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BASIC STRUCTURE AND PROMINENT FUNCTIONS OF VERTEBRATE INTEGUMENT INTRODUCTION The integument or the outer cover of the body is commonly referred to as the skin. Together with its derivatives it makes up the integumentary system. It is continuous with the mucous membrane lining the mouth, eyelids, nostrils, rectum and the openings of the urino-genital ducts. The skin functions primarily to cover and protect the tissues lying beneath it. In other words, it forms the external protective covering of an animal. Forms interface between organism and external environment. Part that the predator sees first, and which offers the first line of defense. Abundantly supplied with sensory nerve endings, which are affected by environmental stimuli and play an important role in communication. General metabolism of the body, temperature regulation and water loss. Character of the skin and its derivatives shows variation in different regions of the body, in different individuals, in the same individual as age advances and in different groups of vertebrates. The type of environment whether aquatic or terrestrial is of importance in connection with these variations. The evolution of vertebrate integument is correlated with the transition of vertebrates from an aquatic to a terrestrial environment. Nevertheless, basic similarities exist in the integument of all vertebrates. INTEGUMENT PROPER In Annelids, Arthropods, integument consists of single layer of cells, the EPIDERMIS, together with an outer non-cellular CUTICLE, secreted by the cells. Annelids have a body covered with an external thin collagenous cuticle (never shed or molted). In Arthropods, the chitinous and rigid cuticle makes up the exoskeleton. Periodic shedding of this cuticle is termed Ecdysis. THE VERTEBRATE SKIN DIFFERS FROM INVERTEBRATE SKIN TWO LAYERS – Outer epidermis derived from ectoderm Inner dermis or corium of mesodermal origin. The relative amount of the two layers varies with the environment. EPIDERMIS – the epidermis is made of stratified epithelium (several layers of columnar epithelium cells). These cells are held together tightly by minute intercellular bridges found on the surface of cells. The innermost layer is stratum Malpighii or stratum germinativum placed over a thin basement membrane. These cells divide constantly to produce new cells. Move upwards, tend to become flattened, protoplasm becomes horny (keratinisation). In fishes and amphibians, this keratinised layer forms a cuticle, but in amniotes, it forms stratum corneum, of hard, horny, flat, cornified cells made largely of keratin, which is tough, waterproof and insoluble protein. It affords protection against mechanical injuries, fungal and bacterial attacks and prevents desiccation. In many Tetrapoda, this layer is shed periodically in pieces or all at once. No stratum corneum in cyclostomes and fishes (since they are fully aquatic) here the epidermis has mucous glands, secreting mucus to keep the skin slimy and protects it from bacteria. The epidermis has no blood vessels and is nourished by capillaries in the dermis. The epidermis rests on a thin basement membrane which separates it from the dermis Dermis has an outer loose layer and inner dense layer Made up of dense connective tissue having cells, muscles, blood vessels, lymph vessels, collagen and elastic fibres, and nerves. Amphibians and reptiles -collagen fibres at right angles in three planes Birds and mammals, they have an irregular arrangement. Substances pass by diffusion from the dermis to the epidermis. Skin contains pigment, if present in epidermis, it occurs as a diffuse substance or as granules. If in dermis, then in the form of granules in special branching cells called chromatophores. The pigment can either collect as a central ball making the skin lighter or spread out into all the branches making the skin darker, thus, chromatophores bring about colour variations. Chromatophores are of many kinds, Melanophores that contain brown to black pigment Lipophores or xanthophores which contain yellow red fatty pigments Iridocytes or guanophores contain crystals of guanine which reflect light. Under dermis, the skin has subcutaneous loose areolar tissue which separates the skin from the underlying muscles, it may contain fat and