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MEDICAL INDICATIONS OF SECTIO CAESAREA IN GENERAL DISTRICT HOSPITAL OF PARE KEDIRI YEAR – Download Download PDF. An amniotic fluid embolism (AFE) is a rare childbirth (obstetric) emergency in which amniotic Williams manual of pregnancy complications. New York: McGraw-Hill Medical. pp. – ISBN ^ Vinay Kumar; Abul K. Abbas; Nelson. emboli air ketubanamniotic fluid embolism. Upload; Login / Register. Home · Topics · Documents · emboli air ketuban ppt. Download emboli air ketuban ppt.

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Download Askep Emboli Cairan Ketuban download document. Askep Emboli Cairan Ketuban. Download as PPTX, PDF, TXT or read online from Scribd . Emboli cairan ketuban: – Komplikasi gawat darurat kehamilan dan persalinan – Kondisi paling . Emboli Air Ketuban - Download as Powerpoint Presentation .ppt /.pptx), PDF File .pdf), Text File .txt) or view presentation slides online.

Wherever he got the ideas expressed in the heading, Mr. Now Tell Us Gentle Mary. For anything not permitted by the above licence then you should contact the publisher first to obtain permission. Price is for score only Price is fune score and complete set of zero parts Note: Tweet Share Full score details The great majority of early publications, including the earliest known to us, ascribe the words to German Protestant reformer Martin Luther. We do not use or store email addresses from this form for any other purpose than sending your share email. McFarland no biographical information available about John T.

We also review the clinical relevance of soft markers to aneuploidy risk assessment and evidence-based strategies for the management of affected pregnancies with each of these markers in light of current literature. Some of the sonographic markers of aneuploidy are described in the Table. Nuchal Fold Thickening Nuchal edema in the second trimester between 15 and 23 weeks is known as the nuchal fold.

Nuchal thickening was the first of the nonstructural markers identified and remains the single most predictive sonographic marker. The nuchal fold is measured with placement of calipers from the outer edge of occipital bone to the outer edge of the skin. Axial image of the fetal head shows thickening of nuchal fold. Nuchal fold is measured during the second trimester on an axial image slightly off the biparietal diameter plane.

The cerebellum, cisterna magna, and occipital bone should be seen. Soft tissue is measured from the outer echogenic line of occipital bone to the outer echogenic skin line. Sagittal image of fetal abdomen shows echogenic bowel. The image should include fetal bowel, liver and iliac bone for comparison. Bowel is considered echogenic if the echogenicity of the bowel is more or equal to that of adjacent iliac bone. Echogenic bowel in the third trimester is a relativelycommon finding with uncertain clinical significance.

Once an echogenic bowel is suspected, the gain of the ultrasound unit is lowered gradually until only bone or bowel is visible.

Echogenic bowel can be classified as focal, multifocal, or diffuse. A grading system has been proposed by several authors to quantify the degree of echogenicity of fetal bowel to decrease the interobserver variation. Grade 1 echogenic bowel refers to echogenicity of the bowel that is less than that of the iliac crest; grade 2 echogenic bowel is equal to that of the iliac crest; and grade 3 echogenic bowel is more echogenic than the iliac crest.

The association of echogenic bowel with aneuploidy and adverse pregnancy outcome is strongest with moderate to severe echogenicity grades 2 and 3. A detailed ultrasound of the fetus should be performed, and an amniocentesis for karyotype for evidence of cytomegalovirus CMV , toxoplasmosis, and parvovirus infection should be recommended. Fetal biometry has been used as a marker for aneuploidy, and it is recognized that the femur and humerus of fetuses with Down syndrome have a tendency to be slightly shorter compared with normal controls.

Benacerraf and colleagues[39] were among the earliest investigators to describe this difference in a series of patients subjected to amniocentesis. The most common method for determination of a shortened humerus or femur is comparing the actual measurement with the expected measurement, typically on the basis of biparietal diameter or another dating parameter rather than on gestational age.

