Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
Retained placenta can be defined as lack of placental expulsion within 30 minutes of delivery of an infant. it is more common in preterm. Retained Placenta can lead to massive PPH and increase maternal morbidity and mortality.
INTRAUTERINE DEATH CME ON INDUCTION OF LABOUR ON 8TH NOVEMBER 2016, Dr sharda...Lifecare Centre
HOW TO DEFINE
IUD or STILL BORN
fetal death after period of viability ( 28 weeks )
24 weeks in USA
24WEEKS OR >500 Gms by WHO
ACOG refers to IUFD as the demise occurring at or later than 20weeks.
Managing and Measuring work was presented at the 2016 Tennessee SHRM State Conference in Memphis, TN by Gwendolyn Tucker.
Coach Gwen highlights that a leader's role includes setting clear objectives, monitoring progress and giving feedback. But, unfortunately, too many managers are unskilled at doing so.
Managing & Measuring Work addresses elements of a robust performance management program necessary for building a culture of accountability, and strategies for implementing in the workplace.
May occur very early on during the attachment or migration stages (No objective evidence e.g. –ve hCG)
May also occur at a later stage (+ve hCG) but process becomes disrupted
Definition: Refers to the failure of the embryo to reach a stage when an intrauterine gestational sac is recognized by ultrasonography.
Implantation failure can apply to patients undergoing ART and patients trying to conceive without any fertility treatment.
It is a separate entity from RPL
Orvieto et al - 3 failed IVF-ET cycles with good quality embryos transferred .
Zeyneloglu et al. - 3 unsuccessful IVF specifically with two embryos of high quality
Simon and Laufer - embryo & endometrium can both play an active role in RIF
Coughlan et al. suggest a more complete working definition taking into account maternal age, number of embryos transferred, and number of cycles completed.
They define RIF as the failure of clinical pregnancy after 4 good quality embryo transfers, with at least three fresh or frozen IVF cycles, and in women under the age of 40
RIF is a complex problem with a wide variety of etiologies / mechanisms/ treatment options.
Recommendations vary depending on the source of their problem. Perhaps the best and yet most complex answer is personalized medicine, a personal approach to each patient depending on her unique set of characteristics.
It would help to establish a set of standardized tests to use, in order to do a preliminary evaluation on each patient, which would then hopefully direct the approach of treatment for each individual couple.
This can be implemented when we have well designed studies that will help us to establish new protocols.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
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Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
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.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
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
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
27. Thrombophilia Gonen R et al. Absence of association of inherited thrombophilia with unexplained third-trimester intrauterine fetal death. AJOG 2005;192:742-6
28.
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33. Silver et al. Work-up of stillbirth: a review of the evidence. AJOG 2007;196:433-444.
WHO suggests live birth has birth weight 500 gm, gestational age of 22 weeks, and body length of 25 cm “ any sign of life” criteria Fetal heart rate Breathing Movement of voluntary muscles 350 g is 50 th percentile for 20 weeks gestation TCA Fetal death reported when ≥500 g or ≥22 weeks Birth and death certificates are not generated after miscarriage ability to call a fetal loss a stillbirth is important
6.2/1000 live births and fetal deaths (total births = live births+fetal deaths) AA have 2x risk stillbirth Some of this increase can be attributed to access to and quality of medical care Even with adequate access , still have higher rate of stillbirth Higher rates diabetes, HTN, abruption, PPROM
In July 2009 the Urban Child Institute in Memphis looked at the discrepancies in still births in Tennessee counties Concluded that differences were related to reporting different GA/weight
Between 24-27 weeks, most common cause if stillbirth is infection (19%) Contribution of infection to stillbirth rate is difficult to define Some pathogens clearly causally associated with stillbirth Parvo CMV Toxo Other pathogens might be associated with increased risk of stillbirth but strong evidence of causal relation is absent Ureaplasma urealyticum Mycoplasma hominis GBS
Nulliparity OR 1.2 – 1.4
24-27 weeks, most common cause still birth Infection Stillbirth related to infection occur most frequently in fetuses <1000 g Abruption Anomalies 21% unexplained Stillbirth related to abruption has decreased over decades After 28 weeks, unexplained stillbirth increases Fetal death that is unexplained by fetal, placental, maternal, or obstetric factors represents 25-60% of all fetal deaths Diagnosis of exclusion Depends on rigorousness of stillbirth assessment
Diagnostic criteria for determining if a fetal death is due to an infection are not well defined and complicated by high frequency of asymptomatic maternal vaginal colonization of some potential pathogens.
