Management of postpartum haemorrhage due to vaginal tears is not a well discussed entity. This lecture goes in depth on management of PPH due to vaginal lacerations.
Vacuum delivery is one of the most important art to learn in labour ward. Kiwi is a simplified vacuum device. Mastering the techniques these devices can achieve good outcomes.
This document provides an overview of imaging modalities used in gynecology, including ultrasound, MRI, CT, and their applications. Key points discussed include:
- Ultrasound is the primary imaging method due to lack of radiation. Resolution depends on transducer proximity and frequency. It is used to evaluate the endometrium, ovaries, fibroids, and adnexal masses.
- MRI provides additional detail on adenomyosis, leiomyosarcoma differentiation, and mapping of large or multiple fibroids.
- CT is used for evaluating lung or upper abdominal metastases and staging of ovarian cancer.
- Transvaginal ultrasound criteria for evaluating ovarian tumors, cysts, and assessing risk
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
Vacuum extraction, also known as ventouse, is a method to assist delivery using a vacuum device attached to the fetal scalp to create suction. The vacuum extractor consists of a suction cup connected by tubing to a vacuum source. It is used when maternal or fetal indications warrant assistance with delivery, such as maternal exhaustion or fetal distress. Risks include scalp laceration and other soft tissue injuries for both mother and baby. The procedure should be abandoned if progress is not made within 20 minutes due to risks of trauma.
This document discusses caesarean section (C/S) in small animals. It covers indications for C/S including uterine inertia, pelvic obstruction, fetal oversize, and fetal death. It describes the C/S procedure including anesthesia, midline incision approach, and removal of puppies. Post-operative care is also discussed, as well as risks of the surgery and use of foster mothers. The overall risk of C/S is low but complications can include bleeding, infection, and wound issues.
1. Uterine inversion occurs when the uterus turns inside out, causing the fundus to prolapse through the cervix. It can be incomplete or complete and acute or chronic in timing. Risk factors include fundal pressure during delivery and premature cord traction.
2. Symptoms include severe abdominal pain, feeling of prolapse, and shock. Management involves calling for help, resuscitation, and manual reversion of the uterus or hydrostatic reduction techniques. Surgical management may be needed if manual reduction fails.
3. Perineal tears range from first degree involving skin only to third degree involving the anal sphincter. Risk factors include primiparity. Management involves repair, analgesia, antibiotics
New microsoft office power point presentationShaells Joshi
This document discusses third stage labor complications and injuries to the birth canal. It defines third stage complications as postpartum hemorrhage, retained placenta, inverted uterus, and amniotic fluid embolism. It describes the causes, signs, and management of these complications. It also discusses classifications and causes of injuries to the birth canal during childbirth, such as lacerations and ways to prevent and manage them. The document provides detailed information on diagnosing and treating various third stage labor complications and birth canal injuries.
Vacuum delivery is one of the most important art to learn in labour ward. Kiwi is a simplified vacuum device. Mastering the techniques these devices can achieve good outcomes.
This document provides an overview of imaging modalities used in gynecology, including ultrasound, MRI, CT, and their applications. Key points discussed include:
- Ultrasound is the primary imaging method due to lack of radiation. Resolution depends on transducer proximity and frequency. It is used to evaluate the endometrium, ovaries, fibroids, and adnexal masses.
- MRI provides additional detail on adenomyosis, leiomyosarcoma differentiation, and mapping of large or multiple fibroids.
- CT is used for evaluating lung or upper abdominal metastases and staging of ovarian cancer.
- Transvaginal ultrasound criteria for evaluating ovarian tumors, cysts, and assessing risk
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
Vacuum extraction, also known as ventouse, is a method to assist delivery using a vacuum device attached to the fetal scalp to create suction. The vacuum extractor consists of a suction cup connected by tubing to a vacuum source. It is used when maternal or fetal indications warrant assistance with delivery, such as maternal exhaustion or fetal distress. Risks include scalp laceration and other soft tissue injuries for both mother and baby. The procedure should be abandoned if progress is not made within 20 minutes due to risks of trauma.
This document discusses caesarean section (C/S) in small animals. It covers indications for C/S including uterine inertia, pelvic obstruction, fetal oversize, and fetal death. It describes the C/S procedure including anesthesia, midline incision approach, and removal of puppies. Post-operative care is also discussed, as well as risks of the surgery and use of foster mothers. The overall risk of C/S is low but complications can include bleeding, infection, and wound issues.
1. Uterine inversion occurs when the uterus turns inside out, causing the fundus to prolapse through the cervix. It can be incomplete or complete and acute or chronic in timing. Risk factors include fundal pressure during delivery and premature cord traction.
2. Symptoms include severe abdominal pain, feeling of prolapse, and shock. Management involves calling for help, resuscitation, and manual reversion of the uterus or hydrostatic reduction techniques. Surgical management may be needed if manual reduction fails.
3. Perineal tears range from first degree involving skin only to third degree involving the anal sphincter. Risk factors include primiparity. Management involves repair, analgesia, antibiotics
New microsoft office power point presentationShaells Joshi
This document discusses third stage labor complications and injuries to the birth canal. It defines third stage complications as postpartum hemorrhage, retained placenta, inverted uterus, and amniotic fluid embolism. It describes the causes, signs, and management of these complications. It also discusses classifications and causes of injuries to the birth canal during childbirth, such as lacerations and ways to prevent and manage them. The document provides detailed information on diagnosing and treating various third stage labor complications and birth canal injuries.
