Antepartum Hemorrhage

Any Bleeding from genital tract after 24 to 28 weeks of pregnancy and Before delivery of the fetus

4% of all pregnancy

Causes:

Placental causes ( 50-70%) (obstetric causes)

_Placental previa

-Placental abruption

-Velamentous insertion of cord

-Marginal sinus rupture

-Circumvellate placenta

-Rarely rupture uterus

Excessive show

Non Obstetric Causes

_Cervical polyp

-Cervical ectopy (erosion)

_Carcinoma cervix

_Vaginal/ vulval Varicositis

_Cervicitis/vaginitis

Indeterminate Bleeding

Abruptio Placentae / accidental hemorrhage

Types:

Revealed / External hemorrhage

Concealed hemorrhage- carries worse risk , increased risk of consumptive coagulopathy / extent of hemorrhage not appreciated

Mixed

Total / partial

Incidence : 0.5%

Etiology

Advancing Maternal age

Race- more common among african american as compared to asians

main etiology is Hypertension such as chronic HTN : pre eclampsia

Uterine over distention e.g multiple pregnancy

Trauma

Cigarette smoking / cocaine

acquired thrombophilias

previous abruption

Pathophysiology:

Vascular injury

Rise in Uterine venous pressure

also separation of placenta

Clinical feature

Symptoms:

Bleeding (may be altered / fresh blood

Abdominal pain- Continuos pain

Too frequent contraction

Back pain

Cartoons want to give their message to the World

Anatomy of Larynx

Larynx

Larynx is the voice box & it also serves as an air passage

Extends from root of the tongue at the inlet of the larynx to the commencement of trachea at the level of 6th cervical vertebra

The cavity of the larynx is continuous below with the trachea, and above opens into the laryngopharynx.

SKELETON OF THE LARYNX

The skeletal framework of the larynx is formed

by a series of cartilages interconnected by

ligaments and fibrous membranes.

Cartilages of Larynx

The cartilages of the larynx are nine in number, three single and three paired.

Three single are thyroid, cricoid and epiglottis.

Three paired are arytenoid ,corniculate and cuneiform .

Thyroid cartilage

It is the Largest cartilage

Made of 2 quadrangular plates

Each plate has 2 surfaces :Inner &outer

4 Borders : Upper,Lower,anterior,posterior

Anterior border

Anterior borders unites at an angle : Laryngeal prominence (Adams apple)

separated by Thyroid notch

Posterior border

Posterior borders : Prolonged upwards & downwards called Sup. &Inf. horns

Superior horn: Lateral thyrohyoid ligament

Inferior horn: Facet at the medial surface for cricoid arch

Cricoid cartilage

Signet ring shaped

Having posterior quadrilateral lamina & an anterior narrow arch

Cricoid Lamina:

Posterior surface:

Median ridge to which the tendinous bands from Longitudnal muscles of oesophagous are attached

Each side:

2 depressions for attatchment of posterior crico-arytenoid muscle

Upper border - 2 facets for articulation with the base of arytenoids

Cricoid arch

Rough external surface having circular facet on each side for articulation with the inferior horn of the thyroid cartilage

Lower border of cartilage:Attachment to Cricotracheal membrane

Epiglottis

Oblong leaf shaped

2ends, upper & Lower

2 surfaces, Anterior &Posterior

2Lateral borders

The lower end attachs to inner surface of thyroid cartilage below thyroid notch by the thyroepiglottic ligament

Arytenoid cartilage

These are placed on the upper border of the lamina of the cricoid

Pyramidal in shape

It has an apex ,base, 3 surfaces-Medial , Lateral & anterolateral

Base-a facet which articulates with the upper border of the cricoid lamina

Apex articulates with corniculate cartilage

Medial surfaces faces each other

Anterolateralsurface-------------- 2 depressions,seperated by a ridge , for muscle (vocalis) &

Ligament(vestibular ligament)

Lateral angle of the base projects laterally as muscular process

Anterior angle of the base projects forwards as the vocal processto which the vocal ligament is attached.