muscles, especially in mammals. Integument of Anamnia shows a decrease in thickness and also a decrease in the degree of ossification. These are of advantage in allowing greater mobility and in amphibians, they permit respiration by the skin. But in Amniota, the skin becomes progressively thicker to prevent loss of water and to retain body heat. STRUCTURE OF INTEGUMENT IN CYCLOSTOMATA Epidermis is multi-layered (stratified) but has no keratin. It has three types of unicellular gland cells: mucus glands (secrete mucus), club cells (scab-forming cells) and granular cells (unknown function). Below epidermis is the cutis formed of collagen and elastin fibres. Star- shaped pigment cells are also present in the cutis. STRUCTURE OF INTEGUMENT IN PISCES The epidermis has several layers of simple and thin cells, but there is no dead stratum corneum. The outermost cells are nucleated and living. The stratum Malpighii replenishes the outer layers of cells which have some keratin. Unicellular goblet or mucous gland cells are found in the epidermis, as in all aquatic animals. The mucous makes the skin slimy reducing friction between the body surface and water, protects the skin from bacteria and fungi and assists in the control of osmosis. Multicellular epidermal glands like poison glands and light producing organs may also be found. The epidermis rests on a delicate basement membrane. The dermis contains connective tissue, smooth muscles, blood vessels, nerves, lymph vessels and collagen fibres. The connective tissue fibres are generally not arranged at right angles but run parallel to the surface. Scales are embedded in the dermis and projected above the epidermal surface. The colours of fishes are due to chromatophores and iridocytes. STRUCTURE OF INTEGUMENT IN AMPHIBIA: The epidermis has several layers of cells, six to eight cells in thickness and is divisible into three layers: stratum corneum, stratum germinativum and a basal portion in contact with the basement membrane. The outermost layer is a stratum corneum, made of flattened, highly keratinised cells. Such a dead layer appears first in amphibians and is best formed in those which spend a considerable time on land. The stratum corneum is an adaptation to terrestrial life (protects body and prevents excessive loss of moisture). In ecdysis, stratum corneum is cast off in fragments or as a whole in some. (moulting / desquamation i.e., removal of unicellular sheet of stratum corneum). The dermis is relatively thin in amphibians, it is made of two layers - upper loose stratum spongiosum and a lower dense and compact stratum compactum. Connective tissue fibres run both vertically and horizontally. Blood vessels, lymph spaces, glands and nerves are abundant in the stratum spongiosum. There are two kinds of glands, multicellular mucous glands and poison glands in the dermis, but they are derivatives of the epidermis. Mucous gland produces mucus (slimy protective covering, helps in respiration). Amphibian skin is an important organ of respiration. Poison glands produce a mild but unpleasant poison which is protective. In the upper part of the dermis are chromatophores. (melanophores and lipophores) Ability of the skin for changing colour to blend with the environment is well developed. INTEGUMENT IN REPTILIA. The integument is thick and dry, it prevents any loss of water, it has almost no glands. The only glands present are scent glands for sexual activity. The epidermis has a well-developed stratum corneum well adapted to terrestrial life. The horny scales of reptiles are derived from this layer. Ecdysis is necessary to remove dead outer layers, hence scales are shed periodically in fragments or cast in a single slough as in snakes and some lizards Scales often form spines or crests. Below the epidermal scales are dermal bony plates or osteoderms in tortoises, crocodiles and some lizards (Heloderma). The dermis is thick and has an upper layer and a lower layer, upper layer has abundance of chromatophores in snakes and lizards. Lower layer has bundles of connective tissue in which collagen fibres lie at right angles. Leather of high commercial value can be prepared from the skin of many reptiles like lizards, snakes and crocodiles. Many lizards and snakes have elaborate colour patterns, they may be for concealment or as warning