Surgical recall
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Chorioamnionitis
DEFINITION Infection of the chorion, amnion and amniotic fluid typically due to ascending infection by organisms from normal vaginal flora. Most often associated with prolonged labour. AETIOLOGY /EPIDEMIOLOGY Incidence 1-5% of term pregnancies and up to **25% in preterm deliveries • Most commonly results from organisms ascending from vagina • May also result from haematogenous spread • Predominant microorganisms include GBS, Bacteroides and Prevotella species, E. coli and anaerobic Streptococcus Medscape: GBS infections are no longer the major cause of EOS. Gram-negative bacteria are now most predominant particularly Escherichia coli RISK FACTORS ***Labour-related: • **Prolonged ROM • Preterm labour • Long labour • Multiple vaginal exams during labour - risk of developing chorioamnionitis increases with each vaginal examination that is performed in the final month of pregnancy, including during labor • Internal monitoring (Eg. fetal scalp electrode!) **Infecti...
Obstetrics examination
1. Introduce yourself – Ask patient name, permission to examine 2. Expose patient – Comment on why only exposing the abdomen 3. Start at foot of the bed – INSPECTION A. General: - Eg. Young, gravid female - Distress? - Adequate nutrition? B. Abdomen: - Globally distended abdomen? (consistent with gravid uterus?) - Scars? - ***Make sure to look specifically for a Pfannenstiel! May have to lift belly! It is not always obvious!! - Notable linea nigra? - Notable striae gravidarum? (New striae = hyperpigmented. Old = hypopigmented) - Umbilicus – inverted, flat, everted? - Movement with respiration? - Hair distribution? - Fetal movements seen? C. Legs: - Ask patient about pain before touching - Pedal oedema? 4. ABDOMEN PALPATION [Leopold’s maneuvers] FIRST MUST: ASK IF ANY PAIN! Can palpate abdomen for – Soft, tense, tender? THEN Leopold’s maneuvers A. Do #1 [Fundal grip] – then feel for the part/pole at the fundus [Describe: Head = “round, firm”. Breech = “Irregu...
Transient ischemic attacks
Transient ischemic attacks (TIAs): Transient ischemic attacks (TIAs) have historically been defined as a stroke like event that completely resolves within 24 hours. The symptoms of a TIA begin abruptly and may persist for only a few seconds or minutes, followed by apparent full resolution. Symptoms of cerebellar hemorrhage Patients with acute cerebellar hemorrhages typically develop a sudden headache and inability to stand, along with nausea, vomiting, and vertigo. The goals of acute stroke management are: To limit or reverse neurologic damage through thrombolysis or neuroprotection To monitor and prevent secondary stroke complications such as elevated intracranial pressure.
Stroke
Stroke: Stroke Is the sudden occurrence of permanent damage to an area of the brain caused by a blocked blood vessel or bleeding within the brain. Strokes can be divided into two major categories: Ischemic, generally caused by a vascular occlusion Hemorrhagic, caused by bleeding within the parenchyma of the brain. Symptom of stroke : Most common symptom focal weakness Sensory loss Speech and language disturbance Visual loss, Objectives of stroke rehabilitation are To achieve a maximum level of functional independence Facilitate neurological recovery Minimize disability Successfully reintegrate back into home, family, and community Reestablish a meaningful and gratifying life. These goals are accomplished through exercise and other treatments to facilitate recovery and reduce impairments; functional training to compensate for residual impairments; and use of assistive devices Modifiable Risk Factors for Stroke ； Hypertension Heart dise...
