changes in pregnancy

skin

choloasma





linea nigra



striae garvidarum



pigmentations




ودى صورة كده تفاريح

كانت خدت جايزة احسن صورة تركيب فى 2006



varicosities





uterus

Changes during pregnancy


اتكلمت عنها المرة اللى فاتت

ده ملخص سريع

ده فيديو لواحدة حامل مصورة فيه بطنها
وصور السونار كلها

اسبوع باسبوع

فيديو لطيف مع موسيقى طفولية شوية

لاحظوا وشها
و ووزنها اللى زاد
وحجم بطنها
و صور السونار






و ده فيديو تفاريح كده
فكرته عجبتنى

الحمل كله فى 30 ثانية

الوقت بيجرى بسرعة




طيب نيجى لشوية طب

Diagnosis of pregnancy

كلام عام كده
1st trimester

1- Missed preiod
2- Morning sickness





وده فيديو من لعبه كمبيوتر عن شخصيه فى اللعبة حامل




3- frequency of micturition
4- Breast symptoms

Pigmentation



Montgomery's glands





5-Apetite changes


نيجى بقى لل
signs and investigations


signs
Hegar sign


Palmar sign
Chadwicks
Godells


Investigations

1- pregnancy tests

Urine tests



وده واحد تانى بال يو اس بى
متطور
و بيرسم رسومات لو فيه حمل و لو مفيش يعمل علامة غلط



ده لما يكون فيه حمل
positive




و طبعا فيه تحليل الدم بس ده فى المعمل



2- Ultrasongraphy

abdominal probe

vaginal probe














مش بس بيشخص حمل

ده كمان بيبين اى شئ مش طبيعى
twins



Bicornate uterus pregnancy


Vesicular mole
(snow storm appearance )


Ectopic
e.g.tubal ectopic


و الاروع كمان انه يشوف دقات قلب الطفل عند الاسبوع السادس

روعة




3- Fetal heart sound ( Sonicaid - doptone )




وده واحد بيستخدم بايد واحدة بس


وده بقى تجربة عملية


بصوا هو مش ميكروفون
بيشتغل بنفس فكرة السونار او الدوبلر

ده فيديو لطيف بيبين الصوت لما يشتغل
هيعجبكم


هتلاقوا الرقم مكتوب
140 - 125
which is normal
fetal Heart rate




2nd trimester

Amenorrhea
Morning sickness and urinary ---- disappear

اهم حاجتين

ABDOMINAL ENLARGMENT

شوفوا الفيديوهات اللى فى الاول

QUICKENING

حركة الطفل

فيديو جميل جدا





signs

Ballotement
معدش حد بيعملها قوى اليومين دول





3rd trimester

أكيد واحدة غبية جدا
والدكتور اغبى منها

لو لسه معرفوش انها حامل و قربت تولد اصلا



شوفوا بطنها قد ايه اصلا




ده بقى صور من زيارة ميدانية لزينهم

PHC



مستلفهم من بروفايل شخص ما على الفيس بوك




























شوية كلام حمضان زى بتاع الكميونيتى للستات الحوامل

استخسرت محطوش ... يمكن يفيد


pregnancy and travel

http://www.youtube.com/watch?v=qTi0YlOCvEw

pregnancy and vomiting
http://www.youtube.com/watch?v=zHbmRrqv3wY

nutrition in pregnancy
http://www.youtube.com/watch?v=3KdxFYTgGEg

warning symptoms
http://www.youtube.com/watch?v=xlVWMeivz3I...feature=related




دول شوية فيديوهات

سونار
3D

حاجة جامدة جدا





وده واحد دماغة عالية جدا

داروي

normal placenta










The placenta. The fetal (umbilical) arteries and their branches are shown white, and the vein and its branches black






anatomy of placenta





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







normal placenta





placentation

placenta formation




what is the placenta</div

دول فيديوهين جامدين

واحد عن 3D Medical Animation of Normal Vaginal Birth




وده عن 3D Medical Animation: Childbirth Stations of Presentation




ENJOY UR STUDY

</div>

[center]د امة الله 87</div>

[center]normal labour

د\اروي

cesarean section


The uterus is exposed through the abdominal wall, and an incision is made in the uterine covering.
The muscles of the uterus are separated, producinga hole for the delivery of the infant.
The infant is delivered throughthe opening in the uterine wall, after which, the uterus is stitched closed.







examples of indication of cs


3D Medical Animation Cesarean Birth (C-section)

د\ اوري
multifetal pregnancy






Ultrasound of a triplet pregnancy



Multifetal pregnancy



twin pregnancy




Twins pregnancy




Twin Pregnancy 11Wks 4D ultrasound




Twin pregnancy at 10 weeks








Two Examples of Twinning
A. Identical Twins Fetuses are of the same sex and share one placenta. One outer membrane envelops both amniotic sacs.
B. Fraternal Twins Fetuses may be of different sex. There are two placentas and two separate amniotic sacs, each with its own membrane.

DR\The Red Rose,د\ اروي

ectopic pregnancy

sites of ectopic pregnancy





ectopic pregnancy in fallopian tube
the commonest site








what is an ectopic pregnancy?
video

http://video.about.com/pregnancy/Ectopic-Pregnancy.htm

ده عنوان الصفحة
فيديو رائع جدا بجد ومبسط

symptoms of ectopic preg




rupture ectopic preg

























Live rupturing ectopic pregnancy

DR\The Red Rose,د\ اروي

ectopic pregnancy

sites of ectopic pregnancy





ectopic pregnancy in fallopian tube
the commonest site








what is an ectopic pregnancy?
video

http://video.about.com/pregnancy/Ectopic-Pregnancy.htm

ده عنوان الصفحة
فيديو رائع جدا بجد ومبسط

symptoms of ectopic preg




rupture ectopic preg

























Live rupturing ectopic pregnancy

دي شويه صور للسونار ectopic pregnancy

Ectopic Left Tube - The scan then moves to the left uterine tube (LT) where ectopic implantation has occurred. Also visible is the left ovary (L OV) and the uterus (UT)


TRV Pelvis (Transvaginal)
Live Ectopic Pregnancy


a ruptured ectopic pregnancy diagnosed in seconds with transabdominal probe, and in the OR in under 45 minutes


ectopic pregnancy




Cervical Ectopic Pregnancy



Ectopic pregnancy, power doppler. Ultrasound image


Case Twenty Eight - Ectopic Pregnancy







tubal ectopic pregnancy




empty uterus



Empty Uterus with Ectopic Pregnancy





ectopic pregnancy - yolk sac

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

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

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

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

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.