colours. There is marked colour change in certain lizards such as chameleon, the colour may change with the environment for concealment or it may change in courtship or threat. The ability of chameleons and some other animals to change colour is known as metachrosis. (metachromatism) In Calotes, chromatophores are controlled by the posterior lobe of pituitary whereas in chameleons they are controlled by the Autonomic Nervous System. INTEGUMENT IN BIRDS Thin, loose, dry and devoid of glands. There is only a uropygial gland at the base of the tail, its oil is used for preening (to clean and tidy its feathers with its beak) and waterproofing the feathers (aquatic birds) Epidermis is delicate except on shanks and feet where it is thick and forms epidermal scales. The rest of the body has a protective covering of epidermal feathers. The keratin producing powers of the epidermis are devoted to producing feathers and scales. The dermis is thin and has interlacing connective tissue fibres, abundant muscle fibres for moving feathers, blood vessels and nerves. The dermis has an upper and lower compact layer, between which is a vascular layer, the dermis also contains fat cells. The skin has no chromatophores. Pigment is found only in feathers and scales. Colour patterns in birds are vivid (concealment, recognition and sexual stimulation) Colours are produced partly by pigments and partly by reflection and refraction from the surface of the feathers. INTEGUMENT IN MAMMALS Skin is elastic and waterproof, much thicker than in other animals, especially the dermis is very thick and is used in making leather. Epidermis is thickest in mammals. Outer stratum corneum containing keratin, cells not dead as believed before. Below this is stratum lucidum (barrier layer), chemical called eleidin Below this stratum granulosum, darkly staining granules of keratohyalin Below this is stratum spinosum whose cells are held together by spiny intercellular bridges. Lastly stratum germinativum which rests on a basement membrane Dermis is best developed in mammals. Upper layer is papillary layer made up of elastic and collagen fibres with capillaries in-between, thrown into folds called dermal papillae, especially in areas of friction Greater lower part of dermis is reticular layer, having elastic and collagen fibres. In both layers there are blood vessels, nerves smooth muscles, certain glands tactile corpuscles and connective tissue fibres in all directions. Below dermis the subcutaneous tissue contains a layer of fat cells forming adipose tissue In the lowest layer of epidermis there are pigment granules, no pigment bearing chromatophores in mammaIs (in man, branching dendritic cells or melanoblasts) FUNCTIONS OF THE INTEGUMENT ▪ PROTECTION ▪ TEMPERATURE CONTROL ▪ FOOD STORAGE ▪ SECRETION ▪ EXCRETION ▪ SENSATION ▪ RESPIRATION ▪ LOCOMOTION ▪ DERMAL ENDOSKELETON ▪ SEXUAL SELECTION 1. Protection: The integument forms a covering of the body and is protective. It protects the body against entry of foreign bodies and against mechanical injuries. It protects the tissues against excessive loss of moisture, this is very important because both aquatic and terrestrial animals are dependent upon water in their bodies for various metabolic activities. The integument forms protective derivatives, such as scales, bony plates, layer of fat, feathers and hair which reduce the effect of injurious contacts. In some animals the skin shows protective colouration which makes the animals resemble their environment, thus, making them almost invisible to their enemies. Poison glands of toads, slippery skin of aquatic animals and an armour of spines of some mammals are protective devices of the integument. The skin forms a covering which prevents the passage of water and solutes in one of the following ways: (a) By formation of cuticle in Protochordata and embryos of fishes and amphibians, (b) By secreting a coat of mucus in fishes and aquatic amphibians, and (c) By formation of keratin layers in the epidermis of tetrapoda. Keratin is formed from the cytoplasm of degenerating cells of the epidermis which finally form a layer of horny stratum corneum. 