Intrapartum sonography can be used to more accurately assess fetal head position, station, descent, and rotation during labor compared to digital examination alone. It also helps predict success of induction of labor and instrumental delivery. The document outlines the basic technique, objectives, and various clinical applications of intrapartum sonography during different stages of labor.
This guideline provides recommendations for the assessment and management of suspected ovarian masses in premenopausal women. A thorough history, examination, and ultrasound are important for evaluating the mass and determining if referral to a specialist is needed. Serum cancer antigen (CA-125) testing has low specificity in premenopausal women but may be useful if significantly elevated. The guideline aims to minimize morbidity by conservatively managing benign masses when possible and using laparoscopic techniques over laparotomy for removal of masses. Referral to a specialist is recommended for suspected borderline or malignant tumors.
This document discusses recurrent pregnancy loss and provides information on definitions, incidence, causes, investigations, and guidelines. Some key points:
- Recurrent pregnancy loss is defined as 3 or more clinically recognized pregnancy losses before 20 weeks. The incidence is about 1 in 300 pregnancies.
- Common causes include genetic factors in the parents or embryo, anatomic abnormalities, endocrine/immune/infectious factors, and inherited thrombophilias.
- Investigations should include parental karyotyping after 2 losses, and karyotyping of pregnancy tissues is recommended by RCOG guidelines to provide counseling and predict outcomes of future pregnancies.
- Biomarkers and ultrasound can provide information on predicting outcomes,
The document discusses screening for ovarian cancer. It provides guidelines from BGCS and NICE regarding screening recommendations for average and high-risk women. It summarizes a large study that found annual screening with CA-125 and transvaginal ultrasound (multimodal screening) increased early-stage cancer detection but did not reduce mortality. Therefore, general population screening is not recommended. For high-risk women, screening may be considered after discussing risks and benefits. Recent advances like liquid biopsies and analyzing the MUC16 gene show promise but require more research before implementing.
This document provides guidelines for elective single embryo transfer (eSET) compared to double embryo transfer (DET) following in vitro fertilization (IVF). It finds that while the cumulative live birth rate is lower for eSET than DET, eSET significantly reduces the risk of multiple pregnancies. The guidelines recommend eSET for good prognosis patients aged 35 or younger in their first or second IVF attempt with at least 2 good quality embryos. This is intended to minimize twin pregnancies while maintaining acceptable live birth rates overall.
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
Intrapartum sonography can be used to more accurately assess fetal head position, station, descent, and rotation during labor compared to digital examination alone. It also helps predict success of induction of labor and instrumental delivery. The document outlines the basic technique, objectives, and various clinical applications of intrapartum sonography during different stages of labor.
This guideline provides recommendations for the assessment and management of suspected ovarian masses in premenopausal women. A thorough history, examination, and ultrasound are important for evaluating the mass and determining if referral to a specialist is needed. Serum cancer antigen (CA-125) testing has low specificity in premenopausal women but may be useful if significantly elevated. The guideline aims to minimize morbidity by conservatively managing benign masses when possible and using laparoscopic techniques over laparotomy for removal of masses. Referral to a specialist is recommended for suspected borderline or malignant tumors.
This document discusses recurrent pregnancy loss and provides information on definitions, incidence, causes, investigations, and guidelines. Some key points:
- Recurrent pregnancy loss is defined as 3 or more clinically recognized pregnancy losses before 20 weeks. The incidence is about 1 in 300 pregnancies.
- Common causes include genetic factors in the parents or embryo, anatomic abnormalities, endocrine/immune/infectious factors, and inherited thrombophilias.
- Investigations should include parental karyotyping after 2 losses, and karyotyping of pregnancy tissues is recommended by RCOG guidelines to provide counseling and predict outcomes of future pregnancies.
- Biomarkers and ultrasound can provide information on predicting outcomes,
The document discusses screening for ovarian cancer. It provides guidelines from BGCS and NICE regarding screening recommendations for average and high-risk women. It summarizes a large study that found annual screening with CA-125 and transvaginal ultrasound (multimodal screening) increased early-stage cancer detection but did not reduce mortality. Therefore, general population screening is not recommended. For high-risk women, screening may be considered after discussing risks and benefits. Recent advances like liquid biopsies and analyzing the MUC16 gene show promise but require more research before implementing.
This document provides guidelines for elective single embryo transfer (eSET) compared to double embryo transfer (DET) following in vitro fertilization (IVF). It finds that while the cumulative live birth rate is lower for eSET than DET, eSET significantly reduces the risk of multiple pregnancies. The guidelines recommend eSET for good prognosis patients aged 35 or younger in their first or second IVF attempt with at least 2 good quality embryos. This is intended to minimize twin pregnancies while maintaining acceptable live birth rates overall.
This document provides an overview of intrauterine insemination (IUI). Some key points include:
IUI is a first-line, non-invasive fertility treatment that involves placing processed sperm directly into the uterus. Success rates range from 6-20% depending on the stimulation protocol used. Factors like age, infertility duration and etiology, and semen quality impact success rates. Strict monitoring is important to minimize risks of ovarian hyperstimulation syndrome while maximizing pregnancy chances. Proper sperm processing techniques and timing of insemination relative to ovulation are also important considerations for IUI.
Cervical incompetence, or premature cervical dilation, can complicate 0.1-2% of pregnancies and cause 15% of preterm births between 16-28 weeks. While the exact cause is often unknown, it may result from congenital cervical weakness, trauma, or DES exposure. Diagnosis is based on recurrent second trimester miscarriage without other identifiable causes. Treatment options include bed rest or a cervical cerclage procedure to stitch the cervix closed and prolong the pregnancy. Cerclage placement can be elective, urgent based on cervical shortening, or emergency if dilation has already begun. The McDonald and Shirodkar techniques are most common, with choice depending on cervical anatomy and prior trauma. Cer
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
The document discusses various fertility preservation strategies for cancer patients undergoing chemotherapy or radiation therapy. It describes how certain cancers are more common in reproductive aged women and men. It then outlines different options for preserving fertility including pharmacological protection with GnRH analogues, IVF with embryo cryopreservation, oocyte cryopreservation, ovarian transposition, and ovarian tissue cryopreservation and transplantation. It notes the limitations, success rates, and complications of each method.
This document discusses the use of laparoscopy in gynecologic oncology. It notes that laparoscopy can be used for procedures like hysterectomy, node dissection, and bowel surgery. Studies show laparoscopy provides benefits like improved vision, less morbidity, shorter hospital stays, and better patient satisfaction compared to open surgery. However, laparoscopy requires a learning curve and is still being evaluated for oncologic outcomes in some cancers. The document reviews evidence for laparoscopy in endometrial, ovarian, and cervical cancers. It concludes laparoscopy is feasible and effective for gynecologic oncology when performed by trained specialists, though more research is still needed.
Laparoscopy can be performed safely during any trimester of pregnancy with optimal timing being the early second trimester. A retrospective study found no differences in outcomes between laparoscopy and laparotomy in pregnant patients under 20 weeks gestation. Initial port placement depends on gestational age, with Palmer's point preferred in the third trimester. Intraoperative CO2 monitoring via capnography should be used. Prophylactic tocolytics are not recommended but may be used to treat preterm labor. Analgesia can be provided with opioids and antiemetics but NSAIDs should generally be avoided after 32 weeks. Risks include uterine penetration, bleeding, rupture, and effects of increased pressure and maternal acidosis on uterop
(1) This study analyzed the risk factors and management patterns of emergency peripartum hysterectomy (EPH) at a hospital in Northeast India over 9 years. (2) The most common indications for EPH were uterine atony (17.39%) and ruptured uterus (49.28%), with ruptured uterus being more common in developing countries. (3) The study found an EPH rate of 1.9 per 1000 deliveries, with most cases undergoing subtotal hysterectomy. Maternal morbidity was comparable to other studies but 2 mothers died due to hemorrhagic shock and sepsis.
