'It is more blessed to give than to receive.

‫ﻓﻰ‬

‫ ﰱ ﺭﻏﻴـﻒ‬BREIF
‫ﻃﻮارئ‬
‫اﻟﻨﺴـﺎ‬
How to Deal with Obstetric emergencies In a Very Simple and Practical Way

Dr.
AHMED
HAMDY

WhiteKnightLove

| 2011 ‫ – ﺍﻣﺘﻴﺎﺯ‬24 ‫ﺍﻟﺪﻓﻌﺔ‬

 Freely you have received; freely give.

‫ﺑﺴﻢ ﺍﷲ ﺍﻟﺮﲪﻦ ﺍﻟﺮﺣﻴﻢ‬

Great thanks to all staff in

OB/GYNA department in faculty of

Medicine at Menofia University

..
And my sincere gratitude to :

Dr.Ibrahim Seif Dr.Mohamed Zakaria Dr.Sherif Sobhy

Dr.Mahy Nabil Dr.Eman Badr Dr.Rehab Zahran

Also,
I would like to thank all of my dear
colleagues for their support ..
WhiteKnightLove

2 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

'It is more blessed to give than to receive.

PART 1

Obstetric sheet 4
Complaints 12
Abdominal pain with pregnancy 13

-Is She in labor ?! 14

-Pre- eclampsia 19

- abruption concealed type 29

-Ectopic pregnancy 31

-Rupture Uterus 33

UTI with Pregnancy 35

ROM 37

Vomiting with pregnancy 43

-Emesis gravidarum
-Hyper-emesis gravidarum
-GIT disorder
WhiteKnightLove

3 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

 ‫‪Freely you have received; freely give.‬‬

‫ﺗﺎﻋﺒﻬﺎ‬ ‫‪OBSTETRIC Sheet‬‬

‫‪ -3‬ﻣﻦ ﺣﺴﻦ ﺍﳊﻆ ‪ ..‬ﺍﻥ ﺃﺳﺌﻠﺔ ﺍﻟﺸﻴﻴﺖ ﺛﺎﺑﺘﻪ ﻣﻬﻤﺎ ﻛﺎﻧﺖ ﺍﻝ‬ ‫ﺑﺴﻢ ﺍﷲ ﻧﺒﺪﺃ ﻣﻊ ﺃﻭﻝ ﺭﻏﻴﻒ‬
‫‪complaint‬‬
‫ﺣﱴ ﻟﻮ ﺟﺎﻳﺔ ﺗﻘﻮﻟﻚ " ﺷﻌﺮﻯ ﺑﻴﻮﺟﻌﲎ " ﻫﺘﺴﺄﳍﺎ ﻧﻔﺲ ﺍﻻﺳﺌﻠﺔ‬ ‫ﻫﻨﺘﻜﻠﻢ ﻋﻦ ﺍﻝ ‪Sheet‬‬
‫ﻛﺎﻥ ﻻﺯﻡ ﻳﻜﻮﻥ ﺍﻭﻝ ﺣﺎﺟﺔ ﻧﺒﺪﺃ ﺑﻴﻬﺎ ﻋﺸﺎﻥ ﺩﻩ ﺍﻭﻝ ﺗﻌﺎﻣﻠﻚ ﻣﻊ ﺍﻟﻌﻴﺎﻧﺔ‬

‫ﳔﺶ ﺑﻘﻰ ﻋﻠﻰ ﺍﻻﺳﺌﻠﺔ‬ ‫ﻗﺒﻞ ﻣﺎﻧﻘﻮﻝ ﻧﺴﺄﻝ ﻋﻦ ﺍﻳﻪ ﻭﻧﺴﺄﻝ ﺍﺯﺍﻯ ؟‬
‫‪---------------------------------------‬‬ ‫ﻓﻴﻪ ﻗﻮﺍﻋﺪ ﻣﻬﻤﺔ ﺟﺪﺍ ﻋﻦ ﺍﻟﺸﻴــﺖ‬

‫ﺍﺣﻨﺎ ﺑﻨﺴﺄﻝ ﻋﻠﻰ ‪ 6‬ﺣﺎﺟﺎﺕ ﺛﺎﺑﺘﲔ‬ ‫‪ -1‬ﺍﻟﺸﻴﺖ ﺩﻩ ﻣﻘﺪﺱ ‪ ..‬ﻳﻌﲎ ﻻﺯﻡ ﺗﺎﺧﺪﻩ ﺣﱴ ﰱ ﺃﻗﺼﻰ ﺣﺎﻻﺕ ﺍﻟﻄﻮﺍﺭﺉ ‪..‬‬
‫ﺗﺎﺧﺪﻩ ﺑﻘﻰ ﻣﻦ‬
‫‪AGE - Married from‬‬
‫ﺍﻟﻌﻴﺎﻧﺔ ﺗﺎﺧﺪﻩ ﻣﻦ ﺃﻫﻠﻬﺎ ‪ ..‬ﺍﳌﻬﻢ ﺩﻩ ﺷﺊ ﺿﺮﻭﻭﻭﻭﻭﺭﻯ ﺟﺪﺍﺍﺍﺍﺍﺍﺍﺍﺍﺍ ‪ ..‬ﻻﻥ ﺍﻧﺎ‬
‫‪Parity - Abortion‬‬ ‫ﺑﺘﻌﺮﻑ ﺑﻴﻪ ﻋﻠﻰ ﺍﻟﻌﻴﺎﻧﺔ ‪ ..‬ﻭﺍﺣﻴﺎﻥ ﻛﺘﲑﺓ ﺑﻴﺤﺪﺩ ﺍﻝ‬
‫‪ managment‬ﺍﻟﻠﻰ ﻫﻌﻤﻠﻬﺎ‬
‫‪Past History - L.M.P.‬‬
‫‪ -2‬ﻋﻠﻰ ﻋﻜﺲ ﺍﻯ ﺷﻴﺖ ﺧﺪﺗﻪ ﻗﺒﻞ ﻛﺪﻩ ‪ ..‬ﺍﻝ‬
‫ﺍﻟﻠﻰ ﺑﻴﺘﻐﲑ ﻣﻌﺎﻧﺎ ﰱ ﺍﻟﺸﻴﺖ ﻫﻰ ﺍﻝ‪complaint‬‬ ‫‪ complaint‬ﻫﻰ ﺍﺧﺮ ﺣﺎﺟﺔ ﺑﻨﺴﺄﻝ ﻋﻠﻴﻬﺎ‪..‬‬
‫ﺍﺗﻌﺮﻑ ﻋﻠﻰ ﺍﻟﻌﻴﺎﻧﺔ ﺍﻻﻭﻝ ) ﻭﻫﻨﻘﻮﻝ ﺍﺯﺍﻯ ﺩﻟﻮﻗﱴ ( ﻭﺑﻌﺪﻳﻦ ﺷﻮﻑ ﺍﻳﻪ ﺍﻟﻠﻰ‬

‫‪WhiteKnightLove‬‬
‫‪4‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
‫‪'It is more blessed to give than to receive.‬‬

‫‪6‬‬
‫‪fixed‬‬

‫‪2‬‬ ‫‪2‬‬ ‫‪2‬‬

‫‪married‬‬ ‫‪Past‬‬
‫‪Age‬‬ ‫‪Parity‬‬ ‫‪Abortion‬‬ ‫‪LMP‬‬
‫?? ‪from‬‬ ‫‪history‬‬

