Академический Документы
Профессиональный Документы
Культура Документы
IE or bimanual examination
IE
Gloved hand
Palpate vaginal wall, cervix
Bimanual examination
2 hands
Palpate adnexa and uterus
Rectovaginal exam
Done in gyne should be smooth and thin
Explain: ipapasok ko lang po yung daliri ko sa pwetan ninyo para matignan kung may
bukol
Remove middle finger and insert in anus
14
-3
+7
+1
EDC: 6
15 or June 6, 2015
AOG computation:
Sept
29
Oct
31
Nov
30
Dec
31
Jan
30
Feb
28
Mar
06
185/7= 26.4 or 26 weeks & 4 days
AOG by Ultrasonography
In the first trimester, gestational sac mean diameter and crown-rump length measurements
have become the primary means of evaluating gestational age. In the second and third
trimesters, fetal head, body, and extremity measurements have been commonly used to
assess gestational age. Those parameters most commonly measured include biparietal
diameter, head circumference, abdominal circumference, and femur length.
Infection screen - Rubella, syphillis, hep B, HIV, TB - important because of the congenital
malformations or deformities it can cause to the fetus
Cystic fibrosis screen Urine drug screen Hgb electrophoresis
5. Demonstrate adequate communication skill in explaining the diagnostics to an
obstetric patient
Good morning po mommy, so ngayon po kukunan lang po naming kayo ng dugo
at ihi, tapos po
6. Formulate 3 d/dx for a given case (bleeding first trimester) (From a Journal by
Bastiaan Jager) REMEMBER, BIBIGYAN TAYO NG CASE SO ETO MGA. POSSIBLE NA SAGOT
TANDAAN NYO PARA MARAMI KAYO PEDE PAGPILIAN DEPENDE SA CASE
Originating from uterus, tubes, amniotic sac with its contents or placenta:
Ectopic pregnancy (see Chapter 12)
Miscarriage (see Chapter 13)
Miscarriage with infection (see Chapter 13)
Molar pregnancy (see Chapter 27)
Subchorionic hemorrhage
Idiopathic bleeding in a viable pregnancy
Originating from cervix or vagina:
Infection (Chlamydia, etc.) (see Chapter 17)
Trauma (e.g. after intercourse, medical treatment)
Malignancies, especially cervix cancer (see Chapter 26)
Cervical abnormalities (e.g. excessive friability or polyps) (see Chapter 9)
UTI, schistosomiasis
Fundal height (cm) should correlate to gestational age (weeks) 3. If not, consider
inaccurate dating (most common), multiple gestations, or molar pregnancy. Past
approximately 36 weeks gestation, the fundal height may not correspond to the gestational
age due to the fetal descent into the pelvis.
An NST usually takes 2040 min to complete. If the NST is nonreactive, the baby may
be asleep. If this is suspected, ask the patient to eat or drink to make the baby active
if not reactive within 12 hours, then additional testing may need to be performed.
Function
Fetal Doppler machines have a small wand that is pressed onto your stomach. The wand
emits a form of ultrasound waves to convert the sound waves that are in your uterus into an
audible heartbeat. Most ultrasound machines in your doctors office have a Doppler function;
on these machines, the Doppler can also produce a visual representation of the blood cells
as they move through your babys blood vessels.
To measure the babys heartbeat, you simply count the number of these beats over a
minutes time; you can also count the number in 15 seconds and multiply that by 4.
Typically, a babys heartbeat is in the range of 120 to 160 beats per minute; if you get lower
than that, you may be hearing your heartbeat across the placenta and not the babys.
Placental abruption. Premature separation of placenta from uterine wall before the
delivery of baby
RISK FACTORS
o Trauma (usually shearing, such as a car accident).
o Previous history of abruption.
o
o
o
o
Vasa previa. A condition in which the unprotected fetal cord vessels pass over the
internal cervical os, making them susceptible to rupture when membranes are
ruptured.
Velamentous insertion. Fetal vessels insert in the membranes and travel unprotected
to the placenta. This leaves them susceptible to tearing when the amniotic sac
ruptures. The vessels are usually covered by Whartons jelly in the umbilical cord
until they insert into the placenta.
Uterine rupture. The disruption of the uterine musculature through all of its layers,
usually with part of the fetus protruding through the opening.
Circumvillate placenta.
Extrusion of cervical mucus (bloody show).
