Induction of labour involves artificially initiating labour through mechanical or pharmacological means. It requires a justified medical indication and favourable cervix. Cervical ripening methods soften the cervix prior to induction and include membrane stripping, dilators, balloons or prostaglandins. Oxytocin is commonly used for induction and is administered via IV. Monitoring is needed as complications can include failed induction, prematurity, operative delivery and fetal distress. Proper patient selection and technique are important for safe induction of labour.
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
it contains a presentation on injuries that occur during baby birth
summary:
Maternal injuries following childbirth process are quite common.
VULVA
PERINEUM
RISK FACTORS FOR THIRD DEGREE PERINEL TEAR
REPAIR OF COMPLETE PERINEAL TEAR
VAGINA
CERVIX
PELVIC HEMATOMA
DIAGNOSIS OF RUPTURE UTERUS
Episiotomy slideshare by dr alka mukherjee & dr apurva mukherjee msalka mukherjee
Normal birth can cause tears to the vagina and the surrounding tissue, usually as the baby's head is born, and sometimes these tears extend to the rectum. These are repaired surgically, but take time to heal. To avoid these severe tears, it is recommended making a surgical cut to the perineum with scissors or scalpel to prevent severe tearing and facilitate the birth. This intervention, known as an episiotomy, is used as a routine care policy during births in some countries. Both a tear and an episiotomy need sutures, and can result in severe pain, bleeding, infection, pain with sex, and can contribute to long term urinary incontinence.
Episiotomies—incisions made between the vagina and anus during childbirth—have long been a topic of debate among clinicians, researchers and advocates. Outdated clinical guidelines previously recommended the routine use of episiotomy to avoid natural vaginal tearing. Over the past two decades, a growing body of literature and increased advocacy efforts have led to a general consensus that episiotomy should not be conducted as a standard practice. Nevertheless, in many parts of the world, the majority of women still undergo episiotomy during childbirth.
In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma.
prostaglandin, labour, pregnancy, obstetrics, delivery, normal labour, normal delivery, first stage of labour, induction of labour, pph, post partum haemorrhage, bleeding in pregnancy, abortion
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Episiotomy slideshare by dr alka mukherjee & dr apurva mukherjee msalka mukherjee
Normal birth can cause tears to the vagina and the surrounding tissue, usually as the baby's head is born, and sometimes these tears extend to the rectum. These are repaired surgically, but take time to heal. To avoid these severe tears, it is recommended making a surgical cut to the perineum with scissors or scalpel to prevent severe tearing and facilitate the birth. This intervention, known as an episiotomy, is used as a routine care policy during births in some countries. Both a tear and an episiotomy need sutures, and can result in severe pain, bleeding, infection, pain with sex, and can contribute to long term urinary incontinence.
Episiotomies—incisions made between the vagina and anus during childbirth—have long been a topic of debate among clinicians, researchers and advocates. Outdated clinical guidelines previously recommended the routine use of episiotomy to avoid natural vaginal tearing. Over the past two decades, a growing body of literature and increased advocacy efforts have led to a general consensus that episiotomy should not be conducted as a standard practice. Nevertheless, in many parts of the world, the majority of women still undergo episiotomy during childbirth.
In women where no instrumental delivery is intended, selective episiotomy policies result in fewer women with severe perineal/vaginal trauma.
prostaglandin, labour, pregnancy, obstetrics, delivery, normal labour, normal delivery, first stage of labour, induction of labour, pph, post partum haemorrhage, bleeding in pregnancy, abortion
Pathophysiology of Normal Labor:
A series of events that take place in female genital organs to expel the product of conception that are fetus, placenta, membranes) out of womb through the vagina into the outer world. We further describe pathogenesis and features of different stages of labor
Cord prolapse is a frightening and life-threatening event that occurs in labor. Rapid identification and immediate appropriate response may well save the life of a neonate. Therefore, clinicians should be knowledgeable in its recognition and management.
