FETAL CIRCULATION IN HINDI

                                                 

                                  FETAL CIRCULATION IN HINDI

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FETAL  CIRCULATION-

 विकासशील भ्रूण के फेफड़े निष्क्रिय होते हैं। भ्रूण माँ के रक्त के माध्यम से अपने ऑक्सीजन और पोषक तत्वों को प्राप्त करता है, और अपने अपशिष्ट को बाहर निकालता है। यह आदान-प्रदान नाल में होता है। प्लेसेंटा से भ्रूण के ऊतकों और वापस प्लेसेंटा तक रक्त प्रवाह भ्रूण परिसंचरण के रूप में जाना जाता है

 

 

•       PLACENTA- यह एक अस्थायी संरचना है जो मां और भ्रूण के संचार प्रणालियों के बीच पदार्थों के आदान-प्रदान की अनुमति देती है। प्लेसेंटा गर्भाशय की दीवार से मजबूती से जुड़ा हुआ है और मातृ रक्त में नहाए हुए भ्रूण केशिकाओं का एक व्यापक नेटवर्क है। यद्यपि भ्रूण की केशिकाएं मातृ रक्त की आपूर्ति के बहुत करीब हैं, फिर भी दोनों परिसंचरण पूरी तरह से अलग हैं।

 

 

VENOUS BLOOD FLOW TO FETUS

एक नाभि शिरा (Umbilical vein) प्लेसेंटा से ऑक्सीजन युक्त रक्त एकत्र करती है और इसे गर्भनाल के माध्यम से शिशु तक पहुंचाती है। एक विशेष शिरा (डक्टस वेनोसस) है जो नाभि शिरा की एक निरंतरता है जो सीधे भ्रूण की inferior vena  cava में रक्त लौटाती है, और अधिकांश रक्त, इसलिए, गैर-कार्यात्मक भ्रूण यकृत को बायपास करता है। भ्रूण की inferior vena  cava भ्रूण के दिल के दाहिने आलिंद में ऑक्सीजन युक्त रक्त पहुंचाती हैं।

 

भ्रूण के दिल में फेफड़ों को बाईपास करने के लिए दो विशेष अनुकूलन हैं क्योंकि यह पहले से ही ऑक्सीजन युक्त रक्त है। फोरामेन ओवल- यह एक वाल्व की तरह बनता है, जिससे रक्त दाएं आलिंद से बाएं आलिंद से फेफड़ों तक प्रवाह करने की अनुमति देता है।

Ductus arteriosus- डक्टस आर्टेरियोसस- यह छोटी रक्त वाहिका फुफ्फुसीय धमनी को अवरोही थोरैसिक महाधमनी से जोड़ती है और अधिक रक्त को प्रणालीगत परिसंचरण में बदल देती है, जिसका अर्थ है कि भ्रूण के फेफड़ों से बहुत कम रक्त गुजरता है। ऑक्सीजन युक्त रक्त भ्रूण प्रणालीगत परिसंचरण में पंप किया जाता है

दो अपरा धमनियां (Placental arteries)  आंतरिक iliac धमनी से निकलती हैं और कम ऑक्सीजन वाले रक्त को गर्भनाल के माध्यम से प्लेसेंटा तक ले जाती हैं। इस तरह से भ्रूण का संचार पूरा हो जाता है।

 

RETURN OF BLOOD TO PLACENTA

 

Two placental arteries arises from internal iliac artery and carry less oxygenated blood to placenta through umbilical cord . In this way the fetal circulation is completed.

 

CHANGES AT BIRTH

जब बच्चा पहली बार अपने फेफड़ों को फुलाता है, तो फुफ्फुसीय रक्त प्रवाह बढ़ जाता है। फेफड़ों से लौटने वाले रक्त से बाएं आलिंद में दबाव बढ़ जाता है, फोरमैन ओवल पर फ्लैप बंद हो जाता है और एट्रिआ के बीच रक्त के प्रवाह को रोकता है। इसलिए दाएं आलिंद में प्रवेश करने वाले रक्त को दाएं वेंट्रिकल में और फुफ्फुसीय नसों के माध्यम से फुफ्फुसीय परिसंचरण में बदल दिया जाता है। जैसा कि फुफ्फुसीय परिसंचरण स्थापित होता है रक्त ऑक्सीजन का स्तर बढ़ता है, जिससे डक्टस आर्टेरियोसस की कमी और बंद हो जाती है। जब प्लेसेंटल सर्कुलेशन बंद हो जाता है, तो जन्म के तुरंत बाद, नाभि शिरा, डक्टस वेनोसस और नाभि धमनियों का पतन हो जाता है, क्योंकि अब इनकी आवश्यकता नहीं है।

FETAL CIRCULATION IN ENGLISH

                                                    

                                  FETAL CIRCULATION IN ENGLISH

               watch my youtube video to understand this topic in easy way-

   https://www.youtube.com/watch?v=j6jyv8LnJFg

 FETAL  CIRCULATION- The lungs of developing fetus are  inactive. Fetus obtains its oxygen and nutrients, and excretes its waste, via the mother’s blood. this exchange take place in the placenta. The blood flow from placenta to fetus tissues and back to placenta is know as fetal circulation

 

PLACENTA- This is a temporary structure that  allows exchange of substances between  circulatory systems of mother and fetus. The placenta is firmly attached to the uterine wall and consists of an extensive network of fetal capillaries bathed in maternal blood. Although the fetal capillaries are in very close proximity to the maternal blood supply yet the two circulations are completely separate.