‫= ‪elderly PG‬‬
‫* ﺧﻠﻔﺘﻰ ﻛﺎم ﻣﺮة ؟‬
‫‪Infertility‬‬
‫‪Precious baby‬‬
‫* ﻃﺒﯿﻌﻰ وﻻﻗﯿﺼﺮى ؟‬ ‫* ﺳﻘﻄﺘﻰ ﻗﺒﻞ ﻛﺪه ؟‬
‫* ﻣﻌﺎﻛﻰ وﻻد وﻻ ﺑﻨﺎت ؟‬ ‫* ﻛﺎم ﻣﺮة ؟‬
‫* اﻟﺼﻐﯿﺮ ﻋﻨﺪه ﻗﺪ اﯾﮫ ؟‬ ‫* ﻛﻞ ﻣﺮة ﻛﺎﻧﺖ ﻓﻰ اﻟﺸﮭﺮ‬
‫اﻟﻜﺎم ؟‬
‫* ﺑﺘﺎﺧﺪى اﻟﺤﻘﻨﺔ اﻟﻐﺎﻟﯿﺔ ﺑﻌﺪ‬
‫اﻟﻮﻻدة ؟‬ ‫* ﻋﻤﻠﺘﻰ ﻋﻤﻠﯿﺔ ﻛﺤﺖ‬
‫ﺑﻌﺪھﺎ ؟‬
‫* ﻣﺸﯿﺘﻰ ﻋﻠﻰ وﺳﯿﻠﺔ ﺑﻌﺪ‬
‫اﺧﺮ ﻣﺮة ؟‬

‫‪WhiteKnightLove‬‬
‫‪5‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
 ‫‪Freely you have received; freely give.‬‬

‫‪-‬ﻛﺎﻡ ﻣﺮﺓ ‪...‬؟‬ ‫‪1- Age‬‬

‫‪ -‬ﻃﺒﻴﻌﻰ ﻭﻻ ﻗﻴﺼﺮﻯ ؟ )*(‬ ‫ﻋﻨﺪﻙ ﻛﺎﻡ ﺳﻨﺔ ؟‬
‫‪ -‬ﻣﻌﺎﻛﻰ ﻭﻻﺩ ﻭﻻ ﺑﻨﺎﺕ ؟‬ ‫ﺍﻟﺴﻦ ﻳﻬﻤﲎ ﰱ ﺣﺎﻻﺕ ﺍﻝ‬
‫‪-‬ﺍﺻﻐﺮ ﻭﺍﺣﺪ ﻗﺪ ﺍﻳﻪ ؟‬ ‫‪elderly PG‬‬
‫‪ -‬ﻣﺸﻴﱴ ﻋﻠﻰ ﻭﺳﻴﻠﺔ ﺑﻌﺪ ﺍﺧﺮ ﻣﺮﺓ ؟‬ ‫ﻭﺍﺣﺪﻩ ‪ 35‬ﺳﻨﺔ ﺍﻭ ﺍﻛﺜﺮ ﻭﺩﻩ ﺍﻭﻝ ﲪﻞ ﺍﻭ ﺑﻘﺎﳍﺎ ﻋﺸﺮ ﺳﻨﲔ ﺑﺘﺴﻘﻂ ﻭﺩﻩ ﺍﻭﻝ‬
‫‪ -‬ﺑﺘﺎﺧﺪﻯ ﺍﳊﻘﻨﺔ ﺍﻟﻐﺎﻟﻴﺔ ﺑﻌﺪ ﺍﻟﻮﻻﺩﺓ ؟)‪(Rh‬‬ ‫ﲪﻞ ﻳﻜﻤﻞ‬
‫ﻭﺩﻯ ﻃﺒﻌﺎ ﻫﻴﺒﻘﻰ ﳍﺎ ﺭﻋﺎﻳﺔ ﺧﺎﺻﺔ ﺳﻮﺍﺀ ﻣﻦ ﻧﺎﺣﻴﺔ ﺍﻟﻮﻻﺩﺓ ﺍﻟﻠﻰ ﻫﺘﺒﻘﻰ‬
‫‪Elective CS‬‬
‫)*( ﲤﺎﻡ ‪ ..‬ﻓﺎﺿﻞ ﺑﻘﻰ ﺳﺆﺍﻟﲔ ﻋﻦ ﺍﻟﻄﺒﻴﻌﻰ ﻭﺯﻳﻬﻢ ﻋﻦ ﺍﻟﻘﻴﺼﺮﻯ‬
‫‪ - PRECIOUS‬ﻻﱏ ﻣﺶ ﻫﺨﺎﻃﺮ ﰱ ﻃﻔﻞ ﺯﻯ ﺩﻩ ﺑﻮﻻﺩﺓ ﻃﺒﻴﻌﻴﺔ ‪-‬‬
‫ﺍﻟﻄﺒﻴﻌﻰ ‪:‬‬
‫‪BABY‬‬
‫ﰱ ﺍﻟﺒﻴﺖ ﻭﻻ ﻣﺴﺘﺸﻔﻰ‬ ‫‪ frequency of visits‬ﺍﻭ ﻣﻦ ﻧﺎﺣﻴﺔ ﺍﻝ‬
‫ﺣﻀﻞ ﻣﺸﺎﻛﻞ ﰱ ﺍﻯ ﻭﻻﺩﺓ ﻣﻨﻬﻢ‬
‫ﺍﻟﻌﻴﻞ ﺍﺗﺰﻧﻖ ﺍﺗﺸﺪ ﲜﻔﺖ ﺍﻭ ﺷﻔﺎﻁ )‪(CPD‬‬ ‫‪2- Married from ....‬‬
‫) ﻧﺰﻓﱴ ‪ /‬ﺳﺨﻨﱴ ‪ /‬ﺍﺗﻨﻘﻠﻚ ﺩﻡ (‬ ‫ﻣﺘﺠﻮﺯﺓ ﺑﻘﺎﻟﻚ ﻗﺪﺍﻳﻪ‬
‫ﺍﻟﻘﻴﺼﺮﻯ ‪:‬‬ ‫‪ infrirtility‬ﻭﺩﻩ ﻋﺸﺎﻥ ﺍﻝ‬
‫ﻟﻴـــــــﻪ ؟‬
‫ﻻﻥ ﳑﻜﻦ ﻳﻜﻮﻥ ﺍﻟﺴﺒﺐ ﻟﺴﻪ ﻣﻮﺟﻮﺩ ﺯﻯ‬ ‫‪3- Parity :‬‬
‫‪contracted pelvis‬‬
‫ﺧﻠﻔﱴ ﻗﺒﻞ ﻛﺪﻩ‬
‫ﺣﺼﻞ ﻣﺸﺎﻛﻞ ﰱ ﺍﻯ ﻗﻴﺼﺮﻳﺔ ﻣﻨﻬﻢ‬

‫‪WhiteKnightLove‬‬
‫) ﻧﺰﻓﱴ ‪ /‬ﺳﺨﻨﱴ ‪ /‬ﺍﺗﻨﻘﻠﻚ ﺩﻡ (‬ ‫ﻭﺩﻯ ﻫﻨﻔﺼ‪‬ﻠﻬﺎ‬
‫‪6‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
‫‪His Heart Cannot Be Pure Whose Tongue Is Not Clean‬‬
‫‪'It is more blessed to give than to receive.‬‬