2. Temperature Control: Heat is produced constantly by oxidation of food stuffs in tissues. This heat is distributed evenly by the circulating blood. The body heat is lost constantly with expired breath, with faeces and urine, and from the surface of the skin. The integument regulates heat and maintains a constant temperature in endothermal animals. In birds the heat is regulated by adjustment of feathers which retain a warm blanket of air, when feathers are held close to the body, they remove warm air and body cooled, when feathers are fluffed out, they keep the warm air enclosed. In mammals, constant evaporation of sweat regulates the body heat. In cold weather contraction of skin’s blood capillaries reduces the loss of body heat. In some animals, fat in the skin prevents loss of heat because it is a non-conductor of heat. 3. Food Storage: The skin stores fat in its layers as reserve food material which is used for nourishment in times of need. In whales and seals the fat of the skin forms a thick layer, called blubber which is not only reserve food but also maintains the body temperature. 4. Secretion: The skin acts as an organ of secretion. Glands of the skin are secretory. In aquatic forms there are secretory mucous glands whose secretions keep the skin moist and slippery. In mammals, sebaceous glands secrete oil which lubricates the skin and hairs. Mammary glands produce milk for nourishment of the young. In birds uropygial glands secrete oil for preening the feathers. Odours of scent glands attract the opposite sex. Lacrymal glands’ secretion wash the conjunctiva of eyeball in mammals. Ear wax (cerumen) secreted by the glands of auditory meatus greases the eardrums and avoids insects to enter the canal. 5. Excretion: The integument acts as an organ of excretion. Shedding of the corneal layer during ecdysis removes some waste substances. In mammals metabolic waste (salts, urea and water) is removed from the blood by means of sweat. Chloride secreting cells are found in gills of marine fishes. 6. Sensation: The skin is an important sense organ because it has various kinds of tactile cells and corpuscles which are sensory to touch, temperature changes, heat, cold, pressure and pain. 7. Respiration: In amphibians, the moist skin acts as an organ of respiration, in frogs the respiratory function of the skin is greater than that of the lungs. 8. Locomotion: Derivatives of the integument bring about locomotion in some animals, such as the fins of fishes aid in locomotion in water, the web of skin in the feet of frogs and aquatic birds aid in swimming, feathers of the wings and tail of birds are used for flying, and extensions of the integument forming “wings” of flying lizards, extinct pterodactyls, flying squirrels and bats. 9. Dermal Endoskeleton: The skin contributes to the endoskeleton. It forms the dermal bones of vertebrates and also forms parts of the teeth. Endoskeleton of head protects the brain and sense organs. In the body it protects the soft, tender viscera. 10. Sexual Selection: The skin acts as an organ of sexual selection. It provides the feathers of birds which often have brilliant colours which are for sexual attraction. Some integumentary glands of mammals produce odours far attracting the opposite sex. Antlers of male deer distinguish it from female. Besides the above functions, mammalian skin synthesizes the vitamin D with the help of Sebum of sebaceous glands. Brood pouches beneath skin in some fishes and amphibians protect unhatched eggs. Nasal glands of tetrapods, keep the nostrils free of dirt and water. Skin also has the power of absorption of oils, ointments, etc
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Please wait outside until I let you in, and put all your stuff at the back just like we've done about 20 times already this semester. Okay? Or this semester and last, and you will be just fine. Now your lecture exam too is 90 marks big. It is 90 multiple choice questions. Okay. It is going to be on cardiovascular disorders, urinary system, fluid balance, Okay. So let's start talking about them. First of all, okay, you need to know the difference between a myocardial infarct, ischemic attack, a congestive heart failure, and angina pectorals. You need to know what a low level inflammatory response that develops over time where the endothelium is damaged due to the aging or prolonged hypertension, where LDLs accumulate, and the endothelium is repaired with collagen is called. That might take you a long time to