In obstetrics, Leopold's Maneuvers are a common and systematic way to determine the position of a fetus inside the woman's uterus. They are used to estimate term fetal weight; the maneuvers consist of each helping to determine the position of the fetus. The maneuvers are important because they help determine the position and lie of the fetus, which in conjunction with correct assessment of the shape of the maternal pelvis can indicate whether the delivery is going to be complicated, or whether a Cesarean section is necessary; the examiner's skill and practice in performing the maneuvers are the primary factor in whether the fetal lie is ascertained. Alternately, position can be determined by ultrasound performed by a physician. Leopold's Maneuvers are difficult to perform on obese women who have polyhydramnios; the palpation can sometimes be uncomfortable for the woman if care is not taken to ensure she is relaxed and adequately positioned. To aid in this, the health care provider should first ensure that the woman has emptied her bladder.
If she has not, she may need to have a straight urinary catheter inserted to empty it if she is unable to micturate herself. The woman should lie on her back with her shoulders raised on a pillow and her knees drawn up a little, her abdomen should be uncovered, most women appreciate it if the individual performing the maneuver warms their hands prior to palpation. While facing the woman, palpate the woman's upper abdomen with both hands. An obstetrician can determine the size, consistency and mobility of the form, felt; the fetal head is hard and moves independently of the trunk while the buttocks feel softer, are symmetric, the shoulders and limbs have small bony processes. After the upper abdomen has been palpated and the form, found is identified, the individual performing the maneuver attempts to determine the location of the fetal back. Still facing the woman, the health care provider palpates the abdomen with gentle but deep pressure using the palm of the hands. First the right hand remains steady on one side of the abdomen while the left hand explores the right side of the woman's uterus.
This is repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities should feel like small irregularities and protrusions; the fetal back, once determined, should connect with the form found in the upper abdomen and a mass in the maternal inlet, lower abdomen. In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen; the individual performing the maneuver first grasps the lower portion of the abdomen just above the pubic symphysis with the thumb and fingers of the right hand. This maneuver should validate the findings of the first maneuver. If the woman enters labor, this is the part which will most come first in a vaginal birth. If it is the head and is not engaged in the birthing process, it may be pushed back and forth; the Pawlick's Grip, although still used by some obstetricians, is not recommended as it is more uncomfortable for the woman. Instead, a two-handed approach is favored by placing the fingers of both hands laterally on either side of the presenting part.
The last maneuver requires that the health care provider face the woman's feet, as he or she will attempt to locate the fetus' brow. The fingers of both hands are moved down the sides of the uterus toward the pubis; the side where there is resistance to the descent of the fingers toward the pubis is greatest is where the brow is located. If the head of the fetus is well-flexed, it should be on the opposite side from the fetal back. If the fetal head is extended though, the occiput is instead felt and is located on the same side as the back. Leopold's maneuvers are intended to be performed by health care professionals, as they have received the training and instruction in how to perform them. If performed at home as an informational exercise, the examiner should take care to not or excessively disturb the fetus, it is important to note that all findings are not diagnostic, as such ultrasound may be required to conclusively determine the fetal position. Leopold's Maneuver Demo Video
France the French Republic, is a country whose territory consists of metropolitan France in Western Europe and several overseas regions and territories. The metropolitan area of France extends from the Mediterranean Sea to the English Channel and the North Sea, from the Rhine to the Atlantic Ocean, it is bordered by Belgium and Germany to the northeast and Italy to the east, Andorra and Spain to the south. The overseas territories include French Guiana in South America and several islands in the Atlantic and Indian oceans; the country's 18 integral regions span a combined area of 643,801 square kilometres and a total population of 67.3 million. France, a sovereign state, is a unitary semi-presidential republic with its capital in Paris, the country's largest city and main cultural and commercial centre. Other major urban areas include Lyon, Toulouse, Bordeaux and Nice. During the Iron Age, what is now metropolitan France was inhabited by a Celtic people. Rome annexed the area in 51 BC, holding it until the arrival of Germanic Franks in 476, who formed the Kingdom of Francia.
