HEALTH FIRST

 PRE-TERM LABOR Definition : "  Pre-term labor is defined as one where the labor starts before the 37 th completed week (<259 days ) , counting from the first day of the last menstrual period " Incidence : Pre- term labor is the significant cause of perinatal morbidity and mortality The prevalence widely varies and ranges between 10-15% Global Statistics : According to the World Health Organization (WHO), approximately 10% of births worldwide are preterm (before 37 weeks of gestation). Regional Variations : Incidence rates can vary significantly between different regions and countries. High-income countries typically have lower rates of preterm birth compared to low-income and middle-income countries Etiology of pre-term labor : The etiology (causes) of preterm labor can be complex and multifactorial, often involving a combination of maternal, fetal, and environmental factors...... Maternal Factors : Infections :  Infections of the genital tract, such as bacterial vagi...

 OLIGOHYDAMNIOS  DEFINITION : "It is an extremely rare condition where the liquor amnii is deficient in amount to the extent of less than 200ml at term." AFI between 5 and 8 is termed as borderline oligohydramnios  INCIDENCE : The incidence of oligohydramnios can vary depending on the population studied and the criteria used to define oligohydramnios. Generally, it is estimated to occur in approximately 1% to 4% of pregnancies. ETIOLOGY / RISK FACTOR : Oligohydramnios, which refers to abnormally low levels of amniotic fluid during pregnancy, can have various causes. These causes can be broadly categorized into maternal, fetal, and placental factors: MATERNAL FACTOR : Dehydration:   Inadequate maternal hydration can lead to reduced amniotic fluid levels. Hypertension and Preeclampsia: These conditions can impair placental blood flow, affecting fetal urine production and thus reducing amniotic fluid. Chronic Hypoxia: Maternal conditions that reduce oxygen delivery to t...

 POLYHYDRAMNIOS DEFINITION : Anatomical definition : " Polyhydramnions is defined as a state where liquor amnii exceed 2000 ml "\ Clinical Definition : " The excessive accumulation of liquor amnii causing discomfort to the patient and when an imaging help is needed to substantiate the clinical diagnosis of the lie and presentation of the fetus  " When the amniotic fluid index is more than 24 cm ( more than 95th centile for gestational age ) and the deepest vertical pocket (DVP) is more than 8 cm. INCIDENCE : The incidence varies from 1 to 2% cases It is more common in multiparae than in primigravidae While minor degree of hydramnios are fairly common , hydramnios sufficient to produce clinical symptoms probably occurs in 1 in 1000 pregnancy ETIOLOGY OR RISK FACTOR : There are several potential causes or etiologies that can lead to polyhydramnios: Maternal Diabetes : Women with pre-existing diabetes or gestational diabetes have an increased risk of polyhydramnios due...

  UMBILICAL CORD The umbilical cord or funis forms the connecting link between the fetus and the placenta through which the fetal blood flows to and from the placenta. It extends from the fetal umbilicus to the fetal surface of the placenta . DEVELOPMENT :  The umbilical cord is developed from the connective stalk or body stalk which is a band of mesoblastic tissue stretching between the embryonic disk and the chorion. Initially, it is attached to the caudal end of the embryonic disk , but as a result of cephalocaudal folding of the embryo and simultaneous enlargement of the amniotic cavity the amnioectodermal junction converges on the ventral aspect of the fetus As the amniotic cavity enlarges out of proportion to the embryo and become distended with fluid, the embryo is carried more and more into the amniotic cavity with simultaneous elongation of the connective stalk , the future umbilical cord. STRUCTURE OF UMBILICAL CORD : The constituents of the umbilical cord when fully...

  AMNIOTIC FLUID ORIGIN OF AMNIOTIC FLUID : The precise origin of the liquor amnii is still not well understood It is probably of mixed maternal and fetal origin. CIRCULATION OF AMNIOTIC FLUID : The water in the amniotic fluid is completely change and replaced in every 3 hour  The presence of lanugo and epithelial scales in the meconium shows that the fluid is swallowed by the fetus and some of its passes from the gut into the fetal plasma  VOLUME :  Amniotic fluid volume is related to gestational age . It measures about 50 ml at 12 weeks  400ml at 20 week  Amniotic fluid reaches its peak of 1 lit at 36-38 week  Thereafter the amount is diminishes till at term it measure about 600-800 ml  As the pregnancy continues post-term , further reduction occur to extent of about 200 ml at 43 week AMNIOTIC FLUID INDEX : Normal Range : The normal range for the AFI is considered to be between 5 cm and 25 cm.  This range may vary slightly depending on gest...