The document discusses various birth-related procedures and their nursing care implications. It covers external and internal versions, amniotomy, methods for inducing labor like cervical ripening and membrane stripping, episiotomy types and care, forceps-assisted birth risks and applications, vacuum extraction risks, cesarean birth indications and preparation, and vaginal birth after cesarean guidelines and risks. The document provides information to help nurses explain procedures and determine appropriate nursing management.
The document defines and discusses retained placenta, which occurs when the placenta is not expelled from the uterus within 30 minutes of delivery. There are several potential causes of retained placenta, including failure of the placenta to separate fully from the uterine wall due to issues like uterine atonicity. Management involves controlling bleeding if present and attempting controlled cord traction or manual removal of the placenta in the operating room if needed. Leaving the placenta retained poses risks like severe bleeding.
The document describes natural Cesarean section (NCS) techniques that aim to make the experience more similar to a vaginal birth. Three key aspects are: 1) parents can watch the birth and baby is slowly extracted to allow self-resuscitation; 2) the baby is placed skin-to-skin on the mother's chest immediately to encourage bonding; 3) the father can help cut the umbilical cord. Proponents believe NCS can decrease maternal anxiety and depression as well as improve neonatal outcomes by reducing separation of mother and baby.
Caesarean section is a surgical procedure to deliver a baby through abdominal and uterine incisions after 28 weeks of pregnancy. The incidence of C-sections has increased due to abandoning difficult procedures and increased use for breech births. Indications include maternal conditions like pelvic abnormalities and previous C-sections, as well as fetal indications like distress. A lower segment transverse incision is most common. Complications can include hemorrhage, injury, infection and rupture of the uterine scar in subsequent pregnancies.
This document discusses uterine rupture and dehiscence. It defines uterine rupture as a disruption of the uterine muscle extending to the uterine serosa or other organs, while uterine dehiscence is a disruption of the uterine muscle with an intact serosa. Risk factors for rupture include prior c-sections, myomectomy scars, and uterine abnormalities. Signs of rupture include severe abdominal pain, vaginal bleeding, maternal tachycardia, and fetal distress. Management involves stabilizing the mother, rapidly delivering the baby via c-section, and potentially performing a hysterectomy. For future pregnancies, women are advised to have planned c-sections or consider permanent contraception due to the risks.
Lower segment caesarean section (LSCS) is a surgical procedure to deliver fetuses after 28 weeks of gestation through an incision in the lower uterine segment and abdominal wall. The rate of cesarean sections is rising due to various factors like identification of high-risk fetuses and mothers, increased use of repeat cesareans, and cesarean delivery on demand. LSCS has absolute indications like placenta previa and relative indications like previous cesarean, fetal distress, and failed induction of labor. It involves making a transverse or vertical incision, delivering the baby, suturing the uterine incision, and closing abdominal layers. Complications can be intraoperative like bleeding or postoperative like infection
1. Caesarean section is a surgical procedure where the fetus, placenta, and membranes are delivered through an incision in the abdominal wall and uterus.
2. The incidence of caesarean sections has steadily increased over the last decade from around 10% to 30% due to improved safety, identification of risk factors, and increased awareness of fetal well-being.
3. Indications for caesarean include cephalopelvic disproportion, previous uterine scar, fetal distress, and malpresentations; contraindications include a dead fetus or one that is too premature.
This document discusses induction of labour, which is defined as artificially stimulating uterine contractions before the onset of natural labour. It outlines the goals, indications, methods, and nursing responsibilities for labour induction. The main methods discussed are medical induction using prostaglandins or oxytocin, and surgical induction through membrane stripping or artificial rupture of membranes. The nursing responsibilities involve properly administering induction medications and procedures, monitoring the woman and fetus during labour induction, and providing general care and support to the woman and newborn.
This document provides an overview of cesarean delivery, including the types of cesarean procedures, reasons for performing cesarean sections, risks and rates of maternal and neonatal morbidity and mortality, steps involved in performing a cesarean section, and important considerations before and after the procedure. It describes the basic surgical steps for performing a cesarean section, from making the abdominal and uterine incisions to extracting the fetus and placenta and closing the incisions. Key learning resources on cesarean delivery are also listed.
Cesarean delivery, also known as C-section, is the birth of a baby through surgical openings made in the mother's abdomen and uterus. This document discusses the history, indications, risks and complications of cesarean delivery. It notes that the C-section rate has quadrupled since 1965 due to various factors like older maternal age, obesity, litigation concerns and increased use of electronic fetal monitoring. The risks of a C-section include infection, hemorrhage, injury to organs and increased risks with additional C-sections like placenta accreta. The document provides an in-depth overview of cesarean delivery.
Caesarean section is the delivery of a fetus through incisions in the mother's abdominal wall and uterus. There are two main types: lower segment Caesarean section (LSCS), which involves a transverse incision in the lower uterus; and upper segment/classical Caesarean section, which uses a vertical incision in the upper uterus. LSCS is preferred since it is less invasive and has better healing. Indications for emergency LSCS include fetal distress, cephalopelvic disproportion (CPD), and failed instrumental delivery. Elective LSCS is recommended for women with two or more previous C-sections or other risk factors like placenta previa. The procedure involves anesthesia, abdominal
Vacuum delivery is a device used to assist delivery by creating negative pressure between a suction cup and the fetal scalp. It has a suction cup, vacuum generator, and traction tubing. There are different cup types, including Malmstrom, Bird, and soft silicone cups. Vacuum delivery is indicated for maternal or fetal distress in the second stage of labor or prolonged second stage. Proper technique involves assessing fetal position, applying the cup to the flexion point, gradually increasing negative pressure, and applying traction in sync with contractions along the curve of Carus. Complications can include cephalhematoma and injuries for the baby or soft tissue injuries for the mother.
