DOCSLIB.ORG

C:\Documents and Settings\Babu\

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
C:\Documents and Settings\Babu\ MME -303 Child Health Indira Gandhi National Open University School of Health Sciences Block 6 CHILDHOOD MORBIDITY UNIT 28 Common Paediatric Problems 5 UNIT 29 Cardiovascular, Haematological and Renal Disorders 24 UNIT 30 Gastrointestinal, Parasitic and Neurological Disorders 61 UNIT 31 Tuberculosis 90 UNIT 32 HIV/AIDS 106 UNIT 33 Common Paediatric Emergencies 119 UNIT 34 Common Paediatric Surgical Problems 130 PROGRAMMECORE TEAM Dr. I.C. Tiwari Dr. (Mrs.) Kamala Ganesh Dr. L.N. Balaji Dr. S.B. Arora Dr. Ruchika Kuba Sr. Consultant, UNICEF Director Professor and Head of Chief, Planning Division Course Coordinator Course Coordinator New Delhi O&G Deptt., MAMC, New Delhi UNICEF, New Delhi SOHS, IGNOU, New Delhi SOHS, IGNOU, New Delhi Dr. S.C. Chawla Dr. Sidharth Ramji Prof. (Col.) P.K. Dutta Dr. T.K. Jena Director Professor and Head of Professor, Deptt. of Paediatrics Programme Coordinator Course Coordinator PSM Deptt., LHMC, New Delhi MAMC, New Delhi SOHS, IGNOU, New Delhi SOHS, IGNOU, New Delhi COURSE REVISION TEAM (1st Revision) Dr. Neena Raina Dr. Harish Kumar Dr. M.S. Prasad Prof. A.K. Agarwal Dr. Ruchika Kuba Technical Officer, WHO Consultant Paediatrics, Head, Deptt. of Paediatrics Director, SOHS Sr. Lecturer and Course SEARO Office, New Delhi D.D.U. Hospital, New Delhi Safdarjang Hospital, IGNOU, New Delhi Coordinator New Delhi SOHS, IGNOU, New Delhi Dr. Siddharth Ramji Dr. A.K. Patwari Dr. T.K. Jena Professor, Deptt. of Peadiatrics National Professional Officer, Dr. Piyush Gupta Reader and Programme LNJP and MAMC, Delhi WHO Nirman Bhawan, Reader, Deptt. of Paediatrics Coordinator New Delhi GTB Hospital and UCMS SOHS, IGNOU, New Delhi New Delhi COURSE REVISION TEAM (2nd Revision) Dr. Siddharth Ramji Dr. M.S. Prasad Dr. (Mrs.) Lalitha Kailash Dr. (Mrs.) Jayam Subramanium Dr. A.K. Agarwal Professor, Deptt. of Peadiatrics Head, Deptt. of Paediatrics Professor, Deptt. of Peadiatrics Ex. Professor, Professor, SOHS, IGNOU, LNJP and MAMC, Safdarjang Hospital, GMC, Thiruvananthapuram, Deptt. of Peadiatrics New Delhi New Delhi New Delhi Kerala Madras Medical College, Chennai Dr. T.K. Jena Dr. S. Aneja Dr. Vinod Anand Dr. B.D. Bhatia Professor and Programme Professor, Deptt. of Peadiatrics Professor, Deptt. of Peadiatrics Professor, Deptt. of Peadiatrics Dr. S. B. Arora Coordinator LHMC, New Delhi LHMC, New Delhi IMS,BHU, Varanashi, U.P. Professor & Director, SOHS SOHS, IGNOU, New Delhi IGNOU, New Delhi COURSE REVISION TEAM (3rd Revision) Dr. Harish Chellani Dr. Anju Seth Dr. Neelam Verma Dr. A. P. Dubey Dr. T.K. Jena Professor and Head Director Professor, Professor and Head, Professor and Head, Professor, Deptt. of Paediatrics Deptt. of Peadiatrics Deptt. of Peadiatrics Deptt. of Peadiatrics School of Health Sciences VMMC & Safdarjung Hospital, LHMC, New Delhi Patna Medical College & LNJP and MAMC, IGNOU, New Delhi New Delhi-110029 Hospital, Patna, New Delhi Bihar-800004 BLOCKPREPARATIONTEAM Writers Unit 28 Unit 29-31 Unit 32 Format Editor Dr. Satinder Aneja Dr. Satinder Aneja Dr. Jagdish Chandra Dr. T.K. Jena Director Professor, Director Professor, Director Professor, Deptt of Paediatrics, Professor and Deptt of Paediatrics, Deptt of Paediatrics, LHMC, New Delhi Programme Coordinator LHMC, New Delhi LHMC, New Delhi Dr. Lalitha Kailash (Pre-revised) SOHS, IGNOU, New Delhi Dr. Jagdish Chandra (Pre-revised) Prof. Deptt of Paediatrics, Director Professor, Thiruvananthapuram Deptt of Paediatrics, LHMC, New Delhi Unit 33 Dr. Rajiv Chadha Director Professor, Deptt of Paediatric Surgery, LHMC, New Delhi CO-ORDINATION Dr. S. B. Arora Dr. T.K. Jena Professor & Director, SOHS Professor and Programme Coordinator IGNOU, New Delhi SOHS, IGNOU, New Delhi PRINTPRODUCTION Mr. Ajit Kumar Section Officer (Pub.), SOHS IGNOU, New Delhi March, 2019 © Indira Gandhi National Open University, 2019 ISBN- All rights reserved. No part of this work may