“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
“Difficulty encountered in the delivery of the fetal shoulders after delivery of the head.”
Shoulder dystocia is an unpredictable obstetric complication with the incidence of 0.15% to 2%.
An increase in the incidence of shoulder dystocia has been recorded over the last 20 years. Incidence appears to be increasing as birth weights increase.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
This topic contains definition, incidence, types, causes, diagnosis, mechanism, management of occipito posterior position and deep transverse arrest and manual rotation of occipito posterior position
this is the first part of my FACE PRESENTATION.this ppt contains all the required content for a face presentation and mechanism of labour in face presntation and also for diagnosis i uploaded another ppt. the main objective of my ppt is the viewers shouldn't get bored of what we say this is simplified yet professional .. have a look at it and enjoy, thank you.
This is the relationship of the longitudinal axis of the fetus to longitudina...ssuser0d3989
Breech Presentation: This is one of the most well-known anomalies in fetal positioning. In a breech presentation, the baby's buttocks or feet are positioned to emerge first during childbirth, rather than the head. Breech presentations occur in approximately 3-4% of full-term pregnancies. There are different types of breech presentations, including frank breech, complete breech, and footling breech.
Transverse Lie: In this position, the fetus is lying horizontally across the uterus, with its head on one side and its feet on the other. This positioning can obstruct the birth canal and make vaginal delivery difficult or impossible.
Face Presentation: This occurs when the fetus presents with its face rather than the top of its head toward the birth canal. Face presentations are relatively rare and may result in prolonged labor or the need for cesarean delivery.
Occiput Posterior Position: In this position, the fetus is facing the mother's abdomen rather than her spine, with the back of the baby's head (occiput) against her spine. This position can lead to back labor and increased discomfort during childbirth.
Compound Presentation: In a compound presentation, one of the baby's limbs (such as an arm or hand) presents alongside the head during delivery. This can complicate the delivery process and increase the risk of injury to both the baby and the mother.
Asynclitic Presentation: This occurs when the baby's head is tilted to one side, making it difficult to descend through the birth canal. Asynclitic presentations can prolong labor and increase the likelihood of instrumental delivery (e.g., forceps or vacuum extraction).
Anomalies in fetal position can be diagnosed through physical examination, fetal ultrasound, or other imaging techniques. Management of these anomalies may involve techniques to try to manually correct the position of the fetus, such as external cephalic version for breech presentations, or interventions during labor and delivery, such as cesarean section.Breech Presentation: This is one of the most well-known anomalies in fetal positioning. In a breech presentation, the baby's buttocks or feet are positioned to emerge first during childbirth, rather than the head. Breech presentations occur in approximately 3-4% of full-term pregnancies. There are different types of breech presentations, including frank breech, complete breech, and footling breech.
Transverse Lie: In this position, the fetus is lying horizontally across the uterus, with its head on one side and its feet on the other. This positioning can obstruct the birth canal and make vaginal delivery difficult or impossible.
Face Presentation: This occurs when the fetus presents with its face rather than the top of its head toward the birth canal. Face presentations are relatively rare and may result in prolonged labor or the need for cesarean delivery.
Occiput Posterior Position: In this position, the fetus is facing the mother's abdomen rather than her spine, with the
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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.
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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
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
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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
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3.
Fetal cranium made of 5 bones- 2 parietal bones / 2
frontal bones and the occipital bone
These are held together by membranous structures
called sutures- permit movements of bones during
labour
There are 4 prominent sutures
1. Coronal suture : separates frontal bones from
parietal bones
2. Sagittal suture : separates two parietal bones
3. Lamboid suture : separates occipital bone from
parietal bones
4. Frontal suture : separates two frontal bones.
4.
Fontanelle : When two or more sutures meet, there is
an irregular membranous part between them called
fontanelle
There are two important fontanelles
1. Anterior fontanelle ( bregma ) : Diamond shaped
area at the junction of coronal and sagittal sutures.
AP/transverse diameter 3 cm. Fused around ~18
months
2. Posterior fontanelle ( lambda ) : Small triangular
area at the junction of sagittal and lamboid sutures
(closes 2-3 months after birth )
5.
6. Regions of Fetal Head
Occiput : The bony prominence that lies behind
posterior fontanelle
Vertex : Diamond shaped area between anterior and
posterior fontanelle
Sinciput : Area in front of anterior fontanelle. Includes
forehead.
Brow – between bregma and root of nose
lying below root of nose and supra orbital bridges
7.
8. Diameters of Fetal Head
Five important diameters.
1. Suboccipito-bregmatic
diameter
2. Suboccipitofrontal
diameter
3. Occipitofrontal diameter
4. Mentovertical diameter
5. submentobregmatic
diameter
9. Suboccipito-bregmatic
diameter
The diameter is from suboccipital
region to centre of the bregma.
Diameter = 9.5 cm
Fetal head circumference is
smallest (32 cm )
Head well flexed
Flexed vertex presentation
11. Occipito-frontal diameter
Diameter extends from the
prominent point of mid-frontal
bone to the most prominent point
of occipital bone
The diameter = 11.5 cm
Fetal head circumference ~ 34.5
cm
Vertex is deflexed
Associated with Direct occipito-
posterior position.
12. Occipito-posterior position
It is a vertex presentation in which
the occiput is placed posteriorly .
It can be:-
1.Right occipto-posterior (the
commonest)
2.Left occipto-posterior.
3.Direct occipto-posterior
Associated diameters are
1. Suboccipito frontal diameter
2. Occipitofrontal diameter
13. Incidence :Incidence :
In 20% of cases the occiput is posterior at the beginning of
labour .