This document provides information on performing a Cesarean section (C-section). It begins by defining a C-section and explaining the different types based on gestational age. It then discusses techniques to reduce operating time and costs. Common causes of C-sections are listed, along with reasons for increasing C-section rates. Preoperative testing, positioning, catheterization, skin preparation, draping, and abdominal entry techniques are outlined. Regional versus general anesthesia options are presented. The document concludes by describing uterine incision techniques and addressing central placenta praevia.
The document discusses Caesarean section, including indications, types, procedure, complications, and mode of delivery in subsequent pregnancies. A Caesarean section is a surgical procedure to deliver one or more babies through incisions in the abdomen and uterus. The rate of Caesarean sections has increased from 5% in 1970 to 25% in 1990 due to factors such as abandoning difficult procedures in favor of C-sections and increased use for breech births. Complications can include hemorrhage, infections, and injuries to the mother or baby.
Induction of labor involves initiating uterine contractions to achieve vaginal delivery. It can be done through medical methods like prostaglandins or oxytocin, or surgical methods like stripping membranes or amniotomy. Key indications for induction include post-term pregnancy, preeclampsia, diabetes, and suspected fetal compromise. Factors like cervical readiness and fetal position are assessed first to determine suitability. Methods involve prostaglandins administered vaginally or oxytocin infusion, which carry risks of hyperstimulation and fetal distress if not carefully monitored.
This document presents a case of a 29-year-old woman who is 3 months pregnant and experiencing bleeding and abdominal pain. On examination, she is found to have an incomplete miscarriage. The document then discusses manual vacuum aspiration (MVA) as a procedure to evacuate the uterine contents in cases of incomplete miscarriage. It covers the advantages, indications, contraindications, equipment, precautions, procedure steps, and potential complications of MVA. MVA is described as a safe, affordable option for uterine evacuation that is easy to learn and use without requiring electricity.
This document summarizes a caesarean section (C-section) procedure performed on a bovine. It describes the animal's medical history of dystocia. On examination, edema and emphysema were observed, making vaginal delivery impossible. The C-section procedure is then outlined in steps, including exteriorizing the uterus, removing the fetus, managing the placenta, and closing incisions. Potential complications are listed. Post-operative care involves antibiotics, analgesics, oxytocin, and wound dressing.
The document describes techniques for using uterine and vaginal balloons to control postpartum hemorrhage (PPH). It discusses various balloon devices that have been used historically and their advantages over traditional gauze packing. Key balloon techniques described include the Sengstaken-Blakemore tube, Bakri balloon, Foley catheters, and condom balloons. The document provides details on how to properly insert and remove different balloon devices to exert controlled pressure on the uterus and stop bleeding in cases of PPH.
The document summarizes the third stage of labor and postpartum hemorrhage (PPH). It defines PPH, describes the causes including uterine atony, retained tissues, trauma, and coagulopathy. It outlines prevention strategies, signs and symptoms, management which includes emptying the uterus, replacing blood loss, achieving hemostasis, and surgical procedures like hysterectomy if needed. PPH is a leading cause of maternal mortality and this document provides guidance on diagnosing and treating both primary and secondary PPH.
The document discusses various birth-related procedures and their nursing care implications. It covers external and internal versions, amniotomy, methods for inducing labor like cervical ripening and membrane stripping, episiotomy types and care, forceps-assisted birth risks and applications, vacuum extraction risks, cesarean birth indications and preparation, and vaginal birth after cesarean guidelines and risks. The document provides information to help nurses explain procedures and determine appropriate nursing management.
The document defines and discusses retained placenta, which occurs when the placenta is not expelled from the uterus within 30 minutes of delivery. There are several potential causes of retained placenta, including failure of the placenta to separate fully from the uterine wall due to issues like uterine atonicity. Management involves controlling bleeding if present and attempting controlled cord traction or manual removal of the placenta in the operating room if needed. Leaving the placenta retained poses risks like severe bleeding.
The document describes natural Cesarean section (NCS) techniques that aim to make the experience more similar to a vaginal birth. Three key aspects are: 1) parents can watch the birth and baby is slowly extracted to allow self-resuscitation; 2) the baby is placed skin-to-skin on the mother's chest immediately to encourage bonding; 3) the father can help cut the umbilical cord. Proponents believe NCS can decrease maternal anxiety and depression as well as improve neonatal outcomes by reducing separation of mother and baby.
Caesarean section is a surgical procedure to deliver a baby through abdominal and uterine incisions after 28 weeks of pregnancy. The incidence of C-sections has increased due to abandoning difficult procedures and increased use for breech births. Indications include maternal conditions like pelvic abnormalities and previous C-sections, as well as fetal indications like distress. A lower segment transverse incision is most common. Complications can include hemorrhage, injury, infection and rupture of the uterine scar in subsequent pregnancies.
This document discusses uterine rupture and dehiscence. It defines uterine rupture as a disruption of the uterine muscle extending to the uterine serosa or other organs, while uterine dehiscence is a disruption of the uterine muscle with an intact serosa. Risk factors for rupture include prior c-sections, myomectomy scars, and uterine abnormalities. Signs of rupture include severe abdominal pain, vaginal bleeding, maternal tachycardia, and fetal distress. Management involves stabilizing the mother, rapidly delivering the baby via c-section, and potentially performing a hysterectomy. For future pregnancies, women are advised to have planned c-sections or consider permanent contraception due to the risks.
