Shared Flashcard Set

Details

Exam 1
Exam 1 Study Guide
124
Anatomy
Professional
01/30/2013

Additional Anatomy Flashcards

 


 

Cards

Term
What is the usual position of the uterine body in the pelvis?
Definition
anteverted & anteflexed
Term
What percentage of the uterine bodies are rotated backwards in the pelvis?
Definition
20%
Term
[image]
Definition
Line one: from sacral promontory to the upper pubic symphysis represents pelvic inlet. above this line is the ‘false’ or greater pelvis.
Line two: from coccyx to lower border of the pubic symphysis, represents the pelvic outlet The true pelvis lies between lines one and two
Term
What is the percentage of women that have a Gynecoid, Anthropoid, Android or a Platypelloid type of pelvis?
Definition
Gynecoid - female (50%)
Anthropoid - ape (20-25%)
Android - male (20-30%)
Platypelloid - wide bowl (3-5%)
Term
Explain Normal Uterine Polarity during Labor
Definition
Normal Polarity - Neuromuscular harmony of the uterus to expel the fetus.
a. Upper Pole - Fundus - pushes fetus down
b. Lower Pole - retracts the muscle up and stretches the cervix open.
Term
Explain Labor complications regarding Primary & Secondary Inertia
Definition
Complications - weak contractions
c. Primary or Hypotonic Inertia
I. longer labor, NOT exhausting
II. may increase hemorrhage in 3rd staged.

