𝐴2 𝒄𝒉𝒂𝒏𝒏𝒆𝒍

بحث عن اعتماد المصادر الخارجية للدراسة خاص للمجموعة الطبية
الي اليكدر يشارك بالبحث ميطول عليكم

https://docs.google.com/forms/d/1Ka869YiIRwgEMqhWl5atFs6ykeRMAuDM50D8EVqyLLo/viewform

Happy new year 🎊

مقابلة مع الدكتور هيثم نبيل
صاحب اعلى معدل تراكمي لطبيب في العراق
نصائح عن الطب العام وتحدياته وابرز الحلول لبعض المشاكل الي تواجه الطلاب

للي يحب يشوف الحلقة كاملة موجودة في داخل القناة وايضا هذا رابط الحلقة
علما الحلقة مُقسمة الى اجزاء في وصف الفيديو ،
مشاهدة ممتعة ❤️

https://5etme.com/k/295998?fbclid=PAZXh0bgNhZW0CMTEAAaZIQpeMGejRpXC7zSzfLWaWNl9k5DH-NNbNODXb9sKDTPLKq8wiG-_nSnk_aem_z-eOZWNqJfgCrSfXUpU0lQ

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بسم الله الرحمن الرحيم
(( يَا أَيَّتُهَا النَّفْسُ الْمُطْمَئِنَّةُ ارْجِعِي إِلَى رَبِّكِ رَاضِيَةً مَرْضِيَّةً فَادْخُلِي فِي عِبَادِي وَادْخُلِي جَنَّتِي ))
انتقلت الى رحمة الله تعالى اليوم الجمعة
والدة زميلتنا (فاطمة علاء)

سائلين الله عز وجل أن يتغمدها برحمته الواسعة وأن يسكنها فسيح جناته ..
وانا لله وانا اليه راجعون.
ولاحول ولاقوة الا بالله العلي العظيم.

Female pelvis
من اسئلة العام
Describe the
1- anthropod pelvis
2- android pelvis
3- gynecoid pelvis

Write about the Paltypelloid pelvic

Mechanism of labour :
https://youtu.be/q1jmVN3ILpY?si=347i4v7maX2vrHhN

https://youtu.be/dYu-0rOnLpA?si=-vec3oofImoiB8sG

https://youtu.be/ruIa1bC4tsw?si=Tiu0MZ84kpfZrY_i

Mechanism of labour
من اسئلة العام

Define
1- engagement
2- presentation

Enumerate the Fetal variable in labor (the passenger) that affect their passge through the pelvis and describe 2 of them?

Write about the fetal lying

توليد - نظري
د. اسراء المعيني

Stages of The Labor

📌Active phase in labour of second stage ➡️
the active second stage is said to begin when she starts making voluntary active efforts
*this phase is diagnostic للsecond stage

📌Normal duration of second stage
1. Primiparous( 2 h )
2. Multiparous (1 h )
More than 3 h increase morbidity

📌events that occur in second stage ➡️
1. Fetal axis pressure increases flexion of the head
2. Contractions of : uterine and abdominal muscle ( urge )
contraction become expulsive as the fetus descends further into the vagina
3. Soft tissue of pelvis is displacement


📌third stage of labour ➡️
begins immediately after delivery of the fetus and involves the separation and expulsion of the placenta and membranes,

📌 events that occur in third stage ➡️
1. Separation of placenta
2. Descent of placenta
3. Expulsion the placenta
4. Control the haemorrhage
Duration of third stage ?
5-15min

📌Signs of separation of placenta➡️مهمه
1. gush of bleeding from site of separation of placental bed.
2.increased the length of cord.
3.uterus become round globular due to decreasing the size of uterus and starting of countraction.

