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In minority (unrotated and malrotated): Provided the fetal and maternal conditions permit, one should take a watchful expectancy for the anterior rotation of the occiput and descent of the head. Hb level at or below 9 g/dl requires detailed investigations and appropriate treatment. To maintain hemodynamic stability, pulmonary artery catheter and a peripheral artery catheter are used. There is complete extension of the head so that the occiput is in contact with the back. The wall becomes gradually thin due to: (i) Relaxation of the muscle fibers to allow elongation, (ii) the muscle fibers are drawn up by the muscle fibers of the upper uterine segment by contraction and retraction during labor (see p. Nuclei in the anterior part A number of nuclei can be distinguished, but we shall refer to them collectively as the anterior nucleus. The lower segment elongates and becomes progressively thinner to accommodate the fetus driven from the upper segment. But the handles should be kept well forward to avoid grasping of the neck by the tips of the blade. It is comparatively lighter and slightly shorter than its Western counterpart but is quite suited for the comparatively small pelvis and small baby of Indian women. During delivery of the chest, intrathoracic pressure increases up to 200 cm of H2O due to vaginal squeeze. Thorough inspection of the gut and omentum for evidence of any injury is mandatory. The fissures subdivide the surface of the cerebellum into narrow leaf like bands or folia. All women with a positive pregnancy test should therefore be considered to have an ectopic pregnancy until proved otherwise. Rigid plastic cup (Kiwi Omnicup) is safe, effective and is useful for rotational delivery. Breastfeeding is allowed provided the mother avoids any contact between her lesions, her hands and the baby. False labor pain is: (i) Dull in nature, (ii) confined to lower abdomen and groin, (iii) not associated with hardening of the uterus, (iv) they have no other features of true labor pain as discussed above and (v) usually relieved by enema or sedative. Polar body biopsy: It is done by removing the first or second polar body in the preconceptional phase. Surgery should be considered in cases of unresponsive failure with pregnancy beyond 12 weeks. Uterine incision - Delivery (U-D) interval is more predictive of neonatal status (Apgar score). It is further estimated that for one maternal death at least 16 more suffer from severe morbidities. Ultrasonography of the fetal thyroid gland is done when the mother is taking antithyroid drugs. Not uncommonly, an atypical form of anemia may be met with and in such cases, the opinion of a hematologist should be sought for. On occasion, blood loss is so rapid and brisk that death may occur within a few minutes. In the irreversible (late) phase, the clinical features are the same as the final pathology is multiple organ failure. The perineum receives both motor and sensory innervation from sacral roots 2, 3 and 4 through the pudendal nerve. Thus the prevention of eclampsia rests on early detection and effective institutional treatment with judicious termination of pregnancy during preeclampsia. Group B: Cervix is tubular and closed-Prior slow dilatation of the cervix is done by introducing laminaria tent followed by suction and evacuation. The patients, however, have got persistent unilateral uneasiness in about one-third of cases before the acute symptoms appear.

