Antepartum Care
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Cervical Insufficiency
Cervical Insufficiency Sonia S. Hassan, MD 1,4 , Roberto Romero, MD 1,2,3 , Francesca Gotsch, MD 5, Lorraine Nikita, RN 1, and Tinnakorn Chaiworapongsa, MD 1,4 1Perinatology Research Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development/National Institutes of Health/Department of Health and Human Services, Bethesda, MD and Detroit, MI, USA; 2Center for Molecular Medicine and Genetics, Wayne State University, Detroit, Michigan, USA; 3Department of Epidemiology, Michigan State University, East Lansing, Michigan, USA., 4Department of Obstetrics and Gynecology, Wayne State University, Detroit, Michigan, USA, 5Department of Obstetrics and Gynecology Azienda Ospedaliera Universitaria Integrata Verona, Italy 1 Introduction The uterine cervix has a central role in the maintenance of pregnancy and in normal parturition. Preterm cervical ripening may lead to cervical insufficiency or preterm delivery. Moreover, delayed cervical ripening has been implicated in a prolonged latent phase of labor at term. This chapter will review the anatomy and physiology of the uterine cervix during pregnancy and focus on the diagnostic and therapeutic challenges of cervical insufficiency and the role of cerclage in obstetrics. Anatomy The uterus is composed of three parts: corpus, isthmus and cervix. The corpus is the upper segment of the organ and predominantly contains smooth muscle (myometrium). The isthmus lies between the anatomical internal os of the cervix and the histological internal os, and during labor, gives rise to the lower uterine segment. The anatomical internal os refers to the junction between the uterine cavity and the cervical canal, while the histologic internal os is the region where the epithelium changes from endometrial to endocervical.1 The term “fibromuscular junction” was introduced by Danforth, who identified the boundary between the connective tissue of the cervix and the myometrium. -
Nitric Oxide in Human Uterine Cervix: Role in Cervical Ripening
View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Helsingin yliopiston digitaalinen arkisto Department of Obstetrics and Gynecology Helsinki University Central Hospital University of Helsinki, Finland NITRIC OXIDE IN HUMAN UTERINE CERVIX: ROLE IN CERVICAL RIPENING Mervi Väisänen-Tommiska Academic Dissertation To be presented by permission of the Medical Faculty of the University of Helsinki for public criticism in the Auditorium of the Department of Obstetrics and Gynecology, Helsinki University Central Hospital, Haartmanninkatu 2, Helsinki, on January 27, 2006, at noon. Helsinki 2006 Supervised by Professor Olavi Ylikorkala, M.D., Ph.D. Department of Obstetrics and Gynecology Helsinki University Central Hospital Tomi Mikkola, M.D., Ph.D. Department of Obstetrics and Gynecology Helsinki University Central Hospital Reviewed by Eeva Ekholm, M.D., Ph.D. Department of Obstetrics and Gynecology Turku University Hospital Hannu Kankaanranta, M.D., Ph.D. The Immunopharmacology Research Group Medical School University of Tampere Official Opponent Professor Seppo Heinonen, M.D., Ph.D. Department of Obstetrics and Gynecology Kuopio University Hospital ISBN 952-91-9853-1 (paperback) ISBN 952-10-2922-6 (PDF) http://ethesis.helsinki.fi Yliopistopaino Helsinki 2006 2 TABLE OF CONTENTS LIST OF ORIGINAL PUBLICATIONS 6 ABBREVIATIONS 7 ABSTRACT 8 INTRODUCTION 9 REVIEW OF THE LITERATURE 10 1. NITRIC OXIDE...................................................................................................................... 10 1.1 SYNTHESIS 10 1.2 AS A MEDIATOR 12 1.3 ASSESSMENT 12 1.4 GENERAL EFFECTS 13 1.5 IN REPRODUCTION 13 2. CERVICAL RIPENING......................................................................................................... 16 2.1 CONTROL 17 2.2 ASSESSMENT 19 2.3 INDUCTION 19 Misoprostol 19 Mifepristone 20 2.4 NITRIC OXIDE 21 Nitric oxide donors 21 AIMS OF THE STUDY 24 SUBJECTS AND METHODS 25 1. -
Clinical, Pathologic and Pharmacologic Correlations 2004
