Obstetrics - Science topic

Ohh.I just sent the message to the correct email address. I'm so sorry. The mistake was from my end🤦🏽‍♀️.

Thank you so much!

Currently, I am working as an independent researcher, focusing on topics related to obstetrics and gynecology. I am based in Monterrey, Mexico, but I am fully open to relocating for opportunities that align with my career goals and interests.

You can find more about my professional background on my LinkedIn profile: www.linkedin.com/in/karen-yunuén-diego-cruz-92825b28a

Feel free to contact me at my email: karendiegoc@gmail.com

Thank you for your consideration!

might not be case of plagiarism because similar rare case may be reported by person in different journal not in same journal but Patients characteristic will be different for each case report

Managing ethical dilemmas and navigating complex decision-making scenarios in obstetric anesthesia care requires a thoughtful and principled approach that prioritizes patient-centered care, communication, and collaboration among healthcare providers. Here are some strategies for effectively addressing ethical dilemmas in obstetric anesthesia:

By applying these strategies, healthcare providers can effectively manage ethical dilemmas and navigate complex decision-making scenarios in obstetric anesthesia care, promoting patient-centered, ethical, and compassionate care for pregnant women and their babies during childbirth.

The legal aspects of obstetric anesthesia practice encompass various considerations related to liability, documentation requirements, and communication with obstetric colleagues and patients. Here's a discussion of each of these aspects:

By addressing these legal aspects of obstetric anesthesia practice, anesthesiologists can help ensure high-quality care, minimize legal risks, and promote positive outcomes for mothers and babies during childbirth. It is essential to remain vigilant, adhere to professional standards, and prioritize patient safety and well-being in all aspects of obstetric anesthesia practice.

Ethical considerations in obstetric anesthesia encompass various principles and dilemmas related to maternal autonomy, fetal rights, and informed consent. Here's an explanation of each of these aspects:

In summary, ethical considerations in obstetric anesthesia revolve around respecting maternal autonomy, protecting fetal rights, and obtaining informed consent from pregnant women. Healthcare providers must navigate these ethical dilemmas with sensitivity, empathy, and respect for the autonomy and well-being of both mother and baby. By upholding these ethical principles, healthcare providers can promote patient-centered care and enhance the overall experience of childbirth for pregnant women and their families.

Postpartum monitoring, early ambulation, and breastfeeding support are crucial aspects of obstetric anesthesia care aimed at promoting maternal recovery, ensuring maternal well-being, and facilitating successful breastfeeding. Here's an outline of the considerations for each of these components:

1. Postpartum Monitoring:

- Vital Signs: Continuously monitor maternal vital signs, including blood pressure, heart rate, respiratory rate, and oxygen saturation, in the immediate postpartum period and during the recovery phase.

- Pain Assessment: Regularly assess maternal pain intensity using validated pain assessment tools to ensure adequate pain relief and optimize maternal comfort.

- Uterine Tone: Assess uterine tone and involution to monitor postpartum hemorrhage risk and ensure appropriate uterine contraction and healing.

- Bleeding: Monitor vaginal bleeding and assess for signs of excessive bleeding or hemorrhage, particularly in the first 24 hours postpartum.

- Bladder Function: Monitor urinary output and assess for urinary retention or bladder dysfunction, especially in patients who received neuraxial anesthesia.

2. Early Ambulation:

- Encourage early ambulation and mobility as tolerated, starting as soon as possible after delivery, to promote venous return, prevent venous thromboembolism (VTE), and expedite maternal recovery.

- Provide support and assistance as needed for postpartum patients, especially those who underwent cesarean section or experienced significant perineal trauma, to facilitate safe ambulation and mobility.

- Educate patients about the importance of early ambulation, the benefits of physical activity in promoting circulation and preventing complications, and strategies for gradual mobilization and rehabilitation.

3. Breastfeeding Support:

- Facilitate early initiation of breastfeeding within the first hour after delivery to promote bonding, establish breastfeeding success, and provide optimal nutrition for the newborn.

- Provide breastfeeding education and support to postpartum patients, including guidance on proper latch technique, breastfeeding positions, milk production, and management of common breastfeeding challenges.

