" مالتيميديا الأوبســـــــــتاتريك ", . خيارات

[DR___RG]

د\ اروي

preeclampsia

normaly,trophoblast invade the maternal spiral arteriol converting them to maternal sinusoids
for exactly unknown cause this physiology doesnot occur in preeclampsia











The Normal and Abnormal Maternal-Fetal Interface





but ,placentation in preeclampsia as follows








Poor placentation and preeclampsia. Normal placentation (A) and poor placentation ( at 15 to 16 weeks of pregnancy
. The placenta is linked to the maternal decidua by anchoring villi. During normal placentation, cytotrophoblasts (blue) cross these placental-maternal bridges and invade the maternal decidua and adjacent spiral arteries. They penetrate the walls of the arteries and replace part of the maternal endothelium (yellow), stimulating remodeling of the arterial wall such that the smooth muscle is lost and the artery dilates
. In the decidua, they are confronted by many NK cells (red) and some macrophages (purple)
. During normal pregnancy, these immune cells facilitate deep invasion of cytotrophoblasts into the myometrial segments (A) and promote extensive spiral artery remodeling. In the preclinical stage of preeclampsia, invasion is restricted ( with impaired arterial remodeling. ©The two stages in development of preeclampsia.







changes in preeclampsia










this could lead to inadequate vascularization of the placenta
could be a primary placental ischemia or secondary to other ischemic factors
placental hypoperfusion due to abnormal uterine vasculature that is unable to accommodate the normal rise in blood flow to the fetus/placenta
this can lead to atherosis, fibrinoid necrosis, thrombosis, sclerotic narrowing of arterioles, and placental infarction






Pathophysiology of preeclampsia and resulting symptoms; EDFMD, endothelium-dependent flow-mediated vasodilation.





Postulated etiology of preeclampsia and proposed benefits of exercise; solid-line boxes, effects of preeclampsia; dashed-line boxes, effects of exercise.
















Preeclampsia is the development of swelling, elevated blood pressure, sudden and rapid weight gain and protein in the urine during pregnancy























<a href="http://www.nature.com/ncpneph/journal/v1/n...neph0035-F4.gif" target="_blank">http://www.nature.com/ncpneph/journal/v1/n...neph0035-F4.gif</a>





Angiotensin receptor activating autoantibodies (AT1-AAs) may underlie many features of preeclampsia. AT1-AAs from preeclamptic patients activate angiotensin receptors (AT1R) on the surface of many cell types and may be responsible for many features of this serious pregnancy disorder.



Angiotensin II Type 1-Receptor-Activating Antibodies in Renal-Allograft Rejection





Primary deficiencies in calcium intake and serum 1,25-(OH)2 D3 levels decrease serum-ionized Ca2+; this causes hypocalciuria via action of increased levels of PTH at kidney and may lead to symptoms of preeclampsia by disturbing pervasive functions of Ca2+ throughout body.




varying degrees of preeclampsia (PE), control pregnancies, and four nonpregnant healthy volunteers. ?P < 0.05 compared to preterm controls, ?P < 0.05 compared to severe preeclampsia. HELLP; hemolysis, elevated liver enzymes, low platelets.




in preeclampsia















survival after preeclampsiia





differentiating among hypertensive disorders in pregnant women. (HELLP = hemolysis, elevated liver enzymes, low platelet count)



MANAGEMENT

تم تحرير المشاركة بواسطة DR___RG: 23 ديسمبر 2008, 03:40 م

[zerohour]

بسم الله الرحمن الرحيم

هنبدا مع بعض موضوع مهم جدا

NORMAL LABOUR

هنبدا الاول بموضوع سهل وجميل

Anatomy of female bony pelvis





















Planes and Diameters of the Pelvis













































Pelvic Size and Its Clinical Estimation













Types of female pelvis

[zerohour]

Gynecoid





Platypoid





Anthropoid






Android



انتهى الجزء الأول

و جاري الاعداد للجزء الثاني

[DR___RG]

د\ اروي

Antepartum haemorrhage

placenta previa


Placenta previa is a complication of pregnancy in which the placenta grows in the lowest part of the womb (uterus) and covers all or part of the cervix








Normally, the placenta is attached to the uterus above the cervix. When the placenta is blocking the cervix, it is called placenta previa. The amount of cervix covered by the placenta may be slight (marginal), moderate (partial), or complete (total). This illustration shows a complete placenta previa.