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
This document discusses screening and treating cervical cancer in a single visit. It provides details on Dr. Kawita Bapat's qualifications and experience in gynecology. It then outlines the benefits of visual inspection with acetic acid (VIA) screening and immediate cryotherapy treatment for VIA-positive women. Several studies have found this single visit approach to be effective at reducing cervical intraepithelial neoplasia. The document advocates for expanding single visit screen and treat programs in India according to WHO and government of India guidelines.
This document provides guidelines for laparoscopic entry techniques. It discusses positioning the patient and various methods for primary and secondary port entry. The preferred primary entry is through the umbilicus using a closed Veress needle technique. Guidelines are provided for Veress needle insertion including abdominal pressure, saline testing, and insufflation. Alternatives like Palmer's point or open Hasson technique should be considered if umbilical entry fails or is risky due to adhesions. Secondary ports should be inserted under direct vision at specific locations and angles to avoid injury.
1) Recurrent pregnancy loss is defined as three or more consecutive pregnancy losses before 20 weeks of gestation. A thorough investigation should be conducted to identify potentially treatable causes.
2) Common etiological factors include uterine anomalies, immunological issues such as antiphospholipid syndrome, endocrine disorders such as thyroid disease or diabetes, genetic factors, and thrombophilic disorders.
3) Evaluation involves a detailed history, physical exam, ultrasound, hormonal and immunological testing. Uterine anomalies require hysteroscopy or laparoscopy. Treatment depends on the underlying cause but may include surgery, medication, lifestyle changes, or cerclage. The goal is to identify modifiable risk factors.
The document provides an overview of postpartum hemorrhage (PPH) including its definition, risk factors, causes, prevention, and management. It discusses predicting patients at risk, preparing for potential hemorrhage, and treating PPH through evaluating tone, tissue, trauma, and thrombin (the 4 Ts). Uterine atony is identified as the leading cause, accounting for 80% of PPH cases. Early use of uterotonic medications and fluid resuscitation are emphasized as essential in management.
The document discusses placenta accreta, a condition where the placenta invades and attaches abnormally to the uterine wall. It has increased in incidence 10-fold over the past 50 years due to rising cesarean delivery rates. Risk factors include placenta previa, prior uterine surgery, and increasing maternal age and parity. Ultrasound and MRI can be used to diagnose placenta accreta prenatally based on signs like lack of a hypoechoic zone between the placenta and uterus. Management options for severe postpartum hemorrhage from placenta accreta include uterine packing, arterial ligation, hysterectomy, and the B-Lynch compression suture
This document discusses uterine distention media used in hysteroscopy. It compares the advantages and disadvantages of gaseous (CO2) and liquid media, including electrolytic (NS, RL) and non-electrolytic (dextran, glycine, sorbitol, mannitol) options. CO2 is well-suited for diagnostic procedures but can obscure visibility in operative cases. Liquid media allow for better visualization but carry risks of fluid absorption and related complications like hyponatremia or renal failure. Proper distention pressure and monitoring of fluid intake and output are essential to prevent adverse effects.
Uterus (womb) as an organ is pivotal not only to giving birth, but also to the overall well-being of women and their physical, emotional, and sexual health.
Entry technique with veress needle in LaparoscopyDrVarun Raju
The document summarizes the Veress needle technique for establishing pneumoperitoneum during laparoscopic surgery. It describes how Janos Veress first developed the spring-loaded needle in 1932 for tuberculosis treatment. Modern Veress needles are 12-15 cm long and have a blunt inner stylet and sharp outer cannula. Placement is typically at the umbilicus using various tests like aspiration and insufflation pressure to confirm intraperitoneal placement before trocar insertion. Complications can occur if not properly positioned.
Dr. Vandana Bansal is a senior gynecologist and obstetrician in Allahabad, India specializing in infertility and IVF. She has over 25 years of experience as a leading laparoscopic and hysteroscopic surgeon in Uttar Pradesh. She established the first test tube baby center in Allahabad 19 years ago and is a pioneer in infertility and IVF in the region. She has received numerous national and international awards for her work, and has authored publications included in distinguished biographical references.
Role of robotics in obstetrics and gynecology . 5.5.2021 pptxShazia Iqbal
This document discusses the role of robotics in obstetrics and gynecology. It begins with an introduction to robotic gynecologic surgery using the Da Vinci system. The key advantages are that it allows for more precise microscopic surgery using instruments controlled by the surgeon at a console. The document reviews the history and increasing applications of robotic surgery. It describes how robotic systems like Da Vinci work and some common gynecologic conditions they are used to treat. In conclusion, robotic surgery is generally safe and beneficial compared to open surgery, but costs remain a limitation.
This document discusses the management of twin pregnancies. It begins by defining multiple gestation and describing the different types of twins. It then discusses the risks of twin pregnancies to both the mother and fetuses, including preterm birth and fetal growth issues. The document outlines the antenatal management of twins, including frequent ultrasound exams and monitoring for preterm labor. Issues around delivery are also covered, such as unstable fetal positions and the risk of locked twins requiring cesarean section. Overall it provides an overview of caring for twin pregnancies from diagnosis through delivery.
Lactate dehydrogenase (LDH) is an enzyme that catalyzes the conversion of lactate to pyruvate. It exists as five isoenzymes (LDH-1 to LDH-5) that differ in their subunit composition and electric charge. The isoenzymes show varying tissue distribution, catalytic properties, and clinical significance. Elevated levels of specific isoenzymes can help identify the origin of tissue damage, as LDH-1 and LDH-2 indicate myocardial infarction while LDH-4 and LDH-5 signify liver damage. The LDH isoenzyme pattern also provides information about different cancer types.
LHD is an enzyme which is width sprid through the body tissue has an important role in the conversion of pyrovate into lactate within the tissue when ever there is hypoxia in the body
Cervical incompetence, or premature cervical dilation, can complicate 0.1-2% of pregnancies and cause 15% of preterm births between 16-28 weeks. While the exact cause is often unknown, it may result from congenital cervical weakness, trauma, or DES exposure. Diagnosis is based on recurrent second trimester miscarriage without other identifiable causes. Treatment options include bed rest or a cervical cerclage procedure to stitch the cervix closed and prolong the pregnancy. Cerclage placement can be elective, urgent based on cervical shortening, or emergency if dilation has already begun. The McDonald and Shirodkar techniques are most common, with choice depending on cervical anatomy and prior trauma. Cer
Hysteroscopic procedures are getting refined and with the advent of miniature scopes , doing these procedures in he office is getting better and more comfortable.
The document discusses various uterus sparing techniques for prolapse surgery in young women who desire to preserve fertility and menstrual function. It describes Shirodkar's sling operation, which has been shown to have high rates of normal vaginal delivery and low recurrence rates of prolapse. Laparoscopic sacrohysteropexy is indicated for young women with prolapse as it has better efficacy than vaginal sacrospinous fixation and results in fewer mesh complications compared to sacral colpopexy with hysterectomy. While sacral colpopexy has high success rates, it also carries risks of serious mesh-related complications requiring reoperation years later.