Causes and management of first and second trimester abortions
anatomical, chromosomal, immunological, hormonal causes and infections. Investigation for detection of cause and possible treatment. Surgical correction of cervical incompetence and medical treatment, progestational drugs
Covers the basic information about abortions that you need to know with in depth discussion of the different types of abortions and their characteristics
In gynecologic cancers, fertility preservation strategies include fertility-sparing surgical approaches and assisted reproductive technologies (ART). Fertility preservation can be considered in women with early stage I epithelial ovarian cancer and most borderline tumors, stages I–III
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
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.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
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
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
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
2. Outline
• Introduction
• Indications
• Contraindications
• Pre-induction assessment
• Cervical ripening
• Methods of induction
• Monitoring of induction process
• Complications
• Conclusion
3. Introduction
• Labour is defined as the onset of painful,
palpable and regular uterine contractions
which cause progressive cervical
effacement and dilatation and descent of
the foetal presenting part, leading to
expulsion of the foetus and placenta.
• Induction of labour is the artificial
initiation of this process, with the aim of
achieving vaginal delivery.
4. Introduction
• Rates of induction vary between countries
and facilities, ranging from as low as 1.4%
to 35.5% of all deliveries.
• Reasons for labour induction vary, but it
typically becomes necessary when the
maternal and/or foetal benefits of delivery
outweigh the potential risks of continuing
the pregnancy.
5. Indications
• Maternal:
• Preeclampsia and other hypertensive
diseases
• Deteriorating maternal disease
• Diabetes mellitus
• Renal, cardiac disease
• Sickle cell disease
• Cholestasis of pregnancy
• Autoimmune disease e.g. SLE
11. Cervical ripening
• Ripening is the process by which the cervix
changes in consistency prior to the onset
of labour
• Reduction in collagen content, presence of
hyaluronic acid and increase in water
content = softening
• Methods include mechanical and
pharmacologic options.
12. Cervical ripening
• Mechanical options shown to have lower
complication rates of tachysystole, but
similar rates of caesarean delivery to
pharmacologic methods
• Mechanical methods include membrane
stripping, hygroscopic dilators and
transcervical balloon catheter, with or
without extraamniotic saline infusion
• Pharmacologic option involves the use of
prostaglandin derivatives
13. Cervical ripening - mechanical
• Membrane stripping
• A finger is inserted through the cervix
and rotated in a circular manner to
sweep (strip) the membranes from the
lower uterine segment
• It induces local prostaglandin formation,
thus enhancing ripening
• Risks: infection, membranes rupture,
bleeding
14. Cervical ripening - mechanical
• Hygroscopic dilators
• Placed in the endocervical canal
• Absorb endocervical tissue fluids,
causing the device to expand within the
endocervix and provide mechanical
pressure – dilatation, stimulate
prostaglandin release
• local effect only
15. Cervical ripening - mechanical
• Hygroscopic dilators:
• Can be natural osmotic dilators e.g.
laminaria tents (made from seaweed, L.
japonicum) or synthetic osmotic dilators
e.g. Lamicel, Dilapan
• Risk of infection
16. Cervical ripening - mechanical
• Transcervical balloon catheter :
• Introduced via the cervix into the
potential space between the membranes
and lower uterine segment, not the
endocervical canal
• Stimulates endogenous prostaglandin
and exerts direct pressure on the cervical
os
17. Cervical ripening - mechanical
• Transcervical balloon catheter:
• Introduced using aseptic technique
• Balloon inflated with 30-50ml of saline,
and retracted t rest against the cervix
• Catheter usually strapped to maintain
pressure on the cervix
• Removed after a 12 hour period for
reassessment
• Risks: membrane rupture, infection
19. Cervical ripening - mechanical
• Extra-amniotic saline infusion:
• Infusion of normal saline into the extra-
amniotic space after passage of a
transcervical catheter
• Similar mechanism of action
• Found to be associated with lower rates
of infection complication, compared with
the catheter-only method
21. Cervical ripening - pharmacologic
• Prostaglandins:
• Increase collagenase activity and
hyaluronic acid levels, thus promoting
rearrangement of extracellular matrix,
increased water content = ripening
• Increase in intracellular calcium ions =
increased myometrial contractility
• Risks: hyperstimulation, nausea and
vomiting, pyrexia, infection
22. • Prostaglandin E2 analogue – dinoprostone
• Prepidil, single use 0.5mg intracervical
gel. Repeated 6 hourly up to 3
doses/24hr or ripening achieved.
• Cervidil, 10mg slow-release vaginal
insert. Used for up to 12 hours or
ripening achieved.
