. No uterotonic agent is on this list. Non-medical interventions for management of PPH 12 3. Undergraduate course lectures in OB&GYN ,Faculty of medicine,Zagazig University – A free PowerPoint PPT presentation (displayed as a Flash slide show) on PowerShow.com - id: 3cc7a3-NWMwN PPH is one of the leading causes of maternal mortality and an important cause for serious morbidity in the developing and developed world. It's FREE! These deaths have a major impact on the lives and health of the families affected. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The middle graph is from a patient who received 800 μg misoprostol orally. Experience with this technique is promising but the evidence is limited to case reports. If the customer is a member then he can enjoy the discounts and offers. If this is excluded and the bleeding continues then this patient might have lower segment bleeding that will require laparotomy to deal with it. Practices observed. . The cord is then clamped and cut, and once signs of placental separation have occurred the placenta is delivered by controlled cord traction. C Passive management could be practised in low risk women delivering at hospitals or those delivering at home or in clinics who can be transferred to the hospital within a very short time in case of an emergency. A recent systematic review examined various techniques used when medical management is unsuccessful. Total Amount. However, AR follow up is also essential in medical billing to fetch the money for practitioners. Vascular embolization procedures have become established and are less invasive interventions with well documented curative effect. This is done by checking the existing database for whether the customer is registered. The … With ‘passive’ (expectant, physiologic, conservative) management, oxytocics are used only if there is excessive bleeding, the cord is clamped relatively late and the placenta delivered with the help of gravity and maternal effort. The vertical axis shows the intra-uterine pressure in mmHg. DO The vertical arrows highlight the point of administering misoprostol whilst the transverse arrows highlight the length of time taken to achieve a change in uterine contractility. Management of severe postpartum hemorrhage with misoprostol. Explore uterus. (Antepartum and Postpartum Hemorrhage, APH. Wider use of thermostable prostaglandins like misoprostol and dissemination of knowledge about new tamponade procedures can minimize its incidence and limit its serious sequelae. Ligation of the internal iliac arteries has been used but requires complex dissection of the lateral pelvic wall. Maycock MMA Can Help Your Practice With Issues Related to COVID-19. Khan The use of Syntometrine however is associated with several problems. To date relatively small controlled trials indicate that injectable prostaglandin analogues seem as effective as Syntometrine19–22. Certain risk factors increase the possibility for developing PPH; the best treatment for the same is prevention, early recognition, and planned multidisciplinary management . H It can be utilized to reduce the risk of PPH. Background 8 2. H RP Transfer to a clinic or hospital in case of an emergency might be slow and complicated. 52) This guideline provides information about the prevention and management of postpartum haemorrhage (PPH), primarily for clinicians working in obstetric-led units in the UK; recommendations may be less appropriate for other settings where facilities, resources and … The initial report showed promising efficacy and identified shivering as a potential side-effect. Studies may report differences in outcome by timing of intervention, etiology, or setting, and we will capture those data and stratify our presentation of results as much as possible. The horizontal arrow shows the time interval taken to achieve tetanic uterine contraction after administering misoprostol. ... a quick onset of action, within a few minutes, but also loses effectiveness quickly because of a short half-life.The medicine is given in a rapid infusion and may cause hypotension. Many of them are also animated. Metabolic. The potential of misoprostol as a therapeutic agent for this phase of labour was also recognized by WHO, who went on to conduct an ambitious multi-centre, randomized controlled trial involving nine countries33. Although risk factors are a prompt to remain vigilant for PPH, in reality only a small proportion of women with risk factors experience PPH. - Title: PowerPoint Presentation Author: s Last modified by: aaa Created Date: 11/27/2005 2:01:46 AM Document presentation format: On-screen Show Company, ??????? Shannon Arulkumaran and others described 14 cases of intractable PPH who avoided surgery by the use of this balloon45. When the uterotonic features of prostaglandins were later identified they were similarly used in the treatment of PPH. El Refaey Inserting the drug vaginally or rectally by the attending clinician is more practical than handling it to a patient who has just