read. Okay? But it is a good question. Okay? You need to know now be really, really clear on these. Okay? You absolutely need to know the difference between right ventricular hypertrophy and left ventricular hypertrophy and what they cause. Because there's two questions on here, and so far, this one hasn't been done very well. Okay? Make sure you understand what right ventricular hypertrophy leads to and you understand what left ventricular hypertrophy leads to. Now the original term, congestive heart failure, that refers to left ventricular hypertrophy leading to backup in the lungs. K? You need to know what arteries or vessels are used in bypass surgery. You need to know what a mini stroke is. Okay? You need to know the difference between thrombus and ballast occlusion and arthroma. You need to know what is a restriction in blood supply generally due to factors in the blood vessels with resultant damage or dysfunction of tissue. You need to know, what are the consequences of an aging cardiovascular system. And then I I've got a matching question for you. You need to match the basic function of the proximal convoluted tubule, the glomerulus, and the peri colic duct. And then two of my favorite questions. Are you ready? Okay. You have to find out which of the following is the best explanation for why the cells of the proximal convoluted tubule contain so many microclonary. Oh, isn't that lovely? Okay. And then the other one you need to know is you need to find the best explanation for the microvilli on the apical surface of the proximal convoluted tubules. So don't get that one wrong because we've talked about microvilli about a bazillion times. Okay? This picture is gonna be on there, folks. Okay? This is the picture of the of the nephron from your textbook. Okay. You need to label things like glomerulus glomerulus afferent arteriole collecting duct nephron move. Okay. Where do you find the granular cells? Okay. The difference between the medulla and the cortex. Make sure you know all of those things. I'll read you this one. This is a good question too. Hydrostatic pressure is the primary driving force of plasma through the filtration membrane into the capsular space. All the publicly following statements reflects why hydrostatic pressure is so high in the glomerular capillaries. Select the one statement that does not explain the high pressure within the glomerular capillaries. So you need to know why glomerular capillary pressure is higher than the rest of the capillaries in the body. You need to know how or why cells or transport proteins are prevented from moving through how yeah. What drives reabsorption of organic nutrients in the proximal condylated tubule? Who drives thus? You need to know the mechanism that establishes the medullary osmotic gradient the The functional and structural unit of the kidneys is what? The g force pushing the blood and solids out of the blood across the filtration membrane is what? Okay. The macular densities cells do what? Function in angiotensin two is to do what? What is, specific gravity or density? Okay. If you talk about the specific gravity or density of urine, how is it different from water? You need to actually, this is just one question, but it should be a pretty simple one. Okay? You need to place the following and correct sequence from the formation of a drop of urine to its elimination of the body. And so you have to go through from well, I'll just read it to you. Major calyx, minor calyx, nephron, urethra, ureter, and collecting that. So you need to put those in order from start to finish. Okay? What would happen if the capsular hydrostatic pressure were increased above normal? You need to know what would happen. Reabsorption of bilevels of glucose and amino acids in the filtrate is accomplished. The 44 more. Okay. So you need to match to their definition. All of your hypo and hypers. Make sure you have some under control. Okay? And then you need to match possible causes. So there's possible causes of respiratory alkalosis, metabolic alkalosis, metabolic acidosis, and respiratory acidosis. Respiratory alkalosis, metabolic alkalosis, metabolic acidosis, and respiratory acidosis. There are possible causes for those four things. You need to match the disorder to the cause. Okay? And then you need to know, the body's motor volume