Secondary Inertia or Exhaustion -
I. can cause obstructive labor and fetal distress due to placental pressure
Term
Explain Bandl’s Contraction Ring of Hypertonic Lower Pole
Definition
a. retraction ring in lower pole that is too tight to allow easy passage of fetus
b. Hour Glass shape uterus
c. Obstructive to labor
Term
Explain Mal-position regarding the Passenger during Labor
Definition
Mal-position
a. OP - occiput posterior
b. pendulous abdomen
c. abnormal pelvis
Term
Excessive Maturity regarding the Passenger during Labor
Definition
a. Poor fit
b. increases time
c. poor molding of head
Term
What is considered to be the effect of a C-1 Subluxation
Definition
Blood supply to pituitary
Sympathetic nervous function
a. Organic function
b. Infertility
c. miscarriage
Term
What is considered to be the effect of a C-7 Subluxation
Definition
Thyroid gland function
a. Anovulation
b. Infertility
Term
What is considered to be the effect of a T-9 & T-10 Subluxation
Definition
Adrenal gland function
a. Decreased ovulation
I. infertility
b. Adrenal failure
I. infertility
Term
What is considered to be the effect of a T-12 Subluxation in women
Definition
WOMEN: Fallopian tube function
– Infertility
– Ectopic pregnancy
• Ovarian function
– Maturation and release of ovum
• Maintenance of pregnancy
– infertility or miscarriage
• Uterine function
– Implantation & gestation of fetus
– infertility or miscarriage
Term
What is considered to be the effect of a T-12 Subluxation in men
Definition
Testicular function
– Maturation & release of sperm
– infertility
• Penile function
– Erection,
– flow of sperm
– infertility
Term
What is considered to be the effect of a L-4 Subluxation in men
Definition
Prostate gland function
a. Decreased viability of sperm
I. infertility
Term
What is considered to be the effect of a Sacral & Coccygeal Subluxation
Definition
Function of cervix
a. Menstrual reflux
I. Endometrosis
1. Infertility
b. Cervical incompetence
I. 2nd trimester miscarriage
Term
What are three 3 types of signs of pregnancy?
Definition
presumptive signs, probable signs, positive signs
Term
– symptoms and sensations that, while possible indicating pregnancy, could also be caused by other reasons.
Definition
presumptive signs
Term
symptoms that, most of the time indicate pregnancy but in certain cases might be false or caused by other conditions
Definition
probable signs
Term
cannot be mistaken for any other conditions, absolute evidence that one is pregnant
Definition
positive signs
Term
What are the Presumptive signs of pregnancy?
Definition
Amennorhea
Nausea and or vomiting (morning sickness)
Unexplained fatigue
Frequent need to urinate
Breast enlargement (tight, tender & tingling)
Ptyalism – excessive salivation
bladder symptoms (Teeny Weenie Bladder)
Skin changes: Most are due to darkening or concentration of the pigment in specific areas of skin.
• Cholasma - mask of pregnancy - face color
• Linea Nigra - dark line down center of abdomen
• Areola’s of breast - darken
• Birthmarks & scars - darken
Quickening – sensation of movement in the abdomen
Term
What are the Probable signs of pregnancy?
Definition
Positive pregnancy test – presence of HCG detected by blood or urine test
Abdominal enlargement -Palpable uterus above the pubis
Ladin’s sign - central soft spot at uterocervical junction
Hegar’s sign - soft spot enlarges to include the entire junction
McDonald sign - uterus can be flexed in half at soft junction
Goodell’s sign - bluish coloring and soften of the cervix at 6 – 8 weeks especially the TIP of the cervix (feels like the lip vs the nose)
Chadwick’s / Jacquemier’s sign - bluish coloration of cervix, vagina, and vulva due to blood vessel congestion at 6 – 8
Kluge’s sign -varicosity's of the vulva
Braun VonFernwald’s sign - softening of the uterus at the spot of implantation
Piskacek’s sign - softening of the uterine cornu, esp. if at the site of implantation
Osiander’s sign - visible pulsation of blood vessels at vaginal fornices
Operculum - mucus plug in the cervical os
Term
Positive pregnancy test –
Definition
presence of HCG detected by blood or urine test
Term
Abdominal enlargement -
Definition
Palpable uterus above the pubis
Term
central soft spot at uterocervical junction is known as ___ sign
Definition
Ladin’s sign
Term
soft spot enlarges to include the entire junction is known as ___ sign
Definition
Hegar’s sign
Term
uterus can be flexed in half at soft junction is known as ___ sign
Definition
McDonald sign -
Term
bluish coloring and soften of the cervix at 6 – 8 weeks especially the TIP of the cervix (feels like the lip vs the nose) is known as ___ sign
Definition
Goodell’s sign -
Term
varicosity's of the vulva is known as ___ sign
Definition
kluge
Term
softening of the uterus at the spot of implantation is known as___ sign
Definition
Braun Vonferwald sign
Term
softening of the uterine cornu, esp. if at the site of implantation is known as ___ sign
Definition
Piskacek’s sign -
Term
visible pulsation of blood vessels at vaginal fornices is known as ___ sign
Definition
Osiander’s sign
Term
mucus plug in the cervical os is known as ___ sign
Definition
Operculum
Term
intermittent contractions of the uterus after the 3rd month is known as ___ sign
Definition
Braxton Hicks sign or Contractions
Term
What are the Positive signs of pregnancy?
Definition
ALL FETAL:
• Parts felt - Leopold’s maneuver
• Movement - felt by doctor - at exam
• Detecting Heartbeat - 2:1 rate to mom
• Funic Soufflé - murmur of umbilicus blood flow at heart rate of Fetus
• Visualizing Skeleton - X-ray or US
Term
What week is the uterus considered palpable abdominally
Definition
7 weeks
Term
What week is the fetal heart audible with a fetascope
Definition
24 weeks
Term
What week are the fetal parts palpable for Leopold’s Maneuver
Definition
26 weeks
Term
What is often blamed for the nausea & vomiting (morning sickness) of early pregnancy?
Definition
increased estrogen and hCG in the circulation
Term
What week of pregnancy is often represented when the uterine fundal height reaches the umbilicus of the pregnant woman?
Definition
20 weeks
Term
What are the weight gains listed for each Trimester in general?
Definition
1st - Trimester = increased eating - 5 lbs
2nd - Trimester = increase in supporting structures and fluid retention - 5 - 10 lbs
3rd - Trimester = growth of fetus - 10 - 20 lbs
Term
What is noted as the 1st sign of subluxation in pregnancy?
Definition
ribs
Term
What is the cause of the “masked anemia of pregnancy”?
Due solely to hemodilution
Definition
due solely to hemodilution
Term
What could be a result of severe hyperemesis gravidarum?
Definition
it could lead to dehydration and liver damage
Term
At what week should the fetal head be turned down most of the time?
Definition
34 weeks
Term
How is the EDC determined using Naegele’s Rule vs. EDD not using Nagele’s Rule?
Definition
EDD calculated as 280 days from first day of the last known menstrual period
Easiest way-
a. Add 9 months + 7 Days from 1st day of last known menstrual period
Naegele’s Rule (EDC)
b. subtract 3 months from LMP then add one year and 7 days
Term
What is the percentage of pregnant women that will actually deliver within 14 days either side of the EDD?
Definition
80%
Term
What are the “risk factors’ you would discuss with the pregnant patient?
Definition
Eating disorder
Caffeine
Alcohol
Smoking and Marijuana
Toxins and pesticides
a. Painting has long been recognized as an unsafe activity for pregnant women. most experts recommend that women avoid painting while they are pregnant.
b. Pesticides and insecticides have been linked to birth defects, especially with exposure during the first trimester
c. Toxoplasmosis – cat & bird litter, soil, undercooked infected foods.
Disorders not related to the Pregnancy
Disorders that require Surgery
Anemia
Fevers
General Infections
Urinary Tract Infections
Thrombo-embolitic Disease
Term
What is the advice to be given to pregnant women regarding exercise?
Definition
Continue level prior to preg. with a reduced schedule as the preg. requires due to physical limitations