The Treaty of Verdun of 843 partitioned Francia into Middle Francia and West Francia. West Francia which became the Kingdom of France in 987 emerged as a major European power in the Late Middle Ages following its victory in the Hundred Years' War. During the Renaissance, French culture flourished and a global colonial empire was established, which by the 20th century would become the second largest in the world; the 16th century was dominated by religious civil wars between Protestants. France became Europe's dominant cultural and military power in the 17th century under Louis XIV. In the late 18th century, the French Revolution overthrew the absolute monarchy, established one of modern history's earliest republics, saw the drafting of the Declaration of the Rights of Man and of the Citizen, which expresses the nation's ideals to this day. In the 19th century, Napoleon established the First French Empire, his subsequent Napoleonic Wars shaped the course of continental Europe. Following the collapse of the Empire, France endured a tumultuous succession of governments culminating with the establishment of the French Third Republic in 1870.
France was a major participant in World War I, from which it emerged victorious, was one of the Allies in World War II, but came under occupation by the Axis powers in 1940. Following liberation in 1944, a Fourth Republic was established and dissolved in the course of the Algerian War; the Fifth Republic, led by Charles de Gaulle, remains today. Algeria and nearly all the other colonies became independent in the 1960s and retained close economic and military connections with France. France has long been a global centre of art and philosophy, it hosts the world's fourth-largest number of UNESCO World Heritage Sites and is the leading tourist destination, receiving around 83 million foreign visitors annually. France is a developed country with the world's sixth-largest economy by nominal GDP, tenth-largest by purchasing power parity. In terms of aggregate household wealth, it ranks fourth in the world. France performs well in international rankings of education, health care, life expectancy, human development.
France is considered a great power in global affairs, being one of the five permanent members of the United Nations Security Council with the power to veto and an official nuclear-weapon state. It is a leading member state of the European Union and the Eurozone, a member of the Group of 7, North Atlantic Treaty Organization, Organisation for Economic Co-operation and Development, the World Trade Organization, La Francophonie. Applied to the whole Frankish Empire, the name "France" comes from the Latin "Francia", or "country of the Franks". Modern France is still named today "Francia" in Italian and Spanish, "Frankreich" in German and "Frankrijk" in Dutch, all of which have more or less the same historical meaning. There are various theories as to the origin of the name Frank. Following the precedents of Edward Gibbon and Jacob Grimm, the name of the Franks has been linked with the word frank in English, it has been suggested that the meaning of "free" was adopted because, after the conquest of Gaul, only Franks were free of taxation.
Another theory is that it is derived from the Proto-Germanic word frankon, which translates as javelin or lance as the throwing axe of the Franks was known as a francisca. However, it has been determined that these weapons were named because of their use by the Franks, not the other way around; the oldest traces of human life in what is now France date from 1.8 million years ago. Over the ensuing millennia, Humans were confronted by a harsh and variable climate, marked by several glacial eras. Early hominids led a nomadic hunter-gatherer life. France has a large number of decorated caves from the upper Palaeolithic era, including one of the most famous and best preserved, Lascaux. At the end of the last glacial period, the climate became milder. After strong demographic and agricultural development between the 4th and 3rd millennia, metallurgy appeared at the end of the 3rd millennium working gold and bronze, iron. France has numerous megalithic sites from the Neolithic period, including the exceptiona
The Apgar score is a method to summarize the health of newborn children against infant mortality. Virginia Apgar, an anesthesiologist at NewYork–Presbyterian Hospital, developed the score in 1952 to quantify the effects of obstetric anesthesia on babies; the Apgar score is determined by evaluating the newborn baby on five simple criteria on a scale from zero to two summing up the five values thus obtained. The resulting Apgar score ranges from zero to 10; the five criteria are summarized using words chosen to form a backronym. The test is done at 1 and 5 minutes after birth and may be repeated if the score is and remains low. Scores 7 and above are normal. A low score on the one-minute test may show that the neonate requires medical attention but does not indicate a long-term problem if the score improves at the five-minute test. An Apgar score that remains below 3 at times, such as 10, 15, or 30 minutes, may indicate longer-term neurological damage, including a small but significant increase in the risk of cerebral palsy.