 

VENOUS BLOOD FLOW TO FETUS

One umbilical vein collects oxygenated blood  from placenta and travel to infant through umbilical cord. There is a special vein (Ductus venosus) which is a continuation of the umbilical vein that returns blood directly into the fetal inferior vena cava, and most blood, therefore, bypasses the non-functional fetal liver. Fetal inferior vena cava pour oxygenated blood into right atrium of fetal heart.

 

There are two special adaptations in fetal heart to bypass the lungs as it is already oxygenated blood.

•       Foramen ovale- This forms a valve-like opening  allowing blood to flow from  right atrium to the left atrium to bypass lungs.

•       Ductus arteriosus- This small vessel connects the pulmonary artery to the descending thoracic aorta and diverts more blood into the systemic circulation, meaning that very little blood passes through the fetal lungs. Oxygenated blood is  pumped into fetal systemic circulation

 

RETURN OF BLOOD TO PLACENTA

 

Two placental arteries arises from internal iliac artery and carry less oxygenated blood to placenta through umbilical cord . In this way the fetal circulation is completed.

 

CHANGES AT BIRTH

When the baby takes its first breath the lungs inflate for the first time, increasing pulmonary blood flow. Blood returning from the lungs increases the pressure in the left atrium, closing the flap over the foramen ovale and preventing blood flow between the atria. Blood entering the right atrium is therefore diverted into the right ventricle and into the pulmonary circulation through the pulmonary veins.

As the pulmonary circulation is established  blood oxygen levels increase, causing constriction and closure of the ductus arteriosus.  When the placental circulation ceases, soon after birth, the umbilical vein, ductus venosus and umbilical arteries collapse, as they are no longer required.

ECLAMPSITA IN ENGLISH

                                                 

                                          ECLAMPSITA  IN ENGLISH

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ECLAMPSIA-

Eclampsia is a neurological condition associated with preeclampsia, manifesting with tonic-clonic convulsions in pregnancy that are not ssocited with other conditions such as epilepsy

Eclampsia can develop any time from 20 weeks’ gestation up to 6 weeks postpartum. It is an medical emergency and should be dealt with a team of physician and gynecologist

 

CLINICAL MANIFESTATIONS-

•        Preceded by symptoms of severe preeclampsia:

•        Severe headache

•        Visual disturbances

•        Epigastric/RUQ pain

•        Nausea, vomiting

•        Oliguria

•        Seizures

•        Seizure chacacteristics

•        Tonic–clonic convulsions

•        Usually self-limiting (1–2 minutes)

•        It May progress to coma

•        Seizure  may recur

•         

COMPLICATIONS-

•        Complications (Maternal)

•        Cerebral hemorrhage

•        Pulmonary edema

•        HELLP syndrome

•        Renal failure

•        Disseminated Intravascular Coagulation (DIC)

•        Death

•        Complications (fetal/neonatal)

•        Intrauterine Growth Restriction (IUGR)

•        Preterm birth

•        Hypoxia/asphyxia

•        Stillbirth

•        Neonatal death

 

CAUSES AND RISK FACOTRS

Pre-eclampsia  is the precursor of eclampsia so all risk factors of preeclampsia are also risk factors for ecclampsia

 

DIAGNOSTIC INVESTIGATIONS-

• Urine examination for protein

• Blood pressures assesment

• Complete blood count

• Serum electrolytes

• Liver function test

• Serum Urea and Creatinine

• Ultrasound

• Doppler velocimetry

• Electro Encephalo Graphy   (EEG)

 

MANAGEMENT-

Immediate Management-

•        Assessment and maintenance of Airway, Breathing, Circulation (ABC)

•        Place woman in left lateral position

•        Maintain airway, suction if needed

•        Oxygen administration

•        Control seizures with Magnesium Sulphate

Magnesium Sulphate Therapy

     It is the Drug of choice for ecclampsia

•        Loading: 4 g IV slowly + 10 g IM (5 g each buttock)

•        Maintenance: 5 g IM every 4 hours

•        Monitor for toxicity (respiratory depression, reflexes, urine output)

•        Ante hypertensive drugs

Obstetric management

•        Definitive treatment = Delivery

•        Stabilize mother first

•        Assess gestational age, fetal condition

•        Induce labor or perform cesarean section if required

If the woman gives birth vaginally, syntometrine and ergometrine should be avoided to manage the third stage of labour and oxytocin

used instead.

NURSING MANAGEMENT-

•        Management during seizures

•        Stay with patient and call for help

•        Provide Position in left lateral side

•        Loosen all tight clothing

•        Maintain airway, suction secretions

•        Protect from injury (do not force objects into mouth)

•        Management after seizures

•        Monitor vital signs, fetal heart rate

•        Insert IV line for fluids/medications

•        Administer MgSO₄ & antihypertensives as prescribed

•        Monitor urine output (≥30 ml/hr)

•        Document events carefully

•        The baby is likely to be initially cared for on the neonatal unit and the woman should be taken to see her babyas soon as her condition permits.

•        Breastfeeding is to be encouraged and psychological support given by themidwife/nurse and neonatal staff.