In this presentation we will focus on aetiological factors that cause infirtility. Our focus is on US depiction of these aetiological factors to help physician in the management of infirtility.
We have nothing to do with direct radiological intervention in the management of infirtility in this presentation.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
Obstetrical Ultrasound• Introduced in the late 1950’s ultrasonography is a safe, non- invasive, accurate and cost-effective means to investigate the fetus• Computer generated system that uses sound waves integrated through real time scanners placed in contact with a gel medium to the maternal abdomen• The information from different reflections are reconstructed to provide a continuous picture of the moving fetus on the monitor screen
In this presentation we will focus on aetiological factors that cause infirtility. Our focus is on US depiction of these aetiological factors to help physician in the management of infirtility.
We have nothing to do with direct radiological intervention in the management of infirtility in this presentation.
ultrasonography in obstetrics, usg in obstetrics, ultrasound in obstetrics, doppler in obstetrics, usg doppler in obstetrics, signs in ultrasound, anomaly scan, pregnancy scan, ultrasound in pregnancy,
Obstetrical Ultrasound• Introduced in the late 1950’s ultrasonography is a safe, non- invasive, accurate and cost-effective means to investigate the fetus• Computer generated system that uses sound waves integrated through real time scanners placed in contact with a gel medium to the maternal abdomen• The information from different reflections are reconstructed to provide a continuous picture of the moving fetus on the monitor screen
Cervical and broad ligament fibroids are rare; with incidence of only 2% and 1% respectively.
Cervical fibroid often present with pressure symptoms and often pose surgical difficulties due to its proximity to bladder and rectum.
Broad ligament fibroid though rare , but have the propensity of growing into large adnexal masses and may mimic ovarian malignancy.
Benign growths in the uterus that can develop during a woman's childbearing years.Highest incidence was seen in Pakistani women 78%, then rural Indian women 37.65%, urban India 24% and Nigerian women 30%. Arobosoba from Nigeria has reported prevalence of uterine fibroids in black women was more (26%), in comparison to Caucasian women (17.9%).
Endometriosis is a painful disorder and can reduce fertility if not treated early. Endometriosis most commonly involves ovaries, fallopian tubes and the tissue lining pelvis.Endometriosis can be a challenging condition to manage.
Fertility enhancing surgeries are usually advised to young women with suspected minimal to moderate disease of tubes, ovaries or uterus.
https://www.femelife.com/ivf-fertility-care/fertility-enhancing-surgeries/
PCOS- An insight into polycystic ovary syndrome
Polycystic ovary syndrome (PCOS) is extremely prevalent and probably constitutes the most frequently encountered endocrine (hormone) disorder in women of reproductive age
Melatonin, a pineal hormone that regulates circadian rhythms, has also been shown to exhibit unique oxygen scavenging abilities. Melatonin supplementation in IVF may lead to better pregnancy rates. Hence role for melatonin in gamete biology is under research.
PGD combines advances in Molecular genetics and in assisted reproductive technology and is conducted before the embryo is placed inside the womb of the woman.Pre implantation genetic diagnosis was introduced to prevent the inheritance of sex linked diseases
A slightly abnormal semen analysis does not mean that a man is necessarily infertile. Instead, a semen analysis helps determine if and how male factors are contributing to infertility
Significant increase in live birth rate is found when IUI is done with stimulation compared with IUI in natural cycle in women with Unexplained Infertility .
Embryogenesis is the process by which the embryo forms and develops. In mammals, the term refers chiefly to early stages of prenatal development from conception to 8 weeks of pregnancy .Later it is referred to as fetogenesis
Sperm is the male reproductive cell and its main sperm function is to reach the ovum and fuse with it to deliver two sub-cellular structures called embryoOn average, each time a man ejaculates he releases nearly 100 million sperm but it takes only one to make a baby .To meet the waiting egg, semen must travel from the vagina to the fallopian tubes, a tough journey that few sperm survive.