The document discusses various fertility preservation strategies for cancer patients undergoing chemotherapy or radiation therapy. It describes how certain cancers are more common in reproductive aged women and men. It then outlines different options for preserving fertility including pharmacological protection with GnRH analogues, IVF with embryo cryopreservation, oocyte cryopreservation, ovarian transposition, and ovarian tissue cryopreservation and transplantation. It notes the limitations, success rates, and complications of each method.
This document discusses the use of laparoscopy in gynecologic oncology. It notes that laparoscopy can be used for procedures like hysterectomy, node dissection, and bowel surgery. Studies show laparoscopy provides benefits like improved vision, less morbidity, shorter hospital stays, and better patient satisfaction compared to open surgery. However, laparoscopy requires a learning curve and is still being evaluated for oncologic outcomes in some cancers. The document reviews evidence for laparoscopy in endometrial, ovarian, and cervical cancers. It concludes laparoscopy is feasible and effective for gynecologic oncology when performed by trained specialists, though more research is still needed.
Laparoscopy can be performed safely during any trimester of pregnancy with optimal timing being the early second trimester. A retrospective study found no differences in outcomes between laparoscopy and laparotomy in pregnant patients under 20 weeks gestation. Initial port placement depends on gestational age, with Palmer's point preferred in the third trimester. Intraoperative CO2 monitoring via capnography should be used. Prophylactic tocolytics are not recommended but may be used to treat preterm labor. Analgesia can be provided with opioids and antiemetics but NSAIDs should generally be avoided after 32 weeks. Risks include uterine penetration, bleeding, rupture, and effects of increased pressure and maternal acidosis on uterop
(1) This study analyzed the risk factors and management patterns of emergency peripartum hysterectomy (EPH) at a hospital in Northeast India over 9 years. (2) The most common indications for EPH were uterine atony (17.39%) and ruptured uterus (49.28%), with ruptured uterus being more common in developing countries. (3) The study found an EPH rate of 1.9 per 1000 deliveries, with most cases undergoing subtotal hysterectomy. Maternal morbidity was comparable to other studies but 2 mothers died due to hemorrhagic shock and sepsis.
UPDATE HPV Vaccination IN Cervical Cancer Prevention Dr Sharda Jain Lifecare Centre
Cervical Cancer In India: A Preventable Tragedy That Requires Urgent Attention
It is estimated that in India, about 160 million women aged 30-59 years are at risk of developing cervical cancer, with fatality rate of 50 per cent
This document discusses screening and treating cervical cancer in a single visit. It provides details on Dr. Kawita Bapat's qualifications and experience in gynecology. It then outlines the benefits of visual inspection with acetic acid (VIA) screening and immediate cryotherapy treatment for VIA-positive women. Several studies have found this single visit approach to be effective at reducing cervical intraepithelial neoplasia. The document advocates for expanding single visit screen and treat programs in India according to WHO and government of India guidelines.
This document provides guidelines for laparoscopic entry techniques. It discusses positioning the patient and various methods for primary and secondary port entry. The preferred primary entry is through the umbilicus using a closed Veress needle technique. Guidelines are provided for Veress needle insertion including abdominal pressure, saline testing, and insufflation. Alternatives like Palmer's point or open Hasson technique should be considered if umbilical entry fails or is risky due to adhesions. Secondary ports should be inserted under direct vision at specific locations and angles to avoid injury.
1) Recurrent pregnancy loss is defined as three or more consecutive pregnancy losses before 20 weeks of gestation. A thorough investigation should be conducted to identify potentially treatable causes.
2) Common etiological factors include uterine anomalies, immunological issues such as antiphospholipid syndrome, endocrine disorders such as thyroid disease or diabetes, genetic factors, and thrombophilic disorders.
3) Evaluation involves a detailed history, physical exam, ultrasound, hormonal and immunological testing. Uterine anomalies require hysteroscopy or laparoscopy. Treatment depends on the underlying cause but may include surgery, medication, lifestyle changes, or cerclage. The goal is to identify modifiable risk factors.
The document provides an overview of postpartum hemorrhage (PPH) including its definition, risk factors, causes, prevention, and management. It discusses predicting patients at risk, preparing for potential hemorrhage, and treating PPH through evaluating tone, tissue, trauma, and thrombin (the 4 Ts). Uterine atony is identified as the leading cause, accounting for 80% of PPH cases. Early use of uterotonic medications and fluid resuscitation are emphasized as essential in management.
The document discusses placenta accreta, a condition where the placenta invades and attaches abnormally to the uterine wall. It has increased in incidence 10-fold over the past 50 years due to rising cesarean delivery rates. Risk factors include placenta previa, prior uterine surgery, and increasing maternal age and parity. Ultrasound and MRI can be used to diagnose placenta accreta prenatally based on signs like lack of a hypoechoic zone between the placenta and uterus. Management options for severe postpartum hemorrhage from placenta accreta include uterine packing, arterial ligation, hysterectomy, and the B-Lynch compression suture
This document discusses uterine distention media used in hysteroscopy. It compares the advantages and disadvantages of gaseous (CO2) and liquid media, including electrolytic (NS, RL) and non-electrolytic (dextran, glycine, sorbitol, mannitol) options. CO2 is well-suited for diagnostic procedures but can obscure visibility in operative cases. Liquid media allow for better visualization but carry risks of fluid absorption and related complications like hyponatremia or renal failure. Proper distention pressure and monitoring of fluid intake and output are essential to prevent adverse effects.
Uterus (womb) as an organ is pivotal not only to giving birth, but also to the overall well-being of women and their physical, emotional, and sexual health.
Entry technique with veress needle in LaparoscopyDrVarun Raju
The document summarizes the Veress needle technique for establishing pneumoperitoneum during laparoscopic surgery. It describes how Janos Veress first developed the spring-loaded needle in 1932 for tuberculosis treatment. Modern Veress needles are 12-15 cm long and have a blunt inner stylet and sharp outer cannula. Placement is typically at the umbilicus using various tests like aspiration and insufflation pressure to confirm intraperitoneal placement before trocar insertion. Complications can occur if not properly positioned.
Dr. Vandana Bansal is a senior gynecologist and obstetrician in Allahabad, India specializing in infertility and IVF. She has over 25 years of experience as a leading laparoscopic and hysteroscopic surgeon in Uttar Pradesh. She established the first test tube baby center in Allahabad 19 years ago and is a pioneer in infertility and IVF in the region. She has received numerous national and international awards for her work, and has authored publications included in distinguished biographical references.
Role of robotics in obstetrics and gynecology . 5.5.2021 pptxShazia Iqbal
This document discusses the role of robotics in obstetrics and gynecology. It begins with an introduction to robotic gynecologic surgery using the Da Vinci system. The key advantages are that it allows for more precise microscopic surgery using instruments controlled by the surgeon at a console. The document reviews the history and increasing applications of robotic surgery. It describes how robotic systems like Da Vinci work and some common gynecologic conditions they are used to treat. In conclusion, robotic surgery is generally safe and beneficial compared to open surgery, but costs remain a limitation.
This document discusses the management of twin pregnancies. It begins by defining multiple gestation and describing the different types of twins. It then discusses the risks of twin pregnancies to both the mother and fetuses, including preterm birth and fetal growth issues. The document outlines the antenatal management of twins, including frequent ultrasound exams and monitoring for preterm labor. Issues around delivery are also covered, such as unstable fetal positions and the risk of locked twins requiring cesarean section. Overall it provides an overview of caring for twin pregnancies from diagnosis through delivery.