• Delay in oxytocin use to avoid potentiated
effect
Cervical ripening - pharmacologic
24. • Prostaglandin E1 analogue – misoprostol
• Off-label use, readily available, stored at
room temperature
• Oral and vaginal administration
• Dose: 25mcg 4-6 hourly, 6 doses/24hr
• Evidence shows more rapid cervical
ripening time and less need for oxytocin
compared with other methods
Cervical ripening - pharmacologic
25. • Nitric oxide donors:
• Nitric oxide thought to be a possible
mediator of cervical ripening
• Agents to stimulate local NO production
– isosorbide mononitrate and glyceryl
trinitrate
• Clinical trials have not shown them to be
as effective as prostaglandins
Cervical ripening - pharmacologic
26. • Mifepristone
• A progesterone receptor antagonist
• Counteracts the inhibitory effect of
progesterone on myometrium
• Maternal and foetal safety profile not
well documented
• Used in the UK in combination with
misoprostol for ripening and induction
following foetal demise
Cervical ripening - pharmacologic
27.
28. Methods of Induction
• Can be medical, surgical or a combination
of both
• Methods used for cervical ripening may in
some cases result in actual onset of labour,
without need for further intervention: a
more common occurrence with use of
prostaglandins
29. Methods of Induction
• Prostaglandin E1 – misoprostol
• Associated with lower incidence of CS
• Incremental doses associated with
shorter induction-delivery time, less
need for oxytocin, but higher occurrence
of tachysystole
• Oral route associated with less
tachysystole, but more need for oxytocin
than vaginal route
30. Methods of Induction
• Oxytocin:
• Endogenous octapeptide produced in
the paraventricular nuclei, has
uterotonic and antidiuretic effects
• Synthetic analogue used in induction of
labour
• Effective with favourable cervix
• Risks: hyperstimulation, water
intoxication
31. Methods of Induction
• Oxytocin:
• Given by intravenous infusion, use of
infusion pump
• Dose titration to achieve adequate
contractions
• Half-life of 3 – 5 minutes, plasma steady
state concentration within 40 minutes
• Relationship between gestational age
and oxytocin receptor concentration
32. Methods of Induction
• Oxytocin:
• Higher dose regimen
associated with
shorter delivery time,
fewer operative
deliveries, less
incidence of neonatal
sepsis and
chorioamnionitis and
more uterine
hyperstimulation
33. Methods of Induction
• Oxytocin:
• 5U in 500mls of saline = 5,000mU in 500mls
= 10mU/ml
• 1ml = 20drops (infusion giving set)
• 20drops = 10mU of oxytocin
• 10drops/min = 5mU/min
• Increment of 10drops = 5mU every 30 minutes
34. Methods of Induction
• Amniotomy:
• Artificial rupture of membranes
• Requires favourable cervix for efficacy
• Implies commitment to delivery
• Results in reduction of amniotic fluid
volume and shortening the myometrial
muscle bundles
35. Methods of Induction
• Amniotomy:
• More effective alone, or in combination
with oxytocin infusion, than oxytocin
alone
• Risks – cord prolapse, abruptio placenta,
infection, injury
• Caution: HIV/AIDS, genital herpes
36. Methods of Induction
• Amniotomy:
• Aseptic, blind technique
• Instrument: amnihook, Kocher’s forceps
• Foetal heart rate check
• Appropriate descent of presenting part,
no cord presentation
• Guided release of amniotic fluid
38. Monitoring of induction process
• Periodic cervical assessment
• Electronic monitoring with
cardiotocography, where available
• Routine management in labour: analgesia,
companionship, hydration
• Availability of facilities for caesarean
section, blood transfusion
40. Complications
• Uterine tachysystole: occurrence of >5
contractions in a 10-minute period
• Uterine tachysystole is further qualified as
being with or without FHR changes
• Hypertonus: refers to excessive uterine
contractions lasting >120secs
• Hyperstimulation: refers to excessive
uterine contractions (tachysystole or
hypertonus) with foetal heart rate changes
41. Conclusion
• Induction of labour not to be undertaken
lightly
• Cervical ripening and induction often a
continuous process
• Appropriate selection of method of
induction in individual patents, in view of
the relative benefits and risks
Definitions may vary with distinctions in state of foetal membranes and presence/absence of uterine contractions.
Can be done in outpatient setting
Lamicel (polyvinyl alcohol polymer sponge impregnated with 450 mg of magnesium sulfate).
Dilapan (made from a stable nontoxic hydrophilic polymer of polyacrylonitrite).