is mostly tied to the level of then I have a couple of clinical correlation questions for you, but they are multiple choice this time. So something happened to Jane. You have to tell me what's happening to Jane. Okay? Now whereas sodium is mainly found in the extracellular fluid, most is found in intracellular systems are. Okay. Which of the following is not a likely source of hydrogen ions in blood plasma, so there's a few types in the tablets, so make sure you know which ones are going to produce acids and which ones aren't. And then Annie had something happen to her as well. Across capillary walls is what? Regulation of potassium balance is what? Now Dave Dave did something silly. Okay? Dave ran a marathon. Okay? And then Dave did something even more silly afterwards. I want you to tell me what happened to Dave. And in addition to that, Nancy is having a panic attack. So I want you to tell me what's happening to Nancy in terms of respiratory aesophosis and respiratory aldosterone. Okay. If thyroid and parathyroid glands were surgically removed, which of the following would go out of balance without replacement therapy? Falling arterial blood pressure holds which? An illness, Doug. Doug has severe diarrhea. Okay. And, is accompanying the loss of bicarbonate or secretions. So how is Doug gonna compensate for that for Doug? Okay. You need to know what the medical term for kidney stones is. You need to know what happens, or what could cause the passage of proteins, red blood cells, and white blood cells into the urine. You need to know how to solve prostatic enlargement, and, you need to know what the presence of white blood cells in urine is called and what is causing it. Okay? And then there's a picture of the lymphatic of the lymph node. Okay. You need to label the lymph node picture. And then you there is going to be a matching question on lymphatic structures, so you need to know what happens in the spleen, the lymph nodes, the thoracic duct, the lymph, and the pyre patches. There's a list, a small short list. Okay? So in other words, you're going to need to know what is classified as a lymphoid organ and what does not. Okay? So make sure you know what your lymphoid organs are. You need to know the pathway of lymph. So it starts in lymph capillaries. Where does it end? Make sure you know all the steps along the way. And then you need to know the functions of the spleen. What did what does the spleen do? And that is it for an example
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1. Hyperemesis Gravidarum/ Pernicious Vomiting Definition: Excessive nausea and vomiting during pregnancy, extending beyond week 12 or causing dehydration, ketonuria, and significant weight loss within the first 12 weeks. Incidence: 1 in 200-300 women Cause: Unknown, but may be associated with increased thyroid function and Helicobacter pylori infection. Signs and Symptoms: • Decreased urine output • Weight loss • Ketonuria • Dry mucous membranes • Poor skin turgor • Elevated hematocrit • Decreased sodium, potassium, and chloride levels • Polyneuritis (in some cases) Assessment: • Hemoglobin: Elevated hematocrit concentration (hemoconcentration) due to inability to retain fluids. • Electrolytes: Decreased sodium, potassium, and chloride levels due to low intake. • Acid-base Balance: Hypokalemic alkalosis (severe vomiting, prolonged period). • Neurological Examination: Polyneuritis due to B vitamin deficiency. Effects (if left untreated): • Intrauterine Growth Restriction (IUGR): Dehydration and inability to provide nutrients for fetal growth. • Preterm birth: Due to complications caused by the condition. • Prolonged hospitalization/home care: Resulting in social isolation. Therapeutic Management: • Fluid and Electrolyte Management: Monitor input and output, blood chemistry to prevent dehydration. • Nutritional Support: Withhold oral food and fluids (usually) and administer total parenteral nutrition (TPN). • Intravenous Fluid Replacement: 3000 ml Ringer's lactate with added vitamin B to increase hydration. • Antiemetic Medication: Metoclopramide (Reglan) to control vomiting. 