- Address maternal concerns or difficulties related to breastfeeding, such as nipple pain, engorgement, low milk supply, or breastfeeding difficulties, and offer appropriate interventions or referrals to lactation consultants or support groups as needed.

- Consider the impact of anesthesia medications on breastfeeding and provide guidance on safe medication use during lactation, including recommendations for pain management and medication timing to minimize neonatal exposure.

4. Patient Education and Discharge Planning:

- Provide comprehensive postpartum education to patients and their families regarding self-care, postpartum recovery, warning signs of complications, and when to seek medical attention.

- Develop individualized discharge plans tailored to each patient's needs, including recommendations for pain management, activity restrictions, wound care, contraception, and follow-up care.

- Collaborate with obstetricians, midwives, nurses, and other healthcare providers to ensure continuity of care and support for postpartum patients during the transition to home.

By prioritizing postpartum monitoring, early ambulation, and breastfeeding support in the obstetric anesthesia setting, healthcare providers can optimize maternal recovery, enhance patient satisfaction, and promote positive outcomes for both mother and baby in the postpartum period.

Providing anesthesia in high-risk obstetric patients with multiple comorbidities or obstetric complications requires a comprehensive approach that takes into account the unique medical and obstetric challenges they present. Here are the key considerations:

By considering these key factors and implementing a multidisciplinary, patient-centered approach, healthcare providers can optimize anesthesia care for high-risk obstetric patients with multiple comorbidities or obstetric complications, ensuring the safest possible outcomes for both mother and baby.

Regional anaesthesia, particularly neuraxial techniques such as spinal and epidural anesthesia, plays a crucial role in managing obstetric emergencies by providing effective pain relief, facilitating rapid maternal intervention, and minimizing the risks associated with general anesthesia. Here's a discussion of the role of regional anaesthesia in obstetric emergencies, including its effects on maternal hemodynamics and surgical outcomes:

In summary, regional anesthesia, particularly neuraxial techniques, plays a critical role in managing obstetric emergencies by providing effective pain relief, facilitating rapid maternal intervention, and minimizing the risks associated with general anesthesia. While neuraxial anesthesia can result in maternal hypotension, appropriate measures can be implemented to maintain hemodynamic stability and optimize surgical outcomes. Close monitoring of maternal and fetal parameters is essential to ensure maternal and fetal safety during obstetric emergencies managed with regional anesthesia.

Uterine rupture is a rare but serious obstetric complication characterized by the tearing of the uterine wall, often leading to life-threatening hemorrhage and fetal distress. The anaesthetic management of uterine rupture requires prompt recognition, aggressive resuscitation, and timely intervention to optimize maternal and fetal outcomes. Here's an outline of the anaesthetic management:

By following these principles and strategies, healthcare providers can effectively manage the anaesthetic care of patients with uterine rupture, optimizing maternal and fetal outcomes while addressing the unique challenges associated with this obstetric emergency.

Placental abruption is a serious obstetric complication characterized by the premature separation of the placenta from the uterine wall before delivery of the baby. The anaesthetic management of placental abruption is aimed at ensuring maternal and fetal safety while addressing the potential risks associated with hemorrhage and maternal instability. Here's an outline of the anaesthetic management:

By following these principles and strategies, healthcare providers can effectively manage the anaesthetic care of patients with placental abruption, optimizing maternal and fetal outcomes while addressing the unique challenges associated with this obstetric complication.

Placenta previa is a condition where the placenta partially or completely covers the cervix, which can lead to severe bleeding during labor and delivery. The anaesthetic management of placenta previa requires careful planning and consideration of the risk of hemorrhage. Here's an outline of the anaesthetic management:

By following these principles and strategies, healthcare providers can effectively manage the anaesthetic care of patients with placenta previa, optimizing maternal and fetal outcomes while addressing the unique challenges associated with this obstetric complication.

The anaesthetic management of obstetric complication preeclampsia requires careful assessment, monitoring, and intervention to optimize maternal and fetal outcomes while mitigating the risks associated with this condition. Here's an outline of the anaesthetic management of preeclampsia:

By following these principles and strategies, healthcare providers can effectively manage the anaesthetic care of patients with preeclampsia, optimizing maternal and fetal outcomes while addressing the unique challenges associated with this obstetric complication.