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When a serious incident has occurred, all staff concerned should prepare contemporaneous statements of their involvement whilst the incident is still fresh in their mind. Hospital or home treatment: Ideally, all patients of preeclampsia are to be admitted in the hospital for effective supervision and treatment. The fetus is too small before 16th week and too large to displace after 28th week. Maternal prognosis is not unfavorable in diagnosed cases but in undiagnosed cases and cases left uncared for, obstructed labor with its consequences may occur (see p. These interfere with the function of a number of enzyme systems and increase capillary permeability. Prostaglandins: Prostaglandins are the important factors, which initiate and maintain labor. Therapeutic Heart disease or severe hypertensive disorders-because of its vasoconstrictive e ect, it may cause transient hypertension or cardiac failure especially when given intravenously. Termination of the expectant treatment:The expectant treatment is carried up to 37 weeks of pregnancy. Monosomy X (45, X) is the single most common chromosomal abnormality in miscarriages (20%). Diversity As we discussed earlier in this chapter, an individual is capable of making a tremendous number of structurally distinct antibodies, perhaps on the order of millions, each with a distinct specificity. The requirement for additional stimuli triggered by innate immune reactions to microbes (signal 2) ensures that adaptive immune responses are induced when there is a dangerous infection and not when lymphocytes recognize harmless antigens, including self antigens. It is the result of the fat necrosis due to pressure, and takes many weeks to disappear. An antibody molecule has a symmetric core structure composed of two identical light chains and two identical heavy chains. History of prophylactic administration of anti-D immunoglobulin following abortion or delivery should be enquired (see also key points p. The operation may be conducted under intravenous diazepam sedation, local paracervical block or under general anesthesia. The resultant dehydration leads to excessive thirst (polydipsia) and to dryness of skin. If the patient is allergic to penicillin, oral azithromycin 2 gm as a single dose is given. Legislative and Policy Actions Girl children and adolescents should have good nutrition, education and economic opportunities. Management: (1) the patient is put to bed rest with the foot end raised above the heart level. In the spinal cord there is an intermingling of grey and white matter on the lateral side of the neck of the dorsal grey column. Till then the fetus is entirely dependent upon the maternal supply of T4 through the placenta, for all neurologic development. If the husband is a carrier, there is 25% chance that the infant will be homozygous sickle cell disease and 50%-sickle cell trait. Sometimes, the external os fails to dilate so that the entire mass is accommodated in the dilated cervical canal and is called cervical miscarriage. Ideal contraceptive methods should be highly (100%) effective, acceptive, safe, reversible, cheap, having non-contraceptive benefits, simple to use and requiring minimal motivation, maintenance and supervision. The main functions attributed to the hypothalamus are as follows: Regulation of Eating and Drinking Behaviour the hypothalamus is responsible for feelings of hunger and of satiety, and this determines whether the animal will accept or refuse food. In other words, motor control of speech is confined to one hemisphere: that which controls the dominant upper limb. Observation for about two hours after delivery to make sure that the uterus is hard and well contracted before sending her to ward. Congenital tuberculosis is diagnosed by-(1) lesion noted in the first week of life (2) Infection of the maternal genital tract or placenta (3) Cavitating hepatic granuloma diagnosed by percutaneous liver biopsy at birth (4) No evidence of postnatal transmission.

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Draw a line running forwards from the lower border of the tragus to a point midway between the ala of the nose and the upper lip. The recognition of antigens by antibodies involves noncovalent, reversible binding. Degree of dilatation required: (i) Incomplete abortion-sufficient to introduce the index finger (usually 16/19). Urge urinary incontinence the involuntary leakage of urine accompanied by, or immediately preceded by, a strong desire to pass urine (void). The red marrow that is found in these bones consists of a spongelike reticular framework located between long bony trabeculae. In oblique occipitoanterior position, there is no movement of the shoulders from the oblique diameter as the neck sustains a torsion of only one-eighth of a circle. Glycosuria on one occasion before 20th week and on two or more occasions, thereafter, is an indication for glucose tolerance test. The fetal biophysical activities that appear first are the last to disappear with fetal hypoxia. Objective is to ensure that a woman enters pregnancy with an optimal state of health which would be safe both for herself and the fetus. Faster in action Short lived onset of action duration clinical uses To stop hemorrhage following delivery, abortion or expulsion of H mole Prophylactic use in late second or in third stage to hasten separation of placenta and to minimize blood loss Nausea and vomiting Rise in blood pressure, stroke Rarely gangrene of the toe In the induction of labor To augment uterine contraction during labor To stop postpartum or postabortal hemorrhage along with ergometrine or in isolation Uterine hyperstimulation, Antidiuretic e ect, uterine rupture Anginal pain or rarely hypotension hazards contraindication See above See p. Unlike in heavy chain isotypes, there are no known differences in function between -containing antibodies and -containing antibodies. The baby is either stillborn or macerated and even if born alive, dies soon after. Fibres connecting identical