given birth to swallow with a glass of water! It is interesting however that more trial data exist in support of their use in prophylaxis compared to treatment. There is a difference in bleeding from the upper segment to that from the lower segment of the uterus. M Surgical interventions in the treatment of PPH 16 C. Management of retained placenta 17 1. • Describe hemorrhagic shock as a complication of postpartum hemorrhage, including medical management … In the current treatment of severe PPH, first-line therapy includes transfusion of packed cells and fresh-frozen plasma in addition to uterotonic medical management and surgical interventions. Between June 2013 and July 2016, a prospective cohort study was conducted at a tertiary perinatal medical facility in Japan. The rectal use of misoprostol came as an answer to this problem. - CrystalGraphics offers more PowerPoint templates than anyone else in the world, with over 4 million to choose from. Postpartum haemorrhage (PPH) is a complication of delivery and the most common cause of maternal death, accounting for about 35% of all maternal deaths worldwide. Labor and Delivery and Their Complications. The patient had spontaneous onset of labor at 39 +5 weeks’ gestation. Friedman Medical Store Management Project in C#.Net. (III-B) … L 4. The blood transfusion rate was lower in women in the misoprostol group. We are at the threshold of major developments in its prevention and treatment due to changing ideas about its definition and medical and surgical management. 2007;75:(6)875-82. We now have new pharmacological and technical developments for prevention and treatment which can greatly reduce its incidence and sequelae. Chapter 21 Postpartum Complications Kathryn R. Alden Learning Objectives On completion of this chapter, the reader will be able to: • Identify causes, signs and symptoms, possible complications, and medical and nursing management of postpartum hemorrhage. Interventional radiography: Embolisation of uterine and internal iliac arteries. In this asp.net project post we will learn how to create medical management system software in c#.net with sql server database. … At the 38-week scan, the fetus was well developed (estimated weight, 4100 g). access/ invasive monitoring 6.- Modify obsterical management 7.- Increased postpartum/postop surveillance Patients at risk Pre-delivery management 38. Replace inverted uterus. (See "Postpartum hemorrhage: Medical and minimally invasive management".) Updated: Jan 02, 2018 Author: Maame Yaa ... (ABCs) of the patient. It is however one of the leading causes of maternal mortality—especially in less developed countries where multiparity, fibroid uterus and anaemia are common. PPH is generally associated with symptoms of hypovolemia. It is recognized that routine pharmacological use of uterotonic agents is an important prophylactic measure against PPH. The spectre of maternal mortality can then only be prevented by initiating surgical haemostasis sooner rather than later. Treatment for primary postpartum haemorrhage (Cochrane Review). Overview and medical management of PPH. Comparison of patient-reported functional recovery from different types of ophthalmic surgery. They are also known to be useful as a last resort in the management of intractable PPH. Rate of falls, fear of falling, and avoidance of activities at-risk for falls in older adults with glaucoma. This chapter describes ways of effective preparation, mobilization of resources and an organized approach to evaluation and surgical amelioration of PPH. When medical management of PPH is unsuccessful, surgical options should be utilized in a timely fashion in order to reduce maternal morbidity and mortality. Software For Easy Managing Of Medical Shop SEHRA MEDICAL STORE Submitted by : Navdeep Singh Sehra 1247936 2. Whereas the need for additional oxytocin was lower in the misoprostol group, shivering was more common in the misoprostol arm. Unlike ergometrine-related agents, prostaglandins are not hypertensive18. El Refaey When medical management fails to reverse coagulopathy, surgical management must be considered as a life-saving procedure. In: Chalmers I, Enkin M, Keirse MJNC (eds). PPH can transform a normal woman in labour to a critically ill patient within minutes. , Coker A, Lawal AH, Abu J, Cowen MJ. NARRATIVE OF PROJECT This project is to design medical store management system. The proposal to use misoprostol to prevent and treat PPH has been investigated in the last 5 years. POSTPARTUMHAEMORRHAGE Presented by: S. Linda devi MSc. It soon became clear that the vaginal route is optimal however because the resulting uterine contractility was more potent and side-effects were lower compared to the oral route. Postpartum hemorrhage (PPH) remains a leading cause of maternal death worldwide, and it is important to understand the relative contributions of different risk factors. Embolization at this point will at least lower the blood pressure around the uterus44. The mean estimated blood loss and haematocrit