Lower segment caesarean section (LSCS) is a surgical procedure to deliver fetuses after 28 weeks of gestation through an incision in the lower uterine segment and abdominal wall. The rate of cesarean sections is rising due to various factors like identification of high-risk fetuses and mothers, increased use of repeat cesareans, and cesarean delivery on demand. LSCS has absolute indications like placenta previa and relative indications like previous cesarean, fetal distress, and failed induction of labor. It involves making a transverse or vertical incision, delivering the baby, suturing the uterine incision, and closing abdominal layers. Complications can be intraoperative like bleeding or postoperative like infection
1. Caesarean section is a surgical procedure where the fetus, placenta, and membranes are delivered through an incision in the abdominal wall and uterus.
2. The incidence of caesarean sections has steadily increased over the last decade from around 10% to 30% due to improved safety, identification of risk factors, and increased awareness of fetal well-being.
3. Indications for caesarean include cephalopelvic disproportion, previous uterine scar, fetal distress, and malpresentations; contraindications include a dead fetus or one that is too premature.
This document discusses induction of labour, which is defined as artificially stimulating uterine contractions before the onset of natural labour. It outlines the goals, indications, methods, and nursing responsibilities for labour induction. The main methods discussed are medical induction using prostaglandins or oxytocin, and surgical induction through membrane stripping or artificial rupture of membranes. The nursing responsibilities involve properly administering induction medications and procedures, monitoring the woman and fetus during labour induction, and providing general care and support to the woman and newborn.
This document provides an overview of cesarean delivery, including the types of cesarean procedures, reasons for performing cesarean sections, risks and rates of maternal and neonatal morbidity and mortality, steps involved in performing a cesarean section, and important considerations before and after the procedure. It describes the basic surgical steps for performing a cesarean section, from making the abdominal and uterine incisions to extracting the fetus and placenta and closing the incisions. Key learning resources on cesarean delivery are also listed.
Cesarean delivery, also known as C-section, is the birth of a baby through surgical openings made in the mother's abdomen and uterus. This document discusses the history, indications, risks and complications of cesarean delivery. It notes that the C-section rate has quadrupled since 1965 due to various factors like older maternal age, obesity, litigation concerns and increased use of electronic fetal monitoring. The risks of a C-section include infection, hemorrhage, injury to organs and increased risks with additional C-sections like placenta accreta. The document provides an in-depth overview of cesarean delivery.
Caesarean section is the delivery of a fetus through incisions in the mother's abdominal wall and uterus. There are two main types: lower segment Caesarean section (LSCS), which involves a transverse incision in the lower uterus; and upper segment/classical Caesarean section, which uses a vertical incision in the upper uterus. LSCS is preferred since it is less invasive and has better healing. Indications for emergency LSCS include fetal distress, cephalopelvic disproportion (CPD), and failed instrumental delivery. Elective LSCS is recommended for women with two or more previous C-sections or other risk factors like placenta previa. The procedure involves anesthesia, abdominal
Vacuum delivery is a device used to assist delivery by creating negative pressure between a suction cup and the fetal scalp. It has a suction cup, vacuum generator, and traction tubing. There are different cup types, including Malmstrom, Bird, and soft silicone cups. Vacuum delivery is indicated for maternal or fetal distress in the second stage of labor or prolonged second stage. Proper technique involves assessing fetal position, applying the cup to the flexion point, gradually increasing negative pressure, and applying traction in sync with contractions along the curve of Carus. Complications can include cephalhematoma and injuries for the baby or soft tissue injuries for the mother.
This document provides information on performing a Cesarean section (C-section). It begins by defining a C-section and explaining the different types based on gestational age. It then discusses techniques to reduce operating time and costs. Common causes of C-sections are listed, along with reasons for increasing C-section rates. Preoperative testing, positioning, catheterization, skin preparation, draping, and abdominal entry techniques are outlined. Regional versus general anesthesia options are presented. The document concludes by describing uterine incision techniques and addressing central placenta praevia.
The document discusses Caesarean section, including indications, types, procedure, complications, and mode of delivery in subsequent pregnancies. A Caesarean section is a surgical procedure to deliver one or more babies through incisions in the abdomen and uterus. The rate of Caesarean sections has increased from 5% in 1970 to 25% in 1990 due to factors such as abandoning difficult procedures in favor of C-sections and increased use for breech births. Complications can include hemorrhage, infections, and injuries to the mother or baby.
Induction of labor involves initiating uterine contractions to achieve vaginal delivery. It can be done through medical methods like prostaglandins or oxytocin, or surgical methods like stripping membranes or amniotomy. Key indications for induction include post-term pregnancy, preeclampsia, diabetes, and suspected fetal compromise. Factors like cervical readiness and fetal position are assessed first to determine suitability. Methods involve prostaglandins administered vaginally or oxytocin infusion, which carry risks of hyperstimulation and fetal distress if not carefully monitored.
This document presents a case of a 29-year-old woman who is 3 months pregnant and experiencing bleeding and abdominal pain. On examination, she is found to have an incomplete miscarriage. The document then discusses manual vacuum aspiration (MVA) as a procedure to evacuate the uterine contents in cases of incomplete miscarriage. It covers the advantages, indications, contraindications, equipment, precautions, procedure steps, and potential complications of MVA. MVA is described as a safe, affordable option for uterine evacuation that is easy to learn and use without requiring electricity.