areas of the two halves of the brain are called commissural fibres. Complications of phototherapy are: Watery diarrhea, skin rashes, dehydration, bronze baby syndrome (dark brown discoloration of the skin), low calcium levels and retinal damage. Overflow incontinence following retention of urine should first be excluded before proceeding to differentiate between the other two. Less responsive in elderly primigravidae or cases with prolonged retention of dead fetus. Similarly, the disposition of the small parts, whether placed to one side or placed anteriorly occupying both the sides, is to be noted. Fertilizable life span of oocyte ranges from 12 to 24 hours whereas that of sperm is 48 to 72 hours. In every case of premature termination before 34 weeks, it is desirable to confirm the fetal lung maturation by measuring the L: S ratio in the amniotic fluid. Sexual health necessitates the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. Incomplete forward rotation: In this condition, the occiput rotates through 1/8th of a circle anteriorly and the sagittal suture comes to lie in the bispinous diameter. As it produces tetanic uterine contractions, the preparation should only be used either in the late second stage of labor (after the delivery of the anterior shoulder) or following delivery of the baby. Amniotic fluid level of 17-hydroxy-progesterone is raised in congenital adrenal hyperplasia. Compression gradually it is moved to the great saphenous vein, ultrasonography was positive the popliteal vein and to its branches with the deep veins of the calf. Examples of sensory ganglia are the dorsal nerve root ganglia of spinal nerves, and the trigeminal ganglion. Some of them wind round the anterior and lateral aspect of the medulla as anterior external arcuate fibres to reach the inferior cerebellar peduncle of the opposite side. Fetus and the neonate may be affected due to transplacental carriage of IgG antibodies. The fornix is a prominent bundle of fibres seen on the medial aspect of the cerebral hemisphere. Methotrexate and misoprostol regimen is less expensive but takes longer time than mifepristone and misoprostol.

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Then the patient looks toxic; blood pressure is raised and abdomen becomes distended. During pregnancy: Classical cesarean or hysterotomy scar is likely to give way during later months of pregnancy. Rarely, the baby may be born which is growth retarded with multisystem abnormalities. Enzymatic cascades result in tremendous amplification of the amount of proteolytic products that are generated at each step. The second imaginary line is a backward continuation of the posterior ramus of the lateral sulcus (excluding the posterior upturned part) to meet the first line. The reason that only antibodies with bound antigens Structure-Function Relationships in Antibody Molecules 115 activate effector mechanisms is that two or more adjacent antibody Fc portions are needed to bind to and trigger various effector systems, such as complement proteins and Fc receptors of phagocytes (see Chapter 13). Abnormal cytology detected on routine screening procedure during antenatal checkup is placed under the following evaluation protocol. History: To note: (1) appearance of any new symptom (headache, dysuria), (2) date of quickening. The clinical features of the revealed and mixed variety are given in tabulated form (Table 19. The patient is placed in lithotomy position and the internal examination is done taking all aseptic precautions. Before 8 weeks: the ovum, surrounded by the villi with the decidual coverings, is expelled out intact. It has high tolerance and less rejection rate as it is done before the onset of fetal immune maturity (first trimester). Through control of the adenohypophysis the hypothalamus indirectly influences the thyroid gland, the adrenal cortex, and the gonads. The peritoneum thereafter, is firmly attached to the anterior and posterior walls of the uterus and upper one-third of the posterior vaginal wall where from where it is reflected over the rectum. The almost nonexistent neck with absence of the cranium makes it easy to feel the facial structure even with semiextended head, (b) Congenital goiter-prevalent in endemic areas, (c) Dolichocephalic head with long 450 Textbook of Obstetrics anteroposterior diameter, (d) Congenital bronchocele. Atypical preeclampsia is defined as the development of preeclampsia (even eclampsia) without fulfilling the standard definition or criteria (hypertension or proteinuria). Angiotensinase activity is depressed, following proteinuria with elimination of 2 globulin (see scheme for pathophysiology). The spinal nucleus of the trigeminal nerve is related superficially to the spinal tract of the nerve. Methods-The methods used depend on the size and vigor of the infant and his ability to suck and swallow. The average blood loss following vaginal delivery, cesarean delivery and cesarean hysterectomy is 500 mL, 1000 mL and 1500 mL respectively. There are methods for collection (manual expression or electric pumps), and milk preservation. The activated B cells differentiate into plasma cells that secrete antibodies of the same specificity as the antigen receptor. If the spontaneous expulsion fails or is not practicable, because of delivery under anesthesia, any one of the following methods can be used to expedite expulsion. Primary dysfunctional labor is defined when the cervix dilates less than 1 cm/hr following a normal latent phase of labor. Fundal attachment of the placenta (75%), short cord and placenta accreta weakness of uterine wall at the placental site are often associated. The wound is to be cleaned with sitz bath several times a day and is dressed with an antiseptic ointment or powder. From here draw a horizontal line that runs forwards to end just behind the neck of the mandible. Itsfibresareinsertedonthe front of the muscular process of the arytenoid cartilage. Internal examination both before and after amniotomy should be carried out with cord accident in mind.