decreasing or increasing activity will jeopardize mother and baby if extremeTYPES - for everyone - Pelvic Rock or tilt and Kegel squeeze, walking

NOT Advisable – to start a vigorous new exercise routine if not previously an exerciser
Term
List the 8 increased risk issues related to smoking during pregnancy.
Definition
Increased risk of an ectopic pregnancy
Increased risk of miscarriage or stillbirth - 115,000 miscarriages and 5,600 stillbirths annually
Increased risk of placenta previa,
Increased risk of placental abruption.
Increased risk of preterm birth.
Increased risk of apnea (breathing lapses) and Sudden Infant Death Syndrome (SIDS or crib death) in babies born to mothers who smoked or babies who were exposed to second hand smoke after birth
Greater chance of genetic defects, such as cleft palate or cleft lip
Increased vaginal bleeding
Term
Among the common complaints listed what are the 2 Traumatic Neuritis conditions listed & what causes them?
Definition
a. Meralgia Paresthetica (superficial femoral cutaneous nerve)
b. Sciatica (Sciatic nerve)
Term
What are the recognized follow-up visits intervals during normal pregnancy
Definition
should occur at 4-wk intervals until 32 wk of pregnancy, at 2-wk intervals until 36 wk, and then weekly until delivery
Term
When does the placenta take over the production of hormones from the Ovaries known as the “switch” also known to be the most common time for spontaneous abortions to occur?
Definition
the 8th - 12th week, or the end of the 1st Tri
Term
What are the signs of pre-eclampsia?
Definition
Increased BP
Proteinuria
Excessive edema
Term
What is “Lightening” regarding the final week of pregnancy?
Definition
Due mainly to engagement of the Fetal head into the pelvis, This is the process where the Fetal head engages into the pelvis at the beginning of the LABOR process.
Although, dilation & contractions may not have started so this isn’t called LABOR just because Lightening occurs. Could be a week before labor
Term
What do the terms “gravidity, Parity & Viable” mean?
Definition
• Gravidity = the total number of pregnancies of any duration.
• Parity = the total number of viable deliveries, NOT the number of babies delivered regardless of their life status
• If fetus is capable of living on its own after delivery (through labor or abortion)
Term
What is the difference between “Still Birth” & “Abortion”?
Definition
If delivery occurs after 26 weeks its called ‘viable’ and if it is dead its a ‘still birth’ but if it lives then dies its not a ‘still birth’.

• If delivery occurs before 26 weeks its called an ‘abortion, NOT counted as a delivery.
Term
What do the terms “primigravida, secundigravida & multigravida” mean?
Definition
Primigravida = preg. for the first time
Secundigravida = preg. for the 2nd time
Multigravida = preg. for the 3rd or more times
Term
What do the terms “primipara & multipara” mean?
Definition
Primipara = delivered one viable preg., even if twins or more
Multipara = delivered two or more viable preg.’s even if twins or more.
Term
When should Folic Acid be started regarding pregnancy and what is the recommended daily intake?
Definition
• 400 mcg daily
– starting at least a month before you begin trying to get pregnant.
• Folic Acid= can reduce the risk of neural tube defects
up to 70% !
Term
What B-vitamin enhances Folic Acid utilization?
Definition
Vitamin B12 (especially with zinc)
Term
What is the amount of Calcium pregnant women need daily?
Definition
1,000mg a day
Term
What is the recommended amount of DHA Omega-3 for pregnant women?
Definition
200mg a day
Term
What is the age to which a child may have an advanced attention span when a pregnant woman takes sufficient DHA?
Definition
a. age 2
Term
What was the percentage (%) of lowered risk of Pre-eclampsia in women that took 200mg of Co-Enzyme Q10?
Definition
10%
Term
What supplement is thought to increase the in-utero baby’s immune system and may reduce the risk of exzema by 58% during the first three months of life?
Definition
Probiotics
Term
Other than Folic Acid what supplement may protect against development of neural tube defects?
Definition
Inositol (B-8)
Term
What is the recommended daily amount of Folic Acid during pregnancy?
Definition
400 mcg daily – 600 mcg
Term
What is the recommended amount of Folic Acid for pregnant women that have had a baby with a neural tube defect previously?
Definition
4 milligrams daily
Term
What is the recommended amount of Iron for pregnant women?
Definition
27 milligrams
Term
How does the intake of caffeine (as much as 2 cups of coffee daily) affect risk of miscarriage or preterm birth?
Definition
It does not appear to lead to miscarriage or preterm birth
Term
Explain the “Lie” regarding the fetal position & Leopold’s evaluation.
Definition
The Lie is the relation of the long axis of the fetus to the mother. Only a longitudinal lie is normal.
Term
What is meant by the “Fetal Presentation” during Leopold’s evaluation?
Definition
That part of the fetus that occupies the lower pole of the uterus.
Term
In the Cephalic Presentation what is the Brow Presentation?
Definition
Head, it is extended or bent backwards. This would be called a brow presentation. It is difficult to deliver because the widest diameter of the head enters the pelvis first
Term
In the Cephalic Presentation what is the Face Presentation?
Definition
a. Fetus head is extended all the way back. This allows a face or chin to present first in the pelvis. If there is adequate room in the pelvis, the fetus may be delivered vaginally
Term
In the Cephalic Presentation what is the Vertex Presentation?
Definition
Full flexion, every fetal joint flexed
Term
What are the 4 “Attitudes of the Presentation” regarding the fetal position?
Definition
A. Complete flexion.
Normal attitude in cephalic presentation. Complete flexion at the head when the fetus "chin is on his chest." This allows the smallest cephalic diameter to enter the pelvis, which gives the fewest mechanical problems with descent and delivery.
B. Moderate flexion or military attitude (Deflexed or Sinciput)
Fetus head is only partially flexed or not flexed. It gives the appearance of a military person at attention. A larger diameter of the head would be coming through the passageway.
C. Poor flexion or marked extension (Brow)
Head, it is extended or bent backwards. This would be called a brow presentation. It is difficult to deliver because the widest diameter of the head enters the pelvis first. This type of cephalic presentation may require a C/Section if the attitude cannot be changed.


