This document discusses hypertensive disorders of pregnancy. It defines various types such as gestational hypertension, preeclampsia, and eclampsia. Preeclampsia is characterized by new onset hypertension and proteinuria after 20 weeks of gestation. Risk factors for preeclampsia are discussed. Eclampsia is defined as the occurrence of seizures in a woman with preeclampsia. Diagnosis and treatment methods are outlined, including expectant management, controlling blood pressure through various drugs, preventing seizures primarily with magnesium sulfate, and potentially terminating the pregnancy. Differential diagnoses are also listed.
This presentation distinguishes miscarriage with its types and causation factors in an organised table method giving the learner a quick guide into this intriguing topic of great debate. -Enjoy and remember to check the sources at the end to further strengthen your medical background.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
In this introductory remark at workshop on vaginal hysterectomy where Dr Shirish Seth was operating faculty.
I spoke “lets promote and propagate vaginal hysterectomy which is an indigenous surgery in line with PM Modi’s mission of MAKE IN INDIA.
Vaginal hysterectomy is like Aam admi surgery which is in the best interest of patients and has best scientific evidences in its favour."
Let us not be driven by glamour,gadgets and gimmicks."
post term pregnancy, post dated pregnancy, prolonged pregnancy,
m.g. reshmi, management of post dated pregnancy,management of post term pregnancy, fetal maturity assesment, post maturity syndrome, mortality and morbidity ,placental dysfunction, aminotic fluid volume in prolonged pregnancy.
This presentation distinguishes miscarriage with its types and causation factors in an organised table method giving the learner a quick guide into this intriguing topic of great debate. -Enjoy and remember to check the sources at the end to further strengthen your medical background.
In cases of Nulliparous prolapse or even patients deserving child bearing uterus preserving surgeries are done.
Recently even for prolapse if women want to preserve uterus for variety of reasons ,with newer minimally invasive methods it is now gaining popularity.Larger studies and longer followup is required.
In this introductory remark at workshop on vaginal hysterectomy where Dr Shirish Seth was operating faculty.
I spoke “lets promote and propagate vaginal hysterectomy which is an indigenous surgery in line with PM Modi’s mission of MAKE IN INDIA.
Vaginal hysterectomy is like Aam admi surgery which is in the best interest of patients and has best scientific evidences in its favour."
Let us not be driven by glamour,gadgets and gimmicks."
post term pregnancy, post dated pregnancy, prolonged pregnancy,
m.g. reshmi, management of post dated pregnancy,management of post term pregnancy, fetal maturity assesment, post maturity syndrome, mortality and morbidity ,placental dysfunction, aminotic fluid volume in prolonged pregnancy.
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Pregnancy induced hypertension introduction
Classification of pregnancy induced hypertension
Preeclampsia -
Definition
Criteria for diagnosis of preeclampsia,
Epidemiology of preeclampsia,
Risk factors of preeclampsia,
Pathogenesis of preeclampsia,
Pathophysiology of preeclampsia,
Course of preeclampsia,
Complications of preeclampsia,
What is HELLP ?
Management of preeclampsia at home, at hospital, during labour, during puerperium,
Management of acute fulminant preeclampsia
Pregnancy is one of the wonderful gifts of God, imposed naturally to womanhood only. It is a period of enormous physio- pathological and psychological adoption in a women’s life.
Pregnancy is a normal physiological process and not a disease, but it is associated with certain risks to health and survival both for women and infant she bears.
Every minute of everyday a women dies of pregnancy related complications.
Hypertension is one of the common problems met during pregnancy and contributes significantly to maternal and perinatal morbidity and mortality.
Pregnancy-induced hypertension is one of the maternal diseases that causes the most detrimental effects to the maternal, fetal, and neonatal organisms.
Pregnancy-induced hypertension is also called toxemia or preeclampsia. It occurs most often in young women with a first pregnancy. Hypertension is the most common medical problem encountered during pregnancy, complicating 2-3% of pregnancies.
- 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
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micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
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
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Antimicrobial stewardship to prevent antimicrobial resistanceGovindRankawat1
India is among the nations with the highest burden of bacterial infections.
India is one of the largest consumers of antibiotics worldwide.
India carries one of the largest burdens of drug‑resistant pathogens worldwide.
Highest burden of multidrug‑resistant tuberculosis,
Alarmingly high resistance among Gram‑negative and Gram‑positive bacteria even to newer antimicrobials such as carbapenems.
NDM‑1 ( New Delhi Metallo Beta lactamase 1, an enzyme which inactivates majority of Beta lactam antibiotics including carbapenems) was reported in 2008
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
3. Definitions
Hypertension in pregnancy:
Bl/P of 140/90 or more is abnormal.