be reproduced in any form, by mimeograph or any other means, without permission in writing from the Indira Gandhi National Open University. Further information about the School of Health Sciences and the Indira Gandhi National Open University courses may be obtained from the University’s office at Maidan Garhi, New Delhi-110 068, India. Printed and published on behalf of the Indira Gandhi National Open University, New Delhi, by Prof. S. B. Arora, Director, School of Health Sciences. Lasertypeset by : Rajshree Computers, V-166A, Bhagwati Vihar, (Near Sec. 2, Dwarka), Uttam Nagar, New Delhi-110059 Printed at: BLOCK 6 INTRODUCTION This block provides you an overview of common paediatric systemic illnesses and emergencies. Unit 28 will take you through the evaluation of common childhood problems. Cardiovascular, haematologic and renal disorders are discussed in Unit 29, while gastrointestinal, liver and neurologic problems are presented in Unit 30. Tuberculosis and HIV are emerging childhood problems which are discussed in Unit 31 and Unit 32. Paediatric emergencies such as resuscitation, poisoning, accidents, etc. are reviewed in Unit 33 of this block. Finally, the Unit 34 on common paediatric surgical problems gives you an insight about the possible surgical procedures. ChildhoodMorbidity 4 UNIT 28 COMMON PAEDIATRIC PROBLEMS Structure 28.0 Objectives 28.1 Introduction 28.2 Child with Fever 28.2.1 Common Causes of Fever 28.2.2 Acute Fever 28.2.3 Fever of Unknown Origin (FUO) 28.3 Child with Rash 28.4 Child with Jaundice 28.5 Child with Sore Throat 28.6 Child with Ear Infection 28.7 Common Skin Disorders 28.7.1 Bacterial Infections 28.7.2 Fungal Infections 28.7.3 Parasitic Infections 28.8 Let Us Sum Up 28.9 Key Words 28.10 Answers to Check Your Progress 28.0 OBJECTIVES After reading this unit, you will be able to: diagnose and treat various types of viral exanthematous illnesses; diagnose common febrile illnesses and plan investigations of a patient with fever of unknown origin; manage a child with jaundice; differentiate self-limiting benign causes of sore throat from potentially serious infections such as diphtheria; and identify and manage common skin disorders in children. 28.1 INTRODUCTION In clinical practice, a child presents with a symptom rather than a disease. Therefore, a step wise approach is required to make differential diagnosis and plan investigations. In this unit, a symptom-wise approach is used to enable you to make a clinical diagnosis of some common problems. Other common conditions are. described in brief. You are required to refer to standard text books for the detailed discussion of these disorders. 5 ChildhoodMorbidity 28.2 CHILD WITH FEVER Fever is the commonest presenting symptom in children. Fever is defined as elevation of body temperature in response to a pathological stimulus. Conventionally temperature >38°C is called fever. Fever greater than 41.5°C is called hyperpyrexia and warrants aggressive antipyretic treatment because of risk of irreversible organ damage, Children presenting with fever can be di\!ided into three groups: (i) acute fever with obvious focus such as tonsillitis or pneumonia etc. (ii) acute fever with no localizing sign or non-specific signs and (iii) prolonged fever of unknown origin. It is the latter two groups which pose diagnostic problem. While evaluating the patient with fever the first important thing to consider is the age of the patient. Acute fever in an infant less than 2 months should always arouse suspicion of serious bacterial infection presence of petechial haemorrhages at any age is also indicative of serious illness and necessitates hospitalization. The other important consideration is duration of fever. Important causes of fever of short duration (2 weeks) and prolonged fever are listed in Table 28.1. The common causes of acute fever are malaria, viral illness( may also cause upper respiratory infection and diarrhea) and bacterial infections such as typhoid fever. 