‫‪example :‬‬ ‫‪4- Abortion :‬‬

‫ﺳﻘﻄﱴ ‪-‬ﻻﻗﺪﺭ ﺍﷲ ‪ -‬ﻗﺒﻞ ﻛﺪﻩ‬
‫‪LMP 5/2/2011‬‬
‫‪EDD 12/11/2011‬‬ ‫‪ .. recurrent abortion‬ﻛﺎﻡ ﻣﺮﺓ ‪.‬؟ *‬
‫ﺧﺎﻧﺔ ﺍﻟﺸﻬﺮ ‪ 2‬ﻓﺰﻭﺩﻧﺎ ‪ 9‬ﺷﻬﻮﺭ ﻭﺍﺳﺒﻮﻉ‬
‫ﻛﻞ ﻣﺮﺓ ﻛﺎﻧﺖ ﰱ ﺍﻟﺸﻬﺮﺍ ﻟﻜﺎﻡ ؟ *‬
‫‪asc. duration (e.g.hypoplasia ) or desc. ( cervical‬‬
‫‪LMP 8/3/2011‬‬
‫) ‪incompetence‬‬
‫‪EDD 15/12/2011‬‬
‫ﻋﻤﻠﱴ ﻋﻤﻠﻴﺔ ﻛﺤﺖ ﺑﻌﺪﻫﺎ ؟*‬
‫ﺧﺎﻧﺔ ﺍﻟﺸﻬﺮ ‪ 3‬ﻓﺰﻭﺩﻧﺎ ‪ 9‬ﺷﻬﻮﺭ ﻭﺍﺳﺒﻮﻉ‬

‫‪5- LMP :‬‬

‫‪LMP 5/4/2011‬‬
‫‪EDD 12/1/2012‬‬
‫ﺧﺎﻧﺔ ﺍﻟﺸﻬﺮ ﺍﻛﺘﺮ ﻣﻦ ‪ 3‬ﻓﻨﻘﺼﻨﺎ ‪3‬ﺷﻬﻮﺭ‬
‫‪LMP 8/7/2011‬‬
‫‪EDD 15/4/2012‬‬
‫ﺧﺎﻧﺔ ﺍﻟﺸﻬﺮ ﺍﻛﺘﺮ ﻣﻦ ‪ 3‬ﻓﻨﻘﺼﻨﺎ ‪3‬ﺷﻬﻮﺭ‬
‫ﺍﻯ ﺗﺎﺭﻳﺦ ﻫﻰ ﺗﻘﻮﻟﻪ ﻳﺎﺍﻣﺎ ﻫﱰﻭﺩ ﻋﻠﻴﻪ ﺍﻭ ﻫﻨﻄﺮﺡ ﻣﻨﻪ‬
‫ﻋﺎﻭﺯ ﰱ ﺍﻻﳒﺎﺯ ﻭﻣﻦ ﻏﲑ ﺣﺴﺎﺑﺎﺕ ؟‬
‫ﺧﻠﻰ ﺍﳉﺪﻭﻝ ﺍﻟﻠﻰ ﲢﺖ ﺩﻩ ﰱ ﺟﻴﺒﻚ ﻋﻠﻰ ﻃﻮﻝ !!‬
‫ﺍﻭﻝ ﻳﻮﻡ ﰱ ﺍﺧﺮ ﺩﻭﺭﺓ ؟‬
‫ﺑﺴﺄﻝ ﻋﻠﻰ ﺃﻭﻝ ﻳﻮﻡ ﰱ ﺍﺧﺮ ﺩﻭﺭﺓ‬
‫‪ EDD‬ﻋﺸﺎﻥ ﺍﺣﺴﺐ ﺍﺧﺮ ﻳﻮﻡ ﺍﳊﻤﻞ‬
‫ﻭﻋﺸﻦ ﺍﻋﺮﻑ ﻫﻰ ﻛﺎﻡ ﺍﺳﺒﻮﻉ ﺩﻟﻮﻗﱴ‬
‫ﺑﻨﺤﺴﺒﻬﺎ ﺍﺯﺍﻯ ؟؟‬
‫‪DD/MM/Year‬‬
‫ﻟﻮ ﺧﺎﻧﺔ ﺍﻟﺸﻬﺮ ) ‪ 3‬ﺍﻭ ﺍﻗﻞ ( ﺯﻭﺩ ‪ 9‬ﺷﻬﻮﺭ ﻭﺍﺳﺒﻮﻉ‬

‫‪WhiteKnightLove‬‬
‫ﻟﻮ ﺧﺎﻧﺔ ﺍﻟﺸﻬﺮ) ‪ 4‬ﺍﻭ ﺍﻛﺘﺮ ( ﺍﻃﺮﺡ ﺗﻼﺗﺔ‬
‫‪7‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
 ‫‪Freely you have received; freely give.‬‬

‫ﺑﺘﺘﻌﺎﳉﻰ ﻣﻦ ﺿﻐﻂ ‪ -‬ﺳﻜﺮ ‪ -‬ﺣﺴﺎﺳﻴﺔ ﻋﻠﻰ ﺻﺪﺭﻙ ‪ -‬ﺗﺸﻨﺠﺎﺕ ‪ -‬ﺑﺘﺎﺧﺪﻯ‬ ‫ﺑﻌﺪ ﻣﺎﺣﺪﺩﺕ ﺍﺧﺮ ﻳﻮﻡ ‪ ..‬ﻭﺍﻟﻠﻰ ﺍﳌﻔﺮﻭﺽ ﻋﻨﺪﻩ ﻳﺒﻘﻰ ﺍﻟﺴﺖ ﻛﻤﻠﺖ ‪ 9‬ﺷﻬﻮﺭ‬
‫ﺣﻘﻦ ﺑﻨﺴﻠﲔ ﻃﻮﻳﻞ ﺍﳌﻔﻌﻮﻝ ‪ -‬ﻋﻤﻠﱴ ﻋﻤﻠﻴﺎﺕ ﻗﺒﻞ ﻛﺪﻩ ﺍﻭ ﺍﺗﻨﻘﻠﻚ ﺩﻡ ﻗﺒﻞ ﻛﺪﻩ‬ ‫ﻛﺎﻣﻠﲔ‬
‫ﺍﺷﻮﻑ ﺑﻘﻰ ﻓﺎﺕ ﻗﺪ ﺍﻳﻪ ﻣﻦ ﺍﻝ ‪ 9‬ﺷﻬﻮﺭ‬
‫ﺑﺘﺘﻌﺎﳉﻰ ﻣﻦ ﺍﻟﻐﺪﻩ ‪ -‬ﻛﺒﺪ ‪ -‬ﻛﻠﻰ ‪ -‬ﻣﺎﺷﻴﺔ ﻋﻠﻰ ﺍﺩﻭﻳﺔ ﺳﻴﻮﻟﺔ ‪ -‬ﺑﺘﺎﺧﺪﻯ ﻋﻼﺝ‬ ‫‪ ::‬ﻣﺜﻼ‬
‫ﻻﻯ ﺣﺎﺟﺔ ؟؟‬ ‫‪LMP 5/2/2011 EDD 12 /11/2011‬‬

‫‪ΩΩΩΩΩΩΩΩΩΩΩ‬‬ ‫‪5/3 ، 5/4 ، 5/6 ، 5/7 ، 5/8، 5/9‬ﻳﺒﻘﻰ‬

‫ﻳﺒﻘﻰ ﻛﺪﻩ ‪ 6‬ﺷﻬﻮﺭ‬
‫ﺑﺲ ﻳﺎﺳﻴﺪﻯ ﺍﺩﻯ ﺍﺳﺌﻠﺔ ﺍﻟﺸﻴﺖ‬ ‫ﻃﻴﺐ ﻋﺎﻭﺯﻳﻦ ﳓﻮﳍﺎ ﻻﺳﺎﺑﻴﻊ ﻋﺸﺎﻥ ﺍﺣﻨﺎ ﺑﻨﺘﻜﻠﻢ ﺑﺎﻻﺳﺒﻮﻉ ﻣﺶ ﺑﺎﻟﺸﻬﺮ‬

