Ultrasonography in .NET Painting PDF 417 in .NET Ultrasonography

Ultrasonography Using Barcode maker for .NET Control to generate, create PDF-417 2d barcode image in .NET framework applications. upc The role of ultra PDF417 for Visual Studio .NET sound in the diagnosis of placental abruption is controversial. In cases of acute revealed abruption there may be no specific ultrasound findings.

It has a role in identifying coincident placenta praevia and can be used for monitoring cases expectantly, and help with the timing of delivery. The parameters that can be assessed are location of haematoma, variation in size and fetal growth. Nyberg et al.

[43] have described ultrasound appearances of acute abruption. 13: Antepartum haemorrhage In cases of prema PDF-417 2d barcode for .NET turity, mild abruption and uterine contractions, the use of tocolytics is controversial. Their use has traditionally been contraindicated, for they can worsen the process of abruption.

b-Sympathomimetics such as terbutaline can cause tachycardia and therefore mask the clinical signs of further blood loss. Some studies have used tocolytics with abruption, achieving a mean latency period to delivery of 12.4 and 18.

9 days, respectively [45,46]. In mild and stable cases of placental abruption, which are remote from term, it seems reasonable to use tocolytics with caution. Tocolytics may allow time for steroid administration to promote fetal lung maturity and newer tocolytics with milder side effect profiles can be used.

. to avoid tetanic uterine contractions. Where possible, amniotomy is performed to hasten delivery, with syntocinon augmentation if needed. Continuous electronic fetal monitoring should be performed to identify early abnormal fetal heart rate patterns, as the perinatal mortality is likely to be higher with vaginal delivery in the absence of continuous fetal monitoring.

. Management of complications Major complicatio ns include haemorrhagic shock, DIC, renal tubular or cortical damage, and postpartum haemorrhage.. Haemorrhagic shock This usually occu rs when the blood loss is in excess of 1000 1500 ml. Blood loss is often underestimated as a result of concealed haemorrhage and variation in clinical judgement. For guidance, trebling the volume of visible blood clot provides a rough estimate of the blood loss.

Resuscitation is aimed at restoring the circulating blood volume for adequate tissue perfusion. Four to six units of blood should be crossmatched and urgent blood sent for full blood count, coagulation profile, renal and liver function tests. The initial haemoglobin and haematocrit can be deceptively high because of haemoconcentration.

While waiting for cross-matched blood, colloids can be used as plasma expanders; dextrose is avoided as it interferes with clotting and blood cross-matching. In emergent situations, uncrossed Rhesus O negative blood can be transfused. Fluid replacement should be monitored closely to avoid overloading.

This can be done by monitoring maternal pulse, blood pressure, jugular venous pulse and hourly urine output. An indwelling urethral catheter should be passed and urinary output should be at least 30 ml/h. With severe haemodynamic compromise, especially in the presence of pre-eclampsia, the central venous pressure (CVP) line should be used.

Measurement of the pulmonary capillary wedge pressure via a Swan Ganz catheter reflects circulatory adequacy better than CVP, but its use depends upon the expertise and facilities. Complications from massive blood transfusion (transfusion in excess of one and a half times the patient s blood volume, or 10 or more units) should be looked out for. These can be hyperkalaemia, hypocalcaemia, thrombocytopaenia and other clotting disorders.

Hyperkalaemia presents clinically. Immediate delivery This depends upon the severity of the placental abruption and fetal survival. In cases of fetal death, regardless of the gestation, and in the absence of other contra-indications, e.g.

haemodynamic instability, it is prudent to aim for a vaginal delivery. Once the initial resuscitation has been initiated, amniotomy is frequently sufficient to induce labour and delivery is achieved fairly rapidly. In some cases syntocinon augmentation may be needed, which must be administered cautiously because of the risk of hyperstimulation and consequent uterine rupture.

When the fetus is alive, at or near-term, prompt delivery is indicated. The decision regarding the mode of delivery is guided by the fetal and maternal wellbeing. In addition, in severe cases the fetal outlook is poor not only for the immediate survival, but about 15% of liveborn infants do not survive [47].

Where there is evidence of fetal compromise and delivery is not imminent, caesarean section should be performed immediately once maternal resuscitation has been commenced. Longer decision-delivery intervals are associated with poor perinatal outcomes [48]. Studies have suggested better perinatal outcomes with caesarean section rather than vaginal delivery [48,49].

However, emphasis must be placed on stabilizing the maternal condition as the presence of coagulopathy contributes to considerable maternal morbidity and mortality, especially with surgery. In mild to moderate cases of placental abruption at term, with no fetal compromise, vaginal delivery is a reasonable option. Prostaglandins can be used for cervical ripening with extreme caution in order.

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