However, the Apgar test's purpose is to determine whether or not a newborn needs immediate medical care. It is not designed to predict long-term health issues. A score of 10 is uncommon, due to the prevalence of transient cyanosis, does not differ from a score of 9. Transient cyanosis is common in babies born at high altitude. A study that compared babies born in Peru near sea level with babies born at high altitude found a significant average difference in the first Apgar score but not the second. Oxygen saturation was lower at high altitude; some ten years after initial publication, a backronym for APGAR was coined in the United States as a mnemonic learning aid: Appearance, Grimace and Respiration. Spanish: Apariencia, Gesticulación, Respiración. Another eponymous backronym from Virginia Apgar's name is American Pediatric Gross Assessment Record. Another mnemonic for the test is “How Ready Is This Child?”, which summarizes the test criteria as Heart rate, Respiratory effort, Irritability and Color.
Ballard Maturational Assessment Bishop score Glasgow Coma Scale Paediatric Glasgow Coma Scale Apgar, Virginia. "The Newborn Scoring System: Reflections and Advice". Pediatric Clinics of North America. 13: 645–650. Online calculator of the Apgar score
Hemodynamics or hæmodynamics is the dynamics of blood flow. The circulatory system is controlled by homeostatic mechanisms, such as hydraulic circuits are controlled by control systems. Hemodynamic response continuously monitors and adjusts to conditions in the body and its environment, thus hemodynamics explains the physical laws. Blood flow ensures the transportation of nutrients, metabolic wastes, O2 and CO2 throughout the body to maintain cell-level metabolism, the regulation of the pH, osmotic pressure and temperature of the whole body, the protection from microbial and mechanical harms. Blood is best studied using rheology rather than hydrodynamics. Blood vessels are not rigid tubes, so classic hydrodynamics and fluids mechanics based on the use of classical viscometers are not capable of explaining hemodynamics; the study of the blood flow is called hemodynamics. The study of the properties of the blood flow is called hemorheology. Blood is a complex liquid. Blood is composed of plasma and formed elements.
The plasma contains 7 % proteins and 1.5 % other solutes. The formed elements are platelets, white blood cells and red blood cells, the presence of these formed elements and their interaction with plasma molecules are the main reasons why blood differs so much from ideal Newtonian fluids. Normal blood plasma behaves like a Newtonian fluid at physiological rates of shear. Typical values for the viscosity of normal human plasma at 37 °C is 1.4 mN·s/m2. The viscosity of normal plasma varies with temperature in the same way as does that of its solvent water; the osmotic pressure of solution is determined by the number of particles present and by the temperature. For example, a 1 molar solution of a substance contains 6.022×1023 molecules per liter of that substance and at 0 °C it has an osmotic pressure of 2.27 MPa. The osmotic pressure of the plasma affects the mechanics of the circulation in several ways. An alteration of the osmotic pressure difference across the membrane of a blood cell causes a shift of water and a change of cell volume.
The changes in shape and flexibility affect the mechanical properties of whole blood. A change in plasma osmotic pressure alters the hematocrit, that is, the volume concentration of red cells in the whole blood by redistributing water between the intravascular and extravascular spaces; this in turn affects the mechanics of the whole blood. The red blood cell is flexible and biconcave in shape, its membrane has a Young's modulus in the region of 106 Pa. Deformation in red blood cells is induced by shear stress; when a suspension is sheared, the red blood cells deform and spin because of the velocity gradient, with the rate of deformation and spin depending on the shear-rate and the concentration. This can influence the mechanics of the circulation and may complicate the measurement of blood viscosity, it is true that in a steady state flow of a viscous fluid through a rigid spherical body immersed in the fluid, where we assume the inertia is negligible in such a flow, it is believed that the downward gravitational force of the particle is balanced by the viscous drag force.