28.2.1 Common Causes of Fever The common causes of fever are given in Table 28.1. We shall learn more about these causes in the subsequent sub-sections. Table 28.1: Common Causes of Fever in Children Causes of fever of short duration Prolonged fever ( <2 weeks) ( >2 weeks) Infections Malaria Typhoid. Respiratory infection e.g. Kala-azar Tonsillitis Malaria Pneumonia Tuberculosis Otitis Media UTI Viral Exanthem Bacterial endocarditis Typhoid fever Abscess in liver Urinary Tract Infection (UTI) Brucellosis Heat hyperpyrexia Infectious mononucleosis Occult pyogenic infection Connective tissue disorders e.g. abscess Rheumatoid arthritis 6 Common Paediatric Meningitis SLE, Kawasaki disease Problems Neoplastic Condition e.g. Leukaemia, lymphoma Others Drug fever Thyrotoxicosis Immune deficiency-HIV Diabetes Insipidus 28.2.2 Acute Fever Evaluate for any focus of infection. Determine whether the child is seriously ill? A sick child has one or more of following symptoms and signs: Symptoms Signs Lethargy “sick” or toxic look Inability to suck lethargy/poor tone Irrititability weak cry Drowsiness tachypnoea poor peripheral perfusion The fundamental basis of diagnosis is to localize the infection by careful history and clinical examination. It should also be remembered that in children disease develops over hours and days and a single examination may not provide the diagnosis. Where there is a doubt, the child should be hospitalized and reexamined. In a small but significant proportion of children no identifiable cause of fever is found even after detailed examination. This problem is more common in infants and toddlers. The common causes of acute fever without obvious focus are viral illness, malaria, otitis media, typhoid fever, occult bacteremia. The diagnosis can be then established by (i) obvious focus such as tonsillitis or pneumonia etc. (ii) acute fever with no localizing sign or non-specific signs and (iii) prolonged fever of unknown origin. It is the latter two groups which pose diagnostic problem. In areas endemic for malaria, empirical therapy for malaria may be started. In case laboratory investigations are not available treatment is often based on clinical diagnosis. Occult bacteremia implies presence of bacteria in the blood stream with minimal clinical signs.
Load more

Recommended publications
  • Serious Hazards of Transfusion (SHOT) Annual Report 2017
    ANNUAL SHOT REPORT 2017 working with Affiliated to the Royal College of Pathologists DS OF ZAR TR A AN H S S F U U O S I I R O E N S A Y N R N A U S A R L E S YEARS IV H N O N T A RE T PORT 21S ANNUAL SHOT REPORT 2017 Serious Hazards of Transfusion (SHOT) Steering Group Chair Professor Mark Bellamy SHOT Medical Director Dr Paula Bolton-Maggs Operations Manager Ms Alison Watt Research Analyst Ms Debbi Poles Patient Blood Management Practitioner Mrs Jayne Addison Clinical Incidents Specialist Mr Simon Carter-Graham Mrs Ann Fogg Laboratory Incidents Specialist Mrs Hema Mistry National Coordinator for Mrs Rachael Morrison (Ms Dory Kovacs in 2018) Transfusion-Transmitted Infections (Public Health England) Working Expert Group (WEG) & Writing Group, on behalf of the SHOT Steering Group Chair: Dr Paula Bolton-Maggs Professor Mark Bellamy, Ms Alison Watt, Ms Debbi Poles, Mrs Hema Mistry, Mr Simon Carter-Graham, Mrs Ann Fogg, Mrs Jayne Addison, Mrs Rachael Morrison, Dr Tom Latham, Mrs Diane Sydney, Dr Helen New, Dr Megan Rowley, Dr Fiona Regan, Mr Chris Robbie, Dr Peter Baker, Dr Janet Birchall, Dr Jane Keidan, Mrs Terrie Perry, Mrs Katy Cowan, Dr Sharran Grey, Mrs Clare Denison, Dr Catherine Ralph, Dr Sarah Haynes, Mrs Pamela Diamond, Dr Anicee Danaee, Ms Tracey Tomlinson, Dr Shruthi Narayan, Mrs Heather Clarke. Steering Group (SG) during 2017 Chair: Professor Mark Bellamy Dr Shubha Allard British Society for Haematology Guidelines National Blood Transfusion Committee Dr Ganesh Suntharalingam Intensive Care Society, Faculty of Intensive Care Medicine
    [Show full text]
  • HEMATOLOGY for THE.Pdf