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A blood loss of more than average should be immediately replaced by blood transfusion, already kept at hand. Although serous cystadenoma is common even during pregnancy the incidence of germ cell tumor (dermoid) is increased two fold during pregnancy compared to the non-pregnant state. The placenta is gradually separated with a sideways slicing movement of the fingers, until whole of the placenta is separated. Such breathlessness is considered physiological where oxygen saturation is more than 95%. Baby sucks the areola (lactiferous sinuses) and the nipple holding between the tongue and the palate. Faulty absorption mechanism: Because of high prevalence of intestinal infestation, there is intestinal hurry which reduces the iron absorption. Preliminaries: In an equipped labor ward, prolonged labor is unlikely to occur in modern obstetric practice. It appears dark in unstained sections as neurons within it contain pigment (neuromelanin). Antibiotics: Endotoxic shock is most commonly due to Gram-negative organisms, so proper antibiotics should be administered in adequate doses. A leash of vessels connecting the main to the small lobe traverse through the membranes. Femur length is measured when the beam from the transducer is perpendicular to the shaft. While piercing the deep perineal pouch it is surrounded by sphincter urethrae membranaceae which acts as an external sphincter. Cases with induced or augmented labor by oxytocin, the infusion should be continued for at least one hour after the delivery. The pill should be started from the day 1 of a cycle and continued as "3 weeks on and 1 week off" regime. Important causes of maternal death: Whereas in the organized sector (developed countries)- hypertensive disorders, hemorrhage and pulmonary embolism are the main causes, in the developing countries-hemorrhage, sepsis and preeclampsia-eclampsia and unsafe abortion are the main causes. For example, if the skin of the sole of a sleeping person is scratched, the leg is reflexlydrawnup. Other services: these include: (i) Sex education and marriage guidance; (ii) Research and evaluation of the program, research about normal reproduction, investigation and treatment of infertility and recurrent abortion. The head has to rotate through 3/8th of a circle to bring the occiput behind the symphysis pubis. Cystic ovarian tumor: the diagnostic points are: (1) the swelling is slow growing, usually takes months to grow (2) Amenorrhea is usually absent (3) It feels cystic or tense cystic (4) Absence of Braxton-Hicks contraction (5) Absence of positive signs of pregnancy (6) Ultrasonography shows absence of fetus. During the first 24 hours, the level remains constant; thereafter, there is 170 Textbook of Obstetrics a steady decrease in height by 1. Precocious puberty leads to early accelerated linear growth with premature epiphyseal closure resulting in restricted final height. Maternal: the injuries are uncommon but may be due to inclusion of the soft tissues such as the cervix or vaginal wall inside the cup. It also helps to record urinary output, (v) A chart is maintained by recording pulse, respiration, temperature, lochial discharge, and fluid intake and output. It usually occurs in clonic stage Chapter 18 Hypertensive Disorders in Pregnancy 275 effectively. The cup is placed against the fetal head nearer the occiput (flexion point) with the "knob" of the cup pointing towards the occiput. The elongation is partly due to the contractions of the circular muscle fibers of the uterus to keep the fetal axis straight. Lymphocytes respond by proliferating and by differentiating into effector cells, whose function is to eliminate the antigen, and into memory cells, which show enhanced responses on subsequent encounters with the antigen. Distensibility of the veins and stagnation of blood in the venous system explain the development of edema, varicose veins, piles and deep vein thrombosis. Avoidance of trauma-specially forceful external cephalic version under anesthesia.