An oocyte is a female gametocyte or germ cell involved in reproduction.It is an immature ovum or an egg
An oocyte is produced in the ovary during female gametogenesis.The female germ cells produce a primordial germ cell pgc which undergoes mitosis to form an oogonium
During oogenesis the oogonium becomes a primary oocyte
Oogenesis consists of several sub processes – oocytogenesis, ootidogenesis and the maturation to form an ovum
Folliculogenesis is a separate sub process and supports all three oogenetic sub process
Intrauterine insemination (IUI) is a fertility treatment that involves placing sperm inside a woman’s uterus to facilitate fertilisation. The goal of IUI is to increase the number of sperm that reach the fallopian tubes and subsequently increase the chance of fertilisation.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
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The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
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Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
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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 patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
How many patients does case series should have In comparison to case reports.pdfpubrica101
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CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
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.
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1. ROLE OF USG IN
INFERTILITY
DR NABANEETA
FEMELIFE FERTILITY FOUNDATION
2. UTERINE/ENDOMETRIAL FACTOR
Endometrial thickness obtained by two-
dimensional sonography is considered the
most important parameter of endometrial growth
a very thin endometrium (below 7 mm) seems to
be accepted as a reliable sign of suboptimal
implantation potential
Endometrial pattern is defined as the relative
echogenicity of the endometrium and the
adjacent myometrium as demonstrated on a
longitudinal ultrasound scan.
3. • The endometrial pattern does not appear to be
influenced by the type of ovarian stimulation
and it is of prognostic value in both fresh IVF,
as well as frozen embryo transfer cycles
5. • volume of the endometrium using 3D
ultrasound may help to correlate cycle
outcome with a quantitative parameter rather
than endometrial thickness
6.
7. UTERINE PERFUSION
• In anovulatory cycles, a continuous increase of
the uterine artery RI has been detected
• in some infertile patients, an end-diastolic
flow is absent
• absent diastolic flow might be associated with
infertility and poor reproductive performance.
8.
9.
10. MULLERIAN ANOMALIES
Congenital uterine malformations are variable in
frequency and are usually estimated to represent
3–4%
septate uterus- During the first trimester of
pregnancy, the risk of spontaneous abortion in
this group is between 28% and 45%, while during
the second trimester the frequency of late
spontaneous abortions is approximately 5%.
Hysteroscopic treatment is currently proposed as
the procedure of choice for the management of
these disorders
14. • contrast 3D hysterosonography offers a more
comprehensive overview of
the uterine cavity and surrounding
myometrium, and gives access to planes
unobtainable by conventional 2D ultrasound
examination.
16. ENDOMETRIAL POLYP
• Endometrial polyp is the anatomic defect that
is implicated in the etiology of arecurrent
pregnancy loss and infertility.
• Polyps appear as diffuse or focal thickening
ofthe endometrium
17.
18.
19. SUBMUCOUS LEIOMYOMAS
• their significance depends on their size and
location
• Large intracavitary myomas, which distort the
shape of the uterine cavity and interfere with
the endometrium are usually removed
hysteroscopically
• Sonographic texture ranges from hypoechoic to
echogenic, depending on the amount of
smooth muscle and connective tissue
21. • Color doppler demonstrates myometrial blood
vessels at its periphery
• A significant difference was shown in blood
flow characteristics for leiomyoma supplying
vessels between entirely subserosal versus
intramural or submucosal myoma
22.
23. ADENOMYOSIS
• A diffusely enlarged uterus without discrete
fibroids, an intact endometrium and multiple
small cysts in the myometrium have been
reported as a suggestive appearance of
adenomyosis
• Disordered echogenicity of the middle layer of
the myometrium is present
24. indistinct junctional zone between the endometrium and
the myometrium, inhomogeneity of the myometrium, a
thick posterior myometrium, and myometrial cysts.