    HEMATOLOGY FOR THE UNDERGRADUATES By: Dr. Muhammad Saboor, PhD Assistant Professor, Baqai Institute of Hematology Director, Baqai Institute of Medical Technology Baqai Medical University and Dr. Moinuddin, FRCP(C), FRCP (E), PhD (Hons.) Professor of Hematology Director, Baqai Institute of Hematology Baqai Medical University HIGHER EDUCATION COMMISSION ISLAMABAD 1 Copyrights @ Higher Education Commission Islamabad Lahore Karachi Peshawar Quetta All rights are reserved. No part of this publication may be reproduced, or transmitted, in any form or by any means – including, but not limited to, electronic, mechanical, photocopying, recording, or, otherwise or used for any commercial purpose what so ever without the prior written permission of the publisher and, if publisher considers necessary, formal license agreement with publisher may be executed. Project: “Monograph and Textbook Writing Scheme” aims to develop a culture of writing and to develop authorship cadre among teaching and researcher community of higher education institutions in the country. For information please visit: www.hec.gov.pk HEC – Cataloging in Publication (CIP Data): Muhammad Saboor, Dr. Hematolog for Undergraduate I. Hematology 616.15 – dc23 2015 ISBN: 978-969-417-181-4 First Edition: 2015 Copies Printed: 500 Published By: Higher Education Commission – Pakistan Disclaimer: The publisher has used its best efforts for this publication through a rigorous system of evaluation and quality standards, but does not assume, and hereby disclaims, any liability to any person for any loss or damage caused by the errors or omissions in this publication, whether such errors or emissions result from negligence, accident, or any other cause. 2 PREFACE Hematology is one of the oldest specialties in conception yet it is the youngest in its inception.
    [Show full text]
  • 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).
    [Show full text]
  • 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.
    [Show full text]
  • • 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
    [Show full text]
  • 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.
    [Show full text]
  • Filterability of Erythrocytes and Whole Blood in Preterm and Full-Term Neonates and Adults
    003 1-3998/86/2012-1269$02.00/0 PEDIATRIC RESEARCH Vol. 20, No. 12, 1986 Copyright O 1986 International Pediatric Research Foundation, Inc. Printed in U.S. A. Filterability of Erythrocytes and Whole Blood in Preterm and Full-Term Neonates and Adults OTWIN LINDERKAMP, BERNHARD J. HAMMER, AND ROLF MILLER Department of Pediatrics, University of Heidelberg, Heidelberg, Federal Republic of Germany ABSTRACT. Filtration techniques are widely used to as- Hyperviscosity in neonates is a frequent and potentially serious sess red blood cell (RBC) deformability and flow behavior condition, which may cause circulatory failure and impaired of RBC in microcirculation. In this study filtration rates of microcirculation in various vital organs (1). Blood viscosity is RBC from 10 very low birth weight infants (24-30 wk mainly determined by hematocrit. However, decreased RBC gestation), 10 more mature preterm infants (31-36 wk deformability can also contribute to an increase in blood viscos- gestation), 10 full-term neonates, and 10 adults were meas- ity. At high hematocrit, the deformability of RBC is particularly ured by using Nucleopore filters with pore diameters of 5 crucial because blood viscosity exhibits a larger increase with pm and filtration pressures of 1, 2,5, and 10 cm H20.The increasing hematocrit when RBC deformability is impaired (2). major results follow: 1) At each of four filtration pressures, Moreover, decreased RBC deformability may hinder the entry filtration rates of washed RBC were significantly (p < of 8-pm diameter RBC into capillaries with diameters of 3-4 pm 0.05) lower in the preterm infants than in the term neonates (3), slow down oxygen uptake and release in capillaries (4), and who in turn showed lower values than adults.