‫ﻛﻞ ‪ 3‬ﺷﻬﻮﺭ ‪ ..‬ﺯﻭﺩ ﺍﺳﺒﻮﻉ **‬

‫ﺑﻌﺪ ﻣﺎﻋﺮﻓﻨﺎ ﺍﺳﺌﻠﺔ ﺍﻟﺸﻴﺖ ﻭﻛﻞ ﺳﺆﺍﻝ ﻧﻄﻠﻊ ﻣﻨﻪ ﺑﺎﻳﻪ‬
‫ﻋﺎﻭﺯﻳﻦ ﺑﻘﻰ ﳔﺘﺼﺮ ﻛﻞ ﺍﻟﺮﻏﻰ ﺩﻩ ﰱ ﺳﻄﺮ ﻭﺍﺣﺪ ﺑﺲ‬ ‫ﺷﻬﻮﺭ = ‪ 13‬ﺍﺳﺒﻮﻉ ‪3‬‬
‫ﺷﻬﻮﺭ = ‪ 26‬ﺍﺳﺒﻮﻉ ‪6‬‬
‫ﻭﻫﻮ ﻋﻨﻮﺍﻥ ﺍﳊﺎﻟﺔ ‪ ..‬ﺍﻟﻠﻰ ﺑﺒﻠﻎ ﺑﻴﻪ ﺍﻯ ﺣﺪ ‪ ..‬ﻭﻳﺒﻘﻰ ﻣﺶ ﳏﺘﺎﺝ ﻳﺴﺎﻝ‬
‫ﻋﻦ ﺣﺎﺟﺔ ﺗﺎﻧﻴﺔ‬ ‫‪6- Past History :‬‬
‫ﻭﻛﻤﺎﻥ ﺑﺎﳌﺮﺓ ﻧﺸﻮﻑ ﺷﻜﻞ ﺍﻟﺘﺬﻛﺮﺓ ﻭﺑﻨﻜﺘﺐ ﻋﻠﻴﻬﺎ ﺍﻳﻪ ؟؟‬ ‫ﻋﺸﺎﻥ ﺗﺮﳛﻮﺍ ﻧﻔﺴﻜﻮﺍ ﺩﻩ ﻃﻘﻢ ﺑﻴﺘﻘﺎﻝ ﻋﻠﻰ ﺑﻌﻀﻪ ﻭﻳﺘﺤﻔﻆ ﺯﻯ ﻣﺎﻫﻮ‬

‫‪WhiteKnightLove‬‬
‫‪8‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
‫‪The Most Diagnostic Tool Is Passage Of Time . Hippocrates , Father Of Medicine‬‬
'It is more blessed to give than to receive.

January 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January

October 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 November

February 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 February

November 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 December

March 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 March

December 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 January

April 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 April

January 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 February

May 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 May

February 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 1 2 3 4 5 6 7 March

June 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 June

March 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 April

July 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 July

April 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 May

August 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 August

May 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 June

September 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 September

June 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 July

October 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 October

July 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 August

November 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 November

August 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 September

December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 December

September 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 October

EDD LMP ‫ ﺗﺤﺘﮫ ﻣﺒﺎﺷﺮة‬EDD ‫ﺣﺪد اول ﯾﻮم ﻓﻰ اﺧﺮ دورة ھﺘﻼﻗﻰ ال‬

WhiteKnightLove
9 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬
 ‫‪Freely you have received; freely give.‬‬

‫‪placenta accreta‬ﻭﺤﺎﺠﺔ ﺘﺎﻨﻴﺔ ﺨﻁﻴﺭﺓ ﺠﺩﺍ‬ ‫‪PARITY + Abortions , Gestational age , complaint‬‬
‫‪ -‬ﺘﺎﻨﻰ ﺤﺎﺠﺔ ﺍﻨﻪ ﻟﻭ ﻤﻌﻤﻠﺘﺵ ﻜﺤﺕ ﻤﻤﻜﻥ ﻴﻜﻭﻥ ﺩﻩ ﻤﺎﻜﻨﺵ ﺴﻘﻁ ﺍﺼﻼ ﻭﻜﺎﻥ ﻤﺠﺭﺩ‬ ‫‪Parity‬‬
‫‪ menstural irregularities‬ﻤﻥ ‪blood clots‬‬ ‫ﺗﻔﺎﺻﻴﻠﻬﺎ ﺑﺘﻜﺘﺐ ﺑﺸﻜﻞ ﺭﺃﺳﻰ ﺯﻯ ﻣﺎﻫﻮ ﻭﺍﺿﺢ ﰱ ﺍﻟﺼﻮﺭﺓ‬
‫‪recurrent abortion‬ﻭﻫﻴﻭﻓﺭ ﻋﻠﻴﺎ ﺍﻨﻰ ﺍﺩﺨل ﻓﻰ ﺩﻭﺍﻤﺔ ﺍل‬ ‫‪P1‬‬
‫‪SVD‬‬
‫‪male‬‬
‫‪youngest 3ys‬‬

‫‪Age‬‬ ‫*‪LMP = */‬‬ ‫ﺩﻩ ﻣﻌﻨﺎﻩ ﻭﺍﺣﺪﻩ ﺧﻠﻔﺖ ﻣﺮﺓ ﻭﺍﺣﺪﻩ ‪ -‬ﻃﺒﻴﻌﻰ ‪ -‬ﻣﻌﺎﻫﺎ ﻭﻟﺪ ﻭﺍﻟﺼﻐﲑ ﻋﻨﺪﻩ ‪3‬‬
‫‪MF‬‬ ‫*‪EDD= */‬‬ ‫ﺳﻨﲔ‬
‫‪P1‬‬
‫‪+‬‬ ‫‪2‬‬ ‫‪,‬‬ ‫) ‪Preg ± 39w, With (ROM , VB..‬‬ ‫‪abortions‬‬
‫‪SVD‬‬ ‫‪1st  3m‬‬ ‫ﻭﺑﺮﺿﻪ ﺑﺸﻜﻞ ﺭﺃﺳﻰ‬
‫‪Male‬‬ ‫‪2nd2m‬‬ ‫‪+2‬‬
‫‪, D&C‬‬ ‫‪1st  3m‬‬ ‫‪2nd2m , D&C‬‬
‫‪Youngest‬‬
‫‪3 years‬‬ ‫ﻭﺩﻩ ﻣﻌﻨﺎﻩ ﻭﺍﺣﺪﻩ ﺳﻘﻄﺖ ﻣﺮﺗﲔ‬
‫‪IUD  3‬‬
‫‪years‬‬
‫ﻛﺎﻧﯿﻮﻻ‬
‫ﺍﻭﻝ ﻣﺮﺓ ﻛﺎﻧﺖ ﰱ ﺍﻟﺸﻬﺮ ﺍﻟﺘﺎﻟﺖ ﻭﺗﺎﱏ ﻣﺮﺓ ﻛﺎﻥ ﰱ ﺍﻟﺸﻬﺮ ﺍﻟﺘﺎﱏ‬
‫وﻓﺼﯿﻠﺔ‬
‫ﻭﻋﻤﻠﺖ ﻛﺤﺖ ﺑﻌﺪ ﺍﻟﺴﻘﻂ ﺍﻟﺘﺎﱏ‬
‫دﺧﻮل ﻗﺴﻢ اﻟﻨﺴﺎ واﻟﺘﻮﻟﻴﺪ‬ ‫ﺒﻌﺩ ﺍﻟﺴﻘﻁ ؟ ‪D&C‬ﺒﺴﺄل ﻟﻴﻪ ﻋﻥ ﺍل‬