Different types of placenta previa












This is a transabdominal image of a Placenta Previa. Notice that the placenta
covers the cervix. The internal cervical os, which is the beginning of the birth
canal, is located immediately to the left of the "C" in cervix.





Placenta previa. The placeta extends over the internal cervical os by 2.6 cm



Marginal Placenta Previa



Complete Placenta Previa




Management of placenta previa

[DR___RG]

د\ اروي

Abruptio placentae





In most pregnancies, the placenta remains firmly attached to the upper part of the uterine wall. In one out of 150 pregnancies - usually during the third trimester - the placenta detaches itself from the wall of the uterus prematurely, causing bleeding. Sometimes only a portion of the placenta separates; other times it pulls away completely.
























A Case of Marginal Placental Abruption with both external bleeding per vaginum & formation of Sub-chorionic Hematoma

Placenta Abruptio

1. Area of Detachment (Abruption)
2. Placenta
3. Baby
4. Uterine Wall



الصورة ديه شرحها ف اللينك ده

http://video.about.com/pregnancy/Placenta-Abruptio.htm

[DR___RG]

د\ اروي

postpartum haemorrhge

[

url="http://www.0zz0.com"][/url]





Bleeding is the first cause of maternal death worldwide












Retained placenta



is one of causes of ppHge



one of causes of retained placenta is placenta accreta





The primary cause of death for antepartum and postpartum haemorrhage are shown . Abruptio placentae was the specific cause of death in 19 (70,4%) of the 27 deaths.






http://www.aafp.org/afp/20070315/875-f2.jpg
Technique of bimanual massage for uterine atony. Bimanual uterine compression massage is performed by placing one hand in the vagina and pushing against the body of the uterus while the other hand compresses the fundus from above through the abdominal wall. The posterior aspect of the uterus is massaged with the abdominal hand and the anterior aspect with the vaginal hand.






Manual removal of placenta




Introducing one hand into the vagina along cord




Supporting the fundus while detaching the placenta




Withdrawing the hand from the uterus



Management of Postpartum Hemorrhage

تم تحرير المشاركة بواسطة DR___RG: 1 يناير 2009, 04:15 م

[DR___RG]

female pelvic floor







The pelvic floor consists of the pelvis [and] the levator ani muscles which go between the pubis and the sacrum. There are a central group of these muscles which surround the urethra and the rectum. Beneath this floor there are also sphincter muscles around the anus and urethra. The side wall's obturator internus insert on the pubic bone [and] can have some effect on the urethra
















episiotomy



medio_lateral episiotomy




1. Clitoris
2. Urethral Opening
3. Vagina
4. Episiotomy Incision
5. Anus




Whether you need an episiotomy will depend on the amount of tissue in your perineum, the size of the baby and your care giver's judgement on whether you are going to tear. Tears are much more difficult to heal than clean edged cuts. The perineal tissue can be stretched using massage and mineral oil as you are pushing. The baby's head will stretch the perineum also. About 50% of women will need an episiotomy.









Repair of episiotomy







Stitches (sutures) are used to close the incision after both the baby and placenta have been delivered. The stitches are absorbed by the body and do not need to be removed.

[DR___RG]

normal labor
Effacement and dilatation of the cervix


************
Abdominal palpation for descent of the fetal head



*****************
Assessing descent of the fetal head by vaginal examination; 0 station is at the level of the ischial spine (Sp


*************
Landmarks of the fetal skull

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Occiput transverse positions




***************
Occiput anterior positions






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Well-flexed vertex


*******************
Descent assessed by abdominal palpation: Refers to the part of the head (divided into 5 parts) palpable above the symphysis pubis; recorded as a circle (O) at every vaginal examination. At 0/5, the sinciput (S) is at the level of the symphysis pubis.



*************


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partogram

[zerohour]

هنكمل مع بعض ال normal labor


Anatomy & diameters of fetal skull





















Fetal lie













Fetal attitude





Fetal presentation

























Fetal engagement













Fetal asynclitism





Diagnosis of Fetal Presentation and Position





انتظروا الباقي غدا - بإذن الله -

[zerohour]

شوية فيديوهات جميلة

يا رب تعجبكم

3D Medical Animation: Childbirth Stations of Presentation

Human Sexuality: Conception

Egg fertilization

Development of Fetus

Normal Vaginal Birth

و ده فيديو حلو أوي

[Chaand]

ياه ... الموضوع ده رائع .... مش عارف ازاي ما دخلتوش قبل كده


جزاكم الله خير جميعا ... و

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