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Risks may outweigh the bene ts depending on individual drug Lethargy, hypotonia, poor feeding Generally no adverse e ects Tooth staining, delayed bone growth drugs contraindicated during Breastfeeding (aaP 2001) Cytotoxic drugs (cyclosporine, doxorubicin, cyclophosphamide): might cause immune suppression. The grey matter of the thalamus is subdivided into three main parts by a Y-shaped sheet of white matter which is called the internal medullary lamina (52. However, twin peak sign is neither present entirely over the placenta nor it is a consistent feature. The bilaminar germ disc is connected with the trophoblast by mesenchymal condensation, called connecting stalk or body stalk which later on forms the umbilical cord. However, the blood pressure tends to rise in the last trimester which may or may not reach its previous level, (2) In 50%, the blood pressure tends to rise progressively as pregnancy advances, (3) In about 20%, it is superimposed by preeclampsia evidenced by rise of blood pressure to the extent of 30 mm Hg systolic and 15 mm Hg diastolic associated with edema and/or proteinuria, (4) Rarely, malignant hypertension supervenes, (5) In 30%, there is permanent deterioration of the hypertension following delivery. In primigravidae, effacement precedes dilatation of the cervix, whereas in multiparae, both occur simultaneously. The basic organization of the antibody molecule deduced from the rabbit IgG proteolysis experiments is common to all Ig molecules of all classes and all species, and the terms Fab, F(ab)2, and Fc are widely used to describe these different portions of human and mouse antibodies. The increased association of sepsis in unsafe induced abortion is due to the fact that: (1) proper antiseptic and asepsis are not taken, (2) incomplete evacuation and (3) inadvertent injury to the genital organs and adjacent structures, particularly the bowels. Patients with severe preeclampsia of <34 weeks should be delivered if criteria mentioned in table p. Unfortunately, he died of an infection on his right hand that he contracted during an operation. Umbilical cord should be clamped immediately to prevent neonatal hypovolemia and anemia. The body of the nucleus lies in the floor of the central part of the ventricle; and the tail in the roof of the inferior horn. T lymphocytes recognize and respond to cell-associated antigens and not to soluble, cell-free antigens. The hoarseness is temporary in case of injury to the external laryngeal nerve (as the function of the paralysed cricothyroid is gradually taken up by the muscle of the normal side). Management: If the outlet is contracted and/or the baby is big, cesarean section even at this stage, is the method of choice. The mechanisms by which different B cell populations migrate to different tissues are similar to the mechanisms we described for tissue-specific migration of effector T cells and depend on expression of distinct combinations of adhesion molecules and chemokine receptors on each B cell subset. Following the birth of the head, usual procedures are to be taken as in normal delivery. Mac-1 also functions as a complement receptor, binding particles opsonized with a product of complement activation called the inactivated C3b (iC3b) fragment (discussed in Chapters 4 and 13), and thereby enhances phagocytosis of microbes. There is not necessarily a right answer as to when investigations and treatment should start. Laterally-The double fold of peritoneum of the broad ligament are attached between which the uterine artery ascends up. In severe and neglected cases, the fetal prognosis is adversely affected by prematurity with its hazards. Presentation and investigation Symptoms are primarily those of itch, but include pain and ulceration; over 20% may be asymptomatic. The distinguishing features are-(1) the mouth and the malar eminences are not in a line; but in breech, the anus and the ischial tuberosities are in one line, (2) sucking effect of mouth, (3) hard alveolar margins and (4) absence of meconium staining on the examination fingers. Inspection: By separating the labia-using the left two fingers (thumb and index), the character of the vaginal discharge, if any, is noted. The mature lymphocytes that emerge from the bone marrow or thymus are called naive lymphocytes. It is the ideal method of application as it has got a negligible compression effect on the cranium. Once the head negotiates the brim, there is no difficulty in the cavity and outlet and normal mechanism follows. It may arise from the blood platelets as in Shwartzman reaction or from release of trophoblastic fragments into the uterine circulation. Use of analgesic drugs is to be limited as the babies are small and rapid delivery may occur. A shearing force is instituted between the placenta and the placental site which brings about its ultimate separation.


