HEALTH SCIENCE INFORMATION

Explanation 🔻The presence of meconium-stained amniotic fluid and a tachycardic fetal heart rate (FHR) are concerning signs that may indicate fetal distress. 🔻 Initial management of variant FHR patterns aims to correct any fetal insult. i.e to address and rectify the underlying issue causing the abnormal FHR pattern. 🔺 One critical concern is the possibility of a cord accident, such as cord prolapse, which can compromise fetal oxygenation and requires immediate evaluation and intervention. While the other options may also be necessary based on further evaluation, the immediate step should be to ensure there is no cord prolapse or other immediate cause for the fetal distress: ➖ Oxygen via a tightly fitting face mask (6-8 liters/min): This can help improve maternal and fetal oxygenation but should follow the exclusion of a cord accident. ➖ Correct maternal hypotension and dehydration: Important for maternal and fetal well-being but not the immediate next step given the signs of potential acute fetal distress. ➖ Decrease uterine activity by using tocolytics: This may be considered if there is evidence of uterine hyperstimulation, but the immediate step is to check for a cord accident. Therefore, performing a vaginal examination to exclude a cord accident is the most appropriate immediate action. References: 1.Williams obstetrics 26th ed page 1173

Explanation 🟣 Given that the woman has been treated for postpartum hemorrhage, the most important component to emphasize in her counseling is: Nutrition, including iron-rich foods 🔴 Postpartum hemorrhage can lead to significant blood loss, resulting in anemia. Emphasizing the importance of nutrition, particularly iron-rich foods, is crucial for her recovery and to rebuild her blood levels. Proper nutrition will aid in her overall recovery and help prevent complications related to anemia. 🟢 While the other components are also important in postpartum care, addressing nutrition and iron intake is the most immediate concern following a significant hemorrhage.

Explanation 🔸 Sampling Error: This type of error occurs when the sample selected is not representative of the entire population. In this case, by selecting only male secondary school students, the researcher has excluded female students, leading to a biased sample that does not accurately reflect the entire high school student population. Consequently, the proportion of alcohol drinking derived from this sample may not be generalizable to all high school students. 🔸 Random Error: This is variability in the data that arises purely by chance and is inherent in any sampling process. While random error can affect the results, it does not stem from the systematic exclusion of a particular group (like female students in this case). 🔸 Non-systematic Error: This term is not commonly used in statistical contexts. It might be intended to refer to random errors or errors that occur without a specific pattern, but it does not directly address the issue of a biased sample selection. 🔸 Non-sampling Error: These are errors not related to the act of sampling itself but to other factors such as data collection errors, measurement errors, or processing errors. While these can affect the results, they do not explain the problem of excluding a significant portion of the population (female students) from the sample. Conclusion The specific issue here is that the sample is not representative of the whole population (all high school students) because it only includes male students. This is a classic case of sampling error.

Explanation ➖ Unknown LNMP ➖1st TM US performed on 05-02-2016 E.C = 9 week +3 days ➖ Current Date of Visit to hospital: 24-09-2016 E.C Let us Calculate the current Gestational age from the first TM Ultrasound ♦️ First, calculate GA between the two dates: GA from 05-2-2016 to 24-09-2016 is 32 wk + 5d (we do have 25 days from Tikmet,Hidar , Tahesas,Tir, Yekatit,Megabit,miazia,24 days from ginbot) - 25+30+30+30+30+30+30+24 =229 days - 229 days divided by 7 =32wk+5d ♦️ GA before 05-02-2016 is 9 wk+3d Next, add the gestational age from the ultrasound 9 wk+3d to GA between the two dates 32 wk + 5d Finally, (32 wk + 5d) ➕ (9 wk+3d) = 42 wk+1d , 👉So,the estimated gestational age at the time of the visit is approximately 42 weeks and 1 days, which indicates post term pregnancy Normal third trimester pregnancy would be up to 40 weeks. Intrauterine fetal death would not present with a normal FHB. Ultrasound already revealed the number of fetus i.e singleton