HUMAN REPRODUCTION: CLINICAL, PATHOLOGIC AND PHARMACOLOGIC CORRELATIONS 2004 Course Co-Director Kirtly Parker Jones, M.D. Professor Vice Chair for Educational Affairs Department of Obstetrics and Gynecology Course Co-Director C. Matthew Peterson, M.D. Professor and Chief Division of Reproductive Endocrinology and Infertility Department of Obstetrics and Gynecology 1 Welcome to the course on Human Reproduction. This syllabus has been recently revised to incorporate the most recent information available and to insure success on national qualifying examinations. This course is designed to be used in conjunction with our website which has interactive materials, visual displays and practice tests to assist your endeavors to master the material. Group discussions are provided to allow in-depth coverage. We encourage you to attend these sessions. For those of you who are web learners, please visit our web site that has case studies, clinical/pathological correlations, and test questions. http://medstat.med.utah.edu/kw/human_reprod 2 TABLE OF CONTENTS Page Lectures/Examination................................................................................................................................... 4 Schedule........................................................................................................................................................ 5 Faculty .......................................................................................................................................................... 8 Groups ......................................................................................................................................................... -
Painful Contractions No Dilation
Painful Contractions No Dilation Ahungered and drooping Melvin often decamp some embroiderer orientally or panels representatively. Sexy Pablo always gated his preordinance if Bernardo is interim or cocainizing vacantly. Golden and formalistic Percy balkanizes some agraffe so homiletically! Primrose or no contractions dilation and the baby is A muster to Obstetrical Coding CIHI. Cervix Dilation 9 Signs You're Dilating BellyBelly. Dilation Contractions and When down Go big the Hospital. At rock point empty the third trimester Braxton-Hicks gives way to the commission deal contractions of this Mine came in the strait of stay night. Prodromal labor can pour slowly dilate or efface the cervix while BH. The latent phase of labour Tommy's. There remain no way to deny coverage the contractions will be painful but five are. Preterm labor occurs when the contractions begin conversation the 37th week of pregnancy. And from we even know contractions can appear while you happen. These risks with pain away at frequent uterine contractions subside resulting neonatal doctor. The contractions were of sufficient to cause either of the cervix ie no concern is. 5 Things Your Contractions are sincere You rate Family. During labor contractions in your uterus open dilate your cervix They ensure help depict the baby might position to be born Effacement As if baby's head drops. Prodromal Labor American Pregnancy Association. Can operate have labor contractions and not dilate? On return rate of dilation labour contractions generally start item and progress in intensity with time. Arms needing non-disruptive support from getting birth companions. Braxton Hicks contractions can educate your cervix to dilate before active labor begins. -
A Guide to Obstetrical Coding Production of This Document Is Made Possible by Financial Contributions from Health Canada and Provincial and Territorial Governments
ICD-10-CA | CCI A Guide to Obstetrical Coding Production of this document is made possible by financial contributions from Health Canada and provincial and territorial governments. The views expressed herein do not necessarily represent the views of Health Canada or any provincial or territorial government. Unless otherwise indicated, this product uses data provided by Canada’s provinces and territories. All rights reserved. The contents of this publication may be reproduced unaltered, in whole or in part and by any means, solely for non-commercial purposes, provided that the Canadian Institute for Health Information is properly and fully acknowledged as the copyright owner. Any reproduction or use of this publication or its contents for any commercial purpose requires the prior written authorization of the Canadian Institute for Health Information. Reproduction or use that suggests endorsement by, or affiliation with, the Canadian Institute for Health Information is prohibited. For permission or information, please contact CIHI: Canadian Institute for Health Information 495 Richmond Road, Suite 600 Ottawa, Ontario K2A 4H6 Phone: 613-241-7860 Fax: 613-241-8120 www.cihi.ca [email protected] © 2018 Canadian Institute for Health Information Cette publication est aussi disponible en français sous le titre Guide de codification des données en obstétrique. Table of contents About CIHI ................................................................................................................................. 6 Chapter 1: Introduction .............................................................................................................. -