Ligaments of larynx

Extrinsic ligaments

These ligaments lie external to the larynx and connect the larynx with the hyoid bone and trachea.

Thyrohyoid membrane

It spans between the superior margin of the thyroid cartilage below and the hyoid bone above.

Its poserior borders thickened to form the lateral thyroid ligaments.

It thickens anteriorly in the the midline to form the median thyrohyoid ligament.

Hyo-epiglottic ligament

The hyo-epiglottic ligament extends from the midline of the epiglottis to the body of the hyoid bone.

It connects the epiglottis with the hyoid bone.

Cricotracheal ligament

The cricotracheal ligament runs from the lower border of the cricoid cartilage to the upper border of the first tracheal cartilage.

The larynx is attached to the trachea by this ligament.

Intrinsic ligaments

They lie within the cartilaginous skeleton of the larynx and connect the thyroid, cricoid and arytenoid cartilages .

Quadrangular membrane

It passes between lateral margin of the epiglottis and the arytenoid cartilage on the same side.

The upper border slopes posteriorly to form the aryepiglottic ligament which constitute the central component of aryepiglottic fold

The lower border forms the the vestibular fold (false vocal cord).

Cricovocal membrane

It is attached to the arch of cricoid cartilage and extends superiorly to end in a free upper margin.

The free upper margin attaches anteriorly to the thyroid cartilage and posteriorly to the vocal processes of the arytenoid cartilages

The upper free margin is thickened to form the vocal ligament, which is under the vocal fold (true 'vocal cord') of the larynx.

The cricothyroid ligament is also thickened anteriorly in the midline to form the median cricothyroid ligament.

Laryngeal joints

Cricothyroid joint

This joint happens between the inferior horns of the thyroid cartilage and lateral surface of the lamina of cricoid cartilage.

It is a synovial joint.

The cricothyroid joints enable the thyroid cartilage to move forward and tilt downwards on the cricoid cartilage and effectively lengthens and puts tension on the vocal ligaments.

Crico-arytenoid joints

It is between the articular facets on the superolateral surfaces of the cricoid cartilage and the bases of the arytenoid cartilages.

It is a synovial joint.

It enables the arytenoid cartilages to slide away or towards each other and to rotate.

These movements abduct and adduct the vocal ligaments .

Cavity of the larynx

The laryngeal cavity extends from the laryngeal inlet down to the lower border of the cricoid cartilage, where it continues into the trachea.

It is divided into three parts by the vestibular and vocal folds ：the Vestibule, Sinus and Infraglottic space

Vestible

It is the part situated between the laryngeal inlet and the vestibular fold.

Sinus

Sinus is the middle part between the vestibular folds above and the vocal folds below.

Infraglottic space

The infraglottic space is the most inferior chamber of the laryngeal cavity and is between the vocal folds and the inferior opening of the larynx.

Named parts of parietal pleura

The names given to the parietal pleura correspond to the parts of the wall with which they are associated

pleura related to the ribs and intercostal spaces is termed the costal part;

pleura covering the diaphragm is the diaphragmatic part;

pleura covering the mediastinum is the mediastinal part;

the dome-shaped layer of parietal pleura lining the cervical extension of the pleural cavity is dome of pleura

Pleuracentesis

through the 7th or 8th intercostal space，on the posterior axillary line, along the superior border of the lower rib

Diuretic Agents

Autonomic Nervous System (ANS)

Cardio Vascular System

Abortions in China

China’s One Baby Law of 1979

It is a law where each family of China is allowed only one child to raise.

The Chinese government set this law due to the rising population of China.

WHY ABORTION SHOULD BE LEGALISED IN THE WORLD???

1. If the mother is going to die

2. Incest

3. Inability to support or care for a child

4. Rape

5. The mother has AIDS or HIV or HPV or whatever and gives it to the baby

6. Its the women's body so her choice

7. To end an unwanted pregnancy.

To prevent the birth of a child with birth defects or severe medical problems

OUTCOMES OF ONE BABY POLICY AND LEGALISED ABORTIONS IN CHINA

Do People feel this law really works ???