If there is a rise of 30 mmHg or more in the systolic blood
pressure or 15 mmHg or more in the diastolic blood
pressure In 2 occasions 6 hours apart.
Mean arterial BP> 105 mmHg .
Systolic + 2 Diastolic
Mean arterial BP = -----------------------------
3
5. National High Blood Pressure Education
Program Classification ( NHEP) 2000
Gestational hypertension.
Preeclampsia (mild, severe).
Eclampsia.
Superimposed preeclampsia upon
chronic hypertension.
Chronic hypertension with
pregnancy.
6. Definitions
Gestational hypertension:
Hypertension for first time after 20 w, without
Proteinuria. BP returns to normal before 12 weeks
postpartum.
Chronic hypertension with pregnancy:
Hypertension antedates pregnancy and detected
before 20 w, & lasts more than 12 weeks postpartum.
7. Definitions
Preeclampsia:
The development of hypertension and Proteinuria
after 20 w
May occur earlier in vesicular mole or twins.
Eclampsia (in Greek= Flash of light):
The occurrence of convulsions (without any
neurological disease) in a woman with pre-eclampsia.
14. A): Signs: :
it is a disease of signs :
2 cardinal signs + or - Edema:
Hypertension:
usually precedes Proteinuria,
Proteinuria: detected by
Boiling test.
Quantitative assay.
15. + or - Edema
The lower extremities.
Abdominal wall, vulva or may be generalized
anasarca.
usually after hypertension.
16. Peripheral edema is not a
useful diagnostic criterion
1) it is common in normal pregnancy.
2) PE can occur without edema (dry type).
so its presence does not ensure a poor prognosis
and its absence not ensure a favorable outcome.
17. B) Symptoms (non specific):
Headache.
Blurring of vision.
Nausea and vomiting.
Epigastric pain (distension of the liver capsule)
Oliguria or anuria
18. Severity Of Pre-eclampsia
The severity of pre-eclampsia is assessed by:
The frequency and intensity of the
signs and symptoms.
The more the severity of PET, the
more likely is the need to
terminate pregnancy.
19. 4) Diagnosis Of Eclampsia:
Eclamptic fit stages ( 4 stages):
Premonitory stage (1/2 minute):
Eye rolled up.
Twitches of the face and hands.
Tonic stage (1/2 minute):
Generalized tonic spasm with episthotonus.
Cyanosis.
Tongue may be bitten between the clenched
teeth.
20. 4) Diagnosis Of Eclampsia:
Clonic stage (1-2 minutes):
Convulsions .
Tongue may be bitten.
face is congested and cyanosed.
conjunctival congestion.
blood stained froth from the mouth,
Stertorous breathing,
temperature may rise.
involuntary passage of urine or stool.
Gradually convulsions stop.
21. 4) Diagnosis Of Eclampsia:
Coma:
Variable duration due to respiratory and metabolic
acidosis.
Deep coma may occurs (cerebral hemorrhage).
Labor usually starts shortly after the fit.
22. Classifications of Eclampsia
Ante partum (65%) with the best
prognosis.
Intrapartum (20%).
Postpartum (15%) with the worst
prognosis as it indicates extensive
pathology and multisystem damage..
23. Classifications of Eclampsia
1)Mild
2) Severe (Eden's criteria):
Coma > 6 hours.
Temperature > 39 (pneumonia or pontine hge)
Systolic Bp > 200 (risk of cerebral hge)
Pulse > 120/min ( acute heart failure).
Anuria or Oliguria( renal failure).
Respiratory rate > 40/min( pneumonia)
More than 10 fits (status eclampticus).
24. Investigations
A. Laboratory:
Urine: 24 hour urine, Proteinuria.
Kidney functions: serum creatinine, urea, creatinine
clearance and uric acid.
Liver functions: bilirubin, Enzymes
Blood: CBC, HCt , Hemolysis and Platelet count
(Thrombocytopenia).
Coagulation Profile: Bleeding and clotting time
35. 2) Control of
Hypertension:
A)Parentral drugs:
1) Hydralazine:
It is a peripheral VD.
The best Antihypertensive drug used during Pre-
eclampsia and Eclampsia.
Dose: 5-10mg IV or IM as initial dose.
Repeated every 20-30 minutes until blood
pressure is controlled.
36. 2)Control of
Hypertension: 2) Labetalol (Trandate):
α and non selective β- adrenergic blocker resulting in
VD.
Dose: 10-20mg IV .
The dose can be doubled every 10 minutes if proper
response is not achieved.
3) Diaz oxide (Hyperstat):
Used in severe dangerous resistant hypertension as a
last resort.
Dose: 50-150mg IV bolus dose.
Repeated every 1-2 minutes until BP decreases.
