Leopold's maneuvers From Wikipedia, the free encyclopedia

Leopold's Maneuvers 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 named after the gynecologist Christian Gerhard Leopold. They are also used to estimate term fetal weight.[1] The maneuvers consist of four

distinct actions, each helping to determine the position of the fetus. The maneuvers are important because they help determine the position and presentation 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 correctly ascertained, and so the maneuvers are not truly diagnostic. Actual position can only

be determined by ultrasound performed by a competent technician or physician. Contents [hide] 1 Performing the maneuvers 1.1 First maneuver: Fundal Grip 1.2 Second maneuver: Umbilical Grip 1.3 Third maneuver: Pawlick's Grip 1.4 Fourth maneuver: Pelvic Grip 2 Cautions 3 References 4 External links [edit]Performing the maneuvers

Leopold's Maneuvers performed by are difficult to perform on obese women and 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 recently emptied her bladder. If she has not, she may need to have a straight urinary catheter inserted to empy it if she is unable to micturate herself. The woman should lie on her back with her shoulders raised slightly on a pillow

and her knees drawn up a little. Her abdomen should be uncovered, and most women appreciate it if the individual performing the maneuver warms their hands prior to palpation. [edit]First maneuver: Fundal Grip While facing the woman, palpate the woman's upper abdomen with both hands. A professional can often determine the size, consistency, shape, and mobility of the form that is felt. The fetal head is hard, firm, round, and moves independently of the trunk while the buttocks feel softer, are

symmetric, and the shoulders and limbs have small bony processes; unlike the head, they move with the trunk. [edit]Second maneuver: Umbilical Grip After the upper abdomen has been palpated and the form that is 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 also 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 then repeated using the opposite side and hands. The fetal back will feel firm and smooth while fetal extremities (arms, legs, etc.) should feel like small irregularities and protrusions. The fetal back, once determined, should connect with the form found in the upper abdomen and also a mass in the maternal inlet, lower abdomen. [edit]Third maneuver: Pawlick's Grip

In the third maneuver the health care provider attempts to determine what fetal part is lying above the inlet, or lower abdomen. [2] 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 yield the opposite information and validate the findings of the first maneuver. If the woman enters labor, this is the part which will most likely come first in a vaginal birth. If it is the head and is not actively engaged in the birthing process, it may be gently 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. [edit]Fourth maneuver: Pelvic Grip 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 gently 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. [edit]Cautions 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. That said, as long as care taken not to roughly or excessively disturb the fetus, there is no real reason it cannot be performed at home as an informational exercise. It is important to note that all findings are not truly diagnostic, and as such ultrasound is required to conclusively determine the fetal position.

Vaccines and Preventable Diseases:

Tetanus (Lockjaw) Vaccination

Tetanus (lockjaw) is a serious disease that causes painful tightening of the muscles, usually all over the body. It can lead to "locking" of the jaw so the victim cannot open his mouth or swallow. Tetanus leads to death in about 1 in 10 cases. Several vaccines are used to prevent tetanus among children, adolescents, and adults including DTaP, Tdap, DT, and Td.

What You Should Know: About the Disease

Vaccine Information Vaccine Safety Who Should Not be Vaccinated?

For Health Professionals: Clinical

Recommendations References & Resources Provider Education Materials for Patients

What You Should Know

About the Disease

Brief description

Symptoms, treatment, transmission, etc.

Pictures of Tetanus Warning: Some of these photos are

quite graphic.

Travelers information

Information and updates on risks for travelers, precautions, prevention, etc.

Vaccine Information
Diphtheria, Tetanus, and Pertussis Vaccines There are four combination vaccines used to prevent diphtheria, tetanus and pertussis: DTaP, Tdap, DT, and Td. Two of these (DTaP and DT) are given to children younger than 7 years of age, and two (Tdap and Td) are given to older children and adults. Several other combination vaccines

contain DTaP along with other childhood vaccines. Children should get 5 doses of DTaP, one dose at each of the following ages: 2, 4, 6, and 15-18 months and 4-6 years. DT does not contain pertussis, and is used as a substitute for DTaP for children who cannot tolerate pertussis vaccine. Td is a tetanus-diphtheria vaccine given to adolescents and adults as a booster shot every 10 years, or after an exposure to tetanus under some circumstances. Tdap is similar to Td but also containing protection against pertussis. Adolescents 11-18 years of age (preferably at age 11-12 years) and adults 19 through 64 years of age should receive a single dose ofTdap. For adults 65 and older who have close contact with an infant and have

not previously received Tdap, one dose should be received. Tdap should also be given to 7-10 year olds who are not fully immunized against pertussis. Tdap can be given no matter when Td was last received. [Upper-case letters in these abbreviations denote full-strength doses of diphtheria (D) and tetanus (T) toxoids and pertussis (P) vaccine. Lower-case d and p denote reduced doses of diphtheria and pertussis used in the adolescent/adult-formulations. The a in DTaP and Tdap stands for acellular, meaning that the pertussis component contains only a part of the pertussis organism.]