From this force balance the speed of fall can be shown to be given by Stokes' law U s = 2 9 μ g a 2 Where a is the particle radius, ρp, ρf are the particle and fluid density μ is the fluid viscosity, g is the gravitational acceleration. From the above equation we can see that the sedimentation velocity of the particle depends on the square of the radius. If the particle is released from rest in the fluid, its sedimentation velocity Us increases until it attains the steady value called the terminal velocity, as shown above. Hemodilution is the dilution of the concentration of red blood cells and plasma constituents by substituting the blood with colloids or crystalloids, it is a strategy to avoid exposure of patients to the potential hazards of homologous blood transfusions. Hemodilution can be normovolemic, which implies the dilution of normal blood constituents by the use of expanders. During acute normovolemic hemodilution, blood subsequently lost during surgery contains proportionally fewer red blood cells per millimetre, thus minimizing intraoperative loss of the whole blood.
Therefore, blood lost by the patient during surgery is not lost by the patient, for this volume is purified and redirected into the patient. On the other hand, hypervolemic hemodilution uses acute preoperative volume expansion without any blood removal. In choosing a fluid, however, it must be assured that when mixed, the remaining blood behaves in the microcirculation as in the original blood fluid, retaining all its properties of viscosity. In presenting what volume of ANH should be applied one study suggests a mathematical model of ANH which calculates the maximum possible RCM savings using ANH, given the patients weight Hi and Hm. To maintain the normovolemia, the withdrawal of autologous blood must be replaced by a suitable hemodilute. Ideally, this is achieved by isovolemia exchange transfusion of a plasma substitute with a colloid osmotic pressure. A colloid is a fluid containing particles that are large enough to exert an oncotic pressure across the micro-vascular membrane; when debating the use of colloid or crystalloid, it is imperative to think ab
Linea nigra referred to as a pregnancy line, is a linear hyperpigmentation that appears on the abdomen. The brownish streak is about a centimeter in width; the line runs vertically along the midline of the abdomen from the pubis to the umbilicus, but can run from the pubis to the top of the abdomen. For pregnant women, linea nigra is attributed to increased melanocyte-stimulating hormone made by the placenta, which causes melasma and darkened nipples. Fair-skinned women show this phenomenon less than women with darker pigmentation. Linea nigra disappears within a few months after delivery. Although linea nigra is discussed outside pregnancy and females of all ages may have it. Except in pregnancy, both genders have highest and equal prevalence of linea nigra from age 11 to 15; this increase in prevalence could be the result of hormonal changes during puberty. After age 15, the prevalence of linea nigra in males declines; the prevalence for both genders drops to below 10% after age 30. Chadwick's sign Linea alba List of cutaneous conditions Perineal raphe Media related to Linea nigra at Wikimedia Commons
James Read Chadwick
James Read Chadwick was an American gynecologist and medical librarian remembered for describing the Chadwick sign of early pregnancy in 1887. James Chadwick received a B. A. at Harvard in 1865, an M. D. from Harvard Medical School in 1871, studied obstetrics in Europe from 1871 to 1873, worked as a gynecologist in Boston. From 1874 he worked at the Boston City Hospital, helping to found the gynecological department, taught at Harvard Medical School, he helped to found, became secretary and president of the American Gynaecological Society. He was a founder of the Boston Medical Library Association in 1875, worked as the librarian until his death, he was voted president of the Association of Medical Librarians in 1904. He was the first president of the Harvard Medical Alumni Association in 1891, he was a supporter of women in the practice of medicine, writing a report which cited the contributions of women in medicine. A strong advocate of cremation, he was president of the Massachusetts Cremation Society from 1894 until his sudden death in 1905 at his summer home in New Hampshire as a result of a fall from a piazza roof.
He contributed many articles on his specialty to the Transactions of the American Gynecological Association, the Boston Medical and Surgical Journal, the American Journal of Obstetrics, among others
The labia are part of the female genitalia. In humans, there are two pairs of labia: the labia majora are larger and fattier, while the labia minora are folds of skin between the outer labia; the labia protect the clitoris and the openings of the vagina and the urethra. Labium is a Latin-derived term meaning "lip". Labium and its derivatives are used to describe any lip-like structure, but in the English language, labium specifically refers to parts of the vulva; the labia majora commonly called outer labia or outer lips, are lip-like structures consisting of skin and adipose tissue, which extend on either side of the vulva to form the pudendal cleft through the middle. The labia majora have a plump appearance, are thicker towards the anterior; the anterior junction of the labia majora is called the anterior commissure, below the mons pubis and above the clitoris. To the posterior, the labia majora join at the posterior commissure, above the perineum and below the frenulum of the labia minora.
The grooves between the labia majora and labia minora are known as the interlabial sulci or interlabial folds. The labia minora called inner labia or inner lips, are two soft folds of fat-free, hairless skin between the labia majora, they enclose and protect the vulvar vestibule and vagina. The upper portion of each labium minora splits to join with both the clitoral glans, the clitoral hood; the labia minora meet posterially at the frenulum of the labia minora, a fold of skin below the vaginal orifice. The fourchette is more prominent in younger women, recedes after sexual activity and childbirth; when standing or with the legs together, the labia majora entirely or cover the moist, sensitive inner surfaces of the vulva, which indirectly protects the vagina and urethra, much like the lips protect the mouth. The outer surface of the labia majora is pigmented skin, develops pubic hair during puberty; the inner surface of the labia majora is smooth, hairless skin, which resembles a mucous membrane, is only visible when the labia majora and labia minora are drawn apart.
Both the inner and outer surfaces of the labia majora contain sebaceous glands, apocrine sweat glands, eccrine sweat glands. The labia majora have fewer superficial nerve endings than the rest of the vulva, but the skin is vascularized; the internal surface of the labia minora is a thin moist skin, with the appearance of a mucous membrane. They contain many sebaceous glands, have eccrine sweat glands; the labia minora have many sensory nerve endings, have a core of erectile tissue. The color, size and shape of the inner labia can vary extensively from woman to woman. In some women the labia minora are non-existent, in others they can be fleshy and protuberant, they can range in color from a light pink to brownish black, texturally can vary between smooth and rugose. The biological sex of an individual is determined at conception, the moment a sperm fertilizes an ovum, creating a zygote; the chromosome type contained in the sperm determines the sex of the zygote. A Y chromosome results in a male, an X chromosome results in a female.
A male zygote will grow into an embryo and form testes, which produce androgens causing male genitals to be formed. Female genitals will be formed in the absence of significant androgen exposure; the genitals begin to develop after 4 to 6 weeks of gestation. The external genitals develop the same way regardless of the sex of the embryo, this period of development is called the sexually indifferent stage; the embroyo develops three distinct external genital structures: a genital tubercle. Sexual differentiation starts on the internal sex organs at about 5 weeks of gestation, resulting in the formation of either testes in males, or ovaries in females. If testes are formed, they begin to secrete androgens that affect the external genital development at about week 8 or 9 of gestation; the urogenital folds form penile shaft in males. The labioscrotal swellings become the labia majora in females, or they fuse to become the scrotum in males; because the male and female parts develop from the same tissues, this makes them homologous.
Sexual differentiation is complete at around 12 weeks of gestation. The genital tissues are influenced by natural fluctuations in hormone levels, which lead to changes in labia size and elasticity at various life stages. At birth, the labia minora are well-developed, the labia majora appear plump due to being exposed to maternal hormones in the womb; the labia majora have the same color as the surrounding skin. Labial adhesions can occur between the ages of 3 months and 2 years, may make the vulva look flat; these adhesions are not a cause for concern, disappear without treatment. Treatment options may include estrogen cream, manual separation with local anesthesia, or surgical separation under sedation. During early childhood, the labia majora look flat and smooth because of decreasing levels of body fat, the diminished effects of maternal hormones; the labia minora become less prominent. During puberty, increased hormone levels significantly change the appearance of the labia; the labia minora become more elastic and wrinkled.
The labia majora regai