The five-day session was described as fraught with tension and disagreement because most of the states were "concerned about the economic implications of migration, looking at the effects of remittances," said Mohammad Zia-ur-Rehman, chief executive of leading Pakistani NGO Awaz Foundation. He said the connection between health and migration was frequently overlooked.
References Introduction The practice of epidurals and spinals in Obstetrics relies on the palpation of anatomical landmarks that are not always easy to feel. A good assessment of the spine includes a careful examination to determine if the vertebrae are aligned, and to locate the iliac crests, the lumbar spinous processes and the interspaces.
These are the landmarks required to perform a safe lumbar puncture, because they identify the level of the spine at which the puncture should be performed and the optimal puncture site.
Other important aspects of the technique such as the angle of puncture and the distance from the skin to the ligamentum flavum cannot be assessed based on inspection and palpation.
If a patient is overweight or has scoliosis, or even worse, is overweight and scoliotic, the appropriate assessment of the lumbar spine becomes even more challenging, increasing changes of failures An introduction to the advantages of sonograms complications of the spinal or epidural anesthesia placement.
Complications of spinal and epidural anesthesia include patient discomfort, trauma to various structures such as nerves, vessels, ligaments and bones, and accidental dural punctures with subsequent postdural puncture headaches. In the past, these complications have been minimized or avoided by meticulous assessment of the landmarks, optimal positioning of the patient and refinement of the technique.
Now, with the availability of bedside ultrasound, we can "see" more of the anatomical structures and our technique has become much less blind.
Perhaps it is appropriate to say that the "art" is giving way to the technology. Ultrasound has recently been utilized to facilitate lumbar spinals and epidurals. Spinal ultrasound is especially challenging, because the structures we need to image are protected by a very complex, articulated encasement of bones, which affords very limited acoustic windows for the ultrasound beam.
In addition, the structures we want to visualize are located even deeper than we are accustomed to when we use ultrasound for peripheral nerve blocks or central lines. For these reasons, the ultrasound probe used for spinals and epidurals must be a low frequency, curved probe mHz.
The low frequency ultrasound beam penetrates deeper, but loses in image resolution. There are two acoustic windows that are effective for lumbar spine sonographic assessment: The information from each of these two scanning planes supplements the other. Typical sonogram of an interspace in the transverse plane.
Artistic enhancement to facilitate memorization of the pattern flying bat. Compared to ultrasound for peripheral nerve blocks where a number of different sonographic patterns have to be memorized, spinal ultrasound is simpler in the sense that only two patterns have to be memorized: For the transverse approach, the typical view is that of a flying bat Figure 1 ; for the longitudinal approach, that of a saw Figure 2.
Typical sonogram of the sacrum and multiple interspaces in the longitudinal plane. Artistic enhancement of the "saw" pattern.
The acoustic window provided by the longitudinal plane is superior to that provided by the transverse plane, such that one can often see the ligamentum flavum and the posterior dura as distinct structures Figure 3. The elements of the interspace can be easily identified, including distinct images of the posterior dura mater, the epidural space and the ligamentum flavum.
The vertebral body-posterior longitudinal ligament-anterior dura mater is seen as a single unit. Back to Top of Page Transverse approach The structures that will be identified by the ultrasound include the spinous process Figure 4the articular processes, the transverse processes, the vertebral body, the ligamentum flavum, the posterior longitudinal ligament, and the anterior and posterior dura mater Figure 5.
Typically, with the current resolution of our equipments, the ligamentum flavum and the posterior dura are seen as a single structure, similar to the anterior dura, the posterior longitudinal ligament and the vertebral body. Typical sonogram of the spinous process in the transverse plane.
The spinous process is seen as a hyperechoic signal close to the skin in slim patientscontinuing as a vertical acoustic shadow, sometimes triangular in shape. Typical sonogram of an interspace in the transverse plane, showing very symmetric images of transverse and articular processes on each side, in addition to the ligamentum flavum-posterior dura mater and the vertebral body-posterior longitudinal ligament-anterior dura mater.
Back to Top of Page Step-by-step assessment of the typical lumbar spine The patient should be positioned similar to the positioning for the actual placement of an epidural. It is suggested that novices learn with the patient sitting first.
The scanning is performed initially in the left paramedian longitudinal plane. With the top of the buttock crease as a starting point, the ultrasound probe is moved in a cephalad direction in the left paramedian longitudinal plane in order to identify the upper end of the sacrum L5-S1 interspaceand to determine the level of each lumbar interspace above.
When a given interspace is aligned with the center of the screen as if there were a virtual vertical line at the center of the screen crossing the "interspace"the midpoint of the probe is marked on the skin.
The clinician can mark one targeted interspace, or also has the luxury of marking all five lumbar interspaces. Once the intervertebral levels are marked on the skin with a regular pen, the ideal insertion point for each interspace can be determined.
This is done by switching the probe to the transverse plane. The insertion point is the intersection of the midline and the interspace.Installation. Download the installer file from initiativeblog.com.
Once done, double-click the downloaded file to start the installation. Medical ultrasound (also known as diagnostic sonography or ultrasonography) is a diagnostic imaging technique based on the application of ultrasound.
It is used to see internal body structures such as tendons, muscles, joints, blood vessels, and internal organs. Abstract and Introduction Abstract.
Quantitative image analysis in sonograms of the thyroid gland Introduction Ultrasonography is the most widely accepted imaging The advantages of this method are its mobility, low cost. The introduction of Ultrasound had so many advantages to expecting parents. The past decades there had been many studies showing those benefits, most were published in . High-resolution, real-time ultrasound is a routine examination for assessing the disorders of the thyroid gland. However, the current diagnosis practice is based mainly on qualitative evaluation of the resulting sonograms, therefore depending on the physician's experience.
H.L. is a year-old woman, gravida 2 para admitted to the birth unit at 38 and 6/7 weeks' gestation . Enabling women to control the number and spacing of their children is essential to reducing maternal deaths and human misery.
Over million women, mostly in the least developed countries, want to use modern family planning methods but can't access them, facing cultural barriers or family resistance, or not having access to contraceptives, or .
Note: The introduction is the same in each section of the Prenatal Testing FAQs. If you've already read it, you may want to skip ahead. All pregnant women in our technology-happy modern society face confusing choices about prenatal testing, its advantages and disadvantages, and its appropriateness for them.
A bistable b-scan image of the maternal abdomen showing abdominal circumference and placenta using a compound contact scanner (Diasonograph®) without gray-scale in the late s.
B-scan image with gray scale of a similar section of the maternal abdomen showing abdominal circumference and placenta using the Nuclear Enterprise® NE .