Minimizing fetal exposure to anaesthetic agents and optimizing fetal well-being during obstetric anaesthesia requires careful planning, monitoring, and intervention. Here are strategies to achieve these goals:

By implementing these strategies, healthcare providers can minimize fetal exposure to anaesthetic agents and optimize fetal well-being during obstetric anaesthesia, ensuring the safest possible outcomes for both mother and baby.

Volodymyr, it is important to find the reason of the pain.

- Infection (endometritis, perineal, UTI)?

- Urinary retention?

- Haematoma or other trauma?

- Neurological? (for example from sacral plexus or pudendus?)

Women postpartum generally can receive both paracetamol and NSAID, some few days of Oxykodon can be okay if the neonatologists are fine with it (or if she is not breastfeeding). In some cases, epidural or nerve block can help postpartum also. But the priority is to find out what's the problem, not just releive pain.

The metan command in Stata is used to perform a descriptive meta-analysis. To do this, the estimates must be converted to proportions by dividing by 100. The "metan" command will generate a forest plot showing the summary estimate and confidence intervals for the met need for EMOC in each country. The results can be interpreted based on the summary estimates and uncertainty around them. By using the metan command in Stata, users can perform a descriptive meta-analysis without relying on external software like CMA.

Per abdominal assessed not enter in brim

Hypoproteinemia

Please also go through the following RG links.

Waiting for recommendations and guidelines. Involve neonatologists too.

hi, add in the profile next to overview ...there is research where you should add the article

Equally, dear Dr. Hossein

Dear Yaminee Ravishankar ,

Look the link, maybe useful.

Regards,

Shafagat

I am interested in the topic

Single port laparoscopy and single port robotic assisted laparoscopic surgery.

Please see the following RG link.

Food Drug Administration USA ( USA), Harrison's principles of internal medicine

Welcome Dr Tanaka. Nice to see u there

Recommended treatment. For decubitus ulcer includes

1. Reduction

2. Ring pessary

3. Estrogen cream

Without pesaary there will be no improvement due to persistent cause which is tiusse necrosis.

Most food species provide the required amount of iron. However, the body needs large amounts of iron during pregnancy. The additional amount is given throughout the pregnancy, as well as within 2 - 3 months after birth, to compensate the iron reserve in the body of the woman after birth. Deficiency symptoms Iron deficiency leads to anemia, which includes symptoms of fatigue, fatigue, shortness of breath and rapid heartbeat. It can also show apathy, irritability and decreased body ability to resist infections. Symptoms and risks in overdose Iron poisoning is very serious. The symptoms are: abdominal pain, nausea and vomiting, accompanied by high body temperature, abdominal distension, dryness and a serious reduction in blood pressure. These conditions require immediate medical treatment. Pharmaceutical preparations Iron sulphate, iron fumarate, iron gluconate and iron compound - polysaccharides can be obtained over-the-counter in medical preparations, vitamins and minerals. Dextran iron given by injection can only be obtained by prescription and at bedtime. Liver sources is the best source of iron. Meat (especially brains and kidneys), eggs, chicken, fish, green leafy vegetables, dried fruits, whole or fortified cereals, bread and some baked goods, nuts and dried pulses are all rich sources of iron. Iron, which comes from meat, chicken and fish, is better absorbed than iron, which comes from vegetables. The dose is determined individually, depending on the nature and severity of the condition. In adults, anemia is usually treated with a dose of 30-100 mg of iron, two or three times a day. In children, the dosage should be reduced by generation and weight. In the case of pregnancy it is recommended to give between 30 - 60 mg per day. Recommended daily dose Details of recommended daily amount (RDA) for iron, 10 mg (from birth to 6 months), 15 mg (from 6 months to 3 years), 10 mg (4 to 10 years) 18 mg (for males between the ages of 11 to 18 years - for females from the age of 11 years to 50 years), 10 mg (for males aged 19 years and above and for females aged 51 and above) the body needs a larger amount during pregnancy and up to two or three months after Birth. I have foods that contain vitamin and iron

 

Dr. Iyer,

I have looked at your stata output which shows you have used Poisson Regression. So before your specific question can be answered, I must first point out that Poisson is not appropriate for a dichotomous variable such as episiotomy (Yes/No). Poisson is only appropriate for a count variable as the dependent variable (e.g. number of children; or number of episiotomies a women have had).