Lactate dehydrogenase (LDH) is an enzyme that catalyzes the conversion of lactate to pyruvate. It exists as five isoenzymes (LDH-1 to LDH-5) that differ in their subunit composition and electric charge. The isoenzymes show varying tissue distribution, catalytic properties, and clinical significance. Elevated levels of specific isoenzymes can help identify the origin of tissue damage, as LDH-1 and LDH-2 indicate myocardial infarction while LDH-4 and LDH-5 signify liver damage. The LDH isoenzyme pattern also provides information about different cancer types.
LHD is an enzyme which is width sprid through the body tissue has an important role in the conversion of pyrovate into lactate within the tissue when ever there is hypoxia in the body
The document discusses the lactate dehydrogenase (LDH) blood test used for heart attack victims. LDH is an enzyme found in most body cells that is released when cells are damaged or die. An LDH blood test can detect elevated levels after a heart attack, indicating heart muscle cell death. The test is most useful within 12-24 hours of a heart attack. Higher-than-normal total LDH combined with higher LDH-1 than LDH-2 isoenzymes suggests a heart attack. The LDH level is measured using a UV-Vis spectrophotometer to detect the decrease in absorbance of NADH at 340nm as LDH converts pyruvate to lactate.
Dokumen tersebut membahas tentang preeklamsia dan eklampsia pada kehamilan. Preeklamsia dan eklampsia merupakan penyebab utama kematian ibu dengan gejala seperti nyeri kepala, gangguan penglihatan, dan kejang. Diagnosis dan penanganannya meliputi evaluasi klinis, pemberian magnesium sulfat untuk mencegah kejang, serta terminasi kehamilan dalam waktu 6-24 jam.
A blood protein marker for the early detection of pre- eclampsia Priyesh Waghmare
The document describes a proposed diagnostic device for the early detection of pre-eclampsia. The device would use a one-step, 15 minute test to measure levels of three biomarkers (PlGF, sflt-1, sEng) in blood to screen pregnant women in their first trimester. Current diagnosis methods are time-consuming and have high rates of false positives. The proposed device aims to provide a simple, rapid, inexpensive and early screening with high sensitivity and specificity to address the market need for improved pre-eclampsia detection.
The document discusses hypertensive disorders in pregnancy, specifically pre-eclampsia and eclampsia. It notes that pre-eclampsia is characterized by new hypertension and proteinuria after 20 weeks of gestation, and can progress to eclampsia involving seizures. Risk factors include primigravidas, family history, and obesity. Magnesium sulfate is the primary treatment for preventing seizures, while antihypertensives are used if blood pressure remains high. Timely treatment is important but outcomes depend on severity of symptoms and can include maternal and fetal complications like premature birth.
This document discusses ozone therapy and its uses. It begins by defining ozone and describing how it is created. It then outlines several methods of ozone therapy administration, including major ozone autohemotherapy where blood is ozonated ex vivo and reinfused. Potential applications of ozone therapy are provided, such as for infectious diseases, cardiac issues, and diabetes. Lastly, specific uses for dental caries, AIDS/cancer treatment, and agriculture are mentioned.
this is a short presentation on eclampsia, i have made it for my class presentation, it includes definition, pathophysiology,clinical features and management.. i hope u vil like it
Lactate dehydrogenase, aldehyde dehydrogenase, and glutamate dehydrogenase are important metabolic enzymes. Lactate dehydrogenase catalyzes the interconversion of lactate and pyruvate via NADH. It exists in different isoforms that localize to specific tissues. Aldehyde dehydrogenase oxidizes aldehydes to carboxylic acids using NAD(P)+. It is found in the liver and other tissues and plays a role in ethanol metabolism. Glutamate dehydrogenase converts glutamate and α-ketoglutarate using NAD(P)H and is important for amino acid metabolism, urea synthesis, and insulin secretion regulation. All three enzymes play key roles in cellular metabolism and their levels/activities can indicate metabolic states
Challenges for drug development jsr slides aug 2013CincyTechUSA
This document discusses the challenges facing the pharmaceutical industry in drug development in the 21st century. It notes that R&D productivity has remained flat despite increased spending. Factors like the patent cliff, rising healthcare costs, and increased regulatory demands mean the industry can no longer rely on the blockbuster drug model. Innovation is now focused on targeted therapies for niche markets. Pharmacologists must guide drug development to demonstrate a new drug's safety, efficacy, and economic value in order to gain approval and reimbursement.
Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the palm, becomes compressed as it passes through the carpal tunnel in the wrist. Symptoms include pain, numbness, and tingling in the hand and fingers. While repetitive wrist motions were originally thought to be the primary cause, any condition that puts pressure on the median nerve can lead to carpal tunnel syndrome. Diagnosis involves tests like Phalen's maneuver and electromyography, while treatment ranges from wrist splints and injections to surgery.
Management of Pre-eclampsiaand eclampsia Case discussionsMouafak Alhadithy
The document discusses the management of pre-eclampsia and eclampsia, defining the conditions and outlining diagnostic criteria and treatment approaches. It provides case studies of patients presenting with hypertension in pregnancy and describes how to evaluate and treat the patients, including through antihypertensive medication, magnesium sulfate administration, and decisions around delivery timing and method. The goal of management is to terminate the pregnancy safely while restoring the health of both the mother and newborn.
This document discusses fluid and electrolyte requirements in neonates. It notes that total body water is 0.7 L/kg in newborns and 0.6 L/kg at 1 year of age. Fluids are required for infants under 30 weeks gestation or under 1250g, sick term neonates, those with severe birth asphyxia, apnea, respiratory distress syndrome, or sepsis. Fluid amounts range from 100 ml/kg for infants under 1kg to 60 ml/kg for those over 1.5kg on the first day, increasing amounts over subsequent days. Electrolyte requirements for sodium, potassium, and calcium are also outlined. Glucose requirements are noted to be an optimal 4-
This document discusses the use of ozone therapy and hyperbaric oxygen therapy. It provides information on how ozone works in the body to kill bacteria, viruses, and fungi. It outlines how ozone therapy has been used successfully to treat various conditions like cancer, arthritis, AIDS, and more. The document also discusses the use of these therapies in countries like Germany, Cuba, and India. It provides examples of how ozone generators can be used to purify air, water, food and disinfect areas.
This document describes the steps in a multi-enzyme complex involved in fatty acid synthesis. It outlines 8 steps: 1) an acyl transfer step, 2) a malonyl transfer step, 3) a condensation step, 4) a keto reduction step, 5) another condensation step, 6) a saturation step, 7) a transfer step, and 8) a cleavage step. Each step involves the action of a different enzyme to transfer, condense, reduce, or cleave chemical groups and ultimately produce a fatty acid.
Re-Engineering Early Phase Cancer Drug Development: Decreasing the Time from ...mconghuyen
The document summarizes efforts to decrease the time required to develop novel cancer therapeutics from target identification to clinical use. It describes how most oncology drugs fail in late stages of development, particularly phases 2 and 3, due to lack of efficacy. To address this, the National Cancer Institute has created programs like the Experimental Therapeutics Program and Chemical Biology Consortium to streamline the discovery and development process. This includes providing resources from target validation through early clinical trials to support academic and biotech projects focusing on areas of unmet medical need. The goal is to rapidly translate discoveries into treatments to benefit public health.