The femur is considered shortened when the measured-to-expected ratio is 0. Femoral or humeral shortening values can be obtained using regression equations published both by Benacerraf and colleagues[39,42] and by Nyberg and colleagues. This may possibly reflect the relative contribution of 95 23 constitutionally small individuals. Four-chamber view of the heart showing a single echogenic intracardiac focus on left side Winn and colleagues[51] studied the potential misinterpretation of an echogenic focus in the heart, and they found that the rate of true EIF cases was 11 per 5.

The most common locations for identification of spurious EIF were in the moderator band, endocardial cushion, and tricuspid valve annulus.

To avoid erroneous identification andmisinterpretation of EIF, recommended ultrasonographic guidelines for diagnosing a true intracardiac echogenic focus are as follows: EIF should be located within the ventricle where papillary muscles are situated; EIF should seen from more than 1 angle; EIF should be seen independent of the zone of specular reflection Note: Be suspicious if the suspected EIF lies in this zone ; and EIF should not show an entrance-exit reflection.

The data that are available from low-risk populations seem to indicate, however, that an isolated focus is not associated with an increased risk of Down syndrome; or, if it is, that risk is much lower than the procedure-related loss rates associated with invasive testing. They consider an isolated echogenic focus as an incidental finding in a woman younger than 35 years of age, and amniocentesis is not recommended. The resultsof the statistical analysis showed that the risk of aneuploidy is increased in fetuses with an EIF.

The finding of EIF should prompt a detailed structural survey and correlation with a priori risk.

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Amniocentesis need not be offered to patients who are otherwise at low risk and have an isolated EIF. Only 1 of the with an isolated EIF had trisomy 21, a number not nearly sufficient to warrant using an isolated EIF to counsel low-risk women about chromosomal anomalies. The choroid plexus is seen in the axial plane of the head and is located in the lateral ventricle.

A CPC appears as a wellcircumscribed echolucent area within the choroid plexus[14] Figure 4. The choroid plexus is homogeneous, with an echogenicity similar to soft tissue. When other anomalies are present, there is a high risk of chromosomal defects, usually trisomy Axial image of the fetal head shows a choroid plexus cyst. Detection of CPC warrants a detailed evaluation of fetal hands for possible overlapping digits and clenched fist to rule out trisomy There were fetuses with CPCs in a total of , births.

They concluded that the presence of CPCs increases the risk for aneuploidy 1. Bronsteen and colleagues[54] studied 49, fetuses between 16 and 25 menstrual weeks; CPCs were identified in 2. The authors found that no fetus with an isolated CPC had trisomy During the study period, 50 cases of trisomy 18 were identified between 16 and 25 menstrual weeks.

CPCs were detected in half of these fetuses. They concluded that prenatal sonographic identification of CPCs warrants an extended anatomic survey that includes the fetal hands. If the fetal examination is otherwise unremarkable, then the risk for trisomy 18 is low. Gupta and colleagues[60] studied a large unselected population and concluded that the predictive value of CPCs is much lower when no other anomalies are detected.

It is probably advisable to regard CPCs as an indication for detailed ultrasound assessment, rather than invasive testing. Axial images of 2 fetuses at the level of the renal pelvis show mild pyelectasis in the first image and significant pyelectasis on right side. Anterior-posterior diameter of the renal pelvis should be taken on an axial view. Further, 9 of these 12 fetuses had associated sonographic abnormalities, and 1 mother had advanced maternal age.

Only 2 chromosomal abnormalities occurred in the setting of isolated pyelectasis in low-risk women 0. The study investigators estimated the risk of aneuploidy 97 25 in a fetus with isolated mild pyelectasis to be 0.

A recent retrospective study reviewed the ultrasound findings of 25, mainly low-risk, unselected women and found cases of pyelectasis with an incidence of 1. None of the fetuses in this series had aneuploidy. The lack of association as an isolated finding has been confirmed by other studies. However, approximately one third to one quarter of fetuses show progression of their pyelectasis,[64,68] and hence the third-trimester ultrasound is recommended to identify worsening or persistent cases.

The persistent pyelectasis or progression needs some degree of postnatal evaluation or surveillance. It provides a noninvasive means by which to adjust the a priori risk on the basis of a variety of sonographic features.