This document summarizes a caesarean section (C-section) procedure performed on a bovine. It describes the animal's medical history of dystocia. On examination, edema and emphysema were observed, making vaginal delivery impossible. The C-section procedure is then outlined in steps, including exteriorizing the uterus, removing the fetus, managing the placenta, and closing incisions. Potential complications are listed. Post-operative care involves antibiotics, analgesics, oxytocin, and wound dressing.
The document describes techniques for using uterine and vaginal balloons to control postpartum hemorrhage (PPH). It discusses various balloon devices that have been used historically and their advantages over traditional gauze packing. Key balloon techniques described include the Sengstaken-Blakemore tube, Bakri balloon, Foley catheters, and condom balloons. The document provides details on how to properly insert and remove different balloon devices to exert controlled pressure on the uterus and stop bleeding in cases of PPH.
The document summarizes the third stage of labor and postpartum hemorrhage (PPH). It defines PPH, describes the causes including uterine atony, retained tissues, trauma, and coagulopathy. It outlines prevention strategies, signs and symptoms, management which includes emptying the uterus, replacing blood loss, achieving hemostasis, and surgical procedures like hysterectomy if needed. PPH is a leading cause of maternal mortality and this document provides guidance on diagnosing and treating both primary and secondary PPH.
A uterine rupture is a serious tear in the wall of the uterus. It is most common in women with a previous c-section scar, though other risk factors exist like induced labor or uterine abnormalities. Symptoms include vaginal bleeding, abdominal pain, and changes in contractions. Immediate surgery is required to deliver the baby via c-section and repair the tear within 10-35 minutes of a complete rupture. Nursing care focuses on rapid intervention, monitoring for signs of rupture and complications like shock, and providing physical and emotional support for the patient and family during surgery.
This article describes a new removable uterine compression suture technique for managing severe postpartum hemorrhage as an alternative to hysterectomy. The technique involves passing a non-absorbable suture through the abdominal wall and lower uterine segment on both sides to compress the uterus against the pubis. Unique to this technique, the sutures are removed 24-48 hours later to prevent uterine synechia while maintaining hemostasis. In testing on 15 patients with PPH, hemostasis was achieved in all cases with one secondary hysterectomy. No complications were reported. The removable suture may offer an effective new option for PPH treatment by controlling bleeding while preserving fertility.
The document discusses complications of the third stage of labour and their management. It defines labour as the process of expelling the products of conception from the womb through the vagina. The stages of labour are outlined as first, second, third, and fourth. Complications of the third stage include postpartum hemorrhage, retained placenta, shock, inversion of the uterus, and amniotic fluid embolism. Postpartum hemorrhage is defined and types, causes, and risk factors are explained. The prevention and management of third stage hemorrhage and retained placenta are described. Other complications such as shock, inversion of the uterus, and disseminated intravascular coagulation are also summarized
This document describes the Hennawy glove balloon catheter, which is used to control postpartum hemorrhage. It consists of a glove with the fingers tied off except one, into which a Foley catheter is inserted. It is inserted into the uterus and inflated to exert pressure and stop bleeding. The document discusses how to prepare it, its advantages over other methods, its mechanisms of action, indications, contraindications and technical considerations for use. It is presented as an inexpensive option for controlling PPH where resources are limited.
Genitourinary fistulas are abnormal connections between the urinary and genital tracts that cause involuntary urine leakage. The most common type is a vesicovaginal fistula between the bladder and vagina, usually resulting from prolonged obstructed labor without medical intervention. Symptoms include continuous urinary leakage from the vagina. Treatment involves identifying the fistula location and surgically repairing the tissues in layers with continuous bladder drainage via catheter. Success requires a single, small fistula without significant scarring or tissue loss.
Delayed ligation technique is recommended for peri-partum hysterectomy for placenta accreta as it allows for quick hemostatic control. The technique involves clamping the round ligaments, utero-ovarian ligaments, and ascending uterine vessels before sequentially ligating them from distal to proximal. For placenta accreta in the lower uterus, total hysterectomy is needed while supracervical hysterectomy may be performed if the placenta is in the upper uterus. Post-operative care focuses on monitoring for bleeding and infection while encouraging early mobilization.
TUBECTOMY PPT by Dr Bandari Sajala, Ms OBGYNSajala Bandari
This document provides information on tubectomy, a form of female sterilization. It discusses the indications, criteria for case selection, preoperative evaluation, anesthesia techniques, contraindications, surgical techniques including laparotomy, minilaparotomy and laparoscopic methods. It describes various tubal ligation methods such as Pomeroy, Irving, Uchida, Madlener techniques. It also discusses complications of the different sterilization procedures and failure rates and reversibility of methods.
Hysterosalpingography is an imaging technique used to evaluate the uterus and fallopian tubes. It involves inserting a cannula through the cervix and injecting radiographic contrast material under fluoroscopy. This allows visualization of the uterine cavity, fallopian tubes and surrounding structures. The document discusses the indications, contraindications, procedure details, normal findings, and various pathologies that can be detected with hysterosalpingography such as uterine anomalies, tubal blockages, adhesions and infections.
This case report describes a 20-year-old woman who experienced a third degree perineal tear and cervical tear during her vaginal delivery. She underwent repair of the tears which involved suturing the anal mucosa, external and internal sphincters, and left side of the cervix. Her post-operative recovery included antibiotics, sitz baths, and pelvic floor exercises. Perineal tears can occur due to obstetric factors like prolonged labor or operative delivery, and non-obstetric injuries. They are classified based on the extent of tissue involvement and proper identification and repair is important for recovery.