📌Fourth stage is ➡️
postpartum period of about 4 hours after the third stage,
And include
1. Observation of mother
2. Care of newborn
✨The mother observe in fourth stage f
1. Atony of uterus
2. Bleeding

📌Stages of labour ⬇️
1. First stage (latent phase + active phase )
2. Second stage ( passive stage + active stage )
3. Third stage
4. Fourth stage

📌Normal duration of labour ➡️
8h - 18h ( first labour )
5h - 12h ( subsequent labour )

📌the labour in first stage ➡️ latent phase ➡️
From onset of labour to 3-4cm dilatation of cervix

📌 labour in active phase first stage ➡️
When cervix dilate from 5-10 cm
هنا اقصى توسع لعنق الرحم


📌What are events occur at first stage
Effacement and dilatation of cervix
ال effacement تبدي قبل اسابيع من الولادة وتكمل بنهايه latent phase

📌the effacement➡️
Effacement is a process by which the cervix shortens in length as it becomes included into the lower segment of the uterus.

* Effacement in nulliparous should be consecutive
* in multiparous may occur simultaneously

📌Duration of latent phase
3-8 h

📌cause of the effacement and dilation of cervix➡️
The retract of upper part of uterus cause effacement and dilatation


📌Actions that occur in uterus in first stage?
1. Fundal dominance
2. Polarity
3. Contraction and retraction

📌 fundal dominance➡️
Contractions start in the fundus and spreads across and downward, usually its lasts longest and its more intense in the fundus, but the peak reached simutansly over the whole uterus and fades from all parts together

📌polarity➡️
This mean the contraction occur in organised and coordinate way between upper pole and lower pole of uterus
1. In upper pole : strongly contraction that expel the fetus
2. In lower pole : contraction slightly and dilate to allow expulsion

📌causes of pain during uterine contractionsمهمه
1. Myomaterial hypoxia
2. Stretching peritoneum over the fundus
3. Stretching of cervix during dilatation
4. Compression of nerve ganglion
Distribution in T10-L1


📌Effect of retraction in normal labour
1. Formation of lower uterine segment , effacement and dilatation of cervix
2. Maintain Descend of presenting part made by uterine contractions and to help in ultimate expulsion of the fetus
3. To reduce the surface area of the uterus favouring separation of placenta.
4. Effective haemostasis after the separation of the placenta





📌normal time to rupture of membrane ➡️
End stage of first stage of labourer


📌passive phase of second stage of labour➡️
Its start from full dilatation upto the descent of the presenting part to the pelvic floor. There is no maternal urge to push and the fetal head is still relatively high in the pelvis

ملخص ملزمه ال labor ✨

📌the labour ➡️
1. Regular contraction of uterus
2. Rffacement and diletation of cervix
3. Dilevary of baby and placenta


📌How can i differentiate false labour from the true one?
1. Contraction
2. Cervical dilatation and effacement
3. Pain or discomfort


📌When can i told that labour was normal ?
1. Spontaneous expulsion
2. Single
3. Mature fetus ( 37 w- 42W )
4. Presented by vertex
5. Vaginal delivery
6. Time between 3h - 18 h
7. Without complication

📌Causes of onset of labour
1. Hormonal factors
2. Mechanical factors
3. Neurological factor:
Hormonal factors
1) Estrogen theory: increase free form
2) Progesterone withdrawal theory:
3) Prostaglandins theory: PGE2 and PGF2a ( increase in maternal and fetal blood as well as the amniotic fluid late in pregnancy and during labour.)
4) Oxytocin theory: decrease oxytocinase from placenta and increase the oxytocin
5) Fetal cortical theory: fetal cortisol that lead to increase oestrogen production from the placenta.