Is it a good way to get rid of high population rates???

Do this policy give birth to other crimes???

WHAT STATISTICS SAY

20 MILLION BIRTHS/ YEAR

‘’DAILY CHINA’’REPORTS

13 MILLION ABORTIONS/YEAR

10% GENDER BASED ABORTIONS

Forced Abortions (statistics N/A)

13,000,000 Abortions/Year

CAN YOU HANDLE THE REALITY????

The government recently forced 10,000 people in southern China into sterilization, which means that those women wont be able to get pregnant.

Sex-selective Abortions

Many families want a male child instead of a women because men would carry on their family name since when a couple gets married, the female accepts her husband’s last name.

It is also because when women get married they are usually required to give money to the husband as a gift.

1.Statistics show that about 24 million Chinese men of marrying age will be unable to find a bride by the end of this decade.

2.The one-baby law has made irregular gender ratios. In some areas, there are up to 168 males for every 100 females.

3.Some authorities fear that men who are unable to find a women to marry will turn towards crime, war, prostitution, and kidnapping of women.

Post-Abortion Syndrome

Symptoms:

Depression

Feelings of despair or loss

Suicidal thoughts

Eating Disorders, drug and alcohol abuse, etc.

Presentations:

Blood

Antimicrobials

Antihistaminics

NSAIDs

CNS Drugs

Endocrine Drugs

GIT Drugs

Anesthetics

Respiratory Drugs

Male Genital System

Descent of testis:

Early in fetal life the testes are situated in the abdominal cavity. Before birth they descend and pass through the inguinal canals to reach the scrotum.

If the testes do not descend into the scrotum, the condition is referred to cryptorchidism.

After puberty the testes produce sperms and secrete hormones.

The testosterone controls the development of male secondary sexual characteristics,

such as hair pattern, muscular development, voice change,

bone growth, normal sexual behavior and sperm production.

so some female pregnant after coitus interruptus.

Sperm cannot be produced at the core body temperature of 37℃, the scrotum’s superficial position provides an environment that is about 3 ℃ cooler, an essential adaptation.

Furthermore, the scrotum responds to changes in external temperature. If the external temperature is too high, the scrotum will constract, If the external temperature is too low, the scrotum will enlarge.

In some case, if the prepuce is longer and the orifice of the prepuce is smaller than normal,the prepuce cannot be retracted over the glans.In this case some secretions may be accumulated within space of prepuce, and leading to inflammation.

This chronic inflammatory of the prepuce is a factor that may cause the carcinoma of the penis. For these reason prophylactic circumcision is commonly performed.

Semen

A typical ejaculation release 2~5ml of semen. This volume of fluid, called a ejaculate, contains:

Spermatozoa. A normal sperm count ranges from 20 million to 100 million spermatozoa per cubic milliliter of sperm.

Seminal fluid. Seminal fluid, the fluid component of semen, is a mixture of glandular secretions with a distinct ionic and nutrient composition. A typical sample of seminal fluid contains the combined secretions of the seminal vesicle (60%), the prostate gland (30%), the sustentacular cells and epididymis (5%), the bulbourethral glands (less than 5%).

Enzymes .

Male sexual response

The chief phases of the male sexual response are:

1. Erection, which allows penis to penetrate into the female vagina;

2. Ejaculation, which expels semen into the vagina.

Erection results from engorgement of the cavernous bodies with blood. During sexual excitement, the arteries supplying the cavernous bodies dilate, increasing the flow of blood to the vascular spaces within, and the smooth muscle in the partitions in these bodies relaxes, allowing the bodies to expand as the blood enter them. As the cavernous bodies begin to swell, they press on the small vein that normally drain them, slowing venous drainage and maintaining engorgement.

Ejaculation begins with a strong contraction of the smooth musculature throughout the reproductive ducts and glands, which squeeze the semen toward and into the urethra. Simultaneously, the bulbospongiosus muscle of the penis contracts rapidly, aqueezing the semen onward through the cavernous portion of urethra and out of body.

Cystoscopy :