For your variable, a binary logistic regression (LR) will be more appropriate. Coincidently I wrote a paper in 2007 on episiotomy, using logistic regression. Although have used LR very frequently lately, I have attached my episiotomy paper for you. I hope it helps.

Dear Sir,

before we think on number of surgeons that we need, it can be useful to think on risk factors leading to fistula. among those factors includes young marriage, obstructed labor, low interval in child spacing, home delivery and others. these factors have to be prevented as well as increasing qualified Dr for treatment.

Amniotomy may hasten Labour progression by allowing fetal axis pressure to come into play early and hasten the release of prostaglandins , all which may impact positively on Labour progression but not necessarily Labour outcome has been well documented.

Similarly amniotomy is a well documented integral and cardinal component of management of placental abduction but not it's prevention. Of crucial significance is the fact amniotomy should be performed in a controlled fashion in order to prevent sudden decompression of intrauterine pressure particularly in cases of uterine overdistension due to e.g. polyhydramnios which may then predispose to placental abduction.

Dear colleague,

You have some options. Please see the following links for instructions:

Additional material:

Sincerely,

Hércules Freitas

If someone found the MGI tool, kindly share.

In the US, women who experience PPROM should be transferred to a Level 3 medical center that has the highest level nursery care available. The woman should be given a betamethasone steroid injection to promote fetal lung maturity. Magnesium sulfate is administered for neuroprotection and should be administered to reduce the incidence of long-term neurological injuries. Antibiotics should be administered to reduce the risk of infection. Maternal vital signs and electronic fetal monitoring should be ongoing. If the maternal temperature begins to increase, chorioamniocitis should be suspected and immediate  cesarean is indicated. The use of tocolytics is no longer recommended for long-term use but may be considered for up to 48 hours when PTL does not stop to give the corticosteroids time to improve fetal lung maturity.

For gestational diabetes, in the US, ACOG recommends a 2 hour Glucose Tolerance Test to be done at the 6 weeks post partum visit to screen for Type 2 Diabetes with our gestational diabetics.

Laparoscopic ovarian drilling can be of help. Ofcource she may be advice on weight reduction if she is overweight

Interesting case, it would be important to know/report on;

how they removed the subserosal fibroid, did they tie off the base and leave a good nubbin of fibroid tissue or did they shave the myometrium in the process; did they use adhesion prevention techniques or did an adhesion attached to the operative site rent the defect in later pregnancy. Was the original fibroid a solitary lesion or was it a multi-fibroid uterus, and one of the intramural fibroids undergo degeneration in pregnancy (predisposing to rupture). All the best.

Thanks Jelena

although rare, tuberculous meningitis also should be checked, since it can concomittantly occur.  More detailed information about her pregnancy status should have been given for such a patient. 

 I disagree with the general opinion that lactating women have a higher  risk of thromboembolic complications because of higher levels of prolactin. There are some evidence that  prolactin has an indirect inhibitory effect  on platelets in hyperprolactinemic patients, suggesting that prolactin might have a protective role in thromboembolic disease. So I believe excessive bleeding could be expected in such patients operated on emergency basis.

Thank you so much Dhia. I appreciate your response and above all, some good literature.

I think that we are in front of a case of severe vaginal discharge may be due to chronic infection associated with immune disturbance , vaginal swap and culture may be benificial 

Big numbers beyond say 1 in 10 represent a challenge to many patients but many can relate to days of the year. So if a risk is 1 in 750 you could give as an example - if you pick a date sometime in the next 2 years and I can correctly guess the date, that is about 1 in 700.

For 1 in 18000 you could say if you pick a date sometime in the next 5 years and I can correctly guess the date, that is about 1 in 18000. 

Dear, I have no knowledge.