    [Show full text]
  • Safety Profile of Misoprostol for Obstetrical Indications
    SAFETY PROFILE OF MISOPROSTOL FOR OBSTETRICAL INDICATIONS Lenita Wannmacher INTRODUCTION Cervical ripening, full‐term labour induction, and postpartum haemorrhage (PPH) are obstetric conditions that require proper and early interventions in order to save maternal and fetal lives. These interventions include pharmacological (uterotonic agents, mainly) and non‐pharmacological methods that have been tested and compared throughout the past decade. Regarding injectable uterotonic medicines (such as oxytocin, ergometrine, syntometrine, prostaglandins, and, more recently, carbetocin), factors limiting their use in low‐resource settings have been their cost, instability at high ambient temperatures, and difficult requirements of administration. In poor and rural settings, birth attendant skills are limited, transport facilities are inadequate, and injectable uterotonics and blood are hardly available. In contrast, misoprostol, a synthetic prostaglandin E1 analogue, presents low cost, storage at room temperature, and widespread availability. Misoprostol could also be easily administered by unskilled attendants or the women themselves, thus making them available for women giving birth at home or in isolated areas. These are benefits that make it particularly appealing for developing poor countries.1 Despite the built evidence of efficacy, induction of full‐term labour in women with a live fetus, as well as prevention and treatment of PPH, remains as a major challenge in modern obstetrics. Safety profile of misoprostol is still a matter of concern, especially relating to doses and routes used for the mentioned purposes.2 Misoprostol can be effectively administered vaginally, rectally, bucally, orally and sublingually. Pharmacokinetic studies have demonstrated the properties of misoprostol after various routes of administration. The rate of absorption varies considerably between routes, and care must be taken to use the correct dose and frequency for the specified route.
    [Show full text]
  • History Midwives Representing MANA Statistics Project the Profession Data Collection Form Alliance of Midwifery of North America Revision 2.0 – Page 1 of 8
    History Midwives Representing MANA Statistics Project the Profession Data Collection Form Alliance of Midwifery of North America Revision 2.0 – Page 1 of 8 Practice Code1 Y N Previous pregnancy and delivery history Midwife Code1 Number of previous: pregnancies Second Midwife Code1 (OPTIONAL) miscarriages5 Third Midwife Code1 (OPTIONAL) induced abortions Birth Code2 (MIDWIFE’S IDENTIFYING CODE) stillbirths5 live births Number of previous: History home births Client’s municipality: ___________________________ birth center births State or Province: ______________________________ Population: (CHOOSE ONLY ONE) caesarean sections | city | suburb | small town | rural VBACs Postal (ZIP) Code episiotomies Mother’s— postpartum hemorrhages age at booking Other previous pregnancy/delivery occurrences: last grade of high school completed gestation <37 weeks gestation >42 weeks post secondary formal education (YEARS) hypertension or pre/eclampsia6 3 Occupation : ___________________________________ breech Race/Ethnic origin: forceps/vacuum Caucasian IUGR/SGA7 African or Caribbean birth defect Native American shoulder dystocia Asian other: __________________________________ Hispanic none other4: _____________________________________ Mother’s height: (OR ESTIMATE) Special group: (CHECK ANY THAT APPLY) Amish feet inches OR Mennonite centimeters Francophone Mother’s prepregnancy weight: Immigrant of <10 years pounds OR kg Immigrant of >= 10 years Method of conception: (CHOOSE ONLY ONE) other group: ________________________________ | coitus Partner status
    [Show full text]
  • Florida Obstetric Hemorrhage Initiative (Ohi) Tool Kit
    FLORIDA OBSTETRIC HEMORRHAGE INITIATIVE (OHI) TOOL KIT A QUALITY IMPROVEMENT INITIATIVE FOR OBSTETRIC HEMORRHAGE MANAGEMENT Updated Version 10/2015 P a g e | 1 v. 10/2015 OHI Tool Kit Suggested Citation: Florida Perinatal Quality Collaborative (2015) Florida Obstetric Hemorrhage Initiative Toolkit: A Quality Improvement Initiative for Obstetric Hemorrhage Management. Acknowledgements: The FPQC gratefully acknowledges and thanks our partner organizations, including ACOG District XII, the Florida Chapter of AWHONN, the Florida Council of Nurse Midwives, the Florida Hospital Association, and the Florida Department of Health. The creation of this toolkit would not have been possible without the volunteer members of our Maternal Health Committee, including the members of the Obstetric Hemorrhage Advisory Team listed on page three of this toolkit, Washington Hill, MD and Karla Olson, as well as Kris-Tena Albers and Rhonda Brown from the Florida Department of Health. The FPQC would also like to thank the California Maternal Quality Care Collaborative, ACOG District II, and the Illinois Department of Public Health for sharing their materials, expertise, and time to assist the FPQC in the development of this Quality Improvement (QI) Initiative. This toolkit has been adapted and modeled from the California Improving Healthcare Response to Obstetric Hemorrhage Toolkit: The California Toolkit, IMPROVING HEALTHCARE RESPONSE TO OBSTETRICAL HEMORRHAGE, was developed through the California Maternal Quality Care Collaborative with leadership from the California Department of Public Health, Maternal Child and Adolescent Health (CDPH-MCAH), and is available through the California Maternal Quality Care Collaborative website: www.cmqcc.org/ob_hemorrhage. Funding for the development of the California toolkit was provided by: Federal Maternal & Child Health Title V block grant funding from the California Department of Public Health; Maternal, Child and Adolescent Health Division and Stanford University.
