This document defines shoulder dystocia and describes the risk factors, diagnosis, management, and complications. Shoulder dystocia is an obstetric emergency where the fetal shoulders are impacted at the birth canal after delivery of the head. Risk factors include previous shoulder dystocia, macrosomia, and prolonged labor. Diagnosis involves failure of shoulder delivery after head delivery. Management begins with non-traction maneuvers like McRoberts position and suprapubic pressure, followed by rotational maneuvers if needed. Complications include brachial plexus injury, fractures, and hypoxic ischemic encephalopathy.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
When fetal head is delivered, but shoulders are stuck and cannot be delivered it is known as shoulder dystocia.
The anterior shoulder becomes trapped behind on the symphysis pubis, whilst the posterior shoulder may be in the hollow of the sacrum or high above the sacral promontory.
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
Please find the power point on Vacuum delivery. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
“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 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
Please find the power point on Vacuum delivery. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Please find the power point on Management of Preterm labor. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
“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 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.
Radial Nerve is very important topic for first year MBBS Students and as well as for day today clinical practice. This slide gives you full course & relations with clear diagrams as well as applied anatomy with clinical Co-relation.
After completion of this session, students should be able to discuss, identify, and describe:
The anatomical factors predisposing to nerve injuries.
The anatomy of deformity, weakness and sensory loss following the nerve injury.
The applied anatomy of clinical examination for specific nerves.
Surgical anatomy of treating nerve injuries.
BREECH PRESENTATION obstetrics and gynacology mbbs final yearsarath267362
BREECH PRESENTATION obstetrics and gynacology mbbs final year
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Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
2. DEFINITIONS
• Obstetric emergency
• vaginal cephalic delivery that requires additional
obstetric maneuvers to deliver the fetus after the
head has delivered and gentle traction has failed
• occurs when either the anterior, or less commonly
the posterior fetal shoulder impacts on the
maternal symphysis, or sacral promontory,
respectively
Source : RCOG Guidelines
3. DEFINITIONS
• Impaction of fetal shoulders at the pelvic outlet
after the delivery of the head
Source: Handbook of Obstetrics & Gynaecologic Emergencies
• Difficulty in delivery of the fetal shoulders
Source: Obstetrics by Ten Teachers
11. RISK FACTORS – Pre-labour
• Previous shoulder dystocia
• Induction of labour
• Infants of diabetic mothers
• Fetal macrosomia >4.5kg
- excessive weight gain during pregnancy
- maternal obesity (BMI>30)
- asymmetric accelerated fetal growth in non-diabetic
patients
- post-term pregnancy
- parity
12. RISK FACTORS – Intrapartum
• Prolonged first stage of labour
• Secondary arrest
• Prolonged second stage of labour
• Oxytocin augmentation
• Assisted vaginal delivery
13. PREVENTION
The risk factor assessment and progress of labour may help in
prediction of it but they are insufficient.
But trials include:
A. Management of suspected fetal macrosomia
B. History of previous shoulder dystocia and its sequelae
C. Partograph may signal you the delay of the stages and any
fetal distress
14. Management of
suspected fetal macrosomia
• Early induction of labour
- Doesn’t prevent SD in non-diabetic woman with
suspected macrosomic fetus
- Reduce incidence of SD at term for GDM mothers
• Elective LSCS
- Should be considered if pregnancies complicated
by pre-existing or gestational DM, regardless of
treatment, with an estimated fetal weight of
greater than 4.5 kg.
16. Preparation for labour
All birth attendants should be aware of the methods
for diagnosing shoulder dystocia and the techniques
required to facilitate delivery.
Birth attendants should routinely look for the signs of
shoulder dystocia.
Timely management of shoulder dystocia requires
prompt recognition.
17. DIAGNOSIS
• Difficulty with delivery of the face and chin
• The head remaining tightly applied to the vulva or
even retracting (turtle-neck sign)
• Failure of restitution of the fetal head
• Failure of the shoulders to descend
19. Routine traction in an axial direction can be used to
diagnose shoulder dystocia but any other traction
should be avoided.
Routine traction is defined as ‘that traction required
for delivery of the shoulders in a normal vaginal
delivery where there is no difficulty with the
shoulders’.
Axial traction is traction in line with the fetal spine
i.e. without lateral deviation.
22. Call for Help, initiate RED ALERT!
• State clearly
• Experienced obstetrician, midwife, nurses,
neonatologist, anesthetist
• Secure IV line
• Lithotomy position, legs in stirrup with buttocks at edge
of bed
• Empty/catheterise the bladder
Time window for brain hypoxia is 5 minutes.
* Fundal pressure should not be used.
* Encourage the mother not to push.