The above comments confirm that there is no published research about taking oral pills of B6 for nausea and vomiting during pregnancy.  My experience as a midwife for 35 years shows that B6 has no positive effect on NVP during  pregnancy.  Perhaps because the women are too sick to take pills. Or it is just too late.  The above comments imply that too much is harmful but only fat soluble vitamins can be toxic . B6 is water soluble and excess is urinated in the urine.

I have found that taking 50 mg a day for 3 months before conception prevents NVP.    I published this.    50 mg dose is available at www.puritan.Com for $6 for 3 month supply

A 10 mg dose would also do it, but I can no longer find less than 50 mg to buy

Women taking B complex pills with B6 inside found no deceased NVP during pregnancy, so encourage only B6 not B complex. 

I know of no other researchers who research the use of B6 to prevent NVP.  Would be interested in hearing from any one like that.

Cars are for the most part reliable.   However, when a certain tire is found to be faulty and risk the lives of 1 in 100,000 users,  it is taken off the market.  NO RCT STUDY IS DONE.  It is taken off the market because it might kill a man or two.  But not so when women are involved.   Killing a woman here or there is just irrelevant collateral damage, according to the person who thinks we need an RCT to know if fundal pressure is dangerous.  Because here we have in this discussion, experienced practitioners with decades of experience who say,  FUNDAL PRESSURE WILL DIRECTLY CAUSE UTERINE RUPTURE and/or destruction of the spleen, both of which are life changing events and sometimes life ending events.  And it is not as if anything bad would have happened if you DID NOT DO FUNDAL PRESSURE.  The baby would have delivered for sure.  Fundal pressure just satisfied the need to move the woman out of labor and delivery ward.   At least when a tire is faulty, well the car was useful at getting the person to another location. But fundal pressure has no need to be used at all.   All those babies will come out, just a bit later.   And the kind owners of the RESEARCHGATE.NET give us a method of communicating facts to each other, so that we dont have to reinvent the wheel and do unnecessary RCT studies about KNOWN PROTOCOLS THAT KILL AND MAIM WOMEN,  like the known and ever present DANGERS of fundal pressure.  Cathleen Gavel obviously is young  and thinks she just discovered some terrific way to deliver babies by using fundal pressure instead of letting the uterus and the mother push it out.   Instead of learning from others,  she wants an RCT .    That defies all logic.  And everyone on this list who has worked for 20 years or more knows it.    Obviously when people are being observed in an RCT, they will be extra careful not to explode the spleen, and the study will be small and not large enough to wait for the inevitable uterine rupture or spleen explosion.   After FUNDAL PRESSURE Is found to be supposedly safe in some study that has not enough participants to say anything, god forbid, then people will go back to rupturing uterus and exploding spleens and now they can do it without remorse because of some small RCT study, by someone who is resistant to listening to people with 35 years of experience,   says so.    To hear anyone say that a RCT study of FUNDAL PRESSURE IS needed, is like saying we need a RCT study to see if we should use hair dryers while in the shower, or whether female genital mutilation, removing the clitoris, increases female sexual pleasure etc etc.    If the purpose of the study is to justify killing women, then it is a very good idea to do a RCT on Fundal pressure.   

During active labour patient is encouraged to pass urine 1-2 hourly according to the local protocol. If the quantity passed is inadequate and and on clinical examination her contractions which were good have now slowed down then I would consider catheterisation. The amount may be just 100 -200 mls only. I might consider self -retaining catheter if I this problem is recurring and remove the catheter when she is fully dilated and ready to deliver.

= How do you know it is appendicitis?  Do you have a  fail safe criterion (criteria) to distinguish what is an "uncomplicated" versus a "complicated appendicitis? The only criterion I know is watching  the progression/regression  of the clinical signs and symptoms every 6 hours, without giving antibiotics nor pain killers. This is true for all patients except the pediatric cases and those whose affect obscure the  interpretation of your objectivity. ... and your labs will  then function as confirmatory tests as they are supposed to do.  

This sounds like a useful and informative study - assuming the methods you select are feasible for your circumstances. My first thought, when I read the word restorative, is the work of Kaplan and Kaplan who study attention restoration and developed a comprehensive theory ART (attention restoration theory) - though this is not what you are describing - I thought I'd point out the overlap. Meanwhile, I am one of the colleagues Dr Newnham referred to above. I have multiple publications regarding the physical birth unit design's influence on women's supporters' experiences. It is a 'wicked' problem - better understanding the space in which such a number of different experiences occur (caregivers, the woman, the supporters). There isn't necessarily one best method - but making sure that you are connecting your well-developed research question very clearly with the population of interest and the existing literature and the possible outcomes is important. 