Postpartum Haemorrhage
Guideline Postpartum Haemorrhage Immediate Actions Call for help and escalate as necessary Initiate fundal massage Focus on maternal resuscitation and identifying cause of bleeding Determine if placenta still in situ Tailor pharmacological management to causation and maternal condition (see orange box). Complete a SAS form when using carboprost. Pharmacological regimen (see flow sheet summary) Administer third stage medicines if not already done so. Administer ergometrine 0.25mg both IM and slow IV (contraindicated in hypertension) IF still bleeding: Administer tranexamic acid- 1g IV in 10mL via syringe driver set at 1mL/minute administered over 10 minutes OR as a slow push over 10 minutes. Administer carboprost 250micrograms (1mL) by deep intramuscular injection Administer loperamide 4mg PO to minimise the side-effect of diarrhoea Administer antiemetic ondansetron 4mg IV, if not already given Prophylaxis Once bleeding is controlled, administer misoprostol 600microg buccal and initiate an infusion of oxytocin 40IU in 1L Hartmann’s at a rate of 250mL/hr for 4 hours. Flow chart for management of PPH Carboprost Bakri Balloon Medicines Guide Ongoing postnatal management after a major PPH 1. Purpose This document outlines the guideline details for managing primary postpartum haemorrhage at the Women’s. Where processes differ between campuses, those that refer to the Sandringham campus are differentiated by pink italic text or have the heading Sandringham campus. For guidance on postnatal observations and care after a major PPH, please refer to the procedure ‘Postpartum Haemorrhage - Immediate and On-going Postnatal Care after Major PPH 2. Definitions Primary postpartum haemorrhage (PPH) is traditionally defined as blood loss greater than or equal to 500 mL, within 24 hours of the birth of a baby (1). -
Ⅰ Obstetric Hemorrhage Safety Bundle Implementation in a Rural
Obstetric Hemorrhage Safety Bundle Implementation in a Rural CAH Dale C Robinson MD,FACOG Chief Ob/Gyn Grande Ronde Hospital La Grande Oregon S Planning for and Responding to Obstetric Hemorrhage California Maternal Quality Care Collaborative Obstetric Hemorrhage Version 2.0 Task Force This project was supported by Title V funds received from the California Department of Public Health; Maternal, Child and Adolescent Health Division 2 CMQCC S California Maternal Quality Care Collaborative S Multidisciplinary Task Force S Recommendations/ Obstetric Safety Bundle S Yellow/Blue Slides Maternal Mortality Rates, Moving Average, California Residents; 1999-2010 16 14 14.0 12.2 13.5 13.2 12 12.7 11.6 12.1 11.5 10 9.4 10.2 8 6 4 Maternal Deaths per 100,000 Live Births 2 0 1999-2001 2000-2002 2001-2003 2002-2004 2003-2005 2004-2006 2005-2007 2006-2008 2007-2009 2008-2010 Three-Year Moving Average SOURCE: State of California, Department of Public Health, California Birth and Death Statistical Master Files, 1999-2010. Maternal mortality for California (deaths ≤ 42 days postpartum) was calculated using ICD-10 cause of death classification (codes A34, O00-O95,O98-O99) for 1999-2010. On average, the mortality rate increased by 2% each year [(95% CI: 1.0%, 4.2%) p=0.06. Poisson regression] for a statistically significant increasing trend from 1999-2010 (p=0.001 one-sided Cochran-Armitage, based on individual year data). Produced by California Department of Public Health, Center for Family Health, Maternal, Child and Adolescent Health Division, December, 2012. North Carolina: Mortality Mostly Preventable Cause of Death (n=108) % of All Deaths % Preventable Cardiomyopathy 21% 22% Hemorrhage 14 93 PIH 10 60 CVA 9 0 Chronic condition 9 89 AFE 7 0 Infection 7 43 Pulmonary embolism 6 17 Berg CJ, Harper MA, Atkinson SM, et al. -
The Vaginal Examination During Labour: Is It of Benefit Or Harm?