difference were significantly lower in women who received misoprostol than those who received the placebo. Compared to hysterectomy or to vascular embolization, the B-Lynch suture is a much simpler procedure and its technique can be easily mastered. - Postpartum Hemorrhage(PPH) Major causes of death for pregnancy women maternal mortality) Postpartum hemorrhage 28%) heart diseases ... - Title: OB-PED-MED-SERG Author: Microsoft Last modified by: USER Created Date: 1/11/2006 9:58:26 PM Document presentation format: On-screen Show (4:3). WHEN MEDICAL MANAGAMENT FAILS SURGICAL MANAGEMENT Uterus conserving : NEED OF TIME Definitive - Hysterectomy CHRISTOPHER BALOGUN-LYNCH In 1997 he published a . Wasting time in anticipation of a response to uterotonic agents in these cases will be futile. BM The bottom graph is from a patient who received 800 μg misoprostol vaginally. They'll give your presentations a professional, memorable appearance - the kind of sophisticated look that today's audiences expect. Key PPH Activities MCHIP is a key contributor to WHO recommendations on PPH, which are likely to be revised in the coming months to include a recommendation in support of advanced distribution of misoprostol for self-administration to prevent postpartum hemorrhage at home birth. Sibai R Surgical techniques such as ligation of the internal iliac artery, compression sutures, and hysterectomy should be used for the management of intractable PPH unresponsive to medical therapy. The vertical arrow indicates the time of the oral administration of misoprostol. The administration of the drug by the rectal or vaginal route might be more practical and effective than the oral route. Management of PPH Specific management Ligature of uterine arteries: Procedure first described by Walters in 1952. We offer secure medical waste disposal and document shredding … . Surgical planning 5.- Anesthesia /I.V. The authors were therefore unable to quantify the proportion of patients who received the oxytocin intravenously or intramuscularly. Hazem El-Refaey, Charles Rodeck, Post-partum haemorrhage: definitions, medical and surgical management. Amount Rs. , Villar J, Ngoc NT et al. PPH is one of the leading causes of maternal mortality and morbidity worldwide and accounts for nearly one-quarter of all maternal deaths.15 Multiple studies have suggested that many deaths associated with PPH could be prevented with prompt recognition and more timely and adequate treatment.16-18 Morbi… The technique involves inserting a catheter in the femoral artery going into the large circulation and then to the uterine vessels. Criteria for the diagnosis of Primary Post partum hemorrhage was that if blood loss occur within 24 hour then … 12/12. . Multiple fertility preserving surgical techniques to control PPH … Anderson JM, Etches D. Prevention and management of postpartum hemorrhage. AF The use of carboprost as an intramyometrial injection, its long list of contraindications and possible side-effects were however prohibitive for the wider use of this prostaglandin analogue. PPH has been categorized as primary or secondary based on the timing of occurrence and the likely cause of bleeding. The definition and classification of PPH have stood the test of time but they are not without problems. It is useful to embed this distinction in the literature and in training as it impacts on management options and pathways and on the speed with which they are adopted. Technique first described for the management of PPH in 1979 by Heaston et al, following persistent bleeding after hysterectomy for the treatment of PPH. Oxford University Press is a department of the University of Oxford. O’Brien SILENT FEATURES 3. Sponsored Links. Prendiville Post-partum haemorrhage (PPH) is a clinical problem of indisputable importance to patients, clinicians and to those interested in achieving equity in reproductive health. They should eat well and resume normal physical ... - Title: PowerPoint Presentation Last modified by: Admin Created Date: 1/1/1601 12:00:00 AM Document presentation format: Other titles: Arial Abadi MT ... - OB hemorrhage accounts for 50% of all postpartum maternal ... 2 chromic on a 75 mm heavy, round bodied needle. Or use it to find and download high-quality how-to PowerPoint ppt presentations with illustrated or animated slides that will teach you how to do something new, also for free. H OP E-mail: Search for other works by this author on: The Prevention and Management of Postpartum Haemorrhage. However, with declining maternal mortality rates in many parts of the world, interest in and attention to maternal morbidity and the important topic of management of secondary PPH is increasing. Standard management … And they’re ready for you to use in your PowerPoint presentations the moment you need them. GJ Obstetricians, midwives, general medical practitioners, health care managers and public health policy-makers, particularly in under-resourced settings are also targeted. P Finally, because oxytocic agents are