Mechanical factors
1) Uterine distension theory
2) Stretch of the lower uterine segment by the presenting part near term triggered the synthesis of prostaglandin

Neurological factors
1. Both α and β adrenergic receptors are present in the myometrium; estrogen
causing the α receptors and progesterone the β receptors to function predominantly.
2. The contractile response is initiated through the α receptors of the post
ganglionic nerve fibres in and around the cervix and the lower part of the uterus


📌Factors influence the progress of labour ?
1. Powers
2. Passages
3. Passenger


♥️Symptoms and signs of labour ?مهمه
1. Contractions ( regular painful contraction at least on in each ten min.
2. Mucus with blood ( show )
3. Leak of liquor ( rupture of membrane)
4. Progressive of shortening and dilatation of cervix

 

Labour and its physiology
من اسئلة العام
Define the 4th stage of labour

Describe the 2nd stage of labour

Describe the 3rd stage of labour

Enumerate the
Signs of placental seperation

د. حنان الجبوري

fertilization&implantation&early development of
the placenta and fetal grow

ڤديوات كلش كلش مفيدة لتخيل المعلومات :

https://youtu.be/nLmg4wSHdxQ?si=9O3l5kaIULt0P3X0

https://youtu.be/42WIByexiXc?si=PcDi2wahwh0ARHQF

https://youtu.be/s-Xpa5UZAZs?si=sNgJkThHFgkridmN

https://youtu.be/1zpV5rzWXMA?si=bm1Ru768VwJUv6Qq

https://youtu.be/PAVo16b_6j4?si=cf6cjsKGn8zsfyR-

https://youtu.be/g7FExgKr-x4?si=efwzhnNXW93_96Jx

و من اسئلة العام عن هالمحاضرة
Define fertilization

📌 cardiac output (CO) starts and reaches its peak 40–50% at about 30–34 weeks. increases further during labor (+50%)


📌increase in the demand of calcium by the growing fetus to the extent of 28 g, 80% of which is required in the last trimester➡️ for fetal bone mineralizatioal

📌lung capacity is reduced by 5% due to diagrammatic elevation


📌Total pulmonary resistance is reduced due to progesterone effect

📌Fiprinolytic activity is depressed till 15 minutes after delivery


📌Blood volume increase about 40-50%
📌Rbc increase about 20-30%


📌Advantages of hemodilution in pregnancy ?
*1) Diminished blood viscosity ensures optimum gaseous exchange between the maternal and fetal circulation.
(2) It protects the woman against the adverse effects of supine and erect posture.
(3) Protection of the mother against the adverse effects of blood loss during delivery.

📌Why ESR increased during pregnancy ?
*1. Diminished blood viscosity
2. Increase fibrinogen and globulin

📌What changes in coagulation components in pregnancy ?
Platelet : slight fall ( gestational thrombocytopenia)
fibrinogen increase about 50%


📌pregnancy is hpercoagulable state
3. Fibrinolytic is depressed till 15 minutes after delivery.


📌What changes in Bp in pregnancy ?
*BP is decrease during pregnancy due to Decrease ( SVR )

📌Calcium metabolism changes?
*1. Increase absorption from intestinal and kidney ( doubled )
2. Increase calcitonin to protect from osteoporosis

📌Change of skeletal system ➡️
*1. There is increased mobility of the pelvic joints due to softening of the ligaments caused mainly by hormone

2. increased lumbar lordosis during later months of pregnancy due to enlarged uterus produces backache and waddling gait.

What most common symptom in git during pregnancy ➡️
1. Heart burn
2. Dyspepsia
3. Constipation
4-esophigites

📌Causes of frequent micturition during➡️ pregnancy ?
1. Pressure of uterus on the bladder
2. Increase GFR By 50%

pregnant feel shortness of breath➡️
*It is probably due to progesterone acting on the respiratory center and also to increase in sensitivity of the center to CO2 .


📌Abnormal clinical findings during pregnant ?
1-palpitation.
2-The apex beat is shifted to the 4th intercostal space.
3-Pulse rate is slightly raised
4-A systolic murmur may be audible in the apical or pulmonary area.
This is
due to decreased blood viscosity and torsion of the great vessels.

Physiology of pregnancy
من اسئلة العام

Enumerate the Hematological changes during pregnancy

What's the physiological change during pregnancy of:
A. Ovarian
B. Respiratory system

Write about the:
A. Cutaneous pigmentation during pregnancy
B. Hypotension syndrom in supin position