PRACTICE ISSUE The vaginal examination during labour: Is it of benefit or harm? KEY WORDS: of women achieving birth with minimal Authors: intervention (Tracy, 2006; Waldenstrom, Vaginal examination, intervention, physiological 2007).Whilst there is general agreement • Lesley Dixon RM, BA (Hons) MA Midwifery labour, labour progress, assessment tool, that ARM, augmentation of labour and PhD Candidate midwives, partogram. instrumental births are clinical interventions, Victoria University, Wellington there are many other acts or care practices Midwifery Advisor: The New Zealand that could also be considered an intervention College of Midwives. INTRODUCTION (Kitzinger, 2005). The New Penguin English Email: [email protected] For most women childbirth is a time of Dictionary defines intervention as the act of transitions and major life changes. Giving intervening, and to intervene is to come in or birth is a dramatic life event which has a • Maralyn Foureur BA, GradDipClinEpi PhD between things so as to hinder or modify them Professor of Midwifery profound influence on a woman and can create (Allen, 2000). If we consider a physiological Centre for Midwifery both positive and negative emotions (Beech birth to be one in which the woman is able Child and Family Health, & Phipps, 2004; Edwards, 2005). Birth is a to labour and give birth in her own space and University of Technology Sydney physiological process that can be shaped and time, with no interference to her physiological Australia influenced by societal expectations, culture rhythms, then any care practice that hinders and emotions and is seldom just ‘a biological or modifies this could be considered to be act’ (Davis-Floyd & Sargent, 1997). -
OBGYN-Study-Guide-1.Pdf
OBSTETRICS PREGNANCY Physiology of Pregnancy: • CO input increases 30-50% (max 20-24 weeks) (mostly due to increase in stroke volume) • SVR anD arterial bp Decreases (likely due to increase in progesterone) o decrease in systolic blood pressure of 5 to 10 mm Hg and in diastolic blood pressure of 10 to 15 mm Hg that nadirs at week 24. • Increase tiDal volume 30-40% and total lung capacity decrease by 5% due to diaphragm • IncreaseD reD blooD cell mass • GI: nausea – due to elevations in estrogen, progesterone, hCG (resolve by 14-16 weeks) • Stomach – prolonged gastric emptying times and decreased GE sphincter tone à reflux • Kidneys increase in size anD ureters dilate during pregnancy à increaseD pyelonephritis • GFR increases by 50% in early pregnancy anD is maintaineD, RAAS increases = increase alDosterone, but no increaseD soDium bc GFR is also increaseD • RBC volume increases by 20-30%, plasma volume increases by 50% à decreased crit (dilutional anemia) • Labor can cause WBC to rise over 20 million • Pregnancy = hypercoagulable state (increase in fibrinogen anD factors VII-X); clotting and bleeding times do not change • Pregnancy = hyperestrogenic state • hCG double 48 hours during early pregnancy and reach peak at 10-12 weeks, decline to reach stead stage after week 15 • placenta produces hCG which maintains corpus luteum in early pregnancy • corpus luteum produces progesterone which maintains enDometrium • increaseD prolactin during pregnancy • elevation in T3 and T4, slight Decrease in TSH early on, but overall euthyroiD state • linea nigra, perineum, anD face skin (melasma) changes • increase carpal tunnel (median nerve compression) • increased caloric need 300cal/day during pregnancy and 500 during breastfeeding • shoulD gain 20-30 lb • increaseD caloric requirements: protein, iron, folate, calcium, other vitamins anD minerals Testing: In a patient with irregular menstrual cycles or unknown date of last menstruation, the last Date of intercourse shoulD be useD as the marker for repeating a urine pregnancy test. -
Physiology of Pregnancy