Causes :-Causes :-
1. Pelvic Factors:- 50% of cases are associated with anthropoid
pelvis or android pelvis .
2.Fetal Factors:- Marked deflection of the fetal head due to high
pelvic inclination or anterior wall placenta .
3.Uterine Factor:- Abnormal uterine contraction which may be
the cause or effect .
14. DiagnosisDiagnosis
Abdominal Examination
Features suggesting the diagnosis include
-backache during labour.
-flattening of the abdomen below the umbilicus .
-the fetal limbs are more easily felt near the midline on both
sides.
-The head not engaged and feels larger than usual
15. Problems associated with Occiput Posterior –
-the head faces the front of the mother's pelvis instead of
turning toward the mother's back.
-delivered with the head facing the ceiling,which is often a
more difficult way to deliver.
vaginal examination
-Elongated bag of membrane which is likely to rupture early .
-High deflexed head with the anterior fontanelle in the centre of
the pelvis .
16. - A large episiotomy may be required.
- OP may lead to dysfunctional labour (in primigravida).
- Contraction may be painful and accompanied by backache
Mechanism of Labour in OP position
First and second stage of labour usually prolonged .
-membrane usually rupture early with the hazards of cord
prolapse and infection .
-In favorable circumstances (90% of cases) good uterine
contraction result in good flexion of the head and the occipt
rotates 3/8 of the circle (135c0
) anteriorly and deliver as
occipito-anterior position .
17. In unfavorable circumstances (10% of cases) the occiput
1. Fail to rotate and remain in the oblique diameter of the pelvis .
2. Rotate anteriorly 1/8th
of circle (short rotation) and the head
become arrested in the transverse diameter of the pelvis (deep
transverse arrest) .
3. Rotate posterioly 1/8th
of the circle to lie on the sacral hollow
this called direct-occipto- posterior position .
And if the fetus is small & pelvis is Adequate spontenous delivery
can occur as face to pubic.
18. ManagementManagement
- Unless there is fetal hypoxia or other complication labour is
allowed to proceed with the following special instructions .
-Provide adequate analgesia (an epidural is ideal).
-Prevent dehydration with intravenous fluid.
-You may need to promote uterine contraction with oxytocin .
-Good monitoring for progress of labour ,fetal condition and
maternal condition .
19. - In the majority of cases anterior rotation of the occipt is
completed and the baby is delivered as occipto-anterior.
- In direct occipto-posterior delivery as face to pubis may
occur ,The perineum should be protected by a generous
episiotomy.
Persistent –occipto posterior and deep transverse arrest .
- If the fetal head is not engaged caesarian section is the
treatment of choice .
- If the fetal head is engaged the treatment will be one of
the following .
20. 1) Manual rotation and delivery by forceps as
occipto-anterior .
2) Rotation to occipto-anterior and extraction using
kielland’s forceps .
3) Ventouse (vacuum extraction).
4) Caesarean section if the above lines of treatment
fail or there is other complicating factor .
5) Craniotomy when the fetus is dead .
21. Mento-vertical diameter
Diameter extending from the
chin to furthest point of vertex.
Measures 13cm
Largest antero-posterior
diameter
Head is partially extended.
Associated with brow
presentation
22. Brow presentation
Incidence:
ranges from 1:1000 to 1:3500
Rarest malpresentation
The presenting diameter 13.5cm
(mento-vertical )
Incompatible with vaginal delivery
Causes
Prematurity
Multiple pregnancies
Goiter or hygroma
23. DiagnosisDiagnosis
Abdominal examination-
suspect if both chin and occiput are palpable
head doesn't descend below ischeal spines
Vaginal examination
Palpate supra orbital ridges/nose, anterior
fontanelle.
Cant palpate chin.
26. Face presentation
Incidence :
1:600- 1:1500
Due to hyper-extension of fetal head
Presenting diameter 9.5 cm
(submento-bregmatic diameter )
Engagement of fetal head late
Progression of labour slow
Probably due to lack of molding of
facial bones
27. CausesCauses
Fetal anomalies.
The most common anomaly that causes face presentation
is anencephaly. Anencephalic babies present face first
because of the faulty development of the cranium.
Tumors on the neck or back may also cause extension of
the head.
Pelvic contractures or android pelvis. This is the major
factor. It accounts for about 40% of face presentations.
Fetopelvic disproportion
Multiparity
28.
Preterm birth
Polyhydramnios. When the membranes rupture the
rush of fluid may cause the head to extend as it
descends.
Coils of umbilical cord around the neck.
DiagnosisDiagnosis
Vaginal examination
The orbital ridges/nose/malar eminences/ mentum/
mouth and gums
29. Management
In the chin-anteriorchin-anterior
position prolonged labor
is common. Descent
and delivery of the head
by flexion may occur.
In the chin-posteriorchin-posterior
position, however, the fully
extended head is blocked
by the sacrum. This
prevents descent and
labour is arrested.
30. Management
Chin-Anterior PositionChin-Anterior Position
If the cervix is fully dilated:
Allow to proceed with
normal childbirth;
If there is slow progress
and no sign of obstruction,
augment labor with
oxytocin;
If descent is unsatisfactory,
deliver by forceps.
If the cervix is not fully
dilated and there are no
signs of obstruction:
augment labor with
oxytocin.
Chin-Posterior PositionChin-Posterior Position
If the cervix is fully dilated:
Deliver by caesarean
section.
If the cervix is not fully
dilated
Monitor descent, rotation
and progress. If there are
signs of obstruction,
deliver by caesarean
section.
*Do not perform vacuumDo not perform vacuum
extraction for faceextraction for face
presentation.presentation.