The document summarizes the purification of lactate dehydrogenase (LDH) from chicken muscle. Key steps included:
1. Homogenizing the muscle tissue to disrupt cells and release LDH.
2. Removing debris via centrifugation.
3. Precipitating and concentrating LDH using ammonium sulfate.
4. Dialyzing the sample to remove salt.
5. Purifying LDH using affinity chromatography on a Cibacron blue column.
6. Analyzing purity via SDS-PAGE gel electrophoresis and activity assays.
Carpel Tunnel Syndrome occurs when the median nerve in the wrist becomes compressed, causing numbness and tingling in the fingers and palm. It is often caused by repetitive stress on the wrist from work activities or arthritis. Symptoms include burning, itching, and numbness in the hands. To prevent Carpel Tunnel Syndrome, one should take breaks, do wrist exercises, wear splints, and maintain proper posture.
UPDATES ON HPT DISORDERS OF PREGNANCY by dr yahya.pptxMaryamYahya8
This document provides an overview of hypertensive disorders in pregnancy. It defines the main categories of hypertensive disorders such as chronic hypertension, gestational hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension. It discusses the pathophysiology, risk factors, diagnosis, and management of these conditions. Hypertensive disorders are a major cause of maternal and fetal morbidity and mortality worldwide. Accurate classification is important for optimizing care and reducing health risks.
Hypertension in pregnancy: A case discussionpharmaindexing
Gestational hypertension and preeclampsia are common disorders during pregnancy, with the majority of cases developing at or near term. The development of mild hypertension or preeclampsia at or near term is associated with minimal maternal and neonatal morbidities. In contrast, the onset of severe gestational hypertension and/or severe preeclampsia before 35 weeks’ gestation is associated with significant maternal and perinatal complications. Women with diagnosed gestational hypertension– preeclampsia require close evaluation of maternal and fetal conditions for the duration of pregnancy, and those with severe disease should be managed in-hospital. The decision between delivery and expectant management depends on fetal gestational age, fetal status, and severity of maternal condition at time of evaluation. Expectant management is possible in a select group of women with severe preeclampsia before 32 weeks’ gestation. Steroids are effective in reducing neonatal mortality and morbidity when administered to those with severe disease between 24 and 34 weeks’ gestation. Magnesium sulfate should be used during labor and for at least 24 hours postpartum to prevent seizures in all women with severe disease. There is an urgent need to conduct randomized trials to determine the efficacy and safety of antihypertensive drugs in women with mild hypertension–preeclampsia. There is also a need to conduct a randomized trial to determine the benefits and risks of magnesium sulfate during labor and postpartum in women with mild preeclampsia.
This document summarizes renal disorders that can occur in pregnancy. It discusses the normal physiologic changes in pregnancy that affect the kidneys as well as specific disorders like preeclampsia, hypertension, AKI, lupus nephritis, diabetic nephropathy, and nephrotic syndrome. It provides diagnostic criteria and recommendations for management and treatment for many of these conditions to help support healthy pregnancies and outcomes.
acute kidney injury during pregnancy, challenges in diagnosis and treatmentMarwa Elkaref
This document discusses acute kidney injury (AKI) during pregnancy. It begins by explaining the physiological changes in pregnancy that make diagnosing AKI difficult. It then discusses the causes and classifications of AKI during pregnancy. Some key causes mentioned include preeclampsia, HELLP syndrome, and septic abortion. The document outlines supportive management of renal function as well as treating the underlying disease. It notes that dialysis may be needed if other procedures are insufficient.
1) The document discusses critical care in obstetrics, covering hemodynamic, respiratory, and metabolic changes in pregnancy as well as common conditions requiring ICU admission such as preeclampsia and hemorrhage.
2) Key principles of obstetric critical care include considering the interests of both the pregnant patient and fetus, with maternal needs taking precedence. Fetal health is maximized by optimizing the mother's medical condition.
3) Complications of preeclampsia discussed include brain edema, hemorrhage, and retinal detachment. Delivery is the primary treatment for severe preeclampsia.
1) Pregnancy induced hypertension complicates 5-10% of pregnancies and is a leading cause of maternal mortality. It includes gestational hypertension, preeclampsia, and chronic hypertension.
2) Preeclampsia is diagnosed when a woman develops high blood pressure and protein in the urine after 20 weeks of pregnancy. Symptoms can include headaches, abdominal pain, and vision changes.
3) Management of mild preeclampsia involves outpatient monitoring while management of severe preeclampsia requires hospitalization, magnesium sulfate treatment, and sometimes antihypertensive drugs. Delivery is the definitive treatment when the condition becomes severe or the pregnancy reaches term.
This document provides guidelines for the management of severe pre-eclampsia and eclampsia. It summarizes the assessment and monitoring of both the woman and fetus. For the woman, it outlines how to measure blood pressure and proteinuria as well as vital signs and lab work that should be monitored. For the fetus, it recommends ultrasound assessments and cardiotocography. It provides guidance on controlling hypertension, including recommended antihypertensive medications, and preventing seizures with magnesium sulfate. The overarching goal is to standardize care to stabilize women and optimize timing of delivery to improve outcomes for both mother and baby.
1) The document discusses pregnancy induced hypertension, its classification, diagnosis, and management. It defines four types of hypertensive disorders in pregnancy: gestational hypertension, preeclampsia-eclampsia (mild and severe), superimposed preeclampsia-eclampsia, and chronic (preexisting) hypertension.
2) For diagnosis of hypertension in pregnancy, blood pressure must exceed 140/90 mmHg. Diagnosis of mild or severe preeclampsia depends on blood pressure levels and presence of proteinuria.
3) Management of mild preeclampsia can involve outpatient monitoring with regular visits or inpatient monitoring with maternal and fetal monitoring and treatment if signs worsen.
This document discusses the clinical management of acute renal failure in obstetric patients. It notes that oliguria is common during pregnancy and postpartum and can be caused by issues like preeclampsia. Conservative management is emphasized, including careful fluid management, monitoring of electrolytes and urine output. Diuretics may help management but are not proven to impact outcomes. Dialysis is indicated for issues like fluid overload, severe hyperkalemia or acidosis, or refractory uremic symptoms. Patients not responding to initial measures or with severe preeclampsia may require specialist care and invasive monitoring.
This document discusses features of pregnancy and childbirth management in women with extragenital pathology. It notes that only 20% of pregnancies proceed without complications, while 30-40% involve extragenital pathology (EGP) such as cardiovascular, kidney, or blood diseases. Pregnancy termination risks are 12% and can affect fetal development. The most common EGP in women ages 21-29 is cardiovascular disease, observed in 7% of cases. Management of pregnancy involves frequent hospitalizations and selecting delivery methods based on the severity of the woman's condition.
Neonatal sepsis
Made Easy to understand all the students
DR ATIQUR RAHMAN KHAN
MBBS,MD,DCH,MRCPS(GLASCOW),FRCP(UK)
Msc Counselling and Psychotherapy
Member American Academy of Paediatrics(AAP)
Member British Association of Perinatal Medicine(BAPM)
Member British Association for Parenteral and Enteral Nutrition(BAPEN)
Associate Member Royal College of Paediatrics and Child Health(RCPCH)
The document discusses various metabolic complications associated with HIV infection and antiretroviral therapy (HAART), including lactic acidemia, lipodystrophy, dyslipidemia, and insulin resistance. Lactic acidemia is proposed to result from mitochondrial toxicity of nucleoside reverse transcriptase inhibitors (NRTIs) and can range from asymptomatic to potentially fatal lactic acidosis. Lipodystrophy involves abnormal fat redistribution including central lipohypertrophy and peripheral lipoatrophy, which are associated with prolonged HAART use and protease inhibitor therapy. Management of these conditions involves treatment interruption or switching antiretrovirals to limit toxicity.