Dear Nurussolehah Yusof,

Here I send you a paper we wrote about it:

There are some articles on abortion.

Triplet pregnancy

In my country, not recommended triple birth pregnancies at home

The exceptions to vaginal delivery include the following:

Presenting triplet in breech position

Conjoined twin anatomy

Most cases of mono-amniotic twins

Signs of fetal distress or an abnormality that warrants abdominal delivery

Higher order births

In my country, cesarean delivery is planned for higher order births

Although the frequency of multiple gestations is lower than singleton gestations, multiple gestations account for a disproportionate share of neonatal morbidity and mortality. Much of this can be attributed to a higher rate of preterm delivery for multiple gestations. The mean gestational age at delivery is 35 weeks for twins, 32 weeks for triplets and 29 weeks for quadruplets. As a result, 25% of twins and 75% of triplets require admission to the neonatal intensive care unit (NICU). Neurologic outcomes also appear to be worse in multiple births. When matched for gestational age at delivery, infants born from multifetal pregnancies have an approximately 3-fold increase in cerebral palsy (see the Gestational Age from Estimated Date of Delivery calculator). There is an approximate fivefold increased risk of stillbirth and sevenfold increased risk of neonatal death.

Monochorionic gestations are at risk for twin twin transfusion syndrome (TTTS) which can occur about 15% of monochorionic pregnancies. TTTS is thought to be caused by vascular anastomoses within the placenta causing one twin to become underperfused (the "donor" twin) and the other twin to show signs of overperfusion (the "recipient" twin). Pregnancies complicated by TTTS are at significantly increased risk of neonatal morbidity and mortality.

Maternal morbidity is also increased in a multifetal gestation. Women with multiples are more likely to be hospitalized with complications including preterm labor, preterm premature rupture of membranes, preeclampsia, placental abruption, pulmonary embolism, and postpartum hemorrhage. As a result, hospital costs are higher in these pregnancies.

Women used a variety of birth positions and a majority gave birth in flexible sacrum positions. No associations were found between flexible sacrum positions and SPT. Flexible sacrum positions were associated with fewer episiotomies.

Perineal injuries and birth positions among 2992 women with a low risk pregnancy who opted for a homebirth

Maybe the following could be useful?

Regards,

Sevgi.

While waiting and re-scanning is probably safe, it is also unnecessary. Given the advanced size of the foetus, the lack of heartbeat is inconsistent with normal pregnancy and is diagnostic of nonviable pregnancy (missed abortion)

Diagnostic criteria for nonviable pregnancy early in the first trimester.  N Engl J Med. 2013 Oct 10;369(15):1443-51.

And hysterectomy  , but it's not a conservative therapy

Dear Peggy we are practicing pudendal  block for operative delivery only   

Thank you so much for your help. Even I could not apply your suggestions, however it is interesting to know utero-injection and Lei lei's teachnology. I could know we can order mutant mouse form Jackson's lab. Thank you so much and sorry for my late reply.

The birth satisfaction scale revised - (BSS-R) produced by Hollins Martin

Caroline J. Hollins Martin, PhD, MPhil, BSc, PGCE, ADM, RM, RGN, MBPsS (Professor of Midwifery), Colin R. Martin, PhD, MBA, BSc, RN, YCAP, CPsychol, CSci, AFBPsS (Professor of Mental Health)  Development and psychometric properties of the Birth Satisfaction Scale-Revised (BSS-R) Midwifery 30 (2014) 610–619 

 You will need a sizeable group to say anything significant.   I do not think you will find one.   I would like to know what is interesting to you about this topic.    I do not think it warrants your time or efforts when there are so many important topics waiting to be researched in the field of midwifery.