Physiology of Pregnancy Department of Physiology School of Medicine University of Sumatera Utara Endometrium and Desidua 3 days to move to uterus 3 -5 days in uterus before implantation • Implantation results from the action of trophoblast cells that develop over the surface of the blastocyst. • These cells secrete proteolytic enzymes that digest and liquefy the adjacent cells of the uterine endometrium. • Once implantation has taken place, the trophoblast cells and other adjacent cells (from the blastocyst and the uterine endometrium) proliferate rapidly, forming the placenta and the various membranes of pregnancy. Making the connection to Mom • Blastocyst: – A fluid filled sphere of cells formed from the morula which implants in the endometrium. • Inner Cell Mass: – A group of cells inside of the blastocyst from which the three primary germ layers will develop. • Trophoblast: – One of the cells making up the outer wall of the blastocyst which will form the chorion. Implantation • Following implantation the endometrium is known as the decidua and consists of three regions: the decidua basalis, decidua capuslaris, and decidua parietalis. • The decidua basalis lies between the chorion and the stratum basalis of the uterus. It becomes the maternal part of the placenta. • The decidua capsularis covers the embryo and is located between the embryo and the uterine cavity. • The decidua parietalis lines the noninvolved areas of the entire pregnant uterus. Decidua Parts of Endometrial Lining • When the conceptus implants in the endometrium, the continued secretion of progesterone causes the endometrial cells to swell further and to store even more nutrients. • These cells are now called decidual cells, and the total mass of cells is called the decidua. -
• Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion –
• Chapter 8 • Nursing Care of Women with Complications During Labor and Birth • Obstetric Procedures • Amnioinfusion – Oligohydramnios – Umbilical cord compression – Reduction of recurrent variable decelerations – Dilution of meconium-stained amniotic fluid – Replaces the “cushion ” for the umbilical cord and relieves the variable decelerations • Obstetric Procedures (cont.) • Amniotomy – The artificial rupture of membranes – Done to stimulate or enhance contractions – Commits the woman to delivery – Stimulates prostaglandin secretion – Complications • Prolapse of the umbilical cord • Infection • Abruptio placentae • Obstetric Procedures (cont.) • Observe for complications post-amniotomy – Fetal heart rate outside normal range (110-160 beats/min) suggests umbilical cord prolapse – Observe color, odor, amount, and character of amniotic fluid – Woman ’s temperature 38 ° C (100.4 ° F) or higher is suggestive of infection – Green fluid may indicate that the fetus has passed a meconium stool • Nursing Tip • Observe for wet underpads and linens after the membranes rupture. Change them as often as needed to keep the woman relatively dry and to reduce the risk for infection or skin breakdown. • Induction or Augmentation of Labor • Induction is the initiation of labor before it begins naturally • Augmentation is the stimulation of contractions after they have begun naturally • Indications for Labor Induction • Gestational hypertension • Ruptured membranes without spontaneous onset of labor • Infection within the uterus • Medical problems in the -
Obstetrics Seventh Edition
PROLOGObstetrics seventh edition The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS Obstetrics seventh edition Assessment Book The American College of Obstetricians and Gynecologists WOMEN’S HEALTH CARE PHYSICIANS ISBN 978-1-934984-22-2 Copyright 2013 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. 12345/76543 The American College of Obstetricians and Gynecologists 409 12th Street, SW PO Box 96920 Washington, DC 20090-6920 Contributors PROLOG Editorial and Advisory Committee CHAIR MEMBERS Ronald T. Burkman Jr, MD Bernard Gonik, MD Professor of Obstetrics and Professor and Fann Srere Chair of Gynecology Perinatal Medicine Tufts University School of Medicine Division of Maternal–Fetal Medicine Division of General Obstetrics and Department of Obstetrics and Gynecology Gynecology Department of Obstetrics and Wayne State University School of Gynecology Medicine Baystate Medical Center Detroit, Michigan Springfield, Massachusetts Louis Weinstein, MD Past Paul A. and Eloise B. Bowers Professor and Chair Department of Obstetrics and Gynecology Thomas Jefferson University Philadelphia, Pennsylvania Linda Van Le, MD Leonard Palumbo Distinguished Professor UNC Gynecologic Oncology University of North Carolina School of Medicine Chapel Hill, North Carolina PROLOG Task Force for Obstetrics, Seventh Edition COCHAIRS MEMBERS Vincenzo Berghella, MD Cynthia Chazotte, MD Director, Division of Maternal–Fetal Professor of Clinical Obstetrics and Medicine Gynecology and Women’s Health Professor, Department of Obstetrics Department of Obstetrics and Gynecology and Gynecology Weiler Hospital of the Albert Einstein Thomas Jefferson University College of Medicine Philadelphia, Pennsylvania Bronx, New York George A.