37. 2)Control of
Hypertension: A )Oral drugs:
1) α-methyl DOPA (aldomet):
It is the most commonly used.
It is α-adrenergic agonist causing depletion of
catecholamine stores.
Dose: 500mg 3-4 times/day orally.
38. 2)Control of
Hypertension: 3) β- adrenergic blockers:
Atenolol (tenormin) 50-100mg 4 times daily.
Labetalol (Trandate) 10-20mg 3 times daily.
4) Prazocin (minipres):
It is postsynaptic α-adrenergic receptor blocker
resulting in VD and reflex tachycardia.
It is a weak Antihypertensive drug so used in
combination with other drugs.
5) Calcium Channel Blocker:
Nifedipine (adalat or Epilat) .
40. Treatment of Eclampsia
1) General and first aid measures( A &B &C &D
…………cont )
Ensure patent airway with tracheal and
bronchial suction.
Put the patients in Trendlenburg position (to
avoid aspiration of secretions) .
Insert a catheter.
Nasogastric tube may be inserted .
Nothing by mouth and fluid chart.
Full laboratory investigation.
41. Treatment of Eclampsia
2) Observation:
Pulse, temperature, BP
and RR.
Level of consciousness.
Duration of coma.
Fetal heart sounds.
Urine output and albuminuria .
Number of convulsions
42. 4) Control of
Convulsions:
A) Magnesium Sulfate (MgSO4):
It is the drug of choice.
Mechanism:
CNS depression.
Mild VD.
Mild diuresis.
Inhibits platelet aggregation.
Increase PGI2 synthesis.
43. Magnesium Sulfate (MgSO4):
It can be given IV (20%) or IM (50%) or SC (15%):
The therapeutic level is 4-7mEq/L.
The total dose of MgSO4 should not exceed 24 gms in 24
hours .
The dose of MgSO4 is monitored by:
Preserved patellar reflex.
Respiratory rate >16/min.
Urine output >100ml/4hours.
Serum Mg++ level.
Is stopped 24 hours after delivery.
N.B Antidote is ca gluconate
44. Magnesium Sulfate (MgSO4):
IV regimen:
initially 4-6 gm (20%) in 100ml solution .
Given over 15-20 minutes.
Then, 2 gm/hour by IV drip.
IM regimen:
10 gms of 50% solution are given deeply IM (5 gms
in each buttock).
Maintain with 5 gm/6 hours of 50% solution.
45. Side effects of MgSO4 (small safety
margin)
At a level of 8-10mEq/L patellar reflex is lost and starts
myometrial inhibition.
10-15mEq/L respiratory depression.
>15mEq/L cardiac depression.
Curare like action.
Synergistic effect with Ca++ channel blockers.
Uterine inertia.
Neonatal hypermagnesemia.
Decreased beat to beat variability in FHS.
Antidote : 10ml of 10 percent calcium gluconate
46. 4) Control of Convulsions:
B ) Phyntoin (Epanutin):
In severe pre-eclampsia
In imminent eclampsia .
The dose is 15mg/kg.
47. 4) Control of Convulsions:
C) Diazepam (Valium):
This regimen is mainly for eclamptic patients.
Initially 20-40mg IV slowly over 5 minutes.
then 10-20mg/6hours.
then the dose is adjusted at 10mg/hour to
maintain drowsiness.
48. Treatment of Eclampsia
7)Termination of Pregnancy
Indications:
Eclampsia.
Retinal hemorrhage:
Deteriorated cardiac, renal or liver functions.
Severe PET not controlled after 24 hours.
Mild PET reaching 38 weeks and not controlled.
Expectant treatment reaching maturity.
Deterioration of the fetal conditions.
Other obstetric indications as CPD, malpresentations, APH,
…
49. 7)Termination of Pregnancy
Methods:
As a rule vaginal delivery is safer and better than CS.
Artificial rupture of membranes .
CS.
50. Treatment of Eclampsia
8) Management during labor:
With the onset of labor give IV hypotensives and
sedation.
The patient must be at rest with oxygen source
and other equipments for treating fits.
Maternal observation.
Continuous electronic fetal monitoring.
51. Treatment of Eclampsia
9) Postpartum management
Improvement is monitored by:
Increased urine output.
Decreased edema.
Disappearance of Proteinuria within 1 week
Decreased hemotocrite value to normal level.
BP normalize within 2 weeks
No ergometrine postpartum.
MgSO4 stopped 24 hours postpartum.
52. Prognosis:
BP usually normalize after placental delivery .
Hypertension may persist.
Postpartum eclampsia carries the worst
prognosis.
Maternal mortality is about 2% in severe
preeclampsia and 10% in eclampsia.
Perinatal mortality rate is about 5% in mild
cases, 25% in severe cases and 30% in eclampsia.