Please find the power point on Inversion of uterus. I tried to present it on understandable way and all the contents are reviewed by experts and from very reliable references. Thank you
Cervical incompetence is the inability for the cervix to retain an intra-uterine pregnancy till term as a result of structural and functional defects of the cervix.
POSTPARTUM HAEMORRHAGE IN MIDWIFERY .pptJuma675663
This document provides an overview of postpartum hemorrhage (PPH) including its definition, causes, risk factors, signs and symptoms, complications, prevention, and management. PPH is defined as blood loss over 500 ml after vaginal birth or 1000 ml after C-section. The main causes (the 4 Ts) are tonicity (70% of cases), tissue (10%), trauma (20%), and thrombin abnormalities. Risk factors, signs, and complications are also outlined. Prevention focuses on active management of the third stage of labor. Management principles involve communication, resuscitation, monitoring, and arresting the bleeding through techniques like uterine massage, drugs, balloon tamponade, compression, and in severe
This document provides information about hysterosalpingography (HSG) and fistulogram procedures. It describes:
- HSG is used to evaluate the uterine cavity and fallopian tubes by injecting radio-opaque dye through the cervix. It can detect abnormalities in the shape of the uterus and fallopian tube blockages.
- A fistulogram uses injected contrast dye to visualize and determine the route and extent of abnormal passages like fistulas or sinuses.
- Both procedures require informed consent and have risks like discomfort, infection or allergic reaction to the contrast dye. Precautions are taken to perform them aseptically and accurately map any abnormalities found.
Anaesthetic management of ruptured ectopic pregnancy by Arowojolu BoluwajiArowojolu Samuel
anaesthetic management of a patient with ruptured ectopic pregnancy. helping anaesthetist to know what to do in emergency anaesthesia. this is an emergency case. salpingectomy. arowojolu boluwaji
This document discusses anorectal malformations, which involve defects of the distal anus and rectum. It may involve absence of an anal opening. Boys are more commonly affected than girls. Types include anal stenosis, anal membrane atresia, rectal atresia, and anal agenesis. Diagnosis involves newborn assessment and tests like ultrasound and intravenous pyelogram. Surgical procedures depend on the type but may include dilation, incision of membranes, or multi-stage procedures including temporary colostomy. Post-operative nursing care focuses on general care, feeding, and colostomy management if present.
This document provides information on third stage complications of labour including secondary postpartum hemorrhage, retained placenta, morbidly adherent placenta, inversion of the uterus, and amniotic fluid embolism. It discusses the causes, risk factors, diagnosis, and management of these complications. Key points covered include the definition of retained placenta, grades of morbidly adherent placenta, risk factors for placenta accreta, and manual and hydrostatic methods for managing an inverted uterus.
Ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, most commonly in the fallopian tubes. It is a medical emergency that requires prompt diagnosis and treatment to prevent life-threatening bleeding. Symptoms include abdominal pain and vaginal bleeding. Diagnosis involves beta-hCG blood tests and ultrasound examination. Treatment options include expectant management, medical management with methotrexate, or surgical management by laparoscopy or laparotomy. The majority of ectopic pregnancies occur in the fallopian tubes, but rare cases can occur in other sites like the ovaries, abdomen, or cervix. Prompt treatment is needed to resolve the ectopic pregnancy and preserve fertility.
Induction of labour is artificially stimulating the onset of labour, prior to the spontaneous onset. This is one of the commonest interventions in obstetrics. 65% of women will give birth without further interventions when induced. However, 15% will have instrument deliveries and 20% will end up with caesarean sections.
One fifth of women will not deliver by 41 weeks of gestation. These women need induction of labour to reduce caesarean section rates. Early induction of labour is needed for certain maternal and fetal indications. However, unnecessary inductions will lead to undesired complications and added health costs. 70% of women do not like induction of labour.
Induction of labour can be prevented by accurate dating and membrane sweeping starting from 39 weeks. There are pharmacological and non-pharmacological methods of induction. Usage depends on presence or absence of a scarred uterus, Bishop’s score, parity, obstetrician’s, and patient’s preferences. There are many complications of induction of labour out of which commonest being uterine hyperstimulation. Induction of labour between 34-41 weeks of gestation can lead to increase caesarean section rates
Haemostasis is very important in laparoscopic surgery. Vessel sealing with energy devises play a major role in keeping the surgical field clear. Energy devices are also used for tissue sealing and transection. Despite never types of energy devises electro-surgery is still very popular in gynaecological laparoscopy. Desiccation, dissection, and coagulation are the main effects of electro-surgery that are used for various purposes. Higher thermal injury with monopolar devices lead to the invention of bipolar devices with less tissue damage. Ligasure, pk gyrus, ENSEAL are some of the more advanced bipolar devices. Ultrasonic devices have the capability of coagulation and cutting tissues. During the process it can produce significant thermal injury. Thunderbeat combines bipolar and ultrasonic energy for coagulation and cutting respectively for more precise effects. Laser devices emit a beam of photons with a high degree of spatial and temporal coherence with tissue effects depending on the time of exposure and power density. CO2, Argon, Nd: YAG, KTP-532 are different laser types with different properties. Plasma is the fourth state of matter following solid, liquid and gas. Argon neutral plasma (System 7550TM ABC, Cardioblate) can produce energy in 3 forms including light, heat and kinetic energy. Laser and plasma energy are gaining more popularity for endometriosis surgery due to its localised effects and better preservation of ovarian follicles.