2. Ectopic Pregnancy Definition: Implantation of a fertilized egg outside the uterine cavity (ovary, cervix, fallopian tube - most common). Incidence: Second most frequent cause of bleeding during the first trimester. Causes: • Obstruction of the fallopian tube: ◦ Adhesions (from previous infection like chronic salpingitis or pelvic inflammatory disease). ◦ Congenital malformations. ◦ Scars from tubal surgery. ◦ Uterine tumor pressing on the proximal end of the tube. ◦ Current use of an intrauterine device (IUD). Signs and Symptoms: • Missed period/amenorrhea. • Positive hCG test. • Sharp, stabbing pain in the lower abdominal quadrants and pelvic pain (at time of rupture). • Scant vaginal spotting/bleeding. • Rigid abdomen (from peritoneal irritation). • Leukocytosis (increased WBC count due to trauma). • Decreased blood pressure and increased pulse rate (signs of shock). • Cullen's sign (bluish tinge around the umbilicus). • Tender mass palpable in the cul-de-sac of Douglas (vaginal exam). • Falling hCG or serum progesterone level (suggesting the pregnancy has ended). • No gestational sac on ultrasound. Therapeutic Management: • Non-ruptured Ectopic Pregnancy: Oral administration of methotrexate followed by leucovorin. • Ruptured Ectopic Pregnancy (emergency): Laparoscopy to ligate bleeding vessels and remove or repair the damaged fallopian tube. 3. Hydatidiform Mole (H-mole)/ Gestational Trophoblastic Disease/ Molar Pregnancy Definition: A gestational anomaly of the placenta consisting of a bunch of clear vesicles resembling grapes. This neoplasm is formed from the swelling of the chorionic villi, resulting from a fertilized egg whose nucleus is lost, and the sperm nucleus duplicates, producing a diploid number 46XX. Incidence: Approximately 1 in every 1500 pregnancies. Risk Factors: • Low socioeconomic group (decreased protein intake). • Women under 18 or over 35 years old. • Women of Asian heritage. • Receiving clomiphene citrate (Clomid) for induced ovulation. Types of Molar Growth: • Complete/Classic H-mole: All trophoblastic villi swell and become cystic. No embryonic or fetal tissue present. High risk for malignancy. • Partial/Incomplete H-mole: Some of the villi form normally. Presence of fetal or embryonic tissue. Low risk for malignancy. Signs and Symptoms: • Uterus expands faster than normal. • No fetal heart sounds heard. • Serum or urine test for hCG strongly positive. • Early signs of preeclampsia. • Vaginal bleeding (dark-brown spotting or profuse fresh flow). • Discharge of fluid-filled vesicles. Diagnosis: • Ultrasound. • Chest x-ray (lung metastasis). • Amniocentesis (no fluid). • Hysteroscopy (via cervix). Management: • Evacuation of the mole: Dilation and curettage (D&C). • Blood transfusion. • Hysterectomy (in some cases). • Monitoring hCG levels: Every 2 weeks until normal. • Contraception: Reliable method for 12 months to prevent confusion with a new pregnancy. 4. Premature Cervical Dilatation/ Incompetent Cervix Definition: Premature dilation of the cervix, usually occurring around week 20, when the fetus is too immature to survive. Incidence: About 1% of pregnancies. Causes: • Increased maternal age. • Congenital structural defects. • Trauma to the cervix (cone biopsy, repeated D&C). Signs and Symptoms: • Painless dilation of the cervix. • Pink-stained vaginal discharge. • Increased pelvic pressure. • Rupture of membranes and discharge of amniotic fluid. Therapeutic Management: • Cervical cerclage: Surgical procedure to prevent loss of the child due to premature dilation. • Bed rest: After cerclage surgery, to decrease pressure on the sutures. 5. Abortion Definition: Termination of pregnancy before the fetus is viable (400-500 grams or 20-24 weeks gestation). Types of Abortion: • Spontaneous Abortion: Pregnancy interruption due to natural causes. ◦ Threatened: Mild cramping, vaginal spotting. ◦ Inevitable/Imminent: Profuse bleeding, uterine contractions, cervical dilation. ◦ Complete: All products of conception expelled spontaneously. ◦ Incomplete: Part of the conceptus expelled, some retained in the uterus. ◦ Missed: Fetus dies in utero but is not expelled. ◦ Habitual: 3 or more consecutive spontaneous abortions. • Induced Abortion: Deliberate termination of pregnancy in a controlled setting. Complications of Abortion: • Hemorrhage. • Infection (endometritis, parametritis, peritonitis, thrombophlebitis, septicemia). Management: • Bed rest. • Emotional support. • Sedation. • D&C: Surgical removal of retained products of conception. • Antibiotics. • Blood transfusion. 