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Tuesday, August 11, 2015

Wednesday, August 5, 2015

Placental implantation

Placental implantation. (A)  Normal placenta.  (B)  Low implantation.  (C)  Partial placenta  previa.  (D)  Complete placenta  previa.

Monday, August 3, 2015

Complications of Pregestational Diabetes Mellitus


Uterine contractions and  cervical dilation  result in visceral pain (T10-L1).
Descent of  the  fetal  head and pressure on  the  vagina and perineum  result in somatic pain (pudendal nerve, S2-S4).
In the  absence  of a  medical  contraindication,  maternal  request  is  a  sufficient medical indication for pain relief  during labor.

Absolute  contraindications  to  regional  anesthesia  (epidural,  spinal,  or 
combination) include the following: 

  • Refractory maternal hypotension 
  • Maternal coagulopathy 
  • Maternal  use  of  a  once-daily  close  of  low-molecular-weight heparin within  12  hours 
  • Untreated  maternal bacteremia 
  • Skin infection over the site  of  needle placement 
  • Increase in  ICP caused by a mass lesion

Sunday, August 2, 2015

Pneumococcal polysaccharide vaccine (PPSV) for Adults

Pneumococcal polysaccharide vaccine (PPSV) should be given once to all adults age > 65. it should also be given to all adults age < 65 with chronic diseases:

Chronic lung disease

  • Asthma
  • COPD
  • Emphysema

  • Chronic cardiovascular disease
  • Diabetes mellitus
  • Chronic liver disease
  • Alcoholism
  • Cochlear implants
  • CSF leaks
  • Immunocompromising diseases

Functional or anatomic asplenia

  • Sickle cell
  • Other hemoglobinopathies
  • Splenectomy
  • Acquired asplenia.

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