Tetanus: Make Sure You and Your Child Are Fully Immunized

Feature explaining tetanus disease and

tetanus vaccine protection

As an adult, do I need this vaccine?

(19 years and older)

Side effects of vaccine

Excerpt from Vaccine Information Statement

Vaccine Information Statement (VIS) (Td/Tdap and DTaP) Questions and Answers
about the various vaccines (DT, DTaP, Td, Tdap)

State Vaccine Requirements

Includes school vaccine requirements

Vaccine Safety
As with all vaccines, there can be minor reactions, including pain and redness at the injection site, headache, fatigue or a vague feeling

of discomfort.

Multiple or combined vaccines and the immune system

TETANUS VACCINE
Tetanus vaccine protects against tetanus, also known as lockjaw. It is recommended that adults receive a booster vaccine every ten years. Standard care in many hospitals is to give the booster to any patient with a puncture wound who is uncertain of when he or she was last vaccinated, or if the patient has had fewer than 3 lifetime doses of the vaccine. The booster cannot prevent a potentially fatal case of tetanus from the current wound, as it can take up to two weeks for tetanus antibodies to form. In children under the age of seven, the tetanus vaccine is often administered as a combined vaccine, TDap or DTaP, which also includes vaccines against diphtheria and pertussis.

For adults and children over seven, the Td vaccine (tetanus and diphtheria) is commonly used.

What is tetanus?
Tetanus is an acute, often-fatal disease of the nervous system that is caused by nerve toxins produced by the bacterium Clostridium tetani. This bacterium is found throughout the world in the soil and in animal and human intestines.

Where do tetanus bacteria grow in the body?

Contaminated wounds are the sites where tetanus bacteria multiply. Deep

wounds or those with devitalized (dead) tissue are particularly prone to tetanus infection. Puncture wounds such as those caused by nails, splinters, or insect bites are favorite locations of entry for the bacteria. The bacteria can also be introduced through burns, any break in the skin, and injection-drug sites. Tetanus can also be a hazard to both the mother and newborn child (by means of the uterus after delivery and through the umbilical cord stump). The potent toxin that is produced when the tetanus bacteria multiply is the major cause of harm in this disease.

How does the tetanus toxin cause damage to the body?

The tetanus toxin affects the site of interaction between the nerve and the muscle that it stimulates. This region is called the neuromuscular junction. The tetanus toxin amplifies the chemical signal from the nerve to the muscle, which causes the muscles to tighten up in a continuous ("tetanic" or "tonic") contraction or spasm. This results in either localized or generalized muscle spasms. Tetanus toxin can affect neonates to cause muscle spasms, inability to nurse, and seizures. This typically occurs within the first two weeks after birth and can be associated with poor sanitation methods in caring for the umbilical cord stump of the neonate. Of note, because of tetanus vaccination programs, only three cases of neonatal tetanus have been reported since 1990, and in each of these cases,

the mothers were incompletely immunized.

What is the incubation period for tetanus?

The incubation period between exposure to the bacteria in a contaminated wound and development of the initial symptoms of tetanus ranges from two days to two months, but it's commonly within 14 days of injury.

What is the course of the tetanus disease? What are the symptoms and signs of tetanus?
During a one- to seven-day period, progressive muscle spasms caused by the tetanus toxin in the immediate wound area may progress to involve the

entire body in a set of continuous muscle contractions. Restlessness,headache, and irritability are common. The tetanus neurotoxin causes the muscles to tighten up into a continuous ("tetanic" or "tonic") contraction or spasm. The jaw is "locked" by muscle spasms, giving the name "lockjaw" (also called "trismus"). Muscles throughout the body are affected, including the vital muscles necessary for normal breathing. When the breathing muscles lose their power, breathing becomes difficult or impossible and death can occur without life-support measures. Even with breathing support, infections of the airways within the lungs can lead to death.

How is tetanus treated?

General measures to treat the sources of the bacterial infection with antibiotics and drainage are carried out in the hospital while the patient is monitored for any signs of compromised breathing muscles. Treatment is directed toward stopping toxin production, neutralizing its effects, and controlling muscle spasms. Sedation is often given for muscle spasm, which can lead to lifethreatening breathing difficulty. In more severe cases, breathing assistance with an artificial respirator machines may be needed. The toxin already circulating in the body is neutralized with antitoxin drugs. The tetanus toxin causes no permanent damage to the nervous system after the patient recovers. After recovery, patients still require

active immunization because having the tetanus disease does not provide natural immunization against a repeat episode.