‫ط‪.‬م‪...... .‬‬ ‫ﻭﻫﺘﻔﺭﻕ ﺍﻴﻪ ﻤﻌﺎﻴﺎ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﺤﻤل ﺍﻟﻤﻭﺠﻭﺩ ﺩﻟﻭﻗﺘﻰ ؟‬

‫‪ scar‬ﻓﻤﻤﻜﻥ ﻴﻜﻭﻥ ﻓﻴﻪ ‪perforation‬ﺍﻭل ﺤﺎﺠﺔ ﺍﻥ ﺩﻯ ﻋﻤﻠﻴﺔ ﻤﻥ ﻤﻀﺎﻋﻔﺎﺘﻬﺎ‬

‫‪WhiteKnightLove‬‬
‫‪ Rupture uterus‬ﻭﻤﻊ ﺍﻟﺤﻤل ﺍﻟﺠﺩﻴﺩ ﻴﺒﻘﻰ ﻓﻰ ﺨﻁﺭ ﻴﺤﺼل ‪uterus‬ﻓﻰ ﺍل‬

‫‪10‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

‫‪'It is more blessed to give than to receive.‬‬

‫‪PG ,preg +_ 36 wks with‬‬ ‫‪Gestational age‬‬

‫‪preg +_ ??? wks‬‬
‫ﺍﻝ ‪ ectopic‬ﺑﻴﺘﺤﺴﺐ ﻣﻊ ﺍﻟﺴﻘﻂ‬
‫ﻭﺩﻩ ﻫﻨﻜﺘﺐ ﺍﻟﺮﻗﻢ ﺍﻟﻠﻰ ﺣﺴﺒﻨﺎﻩ ﻓﻮﻕ‬
‫) ﻣﻊ ﺍﻧﻪ ﺍﳌﻔﺮﻭﺽ ﺑﻴﺘﻌﻤﻞ ﰱ ﺧﺎﻧﺔ ﻟﻮﺣﺪﻩ ‪ ..‬ﺑﺲ ﻫﻨﺎ ﺑﻴﺘﺤﺴﺐ ﻛﺪﻩ !! (‬
‫ﺍﺣﺴﺐ ﻫﻰ ﻛﺎﻡ ﺷﻬﺮ ﻭﺣﻮﳍﺎ ﻻﺳﺎﺑﻴﻊ ﺯﻯ ﻣﺎﻗﻠﻨﺎ ﻓﻮﻕ‬
‫ﳑﻜﻦ ﻧﻘﻮﳍﺎ ﻋﻠﻰ ﺑﻌﻀﻬﺎ ﺑﻘﻰ ﺯﻯ ﻣﺎ ﻫﻰ ﰱ ﺍﻟﺼﻮﺭﺓ ﺑﺎﻟﻈﺒﻂ‬

‫ﺭﻛﺰﻭﺍ ﰱ ﺍﳊﺘﺔ ﺍﻟﻠﻰ ﺟﺎﻳﺔ ﻋﺸﺎﻥ ﺭﲬﺔ‬

‫ﻓﻴﻪ ﺷﻮﻳﺔ ﺣﺎﻻﺕ ﻧﺒﻘﻰ ﻭﺍﺧﺪﻳﻦ ﺑﺎﻟﻨﺎ‬

‫ﻫﻨﺎ ﰱ ﻣﺼﺮ ﺍﻝ ‪age of viability = 28 wks‬‬

‫* ﳌﺎ ﺍﻗﻮﻝ ﻋﻠﻰ ﻋﻴﺎﻧﺔ ‪ = P3 ..‬ﺧﻠﻔﺖ ﺗﻼﺕ ﻣﺮﺍﺕ ‪ ..‬ﻭﺩﻩ ﺭﺍﺑﻊ ﲪﻞ‬
‫ﻳﻌﲎ ﺗﻘﺮﻳﺒﺎ ‪ 6‬ﺷﻬﻮﺭ ﻭﻧﺺ‬

‫* ﻭﺍﺣﺪﻩ ﳐﻠﻔﺘﺶ ﻭﺳﻘﻄﺖ ﻣﺮﺗﲔ‬

‫ﻳﻌﲎ ﻟﻮ ﻭﺍﺣﺪﻩ ﺟﺖ ﻗﺎﻟﺘﻠﻚ ﺍﻧﺎ ﺳﻘﻄﺖ ﰱ ﺍﻟﺴﺎﺩﺱ ﺍﻭ ﺍﻟﺴﺎﺑﻊ‬
‫‪P0 + 2‬‬
‫ﻫﻞ ﻫﻨﻌﺘﱪﻩ ﺳﻘﻂ ﻭﻧﻜﺘﺒﻪ ﻣﻊ ﺍﻝ ‪ abortion‬؟؟؟؟؟؟؟؟؟؟‬ ‫ﺍﻟﺼﻔﺮ ﺑﻴﺘﻨﻄﻖ " ﺍﻭ " " ‪" o‬‬

‫ﻻ ‪ ..‬ﺍﻟﻠﻰ ﺑﻌﺪ ‪ 28‬ﺍﺳﺒﻮﻉ ﺑﻨﺤﺴﺒﻪ ﻣﻊ ﺍﻟﻮﻻﺩﺍﺕ ‪ ..‬ﺍﺯﺍﻯ ؟‬ ‫* ﻭﺍﺣﺪﻩ ﳐﻠﻔﺘﺶ ﻭﻣﺴﻘﻄﺘﺶ‬

‫ﺍﳉﻨﲔ ﺑﻴﱰﻝ ﻋﻦ ﻃﺮﻳﻖ ﻭﻻﺩﺓ ﻃﺒﻴﻌﻴﺔ ﺑﻴﺪﻭﻫﺎ ‪ induction‬ﳊﺪ ﻣﺎﺗﻔﺘﺢ ﻭﻳﱰﻟﻮﻩ‬ ‫ﻣﻔﻴﺶ ﺣﺎﺟﺔ ﺍﲰﻬﺎ‬
‫ﻳﺒﻘﻰ ﻗﺒﻞ ‪ 28‬ﺍﺳﺒﻮﻉ ﻧﻜﺘﺒﻪ ﻣﻊ ﺍﻟﺴﻘﻂ‬ ‫‪ P0+0‬ﻏﻠﻂ‬
‫ﺑﻌﺪ ‪ 28‬ﺍﺳﺒﻮﻉ ﳓﺴﺒﻬﺎ ﻭﻻﺩﺓ ﻃﺒﻴﻌﻴﺔ‬ ‫ﺑﺘﺘﻜﺘﺐ ‪primigravida = PG‬‬

‫‪WhiteKnightLove‬‬
‫‪11‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
 Freely you have received; freely give.

