosis of preeclampsia in the absence
of proteinuria when any of the following findings are
present:
1) Persistent epigastric or right upper quadrant pain,
2) Persistent cerebral symptoms,
3) Fetal growth restriction,
4) Thrombocytopenia,
5) Elevated serum liver enzyme concentrations
18.
19. • Preconception
- Partner related
Nulliparity
limited exposure to paternal sperms
Partner who fathered a preeclamptic pregnancy in
another women
-Non partner related
History of Preeclampsia in previous pregnancy
Advanced maternal age
Family history of Preeclampsia
History of placental abruptio, IUGR, fetal death
21. Exact mechanism unknown, disease of theories.
1. ABNORMAL PLACENTATION
Stage1: failure of trophoblastic invasion into
myometrium
Penetrates only decidua
superficial placentation ↓placental
perfusion
stage2 : endothelial damage
systemic manifestations of Preeclampsia
22.
23.
24.
25. Family history of pre eclampsia: genetic origin
Mutations in Complement Regulatory Protein gene
Genes assoc.:
MTHFR, F5 leiden, AGT, HLA, NOS3, F2(prothrombin), ACE
26.
27. Exposure to sperms of different partner
long term exposure to paternal antigen in
sperms of same partner- protective
activated auto antibodies to angiotensin
receptor-1 AA-AT1activate AT1
receptorsincreased sensitivity to angiotensins
hypertension
32. Vasospasm and exaggerated responses to
catecholamines
Characteristically, blood pressure and SVR are
elevated
Severe preeclampsia is usually a hyperdynamic
state
33. Pulmonary edema is a severe complication – 3 %
Plasma colloid osmotic pressure is diminished and
increased vascular permiability influences PE
T3 POST PARTUM
NORMAL 22 17
PRE ECLAMPSIA 18 14
34. Hemoconcentration
Thombocytopaenia most common
Platelet count correlates with disease severity and
incidence of abruptio placentae
DIC due to activation of coagulation
cascadeoverconsumption of coagulants and
platelets spontaneous haemorrhage
39. No screening test is really helpful
Various screening methods are:
Diastolic notch at 24weeks by doppler ultrasonography
Absence or reversal of end diastolic flow
Average mean arterial pressure ≥ 90 mmHg in second
trimester
Angiotensin infusion test: angiotensin infusion required to
raise the blood pressure >20 mm Hg from baseline
Roll over test: rise in blood pressure >20 mmHg from
baseline on turning supine at 28-32 weeks gestation is
positive.
40. Regular Antenatal checkup:
rapid gain in weight
rising blood pressure
edema
proteinuria/deranged liver or renal profile
Low dose Aspirin in High risk group: ↑PGs and↓TXA2
Calcium supplementation: no effects unless women
are calcium deficient
Antioxidants- Vitamin C and E
Nutritional supplementation: zinc, magnesium, fish
oil, low salt diet
41. Maternal
Gestational age 38 weeks*
Platelet count <100,000/mm3
Progressive deterioration in hepatic function
Progressive deterioration in renal function
Suspected placental abruption
Persistent severe headaches or visual changes
Persistent severe epigastric pain, nausea, or
vomiting
Fetal
Severe intrauterine growth restriction
Nonreassuring fetal status
Oligohydramnios
43. . Maternal evaluation :
Hemoglobin and hematocrit
platelet count : decreased, if < 1 lakh
coagulation profile
LFTs : indicated in all patients
KFTs : raised (S.urea creatinine is
decresaed in Normal pregnancy)
Urine Routine : proteinuria
44. Fetal evaluation :
Daily fetal movement count
Ultrasound
Doppler ultrasound for fetal blood flow
Velocimetry
45. . Seizure Prophylaxis
Routinely used in severe PE
Magnesium sulphate: most commonly used
Initiated with onset of labor till 24h postpartum
For caesarean, started 2hrs before the section till
12hrs postpartum
46. Delivery
The only definitive treatment
Preeclamptic patients divided into 3 categories
A- Preeclampsia features fully subside
B- partial control, but BP maintains a steady
high level
C- persistently increasing BP to severe level
47. Gp A: can wait till spontaneous onset of labor
don’t exceed Expected Date of Delivery
Gp B: >37wk terminate w/o delay
<37wk, expectant management at least
till 34wks
Gp C: terminate irrespective of POG,
start seizure prophylaxis and
steroids if<34wks
50. Is the diagnosis correct
Condition of mother before the start of
anaesthetic
Evidence of end organ damage
Airway
Haemodynamic monitoring
Fluid status: volume depleted patients
BP control
51. Coagulation status
Choice of anesthetic technique for LSCS
Evidence of recent bleeding causing hemodynamic
instability.
Drug history and status of the fetus
53. MEDICAL
General Measures-
Good rest , Salt restricted diet in severe cases,regular
follow up ,identification of risk factors and use of
predictors.
Specific Measures
Antihypertensive drug therapy
54.
55.