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Defibrination is likely to be more following retention of dead fetus due to Rh-incompatibility. These are related to: (a) Presence of social evils-illiteracy, early pregnancy, ignorance or prejudice, (b) Unregulated fertility and unsafe abortion, (c) Poor socioeconomic condition, (d) Inadequate maternity services, (e) Underutilization of the existing services, (f) Lack of communication and referral facilities. The pyramids, the medial lemniscus, the spinal nucleus and tract of the trigeminal nerve, and the reticular formation are present in the same relative position as at lower levels. Rarely, spontaneous rupture may not take place at all, allowing the baby to be "born in a caul". Some of them are as follows: Somatomotor control Through its direct connections with the spinal cord; and indirectly through the corpus striatum, the cerebral cortex and the cerebellum, the reticular formation has an influence on fine control of movements including those involved in postural adjustments, locomotion, skilled use of the hands, speech etc. The dose (amount) and duration of teratogen exposure may cause variable response from no effect level to lethal level. Antishock treatment: Antishock measures are to be taken energetically with simultaneous preparation for urgent laparotomy. Compare the color of the test end with the supplied color chart as per instruction of manufacturer. Alternatively, the placenta may have to be cut promptly to enter into the amniotic sac to deliver the baby. Persistent hypotension leads to acute tubular necrosis and ultimately renal failure. Organ changes depend on the degree of hypoperfusion and extent of the underlying pathology: (a) Kidney-Patchy and massive cortical necrosis leading to oliguria, anuria and azotemia. Pseudocyesis (Syn: Phantom, spurious, false pregnancy): It is a psychological disorder where the woman has the false but firm belief that she is pregnant although no pregnancy exists. Finally, tubal rupture occurs when the muscles and the serosa are maximally stretched and undergo necrosis. Perineal and vulval infiltration with 1% lignocaine is enough for local anesthesia. The features of retroplacental hematoma are: (a) Depression found on the maternal surface of the placenta with a clot which may be found firmly attached to the area (b) Areas of infarction with varying degree of organization. In such cases, the ear is to be located and unfolded pinna points toward the occiput. It is bounded in front by the lower border of the symphysis pubis; laterally by the ischiopubic rami, ischial tuberosity and sacrotuberous ligament and posteriorly by the tip of coccyx. It usually appears soon following the missed period and rarely lasts beyond 16 weeks. It is best regarded as a benign neoplasia of the chorion with malignant potential. Addition of fentanyl (to enhance the onset of block) or morphine (to improve pain control) may be done. Cross match blood when above average blood loss (placenta previa, prior multiple cesarean delivery) is anticipated. Chapter 1 Anatomy of Female Reproductive Organs the reproductive organs in female are those which are concerned with copulation, fertilization, growth and development of the fetus and its subsequent exit to the outer world. Abdominovaginal method (Muller-Munro Kerr): this bimanual method is superior to the abdominal method as the pelvic assessment can be done simultaneously. Recurrent marginal hemorrhage as diagnosed on serial ultrasound is thought to be the cause. It is probably due to-(a) separation of slough exposing a bleeding vessel or (b) from granulation tissue, (5) Withdrawal bleeding following estrogen therapy for suppression of lactation, (6) Other rare causes are: chorionepithelioma-occurs usually beyond 4 weeks of delivery; carcinoma cervix; placental polyp; infected fibroid or fibroid polyp and puerperal inversion of uterus. Colloids: Polygelatin solutions (Hemaccel, Gelofusion) are iso-osmotic with plasma. The same process is responsible for causing tissue damage and underlies many important diseases.