12. ENUMERATE
BASELINE FHR: the mean level of FHR when this is stable, excluding
acceleration and deceleration. It is determined over a period of 5-10 minutes and
expressed in beats per minute (BPM)
BASELINE VARIABILITY: the minor fluctuation in baseline FHR occuring at 3-5
cycles per minute. It is measured by estimating the difference in beat per minutes
between highest peak and the lowest trough of fluctuation in one minute segment
of trace. It is considered reduced if less than 5
ACCELERATION: transient inc in FHR of 15 bpm or more and lasting 15 seconds
or more
DECELERATION: transient episodes of slowing FHR below the baseline level or
more than 15 bpm and lasting 15 sec or more
10 AL-OS, BANAL, CALUMA, CAVANEYRO, MANALASTAS, MARALLI, MEJIA,
MOJARES & ONG
SBCM BATCH 2017
TYPES OF DECELERATION
1. Early deceleration - uniform, repetitive, periodic slowing of FHR with onset
early in the contraction and return to baseline at the end of contraction
2. Late deceleration - uniform repetitive periodic slowing of FHR with onset mid to
end of contraction and nadir more than 20 second after the peak of contraction
and ending after the contraction
(Nadir: worst and lowest point something)
3. Variable deceleration: variable, intermittent periodic slowing of FHR with rapid
onset and recovery. Time relationships with contraction cycle are variable and
they may occur in isolation
4. Prolonged deceleration: an abrupt dec in FHR to level below baseline last
atleast 60-90 sec. These decelerations become pathological if they cross to
contraction: >3 mins
5. Atypical variable: variable deceleration with any of the following additional
deceleration component - loss of primary or secondary ruse in baseline rate slow return to baseline FHR after the end of contraction - prolonged secondary
rise in baseline - continuation of baseline rate at lower level
6. Sinusoidal pattern:
a regular oscillation
of baseline long term
variability resembling
a sine wave. This
smooth, undulating
pattern lasting at
least 10 min and
amplitude of 5-15
CAUSES OF FHR
BRADYCARDIA bradycardia: <100
bpm
1. Fetal hypoxia - bradycardia is a late sign of fetal hypoxia (continual lack of
oxygen) - the heart rate slow in response to a depression of heart muscle
(myocardial) activity caused by this continued decrease in needed oxygen
2. Medication: narcotics
3. Epidural: causes vasodilation
4. Synthetic oxytocin / pitocin: bradycardia via hyperstimulation of the uterine
muscle
5. Maternal hypotension
CAUSES OF TACHYCARDIA -161-180 (suspicious) - >180 pathological
1. FETAL HYPOXIA: early sign of hypoxia 2. Medication: terbutaline
1.
Vesicles
Excoriation
2. Palpate vaginal walls
Mass
Cyst
3. Cervix
Dilatation how open the cervix (1-10cm)
Effacement how thin the cervix feels and measured in % (0% cervix long and
thick, 10% cervix is paper thin
Position leans towards the back (posterior) behind the baby's back
Station how far the baby's head has come down into the pelvis
Assess the fetal presentation (head, foot, buttocks)
BIMANUAL EXAMINATION
palpate the uterus by pressing it between your right middle and index fingers and your left hand
placed on the lower abdomen. Feel for any masses
You should also try to palpate each of the ovaries. This is done by placing your internal fingers in
the right fornix and trying to press the ovary between them and your left hand placed in the right
iliac fossa.
Rectovaginal examination
The rectovaginal exam is a diagnostic tool that helps doctors to more fully examine the internal
pelvic anatomy and check the vaginal and rectal areas for abnormalities.
feel for signs of tumors that might be located behind the uterus, on the lower walls of the vagina
or in the rectum.
evaluate the tissue between the uterus and vagina, the tone and alignment of the pelvic organs
(like the ovaries and fallopian tubes) and the ligaments that hold the uterus in place.
failure to progress
20 hours or more for nulli and 14 hours or more for multi
There is a slow effacement of the cervix.
Protracted descent
deceleration phase lasting more than 3 hours in nulliparas or more than 1 hour in
multiparas
no progressive cervical dilatation in the active phase of labor for 2 hours or more
Arrest of descent
Failure of descent
descent failing to occur during the deceleration phase of dilatation and during the
second stage.
Dystocia
1.) Call for HELP!!
19 AL-OS, BANAL, CALUMA, CAVANEYRO, MANALASTAS, MARALLI, MEJIA,
MOJARES & ONG
SBCM BATCH 2017
Levonorgestrel - oral contraceptives contraindication, smokers over 35, DM, HTN, CAD