Stillbirth rate 4x higher than singletons
Childbearing increasing among older women Older women are at increased risk for adverse outcomes Low birth weight Preterm Fetal mortality Significant proportion of perinatal deaths in older women are related to lethal congenital and chromosomal abnormalities Increased risk of unexplained stillbirth late in pregnancy persists in older women even after controlling for risk factors such as HTN, DM, previa, multiple gestation AMA remains as independent risk factor after accounting for medical conditions that occur in older women Increased risk associated with anomalies has been reduced with prenatal diagnostic testing and availability of abortions Peak rise period in older mothers between 37-41 weeks but NO studies to examine differential risk antepartum vs intrapartum
Mature gravidas at increased risk of various adverse outcomes Low birth weight Preterm SGA Stillbirth Link between advanced maternal age and stillbirth but little information on timing of in utero death Stillbirth defined In utero death > 20 weeks Excluded congenital malformations and chromosomal abnormalities Women 35-39 were more than 2-fold as likely to experience intrapartum stillbirth while those 40 or greater were 3x as likely Highest risk of stillbirth exhibited among mothers in oldest age group Higher levels of obstetric complications in older women could contribute to elevated risk for still birth Information on pregnancy complications not readily available in this data base Etiologic factors for antepartum and intrapartum stillbirth have been suggested to be different Preeclampsia, HTN, abnormal placental conditions are more likely to cause antepartum stillbirth Excess of these conditions in older women may explain 4-fold increment in occurrence of antepartum stillbirth among older women Intrapartum stillbirth more likely to result from fetal distress, obstructed labor Indication of access to and quality of care during delivery Different risk estimates for antepartum vs intrapartum stillbirth with maternal age may reflect dynamics in distribution and patterns of these etiologic factors as women age
Thinner women may be better able to perceive fetal movement Hyperlipidemia Increased endothelial dysfunction Platelet aggregation Clinically significant atherosclerosis Sleep studies show obese women snore more and have increased apnea-hypoxia events Increased episodes oxygen destauration Snoring associated with pregnancy induced hypertension and growth restriction
One of several studies which challenge association between thrombophilia and complications No difference in study and control group Findings are consistent with studies from Germany and Austria
Most important tests in still birth evaluation Autopsy Identification of birth defects and morphologic abnormalities suggesting genetic or developmental abnormalities Determine and/or confirm other causes of stillbirth Infection Anemia Hypoxia Metabolic abnormalities Comparative genomic hybridization Scan genome for differences from normal reference genome without mitotic activity Detects only copy number changes relative to the average in the entire specimen Does not detect triploidy No information on chromosome architecture Cannot discern translocation from non-dysjunction Down’s Does not detect balanced chromosomal rearrangements Only detects changes in substantial percentage of cells
After autopsy and histologic evaluation, pathologist can proceed with appropriate culture and nucleic acid specimens for bacteria and viruses taken for organisms suspected on basis of histology Parvovirus serology may be useful Implicated in meaningful proportion of cases RPR Syphilis is a generally accepted cause of stillbirth TORCH serology questionable Toxo, rubella, CMV, HSV Traditionally advised but titers rarely clinically useful Routine placental bacterial cultures may be useful but problematic Avoid vaginal wall contamination Culture between membranes Ureaplasma and mycoplasma in addition to aerobic and anaerobic cultures may be useful Incidence in live-born pregnancies unknown Nucleic acid based tests for bacterial or viral products may be more sensitive but also associated with more false positive results
FMH common cause of stillbirth – screening advised KBT Fetal cells in maternal blood Elution of hemoglobin from adult cells Acid resistant fetal hemoglobin remains intact Statistical imprecision in quantifying FMH
Testing cases characterized by placental insufficiency appropriate given apparent pathophysiology of these conditions Limited evidence that treatment in subsequent pregnancy improves outcomes Some heritable thrombophilias are present in a large proportion of normal individuals – positive test may be unrelated to stillbirth
Recurrent stillbirth 2 unexplained previous stillbirths at 37 and 38 weeks 35 weeks gestation with decreased FM 3 days after negative CST D/C’d home after reactive NST Returned 16 hours later with no FM x 5 hrs IUFD confirmed
Nonrecurring conditions Testing of limited value Affected mothers better served with screeening, education, counseling Recur but not predictable Unlikely to benefit from testing in subsequent pregnancies.
Rates of delivery for abnormal or equivocal testing were 16.3% at or before 39 weeks and 1% before 36 weeks
Must be considered in any strategy that may lead to iatrogenic late preterm birth
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