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Superior to the hypophysis, the dura mater is folded on itself to form the diaphragma sellae. Intrapartum therapy with ampicillin 2 gm initially, then 1 gm 6 hourly is effective. There may be bleeding from the suture sites (episiotomy wound) or hematoma formation in the abdominal wound following cesarean section or formation of a vulval hematoma following vaginal delivery. In contrast, repeated exposure to a microbe enhances the rapidity, magnitude, and effectiveness of adaptive immune responses. This is the salpingopharyngeal fold and is produced by a muscle called the salpingopharyngeus. These finger like buds are called primary stem villi - surrounded by lacunar spaces which will later form into intervillous spaces. By drawing the head in upward direction, the posterior shoulder is delivered out of the perineum. Antacids, oxalates and phosphates will reduce absorption while ascorbic acid, lactate and various amino acids increase its absorption. If the baby fails to attain the weight gain evidenced by weekly weighing or appears unsatisfied, the feeding is to be increased until the baby gains weight. Obvious causes for the placental separation such as trauma or hypertension are usually absent. The demonstration of secretion from the breast of a woman who has never lactated is an important sign of pregnancy. Secondary broad ligament pregnancy: Rarely pregnancy may continue in the same process as in abdominal pregnancy between the two layers of the peritoneum. This fascia is so called because it is thickest in its upper part where it bridges across a gap between the muscle layer of the pharynx and the base of the skull (45. With the onset of labor, the membranes attached to the lower uterine segment are detached and with the rise of intrauterine pressure during contractions there is herniation of the membranes through the cervical canal. Chance of scalp avulsion or subaponeurotic hemorrhage (iii) suspected fetal coagulation disorder and (iv) suspected fetal macrosomia (4 kg). Half-Life of Antibodies the half-life of circulating antibodies is a measure of how long those antibodies remain in blood after secretion from B cells (or after injection in the case of an administered antibody). Cardiac disease, venous thrombosis, antiphospholipid syndrome are some of the indications. Oxygen carrying capacity is reduced when hemoglobin level is < 8 g/dL even in a euvolemic patient. Chapter 37 Operative Obstetrics 653 A screw is attached usually at the end (or at the base) of one blade (commonly left). Management, if version fails or is contraindicated: the pregnancy is to be continued with usual checkup and unexpectedly, one may find that spontaneous version has occurred. Oxytocin receptors present in the myometrium are more in the fundus than in the cervix. Base deficit mEq/L) 1 3 Level 3: Other intensive care units: For patients requiring long-term ventilator support. Thus, the device is not pushed out of the tube but held in place by the plunger while the inserter is withdrawn (withdrawal technique in. This results in the downgrowth of the columnar epithelium to a variable extent beyond the external os replacing the squamous epithelium producing "pregnancy ectopy" It appears for. Hazards: (1) Cord prolapse; (2) Uncontrolled escape of amniotic fluid and placental abruption; (3) Injury to the cervix or the presenting part; (4) Rupture of vasa previa leading to fetal blood loss; (5) Amnionitis. Immune complexes may be dissociated into smaller aggregates either by increasing the concentration of antigen so that free antigen molecules will displace antigen bound to the antibody (zone of antigen excess) or by increasing antibody so that free antibody molecules will displace bound antibody from antigen determinants (zone of antibody excess).


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The fibres of the alveus pass medially and collect to form a bundle of fibres, the fimbria, which projects above the medial part of the hippocampus (52. It mainly affects the erythroid precursor cells resulting in anemia, thrombocytopenia, aplastic crises, congenital heart failure and hydrops. The pelvis is anatomically divided into a false pelvis and a true pelvis, the boundary line being the brim of the pelvis. Placenta accreta may be diagnosed with loss of retroplacental sonolucent zone beneath the previous cesarean section scar. There is unfolding of the isthmus; beginning 12 weeks onwards and takes part in the formation of the lower uterine segment. Continued study of perinatal mortality problems by demographic studies, regular clinically allied interdepartmental meetings and pathological research. The part of the medial surface behind the paracentral lobule and the gyrus cinguli shows two major sulci that cut off a triangular area called the cuneus. Considering the magnitude of the problem, many developing countries, India in particular, have taken this as a national program of vital importance. The most medial fibres (from the legs) come to lie most anteriorly in the medial lemniscus. Articulated forceps are held in front of the perineum in a position that they are expected to assume after application. Treatment is usually resection during hysteroscopy and the polyp should be sent for histological assessment. In the female, these are identified in menstrual fluid, endometrium, decidua and amniotic membrane. The ligands on leukocytes that bind to E-selectin and P-selectin on endothelial cells are complex sialylated carbohydrates related to the Lewis X or Lewis A family of blood group molecules. Movement of restitution occurs rotating the head through one-eighth of a circle in the direction opposite to that of internal rotation. The classical features of bleeding in placenta previa are sudden onset, painless, apparently causeless and recurrent. Lie transverse: If the lie is transverse, it should be corrected by external version into a longitudinal lie preferably cephalic, if fails, podalic. Feeling of hard skull bones either through the cervix or through the fornix usually suggests maturity. Reconstruction of a 3D image from a subvolume of images can be made using computer software. In gynaecological cancers this is the pelvis, and therefore tissues in this area are prone to damage. Functions of Macrophages Tissue macrophages perform several important functions in innate and adaptive immunity. Confirmation of diagnosis: (1) Speculum examination is done taking aseptic precautions to inspect the liquor escaping out through the cervix; (2) To examine the collected fluid from the posterior fornix (vaginal pool) for: (a) Detection of pH by litmus or Nitrazine paper. The pathways involved are both ascending and descending; crossed and uncrossed, somatic and visceral. Neonates are protected from infections by IgG antibodies they acquire from their mothers through the placenta during gestation. The patient needs more frequent antenatal supervision with periodic checkup of fasting plasma glucose level which should be less than 90 mg%. The mechanism of the placental separation in preeclampsia is: Spasm of the vessels in the utero-placental bed (decidual spiral artery) anoxic endothelial damage rupture of vessels or extravasation of blood in the decidua basalis (retroplacental hematoma).

