Complete Guide to Pregnancy and Delivery by Dr. Ganesh Govekar
Explore in-depth information on pregnancy, delivery, and postpartum signs and symptoms as well as recent delivery signs, including details on cervix, uterus, and more. Learn about the different stages of pregnancy, abortion, and other related topics. This comprehensive guide covers everything from conception to post-term care.
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Presentation Transcript
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, 7thday 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-5thto 10thday Lochia alba- 10thday onwards upto 2-3 weeks
Cervix- thin collapsed and flabby External os laceration of outer margin, contract slowly, 2ndday- 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-2ndwk 1-2cm-6wk
Ovaries & fallopian tubes congested for few days - large C.L. in one ovary Uterus morphology:- 1. LSCS-fresh healing incision 2. -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: 1. FHS 2. Fetal parts 3. Fetal movements 4. X ray - 2-3wk 5. 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: 1. Female >35 2. H/O 2 spont abortion 3. H/O exposure to teratogenic agent 4. 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.