6. Placenta Previa Definition: The placenta is implanted in the lower uterine segment, covering the cervical os, obstructing the birth canal. Incidence: 5 per 1000 pregnancies. Signs and Symptoms: • Abrupt, painless vaginal bleeding (bright red). • Bleeding may stop or slow after the initial hemorrhage, but continue as spotting. Types: • Total: Placenta completely obstructs the cervical os. • Partial: Placenta partially obstructs the cervical os. • Marginal: Placenta edge approaches the cervical os. • Low-lying: Placenta implanted in the lower rather than the upper portion of the uterus. Therapeutic Management: • Immediate Care: Bed rest in a side-lying position. • Assessment: Monitor vital signs, bleeding, and fetal heart sounds. • Intravenous Therapy: Fluid replacement with large gauge catheter. • Delivery: Vaginal birth (safe for infant if previa is less than 30%). Cesarean section (safest for both mother and infant if previa is over 30%). 7. Abruptio Placenta/ Premature Separation of Placenta/ Accidental Hemorrhage/ Placental Abruption Definition: Separation of a normally implanted placenta after the 20th week of pregnancy, before birth of the fetus. Incidence: Most frequent cause of perinatal death. Causes: • Unknown. • Predisposing Factors: ◦ High parity. ◦ Advanced maternal age. ◦ Short umbilical cord. ◦ Chronic hypertensive disease. ◦ PIH. ◦ Trauma (automobile accident, intimate partner abuse). ◦ Cocaine or cigarette use. ◦ Thrombophilitic conditions (autoimmune antibodies). Classification: • Total/Complete: Concealed hemorrhage. • Partial: Concealed or apparent hemorrhage. Signs and Symptoms: • Sharp, stabbing pain in the uterine fundus. • Contractions accompanied by pain. • Uterine tenderness on palpation. • Heavy vaginal bleeding (may be concealed). • Signs of shock. • Tense, rigid uterus. • Disseminated Intravascular Coagulation (DIC). Therapeutic Management: • Fluid Replacement: IV fluids. • Oxygen: Limit fetal hypoxia. • Fetal Monitoring: External fetal heart rate monitoring. • Fibrinogen Determination: IV fibrinogen or cryoprecipitate. • Lateral Position: Prevent pressure on the vena cava. • Delivery: CS is the method of choice if birth is not imminent. 8. Premature Rupture of Membranes Definition: Rupture of the fetal membranes with loss of amniotic fluid during pregnancy before 37 weeks. Incidence: 5%-10% of pregnancies. Causes: • Unknown. • Associated with: Infection of the membranes (chorioamnionitis), vaginal infections (gonorrhea, streptococcus B, Chlamydia). Signs and Symptoms: • Sudden gush of clear fluid from the vagina with continued minimal leakage. • Nitrazine paper test: Amniotic fluid turns the paper blue (alkaline), urine remains yellow (acidic). • Microscopic examination: Amniotic fluid shows ferning, urine does not. • Ultrasound: Assess amniotic fluid index. • Signs of infection (increased WBC count, C-reactive protein, temperature, tenderness, odorous vaginal discharge). Therapeutic Management: • Bed Rest: To prevent further leakage and risk of infection. • Corticosteroids: To hasten fetal lung maturity. • Prophylactic Antibiotics: To reduce risk of infection. • Intravenous Penicillin/Ampicillin: If (+) for streptococcus B. • Induction of Labor: If fetus is mature and labor does not begin within 24 hours. 9. Pregnancy-Induced Hypertension (PIH)/ Toxemia Definition: Vasospasm occurring in both small and large arteries during pregnancy, causing elevated blood pressure, proteinuria, and edema. Incidence: Rarely occurs before 20 weeks of pregnancy. Risk Factors: • Multiple pregnancy. • Primiparas younger than 20 or older than 40. • Low socioeconomic background. • Five or more pregnancies. • Hydramnios. • Underlying diseases (heart disease, diabetes). • Rh incompatibility. • History of H-mole. Categories: • Gestational Hypertension: Blood pressure 140/90 or greater, without proteinuria or edema. • Preeclampsia: Blood pressure 140/90 or greater, with proteinuria and edema. • Eclampsia: Seizures or coma accompanied by preeclampsia. Therapeutic Management: • Preeclampsia: Bed rest, balanced diet, left lateral position. • Severe Preeclampsia: Hospitalization, diazepam, hydralazine, magnesium sulfate. • Eclampsia: Magnesium sulfate, diazepam, oxygen therapy, left lateral position
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