56. To establish & maintain hemodynamic stability (control
hypertension & avoid hypotension)
To provide excellent labor analgesia
To prevent complications of preeclampsia
To be able to rapidly provide anesthesia for Caesarean
Section
57. Neuraxial analgesia:
Lumbar Epidural-
gradual onset of sympathetic blockade
cardiovascular stability
↓ stress response
maintains uteroplacental circulation
avoids neonatal depression
extended analgesia if cesarean required
excellent post op analgesia
58. Combined Spinal Epidural Analgesia
Advantages
(1) provision of high-quality analgesia, which
attenuates the hypertensive response to pain
(2) reduction in levels of circulating catecholamines
(3) improvement in intervillous blood flow
(4) Provision of anesthesia through catheter for
emergency cesarean delivery
Disadvantage
epidural catheter function cannot be fully evaluated until
after resolution of the intrathecal analgesia
59. special considerations in pre eclampsia
(1) assessment of coagulation status,
(2) intravenous hydration prior to the epidural
administration of LA
(3) treatment of hypotension,
(4) use of an epinephrine-containing LA solution
62. Invasive central blood pressure monitoring not
routinely indicated
Does not improve patient outcome
Indications:
-Oliguria patients
-Unresponsive or refractory hypertension
-Persistent arterial desaturation
-Pulmonary edema
- massive hemorrhage
-frequent ABG measurement
63. Begins with the securing of a good IV access and
rapid fluid administration , An 18G is provided .
Choice of fluid should be isotonic saline or isotonic
solution containing electrolytes.
Only dextrose containing solutions should be avoided
as oxytocin infusions are known to have an antidiuretic
effect and can result in water intoxication
Patient transfers should be in left lateral position and
positioned same on table
67. Spinal anesthesia is a generally preferred anesthetic
technique in emergency
Simple to perform, provides rapid onset and a dense
block
spinal anesthesia can be safely used with 0.5 %
bupivacaine (5 – 10mg) along with 20 micg fentanyl
68. Epidural anesthesia considered the optimal
anesthetic technique for cesarean delivery
Advantages
relatively stable maternal BP
Increased uteroplacental blood flow
ability to titrate the administration of LA and
intravenous fluids
reduce the possibility of fluid overload and pulmonary
edema.
post op analgesia
69. Extension of an existing continuous lumbar epidural
aneshesia
Injection of 8 to 10 ml of 1.5 to 2 % lidocaine with
epinephrine 1 : 200000, 0.5 % bupivacaine , or
0.5 % ropivacaine provides level of T 10 analgesia
Addition of 25 – 50 micg fentanyl to LA will
• speed up the onset of block
• improve the quality and duration
• decrease visceral discomfort associated with uterine
exteriorization, interiorization, peritoneal retraction
70. platelet count lower than 50,000/mm3 precludes the
administration of neuraxial anesthesia.
For women with a platelet count between 50,000/mm3
and 80,000/mm3, the risks and benefits of neuraxial
anesthesia must be weighed against the risks of
general anesthesia
A platelet count of 75,000/mm3 to 80,000/mm3 for
epidural catheter removal
71. Indications
- coagulopathy
-sustained fetal bradycardia with reassuring
maternal airway
- severe ongoing maternal hemorrhage
- patients refusal
- contraindications to neuraxial technique
72. 1.Difficult intubation-
-smaller size tube
-difficult airway cart ready
2. Exaggerated and prolonged hypertensive response to
laryngoscopy and intubation: -risk of intracranial
hemorrhage.
-labetalol(10 mg),
esmolol( 2mg/kg ),
nitroglycerine (0.1 mg/kg/min),
nitroprusside(0.5mcg/kg/min)
remifentanyl (1mcg/kg)
73. 3.MgSO4 prolong action of both depolarising and
NDMR , as it inhibits calcium facilitated
presynaptic transmitter release
4. Impairs uterine and intervillous blood flow
5. Acid aspiration prophylaxis followed
74. 1. Induction :
Denitrogenation for 3 mins of 100 % oxygen
rapid sequence induction
induced with thiopentone(4-5 mg/kg) and
Sch(1-1.5mg/kg)
2. Intubation :
small size cuffed ETT 6 to 6.5
difficult airway cart should be ready
75. 3. Maintenance :
Maintained with 50 % N20 in O2 and volatile
halogenated agent ( isolflurane, desflurane )
after delivery, inhalational agent decreased
ratio of N2O: O2 increased to 70 : 30
narcotics, BZD administered
4. Extubation :
exaggerated CVS response should be avoided by pre
treating with lignocaine or esmolol
5. Post operative pain relief :
Intravenous or epidural opioids like fentanyl
76.
77.