This document summarizes the normal physiological changes that occur in various maternal body systems during pregnancy. It describes how the cardiovascular, respiratory, renal, hematologic, gastrointestinal and reproductive systems adapt to accommodate the growing fetus. Key changes include increased blood volume, heart rate and kidney function as well as common symptoms like nausea and backache. Understanding these changes is important for identifying complications and educating patients about normal pregnancy.
Hypertensive Disorders of Pregnancy .pdfNenyiGhartey1
This document provides an overview of hypertensive disorders in pregnancy (HDPs). It defines HDPs and classifies the main types as chronic hypertension, gestational hypertension, preeclampsia, and superimposed preeclampsia. Preeclampsia is the most dangerous type and can cause multiple maternal organ complications as well as fetal growth restriction. Accurate blood pressure measurement and assessment of proteinuria are key to diagnosis. Treatment involves monitoring for preeclampsia symptoms and delivery of the baby if indicated.
HELLP syndrome is a severe form of preeclampsia characterized by hemolysis, elevated liver enzymes, and low platelets. It occurs in 0.5-0.9% of pregnancies and is diagnosed based on evidence of hemolysis, elevated liver enzymes, and low platelet count. Management of HELLP syndrome depends on disease severity and gestational age, ranging from termination of pregnancy for severe cases to conservative management including blood pressure control, magnesium sulfate to prevent seizures, and corticosteroids to improve platelet and liver function for mild to moderate cases before 34 weeks gestation.
1) HELLP syndrome is a serious condition characterized by hemolysis, elevated liver enzymes, and low platelets that can occur in pregnant women with preeclampsia.
2) It is important to monitor pregnant patients closely for signs and symptoms of HELLP syndrome and test for liver enzymes, platelets, and signs of hemolysis.
3) If HELLP syndrome is diagnosed, the goal is stabilization of the mother followed by expedited delivery, usually within 48 hours, as expectant management poses high risks.
This patient is a 34-week pregnant primigravida with preeclampsia superimposed on chronic hypertension and HELLP syndrome.
Key features include hypertension since 19 weeks of gestation, elevated liver enzymes and low platelet count consistent with HELLP syndrome, and oligohydramnios.
Given the severity of preeclampsia and HELLP syndrome, the doctor would admit the patient to closely monitor for maternal and fetal complications. Emergency medications like magnesium sulfate would be started. The patient would also undergo induction of labor and corticosteroids given for fetal lung maturity, rather than waiting until term due to risk of worsening complications. Postpartum, the patient would continue antihypertensive treatment and
Similar to Serum lactate dehydrogenase : a biochemical marker in pre-eclampsia and eclampsia. (20)
This presentation by Professor Alex Robson, Deputy Chair of Australia’s Productivity Commission, was made during the discussion “Competition and Regulation in Professions and Occupations” held at the 77th meeting of the OECD Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found at oe.cd/crps.
This presentation was uploaded with the author’s consent.
XP 2024 presentation: A New Look to Leadershipsamililja
Presentation slides from XP2024 conference, Bolzano IT. The slides describe a new view to leadership and combines it with anthro-complexity (aka cynefin).
This presentation by OECD, OECD Secretariat, was made during the discussion “Competition and Regulation in Professions and Occupations” held at the 77th meeting of the OECD Working Party No. 2 on Competition and Regulation on 10 June 2024. More papers and presentations on the topic can be found at oe.cd/crps.
This presentation was uploaded with the author’s consent.
Carrer goals.pptx and their importance in real lifeartemacademy2
Career goals serve as a roadmap for individuals, guiding them toward achieving long-term professional aspirations and personal fulfillment. Establishing clear career goals enables professionals to focus their efforts on developing specific skills, gaining relevant experience, and making strategic decisions that align with their desired career trajectory. By setting both short-term and long-term objectives, individuals can systematically track their progress, make necessary adjustments, and stay motivated. Short-term goals often include acquiring new qualifications, mastering particular competencies, or securing a specific role, while long-term goals might encompass reaching executive positions, becoming industry experts, or launching entrepreneurial ventures.
Moreover, having well-defined career goals fosters a sense of purpose and direction, enhancing job satisfaction and overall productivity. It encourages continuous learning and adaptation, as professionals remain attuned to industry trends and evolving job market demands. Career goals also facilitate better time management and resource allocation, as individuals prioritize tasks and opportunities that advance their professional growth. In addition, articulating career goals can aid in networking and mentorship, as it allows individuals to communicate their aspirations clearly to potential mentors, colleagues, and employers, thereby opening doors to valuable guidance and support. Ultimately, career goals are integral to personal and professional development, driving individuals toward sustained success and fulfillment in their chosen fields.
Collapsing Narratives: Exploring Non-Linearity • a micro report by Rosie WellsRosie Wells
Insight: In a landscape where traditional narrative structures are giving way to fragmented and non-linear forms of storytelling, there lies immense potential for creativity and exploration.
'Collapsing Narratives: Exploring Non-Linearity' is a micro report from Rosie Wells.
Rosie Wells is an Arts & Cultural Strategist uniquely positioned at the intersection of grassroots and mainstream storytelling.
Their work is focused on developing meaningful and lasting connections that can drive social change.
Please download this presentation to enjoy the hyperlinks!
Mastering the Concepts Tested in the Databricks Certified Data Engineer Assoc...SkillCertProExams
• For a full set of 760+ questions. Go to
https://skillcertpro.com/product/databricks-certified-data-engineer-associate-exam-questions/
• SkillCertPro offers detailed explanations to each question which helps to understand the concepts better.
• It is recommended to score above 85% in SkillCertPro exams before attempting a real exam.
• SkillCertPro updates exam questions every 2 weeks.
• You will get life time access and life time free updates
• SkillCertPro assures 100% pass guarantee in first attempt.
This presentation, created by Syed Faiz ul Hassan, explores the profound influence of media on public perception and behavior. It delves into the evolution of media from oral traditions to modern digital and social media platforms. Key topics include the role of media in information propagation, socialization, crisis awareness, globalization, and education. The presentation also examines media influence through agenda setting, propaganda, and manipulative techniques used by advertisers and marketers. Furthermore, it highlights the impact of surveillance enabled by media technologies on personal behavior and preferences. Through this comprehensive overview, the presentation aims to shed light on how media shapes collective consciousness and public opinion.
Suzanne Lagerweij - Influence Without Power - Why Empathy is Your Best Friend...Suzanne Lagerweij
This is a workshop about communication and collaboration. We will experience how we can analyze the reasons for resistance to change (exercise 1) and practice how to improve our conversation style and be more in control and effective in the way we communicate (exercise 2).
This session will use Dave Gray’s Empathy Mapping, Argyris’ Ladder of Inference and The Four Rs from Agile Conversations (Squirrel and Fredrick).
Abstract:
Let’s talk about powerful conversations! We all know how to lead a constructive conversation, right? Then why is it so difficult to have those conversations with people at work, especially those in powerful positions that show resistance to change?
Learning to control and direct conversations takes understanding and practice.
We can combine our innate empathy with our analytical skills to gain a deeper understanding of complex situations at work. Join this session to learn how to prepare for difficult conversations and how to improve our agile conversations in order to be more influential without power. We will use Dave Gray’s Empathy Mapping, Argyris’ Ladder of Inference and The Four Rs from Agile Conversations (Squirrel and Fredrick).