23. Episiotomy
• To create more space for greater access to the
pelvis
• An episiotomy is not always necessary.
30. Third-linemaneuvers
* The baby most likely in hypoxic-acidotic state…
Cleidotomy
Zavanelli maneuver (mostly for bilateral dystocia)
Symphysiotomy
Future: Posterior axillary sling
31. Cleidotomy
• Anterior clavicle is pressed against the ramis of the
pubis.
• Avoid puncturing the lung by angling the fracture
anteriorly.
• Theoretically, a fracture of the clavicle is less
serious than a brachial nerve injury and often heals
rapidly.
32. Zavanelli maneuver
Consists of cephalic replacement
+ caesarean delivery.
• Relax uterus with terbutaline
• Rotate head back to OA
(“reverse restitution”)
• Flex neck
• Upward pressure
• To Operation Theatre
33. Symphysiotomy
• Insert Foley catheter
• Use vaginal hand to
laterally displace
urethra to avoid
injury
• Incise symphysis
through mons pubis
36. FETAL COMPLICATIONS
• Brachial plexus injury
• Fetal fractures - humerus or clavicle
• Erb’s palsy
• Perinatal asphyxia
• HIE
• Neonatal death
37. Brachial Plexus Injury
• Most cases resolve
without permanent
disability
• Larger infants at higher
risk
• Due to excess traction,
maternal propulsive
force
• Damage to the
posterior shoulder
plexus is unlikely due
to healthcare
professional
38.
39. Future pregnancy
• Mode of delivery – LSCS or vaginal delivery
• Important to discuss with patient and her husband
Since this phenomenon occurs because of a relative size or positional discrepancy between the fetal and pelvic bony dimensions, it nearly always occurs in parturients undergoing cephalic vaginal delivery after 34 weeks’ gestation.
During the fetal head’s cardinal movements of descent, flexion, and internal rotation within the bony pelvis, the shoulders descend to reach the pelvic inlet.
During the head’s subsequent extension, delivery, and external rotation, prior to final expulsion, the shoulders need to rotate within the bony pelvis in a winding fashion to arrive in the most accommodating dimension of the pelvis, its oblique diameter. If either the fetal shoulder dimensions are too large or the maternal pelvis is too narrow, or both, to permit shoulder rotation to the oblique pelvic diameter, persistent anteroposterior orientation of the fetal shoulders may result in the anterior shoulder being obstructed behind the symphysis pubis impeding delivery and leading to shoulder dystocia. If the sacral promontory also obstructs the posterior shoulder, bilateral (and more difficult) shoulder dystocia occurs.
Unilateral shoulder dystocia is usually easily dealt with by standard techniques. (B. Harris, Shoulder dystocia. Clinical Obstetricsand Gynecology, 1984l 27:106)
The posterior shoulder is not in the hollow of the pelvis. This presentation often requires a cephalic replacement. (C.Pauerstein [ed.], Clinical Obstetrics, Churchill Livingstone, New York, 1987.)
Fundal worsen impaction and may result in uterine rupture
-Hyperflex hips(raises symphysis pubis about 9mm, provide clearance to release the anterior shoulder behind the symphysis, lumbosacral spine flattened-advance posterior fetal shoulder into the hollow of sacrum) and knees, abduct and outward rotation of hips
-Encourage maternal pushing
-Lateral neck traction / downward axial traction on the fetus
To dislodge the anterior shoulder form symphysis by pushing it into oblique diameter
-Stand on platform on the same side of the fetal spine
-Lateral suprapubic pressure
-Use the flats of assistant’s hands
-Apply behind anterior shoulder
-Continuous pressure
-If unsuccessful after 30 sec, use rocking motion
Anterior shoulders
-hand into posterior aspect of vagina
-moving it up to posterior aspect of anterior shoulder
-push anterior shoulder from behind into oblique position
Posterior shoulder
-push posterior aspect of posterior shoulder through 180°, with change of hand at 90°
Use right hand if baby facing maternal left
Enter posterior aspect of vagina
Retrieve posterior hand or forearm
Sweep across the chest & face
Deliver the posterior arm
Causing increase in maternal morbidity
Detailed explanation of what was done and why done; also what may happen to the mother and the baby after delivery and in the future should be discussed with the parents.
Brachial plexus injury (BPI) is one of the most important fetal complications of shoulder dystocia, complicating 2.3% to 16% of such deliveries. Most cases of BPI resolve without permanent disability, with fewer than 10% resulting in permanent neurological dysfunction.
A neonatologist should take care to the baby for:
1) Resuscitation as the baby may be in distress
2) Injury: BPI (Erb’s palsy) is one of the most important complications of shoulder dystocia, complicating 2.3% to 16% of such deliveries.