not stable at high ambient temperatures, they require special storage conditions. Issues related to primary or early PPH are reviewed separately: (See "Overview of postpartum hemorrhage".) It involves the administration of an oxytocic drug either intramuscularly or intravenously with, or immediately after, the birth of the baby. Preparing for birth Name of presenter: Prevention of Postpartum Hemorrhage Initiative (POPPHI) Project BASICS. management for women at risk of PPH • Identify initial management of PPH • Recognise treatment and care options relevant to cause of PPH . And, best of all, most of its cool features are free and easy to use. Am Fam Physician. P Rectally administered misoprostol for the treatment of postpartum hemorrhage unresponsive to oxytocin and ergometrine: a descriptive study. This figure is almost certainly an underestimate. , Manley DG. It does not require special training and is illustrated in Figure 2a and b. CrystalGraphics 3D Character Slides for PowerPoint, - CrystalGraphics 3D Character Slides for PowerPoint. Use of misoprostol in third stage of labour. Queensland Clinical Guidelines: Primary postpartum haemorrhage 3. The fate of such a woman will therefore vary widely, depending not only on where she lives in the world but also on where she lives in her own country. Desai S and Henderson SO. The successful management of PPH requires a multidisciplinary team approach. Haemostasis following placental separation is thereby initially a mechanical process not primarily dependent upon an intact coagulation system. In some cases calls were made to exert political pressure on governments to tackle the problems. Lokugamage , Kanhai HH, Keirse MJ. Misoprostol and the politics of fear. Studies designed to simulate the storage conditions commonly found in tropical countries found that a variety of brands of ergometrine lost 21–27% of their active ingredients after 1 month, and over 90% after 1 year of storage exposed to light and at 21–25°C10,11. Surbek et al31 also conducted a double-blind randomized controlled trial comparing a single oral dose of misoprostol (600 μg) with placebo in the third stage of labour. Linking certain aspects of foreign aid to advances in reproductive health was portrayed as an effective leverage to implement change. G Even the mild self-limiting cases have consequences for the patient’s puerperium in the form of fatigue, tiredness, failure to breast-feed and possible need for haematinics or blood transfusion. Start Video 0 Likes. Should uterotonics be offered as treatment for retained placenta? H AR follow- up management: Essential in the medical billing process - You must be aware of the Accounts receivable or AR in medical billing. Approximately,half a million women die annually fromcauses related to … We assessed the incidence of these among cases of transvaginal delivery. Dr. Suhas Otiv Consultant, KEM Hospital, Pune Lancet 2006; l368:1189-200 Mortality from PPH Half of 500,000 maternal deaths globally 28 % of maternal deaths in developing countries Risk of death from PPH 1 in 1000 deliveries - developing countries 1 in 100,000 deliveries developed countries Furthermore, there was an unexplained statistical heterogeneity between the individual centres for the primary outcome of measured blood loss. Title: Surgical Management of Post Partum Haemorrhage 1 Surgical Management of Post Partum Haemorrhage 2 Emeritus Professor C B-Lynch GORSL 2007. , Russell WC. - Postpartum Hemorrhage Pongsun Puntachai , MD OB & GYN Department Sanpasittiprasong hospital , Ubon Ratchathani ... | PowerPoint PPT presentation | free to view, - Title: Postpartum Hemorrhage Author: JOKE Last modified by: JOKE Created Date: 4/29/2010 12:19:37 PM Document presentation format: On-screen Show Other titles. Results 12 Box 1: Recommendations for the prevention of PPH – uterotonics 15 Box 2: Recommendations for the prevention of PPH – cord management and uterine massage 16 Table 1: Recommendation status of … F. Grading the Strength … A patient who fails to respond to uterotonic agents and continues to bleed will quickly become haemodynamically unstable and develop a cascade of clotting abnormalities. Studies of premenopausal women in which the outcome measures were either change in menstrual loss, uterine or fibroid size (volume) or improvement in quality of life were included. Philadelphia: Elsevier Saunders; 2014. Displaying Powerpoint Presentation on Surgical Management Of PPH available to view or download. Whilst this large trial is often quoted to have shown that there is a 1% difference in PPH between oral misoprostol and oxytocin, the subtle but profound effect of administration of oxytocin by the intravenous route on the results is often overlooked or ignored. We are at the threshold of major developments in its prevention and treatment due to changing ideas about its definition and medical and surgical management. About 2-3cm of the myometrium should be included in the suture.
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