In the session you will experience how preparing and reflecting on your conversation can help you be more influential at work. You will learn how to communicate more effectively with the people needed to achieve positive change. You will leave with a self-revised version of a difficult conversation and a practical model to use when you get back to work.
Come learn more on how to become a real influencer!
Suzanne Lagerweij - Influence Without Power - Why Empathy is Your Best Friend...
Serum lactate dehydrogenase : a biochemical marker in pre-eclampsia and eclampsia.
1.
2. INTRODUCTION
• Hypertensive disorders in pregnancy and their complications rank as one of the
major cause of maternal mortality and morbidity in the world. (5-10%)
• Preeclampsia complicates 2-8% of pregnancies.
• It accounts for approximately a quarter of all antenatal admissions.
• In addition, as it is strongly associated with fetal growth retardation and
prematurity, it also contributes largely to perinatal mortality and morbidity.
• Pre-eclampsia is a multi-system disorder of unknown etiology, unique to pregnancy,
with onset after 20 weeks of gestation.
• Eclampsia is the occurrence of convulsions in association with the signs and
symptoms of pre-eclampsia
3. Lactate Dehydrogenase (LDH) : an intracellular enzyme
• In the scenario of increased cell leakiness, hemolysis and cell death, LDH levels are
increased in the serum.
• There is enormous vasculo-endothelial cell damage and cellular death in
preeclampsia.
• Serum LDH levels can be used to assess the extent of cellular death and thereby
the severity of disease.
4. The Global Burden of Hypertensive Disorders In Pregnancy
• Worldwide Hypertensive Disorders in Pregnancy is the second leading cause of
maternal mortality; following haemorrhage , according to WHO systematic analysis
published in 2014.
Fig 1. Global causes of maternal deaths : a WHO systematic analysis
[ The Lancet Global Health , June 2014 ; Vol 2 , issue 6 ]
27%
14%
11%9%
8%
3%
28%
GLOBAL MMR (2003 - 2009 )
Haemorrhage 27%
HDP 14%
Infection 11%
obstructed labour 9%
unsafe abortions 8%
embolism 3%
other causes 28%
5. Common causes of Maternal deaths in PMCH , PATNA ( 2013 )
• During this study, I found that in our institute Patna Medical College and Hospital,
Patna, Hypertensive disorders in pregnancy is the leading cause of maternal
mortality and morbidity with worse fetal outcomes. This may be accounted to the
reason that Patna Medical College being a tertiary centre, is a hub of all referred
cases from urban and rural areas of Bihar.
30%
23%11%
10%
26%
MATERNAL MORTALITY IN PMCH
HDP 30%
Haemorrhage 23%
Anaemia 11%
Sepsis 10%
Others 26%
6. AIMS AND OBJECTIVES
• To evaluate the correlation of high serum LDH levels in pre-eclampsia and
eclampsia to predict the severity of the disease.
• To improve the feto-maternal outcome in these patients.
7. MATERIAL AND METHODS
• The study was conducted in the department of Obstetrics and Gynaecology, Patna
Medical College and Hospital, Patna, Bihar, India from October 2012 to September
2014.
• Total 100 pregnant women were selected from outpatient department and labour
room emergency. All women were in their 3rd trimester of pregnancy.
• The cases were studied in the following groups.
• Group A (Mild pre-eclampsia) 25 pregnant women having Singleton
pregnancy,Gestational age 28-40 wks,Blood pressure systolic ≥ 140mmHg,Diastolic ≥ 90
mmHg ,Proteinuria >300mg/ 24 hr or 1+ by dipstick.
• Group B (Severe pre-eclampsia) 25 pregnant women having Singleton
pregnancy,Gestational age 28-40 wks,Blood pressure Systolic >160 mmHg,Diastolic > 110
mmHg,Proteinuria >3+
• Group C (Eclampsia) 25 pregnant women having Singleton pregnancy,Gestational age 28-
40wks, Convulsions
• Group D (Normal control group) 25 pregnant women having Singleton pregnancy
Gestational age 28-40 wk, Normotensive
8. • The Subjects were also divided according to the S.LDH levels into following groups.
– (a) < 600 IU/l
– (b) 600–800 IU/l
– (c) > 800 IU/l
• NORMAL SERUM LDH VALUES
– Non pregnant women115 to 211 IU/L
– First Trimester 78 to 433 IU/L, Second Trimester 80 to 447 IU/L , Third Trimester 82 to 524 IU/L .
• Serum LDH value above the reference range was taken as raised.
• Plain blood sample on empty stomach was collected for analysis of LDH which was
done in fully automated biochemistry analyzer.
• Exclusion criteria
• Medical disorders : liver disorders, diabetes, renal disease, chronic hypertension,
cardiovascular illness, epilepsy, thyroid disorders, hemolytic diseases, Urinary tract
infections.
• Obstetric complications e.g. Twin pregnancy.
9. No. of cases(100)
This study included 100 patients and was divided in 4 groups each with 25 patients.
25 of these were taken as control.
75 cases were divided according to the severity of hypertensive disorders in
mild pre-eclampsia, severe pre-eclampsia and eclampsia.
25
2525
25
CASE DISTRIBUTION
A -MILD PRE ECLAMPSIA
B - SEVERE PRE ECLAMPSIA
C - ECLAMPSIA
D - CONTROL
10. Age distribution.
This graph shows that 40% of patients with eclampsia (i.e.10 in 25)and 36% of patients
with severe pre-eclampsia (i.e. 9 in 25) belong to age group 18-21 years.
0
5
10
15
20
25
30
35
40
A- mild pre
eclampsia B -severe pre
eclampsia C -eclampsia
D -control
24
36
40
20
24
24
24
28
28
20
12
2824
20
24
24
No.ofpatients(%distribution)
18-21yrs
22-25yrs
26-29yrs
30-33yrs
11. Distribution according to parity
Majority of patients with severe pre eclampsia (40%) and eclampsia (48%) were
primi-gravida
0
10
20
30
40
50
A-mild pre
eclampsia B-severe pre-
eclampsia C-eclampsia
D-control
28
40
48
24
24
16
24
28
24
20
8
24
24
24
20
24
No.ofpatients(%distribution)
G1
G2
G3
G4 & more
12. Gestational age at delivery.
76% cases of eclampsia and 68% cases of severe pre eclampsia delivered before term
i.e. at <37 weeks.
84% cases of mild pre-eclampsia delivered at term.
Whereas all patients in control group delivered at term.
0
5
10
15
20
25
A-mild
preeclampsia B-severe
preeclampsia C-eclampsia
D-control
1
7
7
0
3
10
12
0
21
8
6
25
No.ofpatients
29-32 weeks
33-36weeks
37-40weeks
13. This graph shows mean ldh levels in all groups.
Highest level was found in eclampsia patients.
40 women had ldh below 600, 20 had ldh b/w 600-
800 and 40 had ldh above 800.
All controls had ldh below 600 IU/ml.
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
600.3
1074.0 1154.2
292.2
S. LDH levels in
IU/L
0
5
10
15
20
25
Group A Group B Group C Group D
14
1
0
25
9
4
7
0
2
20
18
0
No.ofpatients
S.LDH groups
<600
600-800
>800
14. This graph shows the mean systolic and diastolic BP
of women in relation to the mean S.LDH levels.