How is tetanus prevented?

Active immunization ("tetanus shots") plays an essential role in preventing tetanus. Preventative measures to protect the skin from being penetrated by the tetanus bacteria are also important. For instance, precautions should be taken to avoid stepping on nails by wearing shoes. If a penetrating wound should occur, it should be thoroughly cleansed with soap and water and medical attention should be sought. Finally, passive immunization can be administered in selected cases (with specialized immunoglobulin).

What is the schedule for

active immunization (tetanus shots)?

All children should be immunized against tetanus by receiving a series of fiveDTaP vaccinations which generally are started at 2 months of age and completed at approximately 5 years of age. Booster vaccination is recommended at 11 years of age with Tdap. Follow-up booster vaccination is recommended every 10 years thereafter. While a 10-year period of protection exists after the basic childhood series is completed, should a potentially contaminated wound occur, an "early" booster may be given in selected cases and the 10 years "clock" reset.

What are the side effects of tetanus immunization?

Side effects of tetanus immunization occur in approximately 25% of vaccine recipients. The most frequent side effects are usually quite mild (and familiar) and include soreness, swelling and/or redness at the site of the injection. More significant reactions are extraordinarily rare. The incidence of this particular reaction increases with decreasing interval between boosters.

What is passive immunization (by way of specialized immunoglobulin)?

In individuals who exhibit the early symptoms of tetanus or in those whose

immunization status is unknown or significantly out of date, the tetanus immunoglobulin (TIG) is given into the muscle surrounding the wound with the remainder of the dose given into the buttocks.

Tetanus At A Glance

Tetanus is frequently a fatal infectious disease. Tetanus is caused by a type of bacteria (Clostridium tetani). The tetanus bacteria often enter the body through a puncture wound, which can be caused by nails, splinters or insect bites, or burns, any skin break, and injection-drug sites. All children and adults should be immunized against tetanus by receiving vaccinations.

A tetanus booster is needed every 10 years after primary immunization or after a puncture or other skin wound which could provide the tetanus bacteria an opportunity to enter the body.

Rabies definition
Rabies is a disease caused by a virus which affects the central nervous system (brain and spinal cord) both in animals and in humans. Animals infected with this virus can spread the disease through contact with saliva or brain tissue. People can contract the disease through bites, produced both from domestic and wild animals. Due to large vaccination

programs against rabies, the disease is increasingly rare in developed countries, but it is more common in the countries less developed.

Symptoms of rabies
Rabies symptoms usually develop between 20 and 60 days after exposure. Rabid animals may become aggressive, combative, and highly sensitive to touch and other kinds of stimulation. And they can be vicious. Rabies symptoms in humans, are similar. After a symptomfree incubation period, the patient complains of malaise, loss of appetite, fatigue, headache, and fever.

A few facts about the rabies vaccine

No matter where the wound is, authorities emphasize that the first and most important preventive measure is by

cleaning of the site with soap and water, and then go for medical attention. Unlike other immunizations, the rabies vaccine is administered after exposure to the virus. If rabies vaccine treatment is demanded, it should be started immediately after exposure.

About the rabies in humans

Rabies humans is contracted from getting bitten by an animal infected with the rabies virus. Rabies has been recognized for over 4,000 years. However, despite great advances in research technology, today rabies humans is almost always deadly , for the ones who do not receive treatment.

Rabies treatment
Rabies has no cure and death is very

possible. Rabies treatment involves supportive care. But, if a person is bitten by a rabid animal, there is an extremely effective post-exposure treatment, which involves rabies vaccine. An exposed person who has never received any rabies vaccine will first receive a dose of rabies immune globulin for short-term protection.

How rabies transmits

Rabies transmission can be made through a lots of paths. The virus is usually present in the nerves and saliva of a rabid animal. The most common rabies transmission are through bites, scratches from an infected animal. Transmission between humans is extremely rare. There were some cases of rabies transmission in humans through cornea transplant surgery. Rabies can also be transmitted through aerosol path, just by going in a cave of bats.

