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February 2004

February 2004. Evolution of Human Birth. Relationship of Pelvis to Fetal Skull. Spider Monkey Proboscis Macaque Gibbon. Orangutan Gorilla Chimpanzee. HUMAN. -Adolph Schultz. Mento Anterior Extended Head Delivers by extn Non Rotational Delivery

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February 2004

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  1. February 2004

  2. Evolution of Human Birth

  3. Relationship of Pelvis to Fetal Skull Spider Monkey Proboscis Macaque Gibbon Orangutan Gorilla Chimpanzee HUMAN -Adolph Schultz

  4. Mento • Anterior • Extended Head • Delivers by extn • Non Rotational • Delivery • Narrow • Shoulders • Baby slips out Primate Delivery • Delivers in • Squatting posture • Reaches down & • Guides baby out of • Birth canal towards • Nipples • Infant assists by • climbing out • Wipes mucus • from mouth • Suckles stat!

  5. Human Posture at DeliveryStudy of 159 cultures-Trevathan 1987 • Sitting 47 • Kneeling 44 • Squatting 26 • Semi Reclining 17 • Lying Down 16 • Standing 9

  6. Fundamental Differencesin Human Birth • Habitual Bipedalism – Delivery Posture • High Encephalization Quotient • Occipito Anterior Position ( Fetus facing away from Mother’s pubes) • Rotational Delivery of Head & shoulders

  7. Fundamental Differencesin Human Birth • Obligatory Midwifery • Delivery in Social Context ( Versus Solitary in Monkeys ) • Physical & Emotional Support • Baby in ‘Altrecial’ state followed by ‘Exterogestation’ -BJOG Nov 2002

  8. TVT for Stress Incontinence • >100 Procedures • in 40 years • Rise &Fall of • -Antr Repair • -Bone Anchors • -Endoscopic Suspensions • TVT 1996 Ulmsten Stanton - Int Urogyn J 2001

  9. Bladder Neck Elevation Mid Urethral Support Urethral Compression

  10. SUCCESS RATE Intrinsic Sphincter Defect & Low Pressure Urethra 74% Mixed Incontinence 85% In Recurring SI 82% COMPLICATIONS Bladder Perforation 6% Voiding Difficulty 4% Haematoma Rare

  11. Results of TVT – Austrian RegistryObs Gyn 2001 • 2795 Patients – 55 Centres • 59% underwent isolated TVT – 41% with other Procedures • Median Operating Time: 30 mts • Anaesthesia: LA 44% - SA 43% - GA 12% • Most voided next day ( Catheter: Intermittent 24% - Indwelling 63% -Suprapubic 9%) • Complications: Bl Perf 2.7% ( 4.4% prev surg ) - Hematoma 19 - Re op 2.4%

  12. Cannibal finds a willing Victim No canines!

  13. Armin Meiwes: "Fantasy fulfilled" • Advertised on Internet - • >400 responded • Interviewed four • Selected Bernd Brandes • Killed,cooked,froze & ate 20kg • of flesh over several weeks • No Law against cannibalism • In Germany • Charged with Murder for • Sexual pleasure • Defence: Victim was willing • -He only abetted Euthanasia

  14. Woman delivers her own Grandchildren 46 year old mother became surrogate for her Indian immigrant daughter in UK with Rokitansky Syndrome and delivered Twins -News

  15. What is the Legal status in India? “Gestational mother is the legal Mother” • Grandmother becomes the Legal Mother of twins • Husband of legal mother is the legal father • Grandfather becomes the Legal Father • Genetic (real) mother becomes the twins’ sister • Genetic (real) father becomes the brother in law

  16. Is there a Solution? • The Genetic Parents must adopt the Twins • Can a woman adopt her sister as her daughter? • Can a man adopt his SIL as his Daughter? • But the Hindu Adoptions Maintenance Act 1956 says: • A Hindu married woman can adopt only if her husband is incapable of giving consent or ceased to be a Hindu • The genetic father’s wife can not adopt his child even if she is the genetic mother

  17. Obesity • BMI >30 (Kg/sq cm) Overweight: 25 - 29.9 - WHO– NIH Definition • Incidence in Females: 28% (>25 yrs) + 27% in others in US – 18% in UK – 40% of Married women in UAE • Obst Complications: Chr HT-PE-DM-CS-Infections-Thr Embolism-Resp Disorders • NN Complications: NTD-LGA-PNM-Childhood Obesity • Gynaecological / Surgical / Medical / Anaesthetic complications -Castro LC & Avina RL: Cur Opinion ObG Jan2003

  18. Obesity • 17% of Children • Between 13-18 years • Overweight or Obese • -WHO study in Chennai • 80% of obese children • Grow into obese Adults Michael 13 Himanshu 15

  19. Bariatric Surgery • Laparoscopic Application • Adjustable Silicon Band • At proximal portion of • Stomach to form pouch • Early satiety • Reversible • Up to 80% excess • wt lost in 2 yrs

  20. Bev & Deb 245 lbs July 02 125 lbs July 03

  21. Thank you!

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