D. Hyperextended (Facial)
Fetus head is extended all the way back. This allows a face or chin to present first in the pelvis. If there is adequate room in the pelvis, the fetus may be delivered vaginally
Term
Normal attitude in cephalic presentation.
Definition
complete flexion
Term
Fetus head is only partially flexed or not flexed. It gives the appearance of a military person at attention. A larger diameter of the head would be coming through the passageway.
Definition
moderate flexion (deflexed or sinciput)
Term
Head, it is extended or bent backwards. This type of cephalic presentation may require a C/Section if the attitude cannot be changed.
Definition
Poor flexion or marked extension (Brow)
Term
Fetus head is extended all the way back. This allows a face or chin to present first in the pelvis. If there is adequate room in the pelvis, the fetus may be delivered vaginally
Definition
hyperextended
Term
found in cases of flat maternal pelvis
head flexed with parietal bone as presenting part
considered to be asynclitic (when saggital suture of fetal skull is tilted either anteriorly or posteriorly instead of being aligned with the pelvic planes of the mother) impact has to do with lateral flexion of head and pressure of the parital bone on either sacrum or pubic bone
Definition
Parietal Presentation:
Term
1 in 200 - 300 births,transverse lie, denominator is shoulder, often need to fracture clavicle or humerus to decrease the presenting diameter
Definition
Shoulder Presentation
Term
prolapse of a limb alongside the presenting part
The arm along side the head being the most common
Definition
Compound Presentation:
Term
In the Breech Presentation what is a Frank Breech?
Definition
flexion at the hips & extension of the knees, feet first
Term
In the Breech Presentation what is a Complete Breech?
Definition
Flexion at both the hip & knee joints, feet first
Term
In the Breech Presentation what is a Footling Breech?
Definition
One or both hips & knees in partial or intermediate extension
sometimes called incomplete breech
Term
What is the risk with Breech Presentations?
Definition
Intracranial hemorrhage
rupture of falx cerebri/tentorium
rapid moulding
neck injury
Erb’s palsy
SCM injury from traction
uterine rupture
prolapsed cord
dislocation of baby’s hip joint from traction
premature placental rupture/ apnea
rupture of internal organs
genital edema
shoulder dislocation
fractured clavicle
Term
occiput facing maternal symphysis pubis
if the occiput is between the ischial spines & the symphysis it is called either right or left occiput anterior
Definition
Occiput Anterior (OA):
Term
occiput located halfway between the sacral prominence and the pubic symphysis
designated either right or left
Definition
Occiput Transverse (OT):
Term
as the occiput position moves toward the sacrum it becomes occiput posterior, either direct, right, or left
(upside down baby)
Definition
Occiput posterior (OP):
Term
What is engagement as related to decent of the fetus?
Definition
The descent of the biparietal diameter through the pelvic brim.
Term
Describe “Station” regarding the Fetal descent into the pelvis.
Definition
Position of baby in regards to lines below head
Term
What is considered a good APGAR score at 1 minute and at 5 minutes?
Definition
7 or higher at 1 minute
8 or higher at 5 minutes is normal
Term
What is a bad APGAR score at 1 minute and at 5 minutes?
Definition
Three or less at one minute indicates need for full active resuscitation
Six or less at 5 minutes suggest perinatal asphyxia and possible neurological problems
Term
Explain Appearance regarding APGAR scores.
Definition
Color norm is completely pink body and extremities this would be a score of 2
If body is pink but hands and/or feet blue, this indicates acrocyanosis (score of 1) (acro – tip, extremity)
If mucous membranes such as lips, appear blue then central cyanosis is likely
This suggest body is not getting adequate oxygen
This would be a score of zero
Term
Explain Pulse regarding APGAR scores.
Definition
Absent (0)
Slow – below 100 (1)
Normal – over 100 (2)
Term
What is indicated by a unilateral flexion problem regarding Activity of the extremities?
Definition
suggest possible fractured clavicle or brachial plexus lesion
Term
Explain Respiration regarding APGAR scores.
Definition
Crying absent (0)
Weak, slow cry (1)
Strong cry (2)
Term
Explain Caput Succedaneum & and how to tell the difference.
Definition
Caput Succedaneum: Swelling on head of newborn extending across suture lines of the skull, Due to subcutaneous serous fluid
Usually resolves within hours to days
Term
Explain Cephalohematoma
Definition
Sub-periosteal hematoma
Located above and confined to area of single cranial bone
Resolves within several weeks
Term
At what week in-utero does the fetal respiratory develop Alvioli and is considered full term?
Definition
36-41 weeks
Term
What is Meconium Aspiration Syndrome and why is it bad?
Definition
Sign of fetal distress
Common cause of CP
May coat alveoli and impede flow of oxygen across the alveoli
Term
In Pulmonary Stenosis what might the signs be in an older child?
Definition
Thickened pulmonary valve
Mild – asymptomatic
Moderate – mild dyspnea with exercise
Severe – dyspnea and fatigue with mild exertion
Squats down during play
Term
Explain Tetralogy of Fallot.
Definition
Pulmonary stenosis
a. Causes right ventricular hypertrophy
Ventricular septal defect
Right ventricular hypertrophy
Over – riding aorta
b. Directly over ventricular septal defect instead of over left ventricle
c. Aorta thus contains some blood from right ventricle causing reduction of oxygen in the blood
Term
Explain the Rooting Reflex as an Autoimatism.
Definition
Touch or stroke infant’s cheek or corner of mouth
Turns head toward stimulus and opens mouth
Last 3 or 4 months
Term
Explain the Moro Reflex as an Autoimatism.
Definition
Supine infant stimulated by sudden loud noise or movement of it’s head
Symmetrical extension of extremities, fingers fan out except for thumb and forefinger forming ‘C’, extension of spine and neck. All followed by bringing extremities back into position of flexion
Strongest during the first 8 weeks of life and bone by 4 months of age
Term
Explain the Fencer Reflex as an Autoimatism.
Definition
Infant supine, examiner turns head to one side
Extension of extremities on side of head rotation
Last until 4th to 6th month of life (reflex to keep them from rolling off something)
Term
Explain the Stepping Reflex as an Autoimatism
Definition
Infant held upright, under the arms allowing plantar surface of feet to touch table top while inclining baby’s body slightly forward
Automatic walking should occur
Term
Explain the Reverse Fencer Reflex as an Autoimatism.
Definition
Inverted:
Infant gently held suspended by ankles in head down position. Flex one leg at knee and hip.
Head should rotate toward side of flexed leg
Movement should be free and easy
Discomfort will result with the head turning mechanism if there is upper cervical subluxation (C1, C2, occiput).
Will override reflex and return head to center then restart cycle