(distribution group wise)
This graph shows higher systolic and diastolic BP in
women with rising S.LDH levels. Levels above
800IU/L were associated with significantly higher BP
148
177 178
113
99
118
111
75
600.3
1074.0
1154.2
292.2
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
1400.0
60
80
100
120
140
160
180
200
Group A Group B Group C Group D
BP Distribution of Means LDH
Systolic BP Diastolic BP
0
20
40
60
80
100
120
140
160
180
<600
600-800 >800
100.8 105 114.45
149.2
160.5
178.3
S.LDH (IU/L)
DIASTOLIC
BP(mmHg)
SYSTOLIC
BP(mmHg)
15. Mean urea and creatinine levels correlated
with high LDH levels.
Mean S. Transaminases and bilirubin were
highest in eclampsia group
29.6
36.4
33.7
20.8
1.0 1.5 1.6 0.7
600.3
1074.0
1154.2
292.2
0.0
200.0
400.0
600.0
800.0
1000.0
1200.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Group A Group B Group C Group D
Distribution of Means
Blood Urea (mg/dl)
Serum Creatinine (mg/dl)
LDH (IU/ L)
25.8
35.6
43.2
24.2
27.9
36.7
50.2
27.0
0.8
1.3
2.2
0.7
0.0
0.5
1.0
1.5
2.0
2.5
20.0
25.0
30.0
35.0
40.0
45.0
50.0
55.0
Group A Group B Group C Group D
Transaminases Distribution of Means Bilirubin
SGPT (IU/L) SGOT (IU/L) S.bilirubin (mg/dl)
16. Rate of still births was higher in cases with
pre-eclampsia and eclampsia group. There
was no still birth in the control group in this
study.
11 out of total 16 still births (68.75%) were in
the group with S.LDH above 800IU/L.
0
5
10
15
20
25
21 20
17
25
4 5
7
0
Still birth
Alive
39
16
28
1
4
11
0
5
10
15
20
25
30
35
40
45
<600 600-800 >800
S.LDH in IU/L
alive
stillbirth
17. It was found that as the LDH increased, mean
gestational weeks at birth decreased, and at
>800 IU/L mean GA was 33.6wks.
It was found that as S.LDH level increased
mean APGAR score decreased.
31
32
33
34
35
36
37
38
39
<600
600-800 >800
38.4
36.9
33.6
Gestational age at birth (in weeks)
gestational age at
birth (in weeks)
0
1
2
3
4
5
6
7
8
9
<600 600-800 >800
7.1
5.6
3.6
8.4
6.9
4.9
S.LDH in IU/L)
APGAR scores vs LDH
APGAR (1 min)
APGAR (5 min)
18. 22 babies (88%) delivered by women with
severe pre-eclampsia and 16 babies (64%) of
eclamptic mothers were low birth weight.
As LDH increased, baby birth weight
decreased. Above 800 IU/L mean birth
weight was 1.9kg
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
<600
600-800
>800
2.9
2.6
1.9
LDH in IU/L
Birth weight in kg
0
2
4
6
8
10
12
14
16
18
20
1
5
6
0
13
17
10
5
11
3
8
20
<1.5kg
1.5-2.5kg
>2.5kg
19. Maximum morbidity was found in women
with S.LDH above 800IU/L.
Women with severe preeclampsia and
eclampsia had most complications.
1 1
3
0
2
4
0 0
1
0 0
4
0 0
1
0 0
1
0 0
2
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
<600 600-800 >800
abruptio placenta
pulmonary
oedema
cerebro vascular
accidents
post partum
eclampsia
HELLP
ARF
sec sut
0
1
2
3
4
5
6
7
8
1
2 2
0
1
2
3
0
0
0
1
0
1
3
0
0
0
1
0
ARF
HELLP
post partum
eclampsia
cerebro vascular
accidents
pulmonary oedema
abruptio placenta
20. DISCUSSION
• Preeclampsia and eclampsia was found to be more common in young women who
were primi-gravida from lower socioeconomic group.
• S. LDH increased as the severity of disease increased.
• The mean blood pressure was found higher.
• Blood investigations shown higher levels of urea, creatinine, bilirubin, SGPT, SGOT
and uric acid.
• Highest morbidity was found in women with S .LDH >800IU/L. Complications
included abruption, pulmonary oedema, acute renal failure, HELLP syndrome,
Cerebrovascular accidents, post partum eclampsia.
• There were 2 maternal mortalities, both with S.LDH >800 IU/L.
• Perinatal morbidity was highest in women with S.LDH >600IU/L.
• There were preterm births, low birth weight babies, low APGAR scores, more NICU
admissions of babies.
• Still birth rates were highest in women with S.LDH>800IU/L.
21. Statistical analysis of the present study was done using “2 sample T-test” and the p-values
were calculated. We compared systolic BP, diastolic BP of patients and gestational age, baby
weight, APGAR scores at one and five minutes of babies in all the cases of group A,B,C with
control group D.
LDH <600 IU/L 600-800 IU/L >800 IU/L Control (<600IU/L)
Systolic BP (mmHg) 149.20±9.65 160.5±16.8 178.3±21.1 112.72±9.78
P Value <0.001
Diastolic BP (mmHg) 100.8±7.99 105±13.6 114.45± 9.69 74.96±7.77
P Value <0.001
Gestational age
(weeks)
38.4±1.4 36.9±1.62 33.55±2.74 38.84±1.11
P Value 0.155 <0.001
Baby Wt. (Kg) 2.94±0.48 2.63±0.47 1.9±0.65 3.14±0.47
P Value 0.106 <0.001
APGAR Score
(1min.)
7.07±2.02 5.6±3.08 3.56±2.6 7.16±0.9
P Value 0.43 0.02 <0.001
APGAR Score
(5min.)
8.40±2.32 6.9±3.58 4.85±3.29 8.8±0.5
P Value 0.261 0.015 <0.001
22. The analysis showed that-
The systolic BP and diastolic BP was significantly higher in patients of all the 3 groups with
S.LDH <600, 600-800 and >800 IU/L when compared against control group. (p value <0.001)
The gestational age at birth of babies was significantly lower in 2 groups with S.LDH 600-800
and >800 IU/L (p value <0.001). The difference was not significant in babies in <600 IU/L
group. (p value 0.155)
The birth weight of babies was significantly lower in 2 groups with S.LDH 600-800 and >800
IU/L (p value <0.001). The difference was not significant in babies in <600 IU/L group.(p
value 0.106)
The APGAR scores at one minute and five minutes of babies was significantly lower in >800
IU/L (p value <0.001). The difference was not significant in babies in <600 IU/L group. (p
value 0.43 at one minute and 0.261 at five minutes) and 600-800 group (p value 0.02 and
0.015 at one and five minutes respectively)
23. • All cases were followed in hospital for at least seven days and discharged
• For further management of their blood pressures they were advised medical
checkup after two weeks, and then four to six weeks later.
• Preconception counselling and Regular ANC during subsequent pregnancy was
advised.
• They were also advised for medical supervision at intervals to rule out chronic
diseases like chronic hypertension, cardiovascular diseases and diabetes in future.
24. CONCLUSION
• Serum lactic dehydrogenase as a biochemical marker is cheap, easily available
test which can be offered to all the patients with hypertensive disorders in
pregnancy.
• Identification of high-risk patients with elevated levels of lactic dehydrogenase,
their close monitoring and prompt and correct management may prevent or at
least reduce the complications .
• Hence , S.LDH along with other severity markers can be used in making decision,
regarding the management strategies to improve the maternal and fetal outcome.
• This would lead to a decrease in the global burden of maternal and perinatal
morbidity and mortality.
25. Pregnancy is nature’s precious
gift which has to be nurtured
during its entire nine months to
achieve good maternal and fetal
outcome