78. Neonate of PIH mother is at higher risk for
prematurity
SGA
asphyxiation
drug depression
meconium aspiration
79. Immediate complications in neonate
respiratory distress
instability of body temperature
poor feeding
hypoglycemia
hypocalcemia
80. Severely PIH prone to
pulmonary edema
convulsions within 24 hrs of delivery
81. 1. Analgesia
2. Fluid balance - strict I/O chart,restrict intake 75ml/hr
3. Haemodynamic control
4. MgSO4 - atleast 24 hrs postpartum or until
diuresis ( 200 ml/hr for atleast 3 hrs )
82. CVA: main leading cause of death in pts with PE
Pulmonary edema, pleural effusion, ARDS
laryngeal edema
Placental abruptio’
Renal failure: oliguria most common
Liver:
Subcapsular liver hematoma
HELLP Syndrome,
hepatic rupture with shock
DIC
Eclampsia
Maternal death
85. Ultimate goal:
>34 wks gestation deliver
<34wks expectant management if stable maternal
and fetal conditions
Platelet transfusion if: <40,000/mm3 before cesarean
<20,000/mm3 before delivery
86. Rupture of a subcapsular hematoma of the liver is a
life-threatening complication of HELLP syndrome
manifest as abdominal pain, nausea and vomiting, and
headaches
pain worsens over time and becomes localized to the
epigastric area
Hypotension and shock typically develop, and the
liver is enlarged and tender
Treatment consisting of intravascular volume
resuscitation, blood and plasma transfusions, and
emergency laparotomy
88. Is the new onset of seizures or unexplained coma during
pregnancy or postpartum period in patients with pre-
existing PE and without pre-existing neurological disorder.
0.1- 5.5 per 10,000 pregnancies
Antepartum(50%): mostly in third trimester
Intrapartum(30%):
Postpartum(20%): usually within 48hours
89. Maternal age less than 20 years
Multigravida
Molar pregnancy
Triploidy
Pre-existing hypertension or renal disease
Previous severe Preeclampsia or Eclampsia
Nonimmune hydrops fetalis
Systemic Lupus Erythematosus
90. Eclamptic convulsions are epileptiform and consist of four
stages
Premonitory stage: twitching of muscles of face, tongue,
limbs and eye. Eyeballs rolled or turned to one side, 30s
Tonic stage: opisthotonus, limbs flexed, hands clenched,
30s
Clonic stage: 1-4 min, frothing, tongue bite, stertorous
breathing
Stage of coma: variable period.
91. Sustained rise in blood pressure
Tachycardia, Tachyponea
Rales
Mental status changes
Hypereflexia
Clonus
Papilloedema
Oliguria or anuria
Right upper quadrant or epigastric abdominal tenderness
Generalized edema
Small fundal height for the estimated gestational age
92. Loss of normal cerebral auto regulatory mechanisms
cerebral hyperperfusion
Edema & ↓cerebral blood flow
93. Early detection and judicious treatment with termination
of pregnancy in Preeclamptic patients
Adequate sedation, Anti hypertensives and prophylactic
Anticonvulsant in peripartum period
Observe for 24-48 hrs postpartum
94. 1. Prevention of seizures
2. Control of seizures
3. correction of hypoxia and acidosis
4. Blood pressure control
5. Delivery after maternal stabilization
95.
96. MgSO4 therapy:
DOC for prophylaxis of eclamptic convulsions
M.O.A:
blocks Ca2+ ion influx into neurons leading to cerebral VD
Other actions: -lowers endothelin-1 levels
- ↑ production of PG I2
- tocolytic action
- attenuates the release of Ach and
sensitivity to Ach at myoneuronal junction
97. Turn patient head to one side,
- apply jaw thrust if airway compromised
- nasopharyngeal airway
- Adequate oxygenation
- ensure adequate breathing , bag and mask ventilation
- secure an i.v line
- Drugs- Antiepileptics
Antihypertensives
- Delivery
98.
99. 1. Zuspan or sibai regime( iv regimen )
4-6 gm i.v over 15 min f/b infusion of 1-2 gm/hr
2. Pritchard regime( im regimen)
4 gm i.v over 3-5min f/b 5 gm in each buttock ( 14 gm
total )
maintenance of 5 gm i.m in alternate buttock 4 hrly
101. Stop infusion
Intravenous Calcium 10 ml 10% over 10 minutes
Endotracheal intubation in respiratory depression
102. o MgSO4 potentiate and prolong the action of both
depolarizing non-depolarizing muscle relaxants
o At higher doses Mg2+ rapidly crosses the placental barrier,
has been found to significantly ↓ FHR variability
o given cautiously with Ca2+ as may antagonize the
anticonvulsant effect of MgSO4
o cautious use in patients with renal impairment
o May ↑ the possibility of hypotension during regional block
103. Indications for cesarean section -
Fetal distress
Placental abruption
Extreme prematurity
Unfavorable cervix
Failed induction of labor
Recurrent seizures
105. Preeclampsia is a multisystem disorder.
Management is supportive, delivery is the only definitive.
Preeclampsia patients: High risk for difficult intubation.
Hypertensive response to laryngoscopy intracranial
hemorrhage.
Spinal Anaesthesia not contraindicated in severe
Preeclampsia
Eclampsia can be prevented by prophylactic MgSO4
therapy
Eclamptic patients should be monitored for at least 24 hrs
post partum.