+ COMPLAINT
‫ﺑﻌﺪ ﻣﺎﻋﺮﻓﻨﺎ ﺍﺯﺍﻯ ﻧﺎﺧﺪ ﺷﻴﺖ ﻭ ﺑﻌﺪ ﻣﺎﺗﻌﺮﻓﻨﺎ ﻉ ﺍﻟﻌﻴﺎﻧﺔ‬
.. ‫ ﻭﺩﻯ ﺍﻧﺖ ﻭﺣﻈﻚ‬Others
complaint ‫ﻓﺎﺿﻠﻨﺎ ﺍﻝ‬
‫ ﳑﻜﻦ ﺣﺎﻻﺕ ﺍﻟﻌﻴﺎﺩﺓ ﲡﻴﻠﻚ ﻃﻮﺍﺭﺉ‬
‫ﺎ ﺍﻟﻨﻬﺎﺭﺩﺓ ؟ ﺍﻳﻪ ﻣﺸﻜﻠﺘﻬﺎ ﺩﻟﻮﻗﱴ ؟‬‫ﻓﺎﺿﻞ ﻧﺴﺄﳍﺎ ﺍﻳﻪ ﺍﻟﻠﻰ ﺟﺎ‬
infection – Gastroenteritis- )
(Anemia – hypotension …etc
‫ ﺍﻟﻠﻰ ﻫﺸﻮﻓﻬﺎ ﰱ ﺍﻟﻄﻮﺍﺭﺉ‬complaint s‫ﺍﻳﻪ ﺍﳊﺎﻻﺕ ﺍﻭ ﺍﻝ‬
defloration injury 
‫ ﺗﺸﻴﻠﻪ‬IUD ‫ ﺍﻭ ﺟﺎﻳﺔ ﺑﱰﻳﻒ ﲤﺪ ﺍﻳﺪﻙ ﺗﻼﻗﻰ‬ ‫ﻓﻴﻪ ﺍﺭﺑﻌﺔ ﺍﺳﺎﺳﻴﲔ‬
1 – Abdominal pain with pregnancy
RAPE ‫ ﺍﻭ‬
2- vaginal bleeding
query appendicitis in Virgin ‫ ﺍﻭ‬ 3 – ROM ( rupture of membranes )
‫ ﺍﻭ ﺗﻄﻠﻊ ﺯﺍﻳﺪﺓ ﻓﻌﻼ ﺑﺲ ﺗﺘﻔﺎﺟﺊ‬Ectopic ‫ﻭﺗﻄﻠﻊ‬ 4- ↓ fetal kicks
‫ﺍﻥ ﻓﻴﻪ ﲪﻞ‬
( ‫) ﺭﺑﻨﺎ ﻳﻌﺎﻓﻴﻨﺎ ﻛﻠﻨﺎ ﻣﻦ ﻣﺼﻴﺒﺔ ﺯﻯ ﺩﻯ‬ complaint ‫ ﰱ ﻛﻞ ﺷﻴﺖ ﻭﻣﻊ ﺍﻯ‬exclusion ‫ﻭﺩﻭﻝ ﻻﺯﻡ ﻧﻌﻤﻠﻬﻢ‬

:) ‫ﺩﻯ ﺍﻣﺜﻠﺔ ﺑﺲ ﺑﺮﺿﻪ ﻳﺎﻣﺎ ﰱ ﺍﳉﺮﺍﺏ ﻳﺎﺣﺎﻭﻯ‬ 5- Hyper-emesis Gravid-arum

6-PRE-ECLAMPSIA
.. ‫ﺩﻯ ﳑﻜﻦ ﺗﻌﻤﻞ ﺍﻯ ﻭﺍﺣﺪﻩ ﻣﻦ ﺍﻻﺭﺑﻌﺔ ﺍﻟﻠﻰ ﻓﻮﻕ‬

WhiteKnightLove
12 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬
God Gives Every Bird Its Food, But He Doesn't Throw It Into The Nest
'It is more blessed to give than to receive.

Recent Pregnancy

Labor Genital
( term,preterm) Associate
*complicated
Recent
Preg. cyst , Fibroid
Late in
Abruption
preg.
Abd.
Recent Pain e'
Pregnancy Rupture
Preg. *Urinary
Uterus Medical
* GIT

Extra-
Early in genital
EP
preg.
Surgical *Appendicitis

WhiteKnightLove
13 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

‫ﺍﳊﻤﻞ = ﺭﺣﻢ ﺟﻮﺍﻩ ﺟﻨﲔ ﺑﻴﻔﻀﻞ ﺟﻮﺍﻩ ‪ 9‬ﺷﻬﻮﺭ‬
‫ﺍﻟﻮﻻﺩﺓ = ﺍﻟﺮﺣﻢ ﻳﺒﺪﺃ ﻳﻄﺮﺩ ﺍﳉﻨﲔ ﺑﺮﻩ‬
‫ﻫﻴﻄﺮﺩﻩ ﺍﺯﺍﻯ ؟؟ ﻫﻴﻌﻤﻞ ﺣﺎﺟﺘﲔ‬
‫ﻫﻴﻨﻘﺒﺾ ﻋﺸﺎﻥ ﻳﺰﻗﻪ ﻟﱪﻩ ) ‪(contractions‬‬
‫ﻳﻔﺘﺢ ﺍﻟﺒﻮﺍﺑﺔ ) ‪( cervix‬‬
‫ﻃﻴﺐ ﺍﻟﻜﻼﻡ ﺩﻩ ﻫﺘﺮﲨﻪ ﺑﺎﻳﻪ ؟؟ ‪ 3‬ﺣﺎﺟﺎﺕ‬
‫‪PAIN ‬‬
‫ﺍﻟﺴﺖ ﺟﺎﻳﺔ ﺑﻮﺟﻊ ‪ ..‬ﻭﻫﻨﺎ ﻓﻴﻪ ﻛﻠﻤﺔ ﺳﺤﺮﻳﺔ ‪ ..‬ﻫﺘﻘﻮﻟﻚ " ﺑﻄﲎ ﺑﺘﺤﺠﺮ‬
‫ﻋﻠﻴــﺎ "‬
‫‪Contractions ‬‬
‫ﻫﺘﺤﺲ ‪ /‬ﻭﺗﻌﺪ ‪TRUE or FALSE --‬‬
‫‪PV ‬‬
‫ﻋﺸﺎﻥ ﺍﺷﻮﻑ ﺍﻟﺒﻮﺍﺑﺔ ﻓﺎﲢﺔ ﻗﺪ ﺍﻳﻪ ‪ ..‬ﻭﻫﻞ ﻫﺘﻌﺪﻯ ﺍﻟﺒﻴﱮ ﻭﻻ ﻷ ؟‬
‫‪14‬‬
‫‪Freely you have received; freely give.‬‬
‫‪IS SHE IN LABOR‬‬
‫ﻗﺒﻞ ﻣﺎﻧﺒﺪﺃ ‪ .‬ﻻﺯﻡ ﻧﺘﻔﻖ ﻋﻠﻰ ﺣﺎﺟﺔ ﰱ ﺍﻻﻭﻝ ‪ :‬ﺍﳌﻮﺿﻮﻉ ﺩﻩ ﺑﻴﺘﻜﻠﻢ ﻋﻦ ﻭﺍﺣﺪﻩ‬
‫ﺟﺎﻳﺔ ﺑﻮﺟﻊ ﻭﻻﺩﺓ ﻓﻘﻂ ‪ ..‬ﻭﻣﺶ ﻣﻌﺎﻩ ﺍﻯ ﺷﻜﻮﻯ ﺗﺎﻧﻴﺔ ﻣﻦ ﺍﻟﻠﻰ ﻗﻠﻨﺎ ﻋﻠﻴﻬﻢ ﻗﺒﻞ‬
‫ﻛﺪﻩ ‪ ..‬ﻻﻥ ﻛﻞ ﺣﺎﻟﺔ ﳍﺎ ﺷﺮﻭﻃﻬﺎ ‪..‬‬
‫ﻧﺒﺪﺃ ﺑﺴﻢ ﺍﷲ ‪..‬‬
‫ﻭﺍﺣﺪﻩ ﺟﺎﻳﺔ ﺑﺘﻘﻮﻟﻚ ﺑﻴﺠﻴﻠﻰ ﻭﺟﻊ ‪..‬‬
‫ﻣﲔ ﻓﻴﻬﻢ ﺍﻟﻠﻰ ﺑﺘﻮﻟﺪ ‪ ..‬ﻭﻣﲔ ﺍﻟﻠﻰ ﻫﺘﺮﻭﺡ‬
‫ﻭﻟﻮ ﻫﺘﺮﻭﺡ ﻫﻨﻮﻋﻴﻬﺎ ﻭﻧﻘﻮﳍﺎ ﺍﻳﻪ ؟؟‬
‫ﻗﺒﻞ ﻣﺎﻧﻘﻮﻝ ﺍﺯﺍﻯ ؟؟‬
‫ﻻﺯﻡ ﻧﻌﺮﻑ ﺍﻻﻭﻝ ﻳﻌﲎ ﺍﻳﻪ ﲪﻞ؟؟ ﻭﻧﻌﺮﻑ ﻳﻌﲎ ﺍﻳﻪ ﻭﻻﺩﺓ ؟؟‬
‫ﺑﻜﻞ ﺑﺴﺎﻃﺔ‬
‫‪WhiteKnightLove‬‬
‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
'It is more blessed to give than to receive.