Hypertensive emergencies are common in pregnancy. Severe hypertension, Preeclampsia, eclampsia, HELLP syndrome are some of these. Management includes control of blood pressure, monitoring, prevension of fits, safe delivery and postpartum care. Future prevention of preeclampsia is possible with Aspirin and calcium supplementation. Only practical way of early detection is currently with the use of uterine artery doppler measurements
It is extremely important to know the anterior abdominal wall anatomy prior to making an abdominal incision. Nerves, blood vessels, muscles and facial coverings are described in this presentation.
Acid base balance is tightly regulated. Buffering systems of the body, respiratory system and renal system contribute to regulation. Strong ion gap is a new concept explaining acid base balance in addition to traditional explanation by Henderson Hasselbach equation
There are several physiological changes occuring in pregnancy which leads to altered pharmacodynamics. Placenta is an incomplete barrier which allows drug transfer to the fetus.
This document discusses endometrial pathologies including normal endometrium, endometrial hyperplasia, epidemiology, risk factors, clinical presentation, diagnosis, classification, atypical hyperplasia, risk of cancer, endometrial cancer types and subtypes, pathology, histopathology, and presentation. It provides details on the gland-to-stroma ratio in normal and hyperplastic endometrium. It notes that endometrial hyperplasia is a precursor to type 1 endometrial cancer and lists obesity, diabetes, PCOS, and HRT as risk factors. Diagnostic tools include ultrasound, pipelle biopsy, hysteroscopy and biopsy.
The document discusses conflict resolution and emotional intelligence. It outlines five styles of conflict resolution - competitive, collaborative, compromising, accommodating, and avoiding. It also discusses different stages of resistance in conflict situations and adapting one's approach. Emotional intelligence is described as having four components - self awareness, self management, social awareness, and relationship management. Effective communication models for conflict resolution include SAFER, CUDSA, and ASSIST.
This document provides information to help someone new to working in the UK as a doctor, including:
1) Details on initial paperwork, orientation, and shadowing other doctors for the first few weeks.
2) Advice on adapting to working more independently quickly as a house officer, including tips on maintaining standards, working with colleagues and patients, and dealing with cultural differences.
3) Suggestions for behavioral modifications like being polite, planning effectively, and understanding differences in hierarchy compared to other systems.
4) An overview of specialty exams and areas of interest like leadership, advanced procedures, and medical education topics.
This document provides information on various topics related to obstetrics and gynecology:
- Risks and outcomes associated with different gestational ages, labor interventions, and deliveries.
- Predictors and management of preterm labor, postpartum hemorrhage, breech presentation, and other high-risk pregnancies.
- Details on twin pregnancies, screening tests for fetal abnormalities, and caesarean section risks.
- Risks of various gynecological procedures like laparoscopy, hysteroscopy, and hysterectomy.
- Causes and management of infertility, endometriosis, fibroids, and heavy menstrual bleeding.
- Details on contraception
Consent' is a patient's agreement for a health professional to provide care.
There are different forms of consent.
Implied - indicate consent nonverbally (for example by presenting their arm for their pulse to be taken
Oral
Written
Pelvic inflammatory disease is ascending infection from the endocervix. There are two main groups of organisms involved. These are STIs and commensals of the female genital tract
This document discusses several pre-malignant gynaecological conditions including endometrial hyperplasia, cervical pre-invasive disease, and vulval intraepithelial neoplasia. It covers the epidemiology, risk factors, clinical presentation, diagnosis, classification, and treatment options for each condition. Endometrial hyperplasia can progress to endometrial cancer if left untreated, and treatment options include progesterone, hysterectomy, or endometrial ablation depending on severity. Cervical pre-invasive lesions are usually caused by HPV infection and may regress on their own, but higher grades have a risk of progressing to invasive cervical cancer without treatment. Screening and treatment modalities aim to identify and treat higher
This document discusses the obstetric management of systemic lupus erythematosus (SLE) and antiphospholipid antibody syndrome (APLS). It provides information on:
1) The increased risks of adverse pregnancy outcomes for patients with SLE/APLS including preeclampsia, intrauterine growth restriction, and preterm birth.
2) Medication management during pregnancy focusing on continuing hydroxychloroquine and tapering corticosteroids due to their safety profiles. Other immunosuppressants are generally avoided due to risks.
3) Increased monitoring is recommended during pregnancy for SLE/APLS patients including frequent visits and testing to monitor for disease flares and complications. Delivery planning focuses
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the 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 lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
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. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Kat...rightmanforbloodline
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
TEST BANK For Basic and Clinical Pharmacology, 14th Edition by Bertram G. Katzung, Verified Chapters 1 - 66, Complete Newest Version.