    [Show full text]
  • Medicalverdicts
    Medical Verdicts Notable judgmeNts aNd settlemeNts times she refused consent; her fam- Wrongful birth claim: Child has ily could not be contacted without her a chromosomal disorder authorization. Proper actions were A woman’S husband and an interpreter came to taken when consent was obtained. her first prenatal appointment at 10 weeks’ gesta- } VERDICT An Illinois defense verdict tion, as she spoke only Mandarin and the father’s was returned. English was limited. The ObGyn offered maternal serum sequential screening. At subsequent visits, Epidural pump stolen— with the husband and interpreter present, the mother saw a geneticist, genetic counselor, and nurse practitioner. At no time was additional while in use genetic testing offered. At the 23-week visit, the husband was present, but the interpreter had not yet arrived; the ObGyn attempted to communi- A WOMAN WAS GIVEN AN EPIDURAL cate through the husband. during labor. While she slept, a newly The baby was born at term with cri-du-chat syndrome. The child is hired physician assistant (PA) entered severely physically and mentally handicapped, and will require constant her room, disconnected the epidural medical and attendant care for life. pump, and stole it. The woman awoke but the PA assured her that every- } patient’S CLAIM The ObGyn did not offer amniocentesis or chorionic thing was fine. Soon, she experienced villus sampling (CVS), and failed to inform the parents that the chance significant labor pains and called the of a 37-year-old woman having a child with a chromosomal aberration nurses, who paged an anesthesiologist was 1.5%.
    [Show full text]
  • Antepartum Care
    Antepartum care (ch7) Preconception care: women’s health before pregnancy is really important, thus several models of preconception care have been developed … why we need it? - By the time the pregnant women have their first prenatal visit, it is too late to address and to reduce (how?? Our goals are assessing the risk + optimizing the health + medical intervention “in prenatal”) the risk of some birth defects like: Poor placental development (due to preeclampsia) low birth weight (<2500 grams) (seen in Preterm birth, and IUGR). * REMEMBER: Organogenesis begins early in pregnancy and placental development starts with implantation, about 7 days after conception. who7 days mostly after need conceptionit? - Women who are in high-risk are those with obesity, diabetes, or hypertension … etc. Preconception care in this type of women should be started 6 months to 1 year before conception is attempted. Examples of medical conditions: Affected by pregnancy: Affect the pregnancy: 1- SLE: 1- DM: Pregnancy should occur during disease quiescence, for less 6 months EGA The relationship between the hemoglobin If disease activate during pregnancy: adverse maternal and obstetrical A1C level and fetal malformation complication Risk: All SLE medication should be reviewed Hg A1c fetal Goal: maintain disease control with maximizing safety profile - Diabetic malformation 2- Hypertension: related fetal risk - Classification: malformation: Normal: Mild to moderate: 140- Severe: <7 Baseline CVS, CNS, <140/90 159/90-109 no benefit of >160/90 must 7.2-9.1 14% Gastric and treat it treat it 9.2- 23% genital - Treatment: methyldopa or labetalol 11.1 urinary, - Contraindication: ACE inhibitors, angiotensin II receptor blockers, direct >11.2 25% Skeleton renin inhibitors - Pregnancy risk: Superimposed preeclampsia, Placental abruption and Fetal - The relationship between the hemoglobin growth restriction.
    [Show full text]