Supine:
Examiner next puts femur heads under constant pressure, pushing it into acetabulum.
Should be equal & firm
If one side feels ‘mushy’ it’s probably side of lateral atlas
If no difference from one side to other then most likely occiput subluxation
Term
What are the listed Minor Symptoms that may go un-noticed or ignored?
Definition
Irritability
Lethargy
Poor – feeding
Restlessness
Term
What percentage was given regarding newborn subluxation of the subocciputal region?
Definition
11.9%
Term
What were upper cervical fixations associated with regarding efficient therapies for babies?
Definition
disturbed sleep patterns and head posture anomalies
Term
Regarding Sleep Habits History what was associated with preference for one position?
Definition
May have upper cervical subluxation with associated head tilt or rotation
Term
Regarding Feeding Habits History explain the ‘draught reflex’.
Definition
“Milk let-down reflex”
OR
“Milk ejection response”
Term
Regarding Feeding Habits History explain what the Colostrum looks like and when it occurs.
Definition
A yellowish fluid that is secreted by the breast even before the birth.
Term
Regarding Feeding Habits History explain the suggested function of Colostrum.
Definition
Suggested function is a ready made supply of antibodies for the baby, pending self production.
High in protein & gamma-globulin
Lower in fat & carbohydrates than milk
Term
Regarding Feeding Habits History explain what the benefits are of Colostrum from breast feeding.
Definition
Aids development of baby’s immune system
Immunoglobulins (particular IgA)
Term
Regarding Feeding Habits History explain the ‘Milk Production’ regarding breast milk.
Definition
Colostrum - 1-3 days - antibodies & protein
First milk - 4-10 days - protein & fat
True milk - 10th day on - fat & protein
Term
Regarding Feeding Habits History what are the problems that occur more often in Formula fed babies?
Definition
Seven times more likely to develop eczema than exclusively breast fed babies
Have higher incidence of gastrointestinal and respiratory infections than breast fed babies
Term
What is the rule of 3’s for Colic?**TQ
Definition
a. Cries more than 3 hours each day
b. More than 3 days each week
c. Starts around 3 weeks of age last to 3 months
Term
Regarding Fever History explain the fever level that would cause you to refer as possible pathological issues.
Definition
IN THE FIRST 2 MONTHS OF LIFE, ANY BABY WITH A FEVER OF 38 DEGREES CELSIUS OR HIGHER (101F) SHOULD BE IMMEDIATELY EVALUATED BY AN APPROPRIATE PHYSICIAN
Term
Explain Trauma History regarding early trauma as well as the ability of the spine to stretch due to Ligament laxity.
Definition
Earliest form of spinal trauma may be due to stresses on the vertebral column while in-utero
Common cause of spinal problems in infants:
 In-utero constraint
 Long arduous labor & birth
 Birthing procedures
 Sudden movement of head on neck
 Falls
 Parents tossing infant in the air
 Falls
 MVA

Infant spinal column can stretch up to 2 inches due to inherent ligament laxity, such a degree of axial stretch may cause neurological damage such as spinal cord rupture and hemorrhage.
May produce only subtle symptoms and go unnoticed by the parents
Any child that has been involved in MVA should undergo thorough neurological examination
Term
Explain Vaccine History regarding which vaccines are expected in the first 4 months.
Definition
DPT
OPV/IPV
E-IPV
HIB
HEP-B
Supporting users have an ad free experience!