Explanation 🔻 During pregnancy, women need to maintain a well-balanced diet that provides essential nutrients for both the mother and the developing fetus. It is important to note that dietary advice during pregnancy should be tailored to the individual's specific needs and should take into consideration any existing health conditions or dietary restrictions. 👉 BMI = 18.5 to <25 kg/m2 is Normal i.e Recommended weight gain in kg is11.5–16 - Moderate carbohydrate and protein diet with adequate vegetables and fruits ➖ Adequate hydration is crucial for overall health and maintaining proper bodily functions. Therefore, advising the pregnant mother to drink plenty of fluids is important to ensure hydration. Water is the best choice for hydration, but other fluids like herbal tea, milk, and fruit juices can also contribute to fluid intake. Staying hydrated helps prevent constipation, supports healthy digestion, and helps maintain amniotic fluid levels. The other options provided are not appropriate advice for a pregnant woman looking to maintain a normal weight gain according to her BMI. ➖ A low fiber diet intake is not recommended as fiber is important for maintaining regular bowel movements and preventing constipation during pregnancy. ➖ High-saturated fatty foods should be limited, as excessive saturated fat intake is associated with increased health risks. Finally, a low intake of protein-rich food is not advisable, as protein is essential for the growth and development of the fetus and the overall health of the mother. This advice aligns with general dietary recommendations for pregnant women to support optimal health and nutrition. References: Eth.National Antenatal Care Guideline | February 2022,page 22

Explanation Case details: ➖Tested HIV Positive ➖Hemoglobin 10g/dl ➖She Planned to become pregnant When to start ART for this woman? Preconception Care Management for HIV-Positive Women 📌 According to current guidelines, ART should be initiated as soon as possible in individuals diagnosed with HIV, regardless of their CD4 count,t clinical stage or hemoglobin level. 📌 Early initiation of ART is crucial for reducing the viral load, improving immune function, and reducing the risk of transmission to the baby if she becomes pregnant. Additionally, immediate initiation of ART helps improve the overall health of the mother. Preconception care: Once a patient is diagnosed to be HIV positive the following should be done: ➕Counseling on the diagnosis and linkage to trained personnel for further counseling. ➕Baseline investigations including CD4 and viral load. ➕Advise on contraception use with focus on avoiding unintended pregnancy; the preference is to give them dual contraception with one of them being condoms. ➕Advise on general health including good nutrition. Adequate caloric intake; consumption of iron rich foods (beans, lentils, meat, liver); iron and folate for three months; and intake of iodized salt. ➕Prevention of malaria: Use of ITN for women living in malaria endemic areas,Screening & treatment for opportunistic infections & STIs. ➕ Initiate ART/ link to PMTCT unit. ART should be initiated for all pregnant and breastfeeding women living with HIV regardless of the clinical stage and CD4 cell count; and continued lifelong. ➕ Discuss future plans for pregnancy and necessary preparations. ➕Provision of prophylaxis for opportunistic infections: Cotrimoxazole for stages 2, 3, 4 HIV/AIDS and those with CD4 <=350. ➕Discuss the importance of partner involvement & screening. ➕Avoid pregnancy for 6 months after recovery from any chronic infections (e.g. Tb). If the patient has a plan of pregnancy counsel on the following: o The impact of HIV on pregnancy. o The risk of MTCT. o Available methods for reduction of MTCT. NOTE: The above-mentioned counseling also applies to pregnant mothers. References: 1. Obstetrics Management Protocol for Hospitals.2020, MOH, Ethiopia. 180 2. Eth National Comprehensive HIV Prevention Care and Treatment Training for Health Care Providers 2020 page 233

Explanation 🔴 After 41 weeks of gestation the risk of perinatal mortality and morbidity increases. Hence to reduce the risk initiate more frequent antepartum fetal wellbeing assessment at 41 weeks. Thus, induction of labor or initiation of fetal surveillance at 41 weeks’ gestation is a reasonable option Gestational age: 41wk+4d based on LNMP and first-trimester ultrasound. Prolonged pregnancy beyond 41 weeks is associated with an increased risk of adverse outcomes. Fundal height and fetal parts palpability: The smaller fundal height and easily palpable fetal parts suggest that the fetus may not be growing adequately, which could be a sign of intrauterine growth restriction. Amniotic fluid index (AFI): The AFI of 2 cm indicates oligohydramnios (low amniotic fluid levels), which may be a sign of placental insufficiency and compromised fetal well-being. Placental location: The anterior and fundal placenta placement is not a contraindication for induction. 🖍 Considering these findings, it is important to initiate labor induction to minimize the risks associated with prolonged pregnancy and ensure the well-being of both the mother and the baby. 🔸 Waiting until labor starts spontaneously may not be recommended in this case due to the increased risks associated with prolonged pregnancy and the presence of other concerning factors. 🔸 Amnioinfusion is typically used for specific indications such as variable decelerations in fetal heart rate due to oligohydramnios, which should be assessed by a healthcare professional. 🔸 Cesarean delivery may be considered if there are additional indications such as non-reassuring fetal status or failed induction, but it is not explicitly indicated based on the information provided. References: 1. Williams obstetrics 26th ed, page 2134 2FMOH, Obstetrics Management Protocol 2021, page,143