26. ENDOMETRITIS
• Chronic endometritis is characterized with
increased echogenicity, thickness and
vascularity of the endometrium
• calcified pelvic lymph nodes or smaller
irregular calcifications in the adnexa, and
deformity of the endometrial cavity suggestive
of adhesions in the absence of a history of
prior curettage or abortion
27. ASHERMAN’S SYNDROME
• Destruction of the endometrium may result in
scarring and the development of bands of scar
tissue, or synechiae within the uterine cavity
• occur as a result of a vigorous curettage of the
uterus following an abortion or, more often,
after curettage of an advanced pregnancy.
28. • Intrauterine synechiae do not present
increased vascularity on color Doppler
examination. Threedimensional ultrasound
demonstrates a significant reduction of the
endometrial cavity volume
29. OVULATORY FACTORS OF
INFERTILITY
Transvaginal sonography is considered the
most reliable method for monitoring the
follicular growth. It enables accurate
prediction of ovulation and detection of the
ovulation abnormalities
Documentation of ovarian stromal vascularity
at the initial baseline scan may be
important and may provide useful
information for assisted reproduction
techniques
30.
31. POLYCYSTIC OVARIAN SYNDROME
• Polycystic ovarian syndrome (PCOS) is one of
the causes of anovulation and amenorrhea. In
its classic form it is characterized by
infertility, oligo and amenorrhea, hirsutism,
acne or seborrhea, and obesity.
• ultrasonographic diagnosis of polycystic
ovaries: multiple (n>10), small (2–8 mm)
peripheral cysts around a dense core of stroma
in enlarged (≥8 ml) ovaries
32.
33. LUTEINIZED UNRUPTURED FOLLICLE
SYNDROME
• Luteinized unruptured follicle (LUF) syndrome
is characterized with regular menses and
presumptive ovulation as suggested by a cyclic
hormonal profile, similar to that seen in
normal ovulatory women but without release
of the ovum.
• lower concentrations of estradiol and
progesterone in peritoneal fluid compared
with normal ovulatory cycles
34. • diagnosis is most commonly made on
ultrasound examination, in which there is
persistence of the ovarian follicle with
progressive loss of its typical echo-free cystic
appearance and accumulation of internal
echogenicity
35. LUTEAL PHASE DEFECT
• The formation of corpus luteum is an
important event in reproductive cycle and one
of the crucial factors in early pregnancy
support
• lack of progesterone, luteal phase of the cycle
shorter than 11 days, and when related to
endometrium, an outof- phase endometrium
by 2 or more days
36. • corpus luteum abnormalitycan be detected by
color Doppler ultrasonography
• increased RI in both ovaries was associated
with a nonviable pregnancy outcome.
37.
38. TUBAL FACTOR OF INFERTILITY
• The normal Fallopian tubes are narrow and
usually not seen by transabdominal or
transvaginal ultrasound unless they contain
fluid within their lumina or area surrounded by
fluid
• Chronic hydrosalpinx is the ultimate remnant
of the PID: the tube is occluded, thin-walled
and filled with fluid
45. Endometriosis
Endometriosis is defined as the presence of
endometrial tissue outside of the
endometrium and myometrium
Endometriotic foci may appear as punctate
spots or patches of variable color, with a
slightly raised or puckered surface, forming
nodules, cysts, or both. In one-third to
onehalf of cases, ovarian endometriotic cysts
are bilateral
The cysts rarely exceed 15 cm in diameter
46.
47. conclusion
Sonography can play a critical role in the diagnosis
and treatment of fertility disorders.
transvaginal color Doppler and 3D ultrasound with
power Doppler facilities have made a significant
improvement in the assessment of infertility
Absent subendometrial an
intraendometrialvascularization on the day of hCG
administration appears to be a useful predictor of
failure of implantation in IVF cycles
Quantification of endometrial volume by 3D
ultrasound in combination with blood flow studies
contributes to the assessment of endometrial
receptivity and has a potential to predict pregnancy
rates in assisted reproductive techniques