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Ear and its clinical correlations By Dr. Rabia Inam Gandapore.pptx
Vaginal tamponade
1. Post Partum Haemorrage
Management of tears
Dr. Indunil Piyadigama
Consultant Obstetrician and Gynaecologist
London Trainees Teaching
14th October 2021
2. Primary PPH
• Blood loss of more than
500 ml from the genital
tract within 24 hrs of
delivery
• More than 50% of
primiparous will have this
amount
• Minor PPH – Blood loss 500 – 1000ml
• Major PPH – Blood loss > 1000ml
Moderate
< 2000ml
Severe
> 2000ml
Life thretening
• > 2500ml (40%)
• Transfusion of 5 or more units of blood
• Treatment for coagulopathy
3. PPH
• Major killer in both developed and developing
countries
• More than half of the deaths due to PPH would
have been prevented even in UK
5. Mostly the emphasis is on
the management of uterine
atony
Management of bleeding
due tears is a neglected area
6. Steps in
management
of bleeding
due to tears
• Initial resuscitation
• Make sure the uterus is well contracted –
Use oxytocics prophylactically
• Careful inspection to identify the bleeding
areas
• Arrest the bleeders
• Exclude intraabdominal bleeding and
concealed haematoms
• Correction of the coagulopathy
• Ongoing monitoring
7. Principles in
arresting
bleeding due
to tears
Good light, preferrably theatre
Exposure
Lithotomy position
Simms speculums
Experienced assistant
Examine from top to bottom
Arrest bleeding
Experience surgeon
Long handled instruments
Atraumatic handling
Use of bsorbable sutures
8. Cervical tears
• Green armytage
• Walk the cervix (leap-frogging)
• Small, nonbleeding lacerations of the cervix do not need to be sutured
• Each side of the laceration can be grasped with a ring forceps back
from the torn edge, and gentle traction can be used to aid exposure
• Use an absorbable, continuous interlocking stitch, and use tapered
(rather than cutting) needles
• Make sure to begin above the apex
• If the apex cannot be visualized, place the stitch as high as possible
and then use it to apply gentle traction to bring the apex into view
9. Vaginal
lacerations
• Technical difficulties to suture
• Specially when its deep in the fornices
• Vaginal tissues are very friable following a
vaginal delivery
• Handling can result in degloving injuries to
the vaginal mucosa leading to further
bleeding
• Generally there is coagulopathy - more prick
points at suturing can add to more bleeding
10. Our
experience
Even at the most experienced hands
it is difficult to suture deep tears
Specially if not attended immediately
or successful in the first attempt
Maternal deaths have occurred
A life saving alternative is using
tamponade
11. An ideal tamponade system
Should be able to achieve high intravaginal pressure
Pressure can be distributed equally over the vaginal wall
Water-tight system so concealed bleeding is less
Less traumatic avoiding further injuries. Specially the degloving injury
Freely available
Can be performed even by an inexperienced person
Can be retained in situ untill the bleeding is settled
12. Different vaginal tamponade systems
Guaze packs
Blood pressure
cuff
Sengesteken
tube
Bakri balloon
with gauze
packs
Vaginal balloons
– Vagistop, Ebbs,
Zhukovsky
13. Gauze packs
Traumatic and degloving injuries can
occur
Concealed haemorrhage
High pressures cannot be achieved
15. Case study
• A 33-year-old woman
• Previous LSCS - fetal distress at 5 cm, 2 years and 3 months prior to the index pregnancy
• Uncomplicated pregnancy
• BMI 29 kg/m2
• Spontaneous labour at 39 weeks+4days of gestation
• Satisfactory progression in labour
• Forceps delivery due to delay in second stage giving birth to a 3.7 kg baby
• Active management of the third stage was carried out and placenta delivered with
controlled code traction
16. • She developed profuse vaginal bleeding
• Examination revealed a contracted uterus and no bleeding was observed through the
cervical os.
• Blood was pooling in the vagina due to multiple vaginal lacerations extending to both
fornices.
• Initial resuscitation was carried out promptly.
• Attempts of suturing the lacerations failed and exact bleeding points could not be
visualised.
• Vaginal tamponade was done with vaginal gauze packs.
17. • Within 15min of tamponade, packs were completely soaked and the patient was in grade
3 haemorrhagic shock.
• Rotational thromboelastometry (ROTEM) results showed severe coagulopathy
• Blood products were started
• Second inspection and attempts to suture the bleeding sites in the theatre under general
anaesthesia by the most senior obstetrician also failed
• As the last resort, condom catheter inflation inside the vagina was carried out
19. Steps
• An 18 FG Foley catheter was inserted
into a latex condom with the catheter tip
about 2 cm away from the tip of the
condom
• The condom was tied to the Foley
catheter using 1 polyglactin 910 suture
about 10cm away from the tip of the
condom
• A second tie was placed distally to make
sure that the device is watertight
• The sutures were done tightly yet not to
occlude the draining channel of the
Foley catheter
• A test fill of the system was done with
about 200mL normal saline running
through the Foley catheter to make sure
the uninterrupted filling as well as for
the water seal
20. • Normal saline was drained out back through the Foley catheter
• The system was introduced into the vagina using a sponge forceps
• The tip of the condom was placed at the posterior fornix
• The end of the Foley catheter was connected to a saline giving set with a normal saline
bottle hanging at about 1 m above the operating table
• While the condom was being distended, the vaginal introitus was sealed with four
interrupted horizontal mattress nylon stitches running between the labia minora
• Condom catheter was distended with 700mL of normal saline under gravitational force
21.
22. The bleeding through the vaginal introitus
settled completely with the vaginal
tamponade
With the guidance of ROTEM, she had 4
units of fresh frozen plasma and 2 pools of
cryoprecipitate by the end of the procedure
23.
24. Thank you
SAMUDRA BOOK PUBLICATIONS
AUTHOR
Dr. Indunil Piyadigama
CONTRIBUTORS
Dr. Madura Jayawardena
Dr. Chandana Jayasundara
EDITED BY
Mr. Tony Hollingworth
Prof. Athula Kaluarachchi
Gynaecology
GUIDE FOR
MD & MRCOG in