Investigations in .NET framework Printer PDF 417 in .NET framework Investigations

Investigations Using Barcode maker for .NET Control to generate, create PDF417 image in .NET applications. databar The urine shou .NET PDF-417 2d barcode ld be examined for protein, ketones and sugar. Commercial dip stix will also test for leukocytes, nitrites and blood their presence may signify a urinary tract infection.

Oral intake is often restricted in labour to reduce the risk of gastric aspiration and Mendelson s syndrome should general anaesthesia be required. The details of nutrition and hydration in labour is discussed in 7. When rehydration is necessary in labour, it is best to give normal saline or Hartman s solution, to maintain a more physiological fluid and electrolyte balance.

This may also help to avoid water intoxication if intravenous oxytocin is used over a long period in high doses.. 2: First stage of labour ABDOMEN 5 5 5 5 Pelvic brim PELVIC CAVITY PDF-417 2d barcode for .NET COMPLETELY ABOVE SINCIPUT HIGH SINCIPUT SINCIPUT SINCIPUT FELT FELT EASILY FELT OCCIPUT OCCIPUT OCCIPUT JUST FELT NOT FELT FELT NONE OF HEAD PALPABLE. OCCIPUT EASILY FELT Figure 2.3 Clinical estimation of descent of head in fifths palpable above the pelvic brim Mobility and posture in labour It is preferab PDF417 for .NET framework le not to confine the mother to bed in early labour. She may prefer ambulation or sitting in a chair.

The upright posture may increase the pelvic diameters and assist in the descent of the fetal head. Although many women prefer to be ambulatory early in labour, few remain upright for long, and they may wish to sit or adopt a reclining, lateral recumbent position or lie down as labour progresses. The dorsal position may cause aorta caval compression and should be discouraged.

The actual position the mother chooses does not appear to influence labour outcomes, and hence the mothers should be encouraged and helped to adopt whatever positions they find most comfortable throughout labour [12].. Meconium Between 15 and VS .NET PDF-417 2d barcode 20% of term pregnancies are associated with meconium staining of the amniotic fluid (MSAF), which is not a cause for concern in the vast majority of labours. Meconium may be demonstrated in the fetal gut in the first trimester, but in utero passage is rare before 34 weeks.

Meconium reflects fetal gut maturity. However, the passage of meconium in labour may have a more sinister explanation. An association between meconium passage in utero and poor neonatal outcome has been recorded by Aristotle.

Meconium aspiration can occur with intrauterine gasping or when the baby takes its first breath, and accounts for 2% of perinatal deaths. The appearance of fresh meconium in labour should prompt evaluation of fetal well-being. Continuous electronic fetal monitoring should be instituted.

Fetal scalp blood sampling should be considered in the presence of fetal heart rate abnormalities. This is particularly true for thick meconium, since this implies that there is little liquor to dilute the meconium, and this itself may indicate placental problems before the onset of labour. Thin meconium, on the other hand, is thin because it has been diluted with an adequate volume of liquor.

In the presence of a normal fetal heart rate, MSAF is not an indication for immediate delivery or fetal blood sampling, especially if it is thin staining. However, if the heart rate becomes abnormal in association. Use of analgesia and anaesthesia Women should b .NET PDF 417 e offered support and encouraged to ask for analgesia at any point during labour. Non-pharmacological measures like labouring in water, supporting women s use of breathing/relaxation techniques, massage and music should be considered.

In the UK, the four most widely used forms of pain relief for labour are transcutaneous electrical nerve stimulation (TENS), nitrous oxide (Entonox), intramuscular narcotics (e.g. Pethidine) and epidural analgesia.

TENS may not be effective in women in well-established labour [12]. A more detailed discussion of analgesia in labour is found in 3..

2: First stage of labour with thick fre PDF417 for .NET sh meconium, early delivery should be considered, particularly in high-risk pregnancies..

Diagnosis of poor progress of labour Progress in la VS .NET PDF 417 bour is confirmed by observing the progressive effacement and dilatation of the cervix and the descent of the presenting part. The use of a partogram for the management of labour facilitates the early detection of abnormal labour progress and identifies those women most likely to require intervention.

This can be used at all levels of obstetric care by basic care providers who have been trained to assess cervical dilatation. When used properly, it helps to detect abnormal labour progress promptly, allowing timely intervention. In a WHO multicentre trial in southeast Asia involving over 35,000 women, the introduction of the partograph as part of an agreed labour management protocol was associated with a reduction in prolonged labour from 6.

4 to 3.4%, and the proportion of labours requiring augmentation reduced from 20.7 to 9.

1%. The caesarean section rates also fell from 9.9 to 8.

3% and intrapartum stillbirths from 0.5 to 0.3%.

There were also improvements in fetal and maternal mortality and morbidity in both nulliparous and multiparous women [11]. The term dystocia or difficult labour refers to poor progress of labour and is diagnosed when the rate of cervical dilatation is slower than anticipated. When a woman is admitted in the active phase of labour, the cervical dilatation can be plotted on the partogram and an expected progress or alert line can be constructed, usually corresponding to 1 cm per hour.

Another line, the action line, can be added 4 h to the right of the alert line, and parallel to it [11,12]. The outcome of spontaneous labours has been studied and three distinct patterns of abnormal progress described [14 16]. These are: (a) prolonged latent phase, (b) primary dysfunctional labour, and (c) secondary arrest of cervical dilatation.

The duration of latent phase is difficult to define. It is considered prolonged if it is greater than 15 h in a nullipara. The latent phase in parous patients has not been studied in detail [12], therefore no such figure exists for multiparas.

Once established in the active phase of labour, primary dysfunctional labour is diagnosed when the progress falls to the right of the. nomogram. If l abour progresses normally in the early active phase but the cervix fails to dilate or dilates slowly thereafter, secondary arrest of cervical dilatation is diagnosed (Figure 2.4).

More than one of these abnormal labour patterns may occur in the same patient, since they frequently share a common aetiology. The use of the partogram with the anticipated progress line for an individual patient annotated allows the prompt recognition of abnormal cervical progress. The descent of the presenting part as the proportion of the presenting part (expressed as fifths) palpable abdominally is also an integral component of the partogram, and it too is plotted at each review.

A poor rate of descent may also be an indication of developing mechanical problems in the labour. Poor progress has conventionally been related to the three P s namely: (a) powers adequacy of the uterine contractions; (b) passages resistance of the birth canal; (c) passenger relating to the size, position, degree of flexion, etc., of the baby.

To these can be added a fourth P : poor practice. Poor progress in labour does not identify the specific cause (that is, fault with the powers, passage or passenger), since these are frequently interrelated. Primary dysfunctional labour (PDL) is the commonest abnormality of the first stage of labour, occurring in up to 25% of spontaneous primigravid labours [15] and 8% of multiparas [16].

The commonest cause is inadequate uterine activity. Secondary arrest of cervical dilatation (SACD) is much less common than the above, said to affect 6% of nulliparas and only 2% of multiparas. Although the commonest cause of SACD (especially in nulliparas) is still inefficient uterine activity, relative disproportion is far more likely to be the explanation than with PDL.

Secondary arrest does not always indicate genuine cephalo-pelvic disproportion, as inadequate uterine contractions can be corrected, resulting in spontaneous vaginal delivery [17]. However, a diagnosis of secondary arrest (especially in a multiparous woman) should prompt a search for obvious problems in the passenger (for example, hydrocephalus, brow presentation, undiagnosed shoulder presentation, large baby, malposition) and the passages (for example, a congenitally small pelvis, a deformed pelvis due to fracture following an accident, or masses in the pelvis). Unfavourable pelvic diameters.

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