  MINOR AILMENTS IN PREGNANCY  Definition: " The minor complaints of pregnant women that occurs due to physiological alteration of hormones (oestrogen , progesterone , prolactin ) and other causative factors which can be managed without medical intervention " MINOR AILMENTS IN PREGNANCY : Nausea and vomiting Backache  Constipation Leg cramp Acidity and heartburn Varicose vein Hemorrhoids Carpal tunnel syndrome(10%) Round ligament pain Ptyalism Syncope Ankle edema Vaginal discharge Minor ailments in pregnancy and its management : NAUSEA  AND VOMITING :  Nausea and vomiting especially in the morning, soon after getting out of bed, are usually common in primigravidae . They usually appears following the first or second missed period and subside by the end of first trimester . About 50% have both nausea and vomiting , 25% have nausea only and 25% are unaffected .                            ...

 ECLAMPSIA  Definition : "Pre-eclampsia when complicated with grand mal seizures (generalized tonic - clonic convulsion) and coma is called eclampsia " The term eclampsia is derived from a Greek word , meaning " like a flash of lightening "  Eclampsia occurs in patient with pre-eclampsia. INCIDENCE : Eclampsia occurs in the 10% of all pregnancy. India accounts 20% of world maternal mortality rate , next to haemorrhage More common in primigravida 75% Eclampsia is 3rd leading cause of maternal mortality after thrombo-embolism and non obstetrical injury  Eclampsia result in death in advance or uncontrollable stage  Causes of convulsion : the causes of cerebral irritation leading to convulsion is not cleared. The irritation may be provoked by.... Anoxia Cerebral edema may contribute to irritation Cerebral dysrhythmia Excessive release of excitatory neurotransmitters ( glutamate ) loss of cerebrovascular autoregulation with forced dilatation and vasospasm Onset of Fi...

  PRE- ECLAMPSIA  Definition : "It is a multisystem disorder of unknown etiology characterized by development of hypertension to the extent of 140/90 mm Hg or more with proteinuria after the 20 th week in a previously normotensive and nonproteinuric women " Some amount of edema is common in normal pregnancy. Edema has been excluded from the diagnostic criteria unless it is pathological. The pre eclamptic features may appears even before the 20th week as in cases of hydatidiform mole and acute polyhydramnios .  Pregnancy -induced hypertension : "PIH is defined as the hypertension that develops as a direct result of the gravid state. It include .... Gestational hypertension Pre-eclampsia  Eclampsia  Incidence : The incidence of pre eclampsia in hospital practice varies widely from 5 to 15% The incidence in primigravidae is about 10% and in multi gravidae 5% Risk factor of pre-eclampsia : Primigravida : young or elderly (first time exposure to chronic villi) Family...

  MANAGEMENT OF SECOND STAGE OF LABOR The transition from the first stage to the second stage is evidenced by the following features : Increasing intensity of uterine contraction Bearing down efforts  Urges to push or defecate with descent of the presenting part Complete dilatation of the cervix as evidence on vaginal examination  Principles of management : To  assist in the natural expulsion of the fetus slowly and steadily To prevent perineal injuries . GENERAL MEASURES : The patient should be in bed Constant supervision is mandatory and the FHR is recorded at every 5 min  To administered inhalation analgesics , if available in the form of gas N2O and O2 to relieve pain during contractions. Vaginal examination is done at the beginning of the second stage not only to confirm its onset but to detect any accidental cord prolapse. The position and the station of the head are once more to be reviewed and the progressive descent of head is ensured. PREPRATION FOR DE...

  Second stage of labor  Definition : "second stage of labor starts from the full dilatation of cervix (not from the rupture of the membranes ) and ends with expulsion of the fetus from the birth canal ." This stage is concerned with the descent and delivery of the fetus through the birth canal. Second stage of labor has two phases : Propulsive : From full dilatation until head touches the pelvic floor . Expulsive: since the time mother has irritable desire to 'bear down' and push until the baby is delivered . Delivery of the fetus is accomplished by the downward thrust offered by uterine contraction supplemented by voluntary contraction of abdominal muscle against the resistance offered by bony and soft tissue of the birth canal . There is always a tendency to push the fetus back into the uterine cavity by the elastic recoil of the tissue of the vagina and the pelvic floor. This is effectively counterbalance by power of retraction. power of retraction , the fetus is ...