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A region of specialized cells surrounding the marginal sinus, called the marginal zone, forms the boundary between the red pulp and white pulp. Methods employed in each visit: (1) Enquire about relevant symptoms like irregular vaginal bleeding, persistent cough, breathlessness or hemoptysis. Detailed descriptions of the various mediators and pathologic manifestations of acute and chronic inflammation can be found in pathology textbooks. In addition, heavy chains exist in two forms that differ at their carboxy-terminal ends: one form of the heavy chain anchors membrane-bound antibodies in the plasma membranes of B lymphocytes, and the other form is found only in secreted antibodies. The triangular interval between the mammillary bodies and the midbrain is pierced by numerous small blood vessels and is called the posterior perforated substance. Asynclitism Marked In primigravidae, engagement occurs in a significant number of cases before the onset of labor while in multiparae, the same may occur in late first stage with rupture of the membranes. Alternatively, the uterine incision may be vertical in the middle of the body of the uterus as low down as possible. Moreover, convulsions may occur even with moderate rise of blood pressure; conversely, even with alarming high rise of pressure, the pregnancy may have an uneventful outcome. The caudate nucleus, the lentiform nucleus, the claustrum and some other masses of grey matter (all of telencephalic origin) are referred to as basal ganglia. Each antibody molecule has either two identical light chains or two identical light chains. Acrosome sperm penetrate the zona pellucida reaches the perivitelline space fuses with the oocyte plasma membrane. Some centres in the cerebrum and cerebellum are regarded, by some authorities, to be closely related, functionally, to this region. Transplacental fetal infections occur with most microorganisms and fetal losses could be caused by any. If the patient is lactating, high calories, adequate protein, fat, plenty of fluids, minerals and vitamins are to be given (see p. In that case rupture of the membranes may be done to induce labor depending upon the type (see below). The medial and lateral striae form the anteromedial and anterolateral boundaries of this substance. Transverse lie-internal version followed by breech extraction under general anesthesia. Y Humoral immunity is mediated by antibodies secreted by B lymphocytes and is the mechanism of defense against extracellular microbes. Supportive therapy is directed to treat generalized peritonitis by gastric suction and intravenous crystalloids infusion. These are attached to the cervix and suspend the uterus from the pelvic sidewall and sacrum respectively. In Chapter 3, we describe the traffic patterns of lymphocytes throughout the body and the mechanisms of migration of lymphocytes and other leukocytes. The gauze is placed high up and packed into the fundal area first while the uterus is steadied by the external hand. High level of serum human chorionic gonadotropin, estrogen and altered immunological states are considered responsible for initiation of the manifestation, which is probably aggravated by the neurogenic factor. Innate lymphoid cells are cells with lymphocyte morphology and functions similar to T lymphocytes, but do not express clonally distributed T cell antigen receptors. These differences correlate with the organization of the subfamilies into separate gene clusters. A dose of 500 mg every 6 hours orally is started till the sensitivity report available.

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