Lakea et al (1997) found in a British cohort study that overweight and obesity in early adulthood appear to increase the risk of menstrual problems, hypertension in pregnancy increasing the risk of abruptio placentae. In a large cohort of singleton pregnancies Aliva et al. (2010) found that the risk of preeclampsia and eclampsia increased significantly with increasing BMI and decreasing age. Extremely obese teenagers were almost four times as likely to develop preeclampsia and eclampsia compared with nonobese women and teenagers were most at risk because of the combined effects of young age and obesity. In estimating risk factors for preeclampsia Baker and Haeri (2012) confirmed that maternal obesity and excessive gestational weight gain place the gravid teen at increased risk for preeclampsia. They suggested that the modifiable nature of these risk factors permits the possibility of intervention and prevention. 

A recent study study of the interrelationship between gestational weight gain, pre-pregnancy body mass index, race/ethnicity with hypertensive disorders during pregnancy showed that although there are some ethnic/racial variations, pregnant women who exceeded gestational weight gain recommendations are at increased risk of hypertensive disorders and risk of abruptio placentae (Masho et al 2016).

Thank you, Dr. Lina, for the outstanding question

I do believe that improvement of midwife practice needs collaborative measures from all healthcare and policy-making stakeholders (including, government, JNMC, JNC, NGOs, Private and military sectors .., etc.), at the national level.  Regarding the malpractice, I think the role of the quality and patient safety department or team is very essential; still, patient's safety is everyone's responsibility.

Maybe in book by Kari, Bo et al 2015 Evidence based physiotherapy for pelvic floor muscles. Although I don't  see the connection because in horseback riding important muscle groups are thigh adductors, gluteals, guadriceps, core muscles...just my oppinion.

There are several issues to consider:

First and foremost,the health of the mother is paramount. If the severe feature are an indication of maternal CNS  dysfunction( Unremitting Headache, Visual disturbance) then temporization is unwise and potentially catastrophic.

IT is reasonable to stabilize with IV magnesium and IV anti-hypertensive agents and then reassess. IF after controlling the BP and seizure prophylaxis with Magnesium, the severe symptoms resolve, then  temporization may be considered BUT the risk to mom and fetus from an abrupt acceleration in condition is high and I would not consider it in a setting where emergent delivery  and experienced nursing are not available.

I have found that some patients with severe features are paradoxically volume overloaded( BNP is markedly elevated) and with careful use of Lasix and labetolol the elevated LFTs and low platelets have improved and normalized.  

So if treatment and optimization of the maternal condition is successful, temporization to get a full course of Betamethasone is warranted and likely to be beneficial.

Beyond 48 hrs, temporization is not going to benefit the fetus unless you are either at the limits of viability(22-25 weeks) OR unless you can get at least a week additional maturation in utero.

Remember the ONLY group that did worse in Liggins initial work on steroid for lung maturation was in the hypertensive, proteinuric, growth restricted fetus.

I agree with the other contributor that temporization in the face of severe features after 34 weeks is unwise and unlikely to benefit the baby, in fact, I usually deliver once a full course of steroids is on board after 32 weeks since the survival is over 95% at that GA.

Did you try to use my questionnaire "Libido Scorring System" in the literature. You can find my full text article free of charge and this questionnaire is very user friendly.

Midwifery led care is at least part of the solution.

Ballard Scoring

I agree with Hamin. But if you take all these facts together it is better to have excellent training and expertize in laparosocopic appendectomy so the surgeon could have less preoperative strategic difficulties. When I started laparoscopic appendectomy it was easier for me to do open appendectomy. Now after more than 200 lap appendectomies I realise that it is more simple procedure technically (for me) and the easiest operations last 15 min and the patients recover ealier.

Therefore whatever the studies claim, my opinion is that laparoscopic appendectomy is better procedure in experienced hands.

Speaking of external tocodynamometers, they are fragile equipment which should be protected from the coupling gel, usually used in close proximity due to the ultrasonic transducer that records the cardiac activity of the fetus  .

Those are tied on maternal uterine fundus where the uterine contractions are most prominantly detected but tend to change its position with maternal movement and contractions.

After placing an external tocodynamometer, one should reset it to the baseline level when there is no uterine contraction, otherwise there would be faulty readings.

whether it is piezoelectronic or a conventional pressure sensor, keep them dry and away from the gel.