: ‫ﻭﻣﻦ ﺍﻷﺧﺮ‬
the most important is true labor pain which is
TRUE and FALSE ‫ﺧﻠﻴﻨﺎ ﻧﻔﺘﻜﺮ ﺍﻓﺮﻕ ﺍﺯﺍﻯ ﺑﲔ ﺍﻝ‬
confirmed by concurrent cervical changes

 if you doubt keep the patient under observation for a FALSE TRUE
while and reassess
History ‫ ﻣﺮﺍﺕ ﰱ‬4 ‫ ﺍﻭ‬3 ‫ﺑﻴﺠﻴﻠﻰ‬ ‫ﺑﻄﲎ ﺑﺘﺤﺠﺮ ﻋﻠﻴﺎ‬
 if this tone become a true labor pains or the cx begin ‫ﺍﻟﻴﻮﻡ‬ ‫ ﺩﻗﺎﻳﻖ‬5 ‫ﺑﻴﺠﻴﻠﻰ ﻛﻞ‬
to dilate, here you will confirm labor onset ‫ﻧﺰﻝ ﺣﺘﺔ ﳐﺎﻁ ﻣﻌﺮﻕ ﺑﺪﻡ‬
 this is particularily important in preterm patients

contractions <3/10min , <40 3-5/10min , >40

... ‫ﻫﺘﻌﺪ‬ sec. sec
.. ‫ﻫﺘﺤﺲ‬ ‫ﺣﺠﺮ ﻓﻌﻼ‬
‫ﺑﻄﻨﻬﺎ ﺑﺘﺸﺪ ﺑﺲ ﻣﺶ ﺯﻯ ﺍﻝ‬
true
true ‫ﳌﺎ ﲢﺲ ﺍﻝ‬
‫ ﺩﻭﻝ ﳑﻜﻦ ﺃﻃﻠﻊ ﺍﺣﺘﻤﺎﻻﺕ‬parameters 3 ‫ﻣﻦ ﺍﻝ‬ ‫ﻣﺶ ﻫﺘﻠﺨﺒﻄﻬﺎ ﻣﻊ ﺣﺎﺟﺔ ﺗﺎﻧﻴﺔ‬
PV <4cm 4cm or more

WhiteKnightLove
15 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬
We Don't See Things As They Are , We See Them As We Are .
 Freely you have received; freely give.

: ‫ﺍﻻﺣﺘﻤﺎﻝ ﺍﻟﺘﺎﻟﺖ‬
: ‫ﺍﻻﺣﺘﻤﺎﻻﺕ‬
‫ ﻛﻔﺎﻳﺔ‬cervix ‫ ﻣﻔﺘﺤﺘﺶ ﺍﻝ‬efficient ‫ ﺑﺲ ﻣﺶ‬contr. ‫ﻓﻴﻪ‬
active phase ‫ﺎ ﻟﺴﻪ ﻣﺶ ﰱ ﺍﻝ‬‫ﻫﺘﺮﻭﺡ ﻻ‬
Pain Contractions Cx Result
‫ﻃﻴﺐ ﺍﻣﱴ ﻣﺶ ﻫﺘﺮﻭﺡ ؟؟ ﻭﺗﺒﻘﻰ ﺟﺮﳝﺔ ﻟﻮ ﺭﻭﺣﺘﻬﺎ ؟؟‬ IN LABOR
Active
previous CS ‫ﺎ ﺗﻜﻮﻥ‬‫ﺍ‬-1 1   >4cm phase
Any Previous CS once contraction = For
admission
admission and close observation ‫ﻫﺘﺮﻭﺡ‬
There is a uterine scar  fear of ‫ﺑﻌﺪ ﻣﺎﺗﺴﺘﺒﻌﺪ‬
Rupture uterus ‫ﺍﻻﺳﺒﺎﺏ ﺍﻟﺘﺎﻧﻴﺔ ﻟﻞ‬
2  X <4cm
associated problem e.g. VB, -2 abd.pain e'
pregnancy
ROM,dec.fetal kicks e.g.
effacement ‫ ﺳﻢ ﻭﺍﻝ‬4 ‫ ﺗﻜﻮﻥ ﻗﺮﺑﺖ ﻋﻠﻰ ﺍﻝ‬-3 UTI…etc
‫ﻫﺘﺮﻭﺡ ﺑﺸﺮﻁ‬
%80 ‫ ﺍﻭ‬%70 ‫ﺣﻠﻮ ﻳﻌﲎ‬
3   <4cm ‫ﻣﺘﻜﻮﻧﺶ‬
.. ‫ﺎ ﺗﻜﻮﻥ ﻣﻦ ﺑﻠﺪ ﺑﻌﻴﺪﺓ ﺳﺎﻋﺘﲔ ﺭﺍﻳﺢ ﻭﺳﺎﻋﺘﲔ ﺟﺎﻯ‬‫ﺍ‬ ‫؟؟؟؟؟؟؟‬......
‫ ﺳﻢ‬6 ‫ ﺳﻢ ﻫﺘﺮﻭﺡ ﺑﻴﺘﻬﻢ‬3 ‫ﻳﻌﲎ ﻫﻰ ﻫﺘﻤﺸﻰ ﻣﻦ ﻋﻨﺪﻙ‬ True contractions = √
‫ ﺍﻭ ﺗﻮﻟﺪ ﰱ ﺍﻟﺘﺎﻛﺴﻰ ﻭﻫﻰ ﺟﺎﻳﺔ ) ﻳﺎﻣﺎ‬fully ‫ﻫﺘﺠﻴﻠﻚ‬ False contractions = X

WhiteKnightLove
( ‫ﺣﺼﻠﺖ ﻛﺘﻴﻴﻴﻴﻴﻴﻴﲑ‬
16 Hard Work Doesn't Guarantee Success, But Improve Its Chances. 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬
‫‪'It is more blessed to give than to receive.‬‬

