Pregnancy & Delivery - PowerPoint Presentation

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Pregnancy & Delivery

Dr. Ganesh Govekar

Delivery

Abortion

Infanticide

Nullity

Divorce-Higher maintenance

Execution of death sentence

Homicide/suicide

Disputed paternity

Legitimacy

Property inheritance

Higher

compen

-husband death

Leave in services

Definition

Complete evacuation of fetus and other conceptional product after attaining the viability.

Full Term

Pre term

Post term

Signs and Symptoms in Recent

Symptoms:

Fatigue-more in prolonged

labour

Loss of weight

Diuresis

- physiological reversal

Afterpains

- milder after 3 days, 7

th

day disappear

Post partum fever (milk fever)

Transient depression (

peurperial

Psychosis)

signs

Breast-

colostrum

(2 days) later pure milk

Abdomen-

linea

albicans

Caeserian

section

Vagina-smooth walled, relaxed, wide, ironed

rugae

, lacerated walls,

carunculae

multiformis

Labia-swollen

Perineum- ruptured

fourchette

and posterior

comm

Lochia

- alkaline discharge, sour disagreeable

odour

Consists of

rbc

,

wbc

,

decidual

sheds, epithelial cells and bacteria

Lochia

rubra

-

upto

4 days

Lochia

serosa-5

th

to 10

th

day

Lochia

alba- 10

th

day onwards

upto

2-3 weeks

Cervix- thin collapsed and flabby

External

os

– laceration of outer margin, contract slowly, 2

nd

day- two finger, 1 wk- one finger

Wall thickened to re-establish.

Uterus- involution

1-3 day-

fundus

midway between

umblicus

and pubic

symphysis

5-6 week- normal size

Lab test- biological test- positive

upto

7-10 days after delivery.

In dead ( Recent-Delivery signs)

As above and

Uterus-

Signs of recent Delivery in dead

Uterus 0 D-20×15 cm-1kg 4-5 cm thick

2-3D-17.5×10cm-800gm

1 wk- 5×3×2inch-1/2 kg

2 wk-3×2 -350gm

6 wk-N(7-8cm) 100-120gm

Placental sites 15cm-shortly

3-4cm-2

nd

wk

1-2cm-6wk

Ovaries & fallopian tubes – congested for few days

- large C.L. in one ovary

Uterus morphology:-

LSCS-fresh healing incision

-Ant & post wall- 4-5cm thick(soon after delivery)

-myometrium-basal

decidua

only

-placental site – palm size

-an ischemic appearance

3) 2-3 days- decidua-2layers 1.) Sup-necrotic

2.) Basal-shed in

lochia

4) 2 wk –

endometrium

-

-placental site- 3-4cm

5) 5-6 wk- placental site get covered by

endometrium

Signs of REMOTE DELIVERY in living

1.ABDO – lax

- wt scar-lat wall

-

linea

nigra

-present

2.Breast –

lax,pendulus

soft,wrinkled

-due to feeding

-

linea

albican

- nipple-enlarged

- areola-

large,dark,montgomery

tub.

3.Vulva-

partialy

open

-perineum-scar

4.Vagina-

rugae

-absent & walls lax

5.Cervix- ext

os

-large, transverse

In vagina-simple-dimple

Signs of Remote in dead

Uterus- large thicker, heavier

-walls- concave

- body twice the cervix.

IN DEAD:-

Ovaries & F.T. – congested, M.E. – C.L-intact/degenerated

Peritoneum- wrinkled & folded

Ligaments 1) broad &2) round –lax, take long time to recover

Positive signs of pregnancy:

FHS

Fetal parts

Fetal movements

X ray - 2-3wk

USG - 6 wk

IN DEAD 1. enlarged uterus

2. C.L.

progre

/

regre

3. conception product

Superfetation

: Twin

preg

- 2 ova

fert

at diff cycle

Superfecundation

: 2 ova discharged at a time

Pseudocyesis

: false/spurious

preg

.

Pregnancy N-280days

max 320-350days

min 210-180days

Negeles

rule:- 9m + 7days

FHS-

definate

signs

- 18-20 wks

-

Muffeled

sound

- 120-160

- not

synchronus

with mother pulse

X ray- 15-16 wk

- skull-

crescentric

-

vert

col

- dots

- ribs- curved parallel shadow/lines

- limbs - linear shadow

spalding

collapse- V.C

Gas-Heart & Vs.

Sonography

-

Gast

ring- 6 wk

Embryo -8wk

F H beat - 12 wk

Head & thorax -14wk

Dx

– IUGR

- malformation

Prenatal diagnosis technique Act

1.Prohibit

Dx

for sex determination- female

foeticide

2.Permit

Dx

for detection of genetic abnormality

Central Govt.- central

supervisary

board to review

implimentation

of act.

Genetic

councelling

centre- Get regd. By

appro

authority.

To be done by- Qualified person

Consent from female.

Test done if following condition satisfied:

Female >35

H/O ≥ 2

spont

abortion

H/O exposure to

teratogenic

agent

H/O mental retardation.

Test done for detection of. 1.Chromo.

Abn

.

2.Genetic/metabolic disorder

3. Hb.

Pathy

4.sex linked disorder

5. cong.

Abn

.

Act provides – Appeal

- conviction – Dr -3yr

Rigourus

- fine 5000

-

prof

death

sente

-perm removal for subsequent offence.