Although the literature is studded with studies on the soft markers of aneuploidy, most are done on high-risk populations. To extrapolate the findings to low-risk populations is neither scientific nor logical. Prospective studies should be conducted to confirm the value of isolated soft markers in low-risk women. Although the management of each of the soft markers is different, a few generalizations can be made. First, the detection of any abnormal finding on ultrasound should prompt an immediate detailed ultrasound evaluation of the fetus by an experienced sonographer.

If CPC or EIF is detected as an isolated marker on a second-trimester sonogram in a patient otherwise considered at low risk for fetal aneuploidy,amniocentesis is not indicated. In these circumstances, a CPC or an EIF should be considered a normal variant and is not considered clinically significant. Nuchal fold thickening, short humerus, or a major structural anomaly even as an isolated finding confers a high enough risk of aneuploidy in both high- and low-risk populations to recommend an amniocentesis.

Echogenic bowel in isolation or in low-risk women needs a battery of investigations to rule out aneuploidy, CF, and viral infections. References 1. Second trimester ultrasound screening for chromosomal abnormalities.

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Prenat Diagn. Down's syndrome: recent trends in the United States. Thompson and Thompson Genetics in Medicine. Prenatal sonographic findings of Down syndrome: review of 94 cases.

SYMPOSIUM of Anesthesia & Co-Existing Disease

Obstet Gynecol. J Ultrasound Med. Ultrasonographically detectable markers of fetal chromosomal defects.

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Ultrasound Obstet Gynecol. Sensitivity and specificity of screening for Down syndrome with alpha-fetoprotein, hcg, unconjugated estriol, and maternal age. Randomized trial to assess safety and fetal outcome of early and mid-trimester amniocentesis. Randomized controlled trial of genetic amniocentesis in low-risk women.

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N Engl J Med. The genetic sonogram : comparison of the index scoringsystem with the age-adjusted US risk assessment. Isolated sonographic markers for detection of fetal Down syndrome in the second trimester of pregnancy.

Benacerraf BR.


Use of sonographic markers to determine the risk of Down syndrome in secondtrimesterfetuses editorial Radiology. Age-adjusted ultrasound risk assessment for fetal Down's syndrome during the second trimester: description of the method and analysis of cases.

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Evaluation of routine prenatal ultrasound examination in detecting fetal chromosomal abnormalities in a low risk population. Hum Genet. Hill LM. The sonographic detection of trisomies 13, 18, and Clin Obstet Gynecol. Second-trimester ultrasound markers for detection of trisomy which markers are best? Can the presumed risk of autosomal trisomy be decreased in fetuses of older women following a normal sonogram? Prenatal detection of fetal trisomy 18 through abnormal sonographic features.

DeVore GR. Stewart T. Screening for aneuploidy: the genetic sonogram. Obstet Gynecol Clin North Am. The genetic sonogram - a method of risk assessment for Down syndrome in the second trimester.

A sonographic sign for the detection in the second trimester of the fetus with Down's syndrome. Am J Obstet Gynecol. Sonographic diagnosis of Down syndrome in the second trimester. Optimal nuchal skin-fold thresholds based on gestational age for prenatal detection of Down syndrome. Early midtrimester fetal nuchal thickness: effectiveness as a marker for Down syndrome.

Critical appraisal of the use of nuchal fold thickness measurements for the prediction of Down syndrome.

Gestational age standardized nuchal thickness values for estimating mid-trimester Down's syndrome risk. J Matern Fetal Med. Cutoff criteria for second-trimester nuchal skinfold thickness for prenatal detection of Down syndrome in a Thai population.

Int J Gynaecol Obstet. Rochon M, Eddleman K. Controversial ultrasound findings. Echogenic fetal bowel during the second trimester: clinical importance. We do not use or store email addresses from this form for any other purpose than sending your share email. McFarland no biographical information available about John T. After you have purchased this item the Cloud Publishing technology is utilised to provide the printing mechanism for the music. Ancient and Modern Church Hymnary 4th ed.

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