‫ﻧﺰﻝ ﻋﻠﻴﻜﻰ ﻣﻴﺔ – ﻛﺘﲑ ﻏﺮﻗﺘﻚ ﻭﻏﺮﻗﺖ‬ ‫‪-2‬‬

‫ﺍﻟﻠﻰ ﺷﺨﺼﺘﻬﺎ ﻭﻻﺩﺓ ﺩﻟﻮﻗﱴ ﻭ ﻫﺘﺤﺠﺰﻫﺎ ‪..‬‬
‫ﺍﻷﺭﺽ‪-‬‬
‫ﻧﺰﻝ ﻋﻠﻴﻜﻰ ﺩﻡ‬ ‫‪-3‬‬ ‫ﻫﺘﻌﻤﻠﻬﺎ ﺍﻳﻪ ؟؟؟‬
‫ﺣﺴﻴﱴ ﺍﳊﺮﻛﺔ ﻗﻠﺖ ﻋﻦ ﺍﻻﻭﻝ ﺍﻭ ﻣﺒﻘﺘﻴﺶ‬ ‫‪-4‬‬ ‫‪Routine :‬‬
‫ﲢﺴﻴﻬﺎ ﺧﺎﻟﺺ‬ ‫ﺿﻐﻂ ﻭﺯﻻﻝ‬ ‫‪-1‬‬
‫ﻓﺼﻴﻠﺔ ﻭﻛﺎﻧﻴﻮﻻ‬ ‫‪-2‬‬

‫ﻣﺮﺍﺟﻌﺔ ﺳﺮﻳﻌﺔ ﻟﻠﻰ ﻗﻠﻨﺎﻩ‬ ‫) ﻟﻮ ﻓﺼﻴﻠﺘﻬﺎ ﺳﺎﻟﺐ ﺍﺳﺄﻝ ﰱ ﺑﻨﻚ ﺍﻟﺪﻡ ﻓﻴﻪ ﻛﺎﻡ ﻛﻴﺲ ﻣﻨﻬﺎ ﻭﻟﻮ ﻣﺶ‬
‫ﻣﻮﺟﻮﺩﺓ ﺍﺑﻌﺖ ﺍﻫﻠﻬﺎ ﻳﺴﺄﻟﻮﺍ ﰱ ﺍﻟﻘﺼﺮ (‬
‫ﻫﺘﺎﺧﺪ ﺷﻴﺖ ﻣﻦ ﺍﻟﻌﻴﺎﻧﺔ ﻋﺎﺩﻯ ﺟﺪﺍ‬
‫ﻫﺘﻘﻮﻟﻚ ﺑﻴﺠﻴﻠﻰ ﻭﺟﻊ ﻫﺘﺸﻮﻑ ﺍﻟﻮﺟﻊ ﺩﻩ ﲢﺠﲑﺓ ﻭﻻ ﻻ‬
‫ﻃﻴﺐ ﺍﻟﻠﻰ ﻫﺘﺮﻭﺡ ﺑﻴﺘﻬﺎ ؟؟ ﻫﺘﻘﻮﳍﺎ ﺍﻳﻪ ؟؟؟‬
‫‪true or false‬‬
‫ﺩﻯ ﺗﺼﺎﺭﻳﻒ ﻭﻻﺩﺓ ﻟﺴﻪ ﻣﻌﺎﺩﻙ ﳎﺎﺵ ﻭﻫﻨﻘﻮﳍﺎ‬
‫ﻭﺑﻌﺪﻳﻦ ﺗﻔﺤﺼﻬﺎ ﺗﺸﻮﻑ ﺑﻘﺖ ‪ 4cm‬ﺍﻭ ﺍﻛﺘﺮ ﻫﺘﺪﺧﻠﻬﺎ‬
‫)‪Instructions ( VIP‬‬
‫ﻭﻻ ﻟﺴﻪ ﻗﺪﺍﻣﻬﺎ ﻭﻗﺖ ﻭﺗﺪﻳﻬﺎ ﺗﻌﻠﻴﻤﺎﺕ ﻭﺗﺮﻭﺡ‬ ‫ﺗﺘﻤﺸﻰ ﻛﺘﲑ ﻭﺗﺸﺮﰉ ﺳﻮﺍﻳﻞ ﻣﺴﻜﺮﺓ‬
‫ﻭﻟﻮ ﺣﺼﻞ ﺣﺎﺟﺔ ﻣﻦ ﺍﳊﺎﺟﺎﺕ ﺍﻟﻠﻰ ﻫﻘﻮﻟﻚ ﻋﻠﻴﻬﺎ ﺩﻯ ﺗﻴﺠﻰ ﻓﻮﺭﺍﺍﺍﺍﺍﺍﺍ‬
‫ﺍﻟﻮﺟﻊ ﺑﻘﻰ ﳚﻴﻠﻚ ﻛﻞ ‪ 5‬ﺩﻗﺎﻳﻖ‬ ‫‪-1‬‬

‫‪WhiteKnightLove‬‬
‫‪17‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
 ‫‪Freely you have received; freely give.‬‬

‫ﰱ ﺍﻟﻌﻤﻠﻴﺎﺕ‬
‫‪1- Re-evaluation : - history - Pv - U/S‬‬
‫‪ 5‬ﻭﺣﺪﺍﺕ ﺳﻴﻨﺘﻮ ) ﺳﻴﻨﺴﻴﻨﻮﻥ ( ﻋﻠﻰ ‪ 500‬ﺭﳒﺮ ‪2- Augmentation By : 505‬‬

‫‪ -3‬ﻟﻮ ﺍﻝ ‪ effacement‬ﻣﺶ ﺣﻠﻮ ‪ ..‬ﺍﻭ ﺑﻄﺊ‬

‫ﻳﺪﻭﺍ ﺍﻣﺒﻮﻝ ﺩﻭﺳﺒﺎ ﻭ ﺍﻣﺒﻮﻝ ﺑﺮﳝﺒﲑﺍﻥ ‪ripening of Cervix :‬‬
‫‪-4‬ﻫﺘﻔﻀﻞ ﺗﺘﺎﺑﻌﻬﺎ ‪ :‬ﺑﺎﻧﻚ ﺗﺴﻤﻊ ﺍﻟﻌﻴﻞ ﻛﻞ ﻧﺺ ﺳﺎﻋﺔ ‪ ..‬ﺗﻔﺤﺼﻬﺎ ﺗﺸﻮﻑ ﻓﺘﺤﺖ ﻗﺪ ﺍﻳﻪ‬
‫‪ -5‬ﻫﺘﺪﺧﻞ ﻛﺸﻚ ﺍﻟﻮﻻﺩﺓ ﳌﺎ ﺗﺒﻘﻰ ‪fully dialted and head on perineum‬‬
‫‪-6‬ﺟﻮﻩ ﺍﻟﻜﺸﻚ ‪:‬‬
‫ﺍﻝ ‪ 505‬ﻫﻴﺒﻘﻰ ‪510‬‬ ‫‪‬‬
‫ﺍﻟﺴﺮﳒﺔ ﺑﻴﺒﻘﻰ ﻓﻴﻬﺎ ‪ 10‬ﻭﺣﺪﺍﺕ ﺳﻴﻨﺘﻮ ‪ ..‬ﰱ ﺍﳌﻼﺣﻈﺔ ﺑﻴﺘﺤﻂ ‪ 5‬ﻋﻠﻰ ﺍﻟﺮﳒﺮ ﻭﳌﺎ ﺗﺪﺧﻞ‬
‫ﺍﻟﻜﺸﻚ ﻳﺪﻭﺍ ﺍﻝ ‪ 5‬ﺍﻟﻠﻰ ﻓﺎﺿﻠﲔ ‪،