Modern vaccines The human diploid cell rabies vaccine (H.D.C.V.) was started in 1967. Human diploid cell rabies vaccines are made using the attenuated PitmanMoore L503 strain of

the virus. Human diploid cell rabies vaccines have been given to more than 1.5 million humans as of 2006. Aside from vaccinating humans, another approach was also developed by vaccinating dogs

to prevent the spread of the virus. In 1979 the Van Houweling Research Laboratory of theSilliman University Medical Center in the Philippines, then headed by Dr. George Beran, [5]developed and

produced a dog vaccine that gave a three-year immunity from rabies. The development of the vaccine resulted in the elimination of rabies in many parts of theVisayas and Mind anao Islands. The

successful program in the Philippines was later used as a model by other countries, such as Ecuador and the Yucatan State of Mexico, in their fight against rabies conducted in collaboration with the World Health

Organization.[6] In addition to these developments, newer and less expensive purified chicken embryo cell vaccine, and purified Vero cell rabies vaccine are now available. The purified Vero cell rabies vaccine uses

the attenuated Wistar strain of the rabies virus, and uses the Vero cell line as its host. [edit]Recombinant rabies vaccine (VRG)

Aerially distributed wildlife rabies vaccine in a

bait from Estonia.

In 1984 researchers at the Wistar Institutedeveloped a recombinant vaccin e called V-RG by inserting the glycoprotein gene from rabies into a vaccinia virus.[7] Th e V-RG vaccine has since been

commercialised by Merial under the trademark Raboral. It is harmless to humans and has been shown to be safe for various species of animals that might accidentally encounter it in the

wild, including birds (gulls, hawks, and owls).[8] V-RG has been successfully used in the field in Belgium, France, G ermany and the United States to prevent outbreaks of rabies in wildlife. The

vaccine is stable under relatively high temperatures and can be delivered orally, making mass vaccination of wildlife possible by putting it in baits. The plan for immunization of normal populations involves dropping bait

containing food wrapped around a small dose of the live virus. The bait would be dropped by helicopter concentrating on areas that have not been infected yet. Just such a strategy of oral immunization

of foxes in Europe has already achieved substantial reductions in the incidence of human rabies. In November 2008, Germany had been free of new cases for two years and is therefore currently believed as being

rabies-free, together with few other countries (see below). A strategy of vaccinating neighborhood dogs in Jaipur, India, combined with a sterilization program, has also resulted in a large reduction in the

number of human cases.[9] [edit]Duration of immunity The duration of immunity afforded to humans by various types of rabies vaccine was found to be between 2 to 3 years.[10][11][12]

[edit]

Wound Care Procedures and Treatments

We use a wide variety of treatments at our Wound Care Center, to provide you the best options available. You will work with our staff to put together a treatment program based on your special needs. Your program may include regular visits to the Wound Care Center to provide treatment, evaluate progress and make any changes that might be needed. Some of the treatments we use are listed below: Antibiotic Therapy. Appropriately used antibiotics may be the right option to treat your wound. Changing activity status. By becoming more physically mobile, your blood and oxygen flow can improve and positively

impact the healing of your wound. Compression Therapy. The application of pressure, through compression stockings or dressings, encourages proper blood flow to your wound. Debridement is the process of removing dead tissue from your wound, so that healthy tissue might be allowed to grow back more fully. Learn more about debridement of a wound > Diabetes management. When working in collaboration with your doctor, we can determine the best plan of action to control the impact your diabetes has on your lifestyle. Dressings. This gauze-like material can be applied in a number of ways, and are sometimes treated with topical medication. A typical dressing will begin hard and then turn to soft as it absorbs fluid from your wound. Education. One of the most important tools in healing your wound is teaching you how to take the best care of yourself and prevent future problems.

Good nutrition. Something as simple as eating better and healthier might be prescribed as part of your treatment plan. Offloading, or not putting pressure on the wound, through use of supportive equipment like crutches or a wheelchair. Skin Graft. In certain serious situations, we can remove healthy skin from one part of your body and graft it to the wound. Wound Vacuum. This treatment may be used to remove unnecessary fluid from your wound. Hyperbaric Oxygen Chamber. You might be referred for treatment time in one of our 3 oxygen chambers, which contain 100% pure oxygen. Exposing your wound to pure oxygen encourages better circulation and faster healing.

Remember: You're A Vital Part Of The Program

Much of the success of your treatment depends on you. You must keep your appointments, follow directions carefully and watch your progress closely between visits. Any time you or your family members have questions, we

encourage you to ask questions. You or your caregiver will be given detailed instructions on home care, dressing or bandage changes and protecting the wound from further injury. Learn home treatment and prevention techniques >

Wound Care Introduction

A wound is a break in the skin (the outer layer of skin is called the epidermis). Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some scarring. The object of proper care is to minimize the possibility of infection and scarring. There are basically 4 phases to the healing

process:

Inflammatory phase: The inflammatory phase begins with the injury itself. Here you have bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells clear the wound of debris over the course of several days. Proliferative phase: Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The

collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar.

Remodeling phase: This begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vesseldensity becomes less, and the wound begins to lose its pinkish color. Over the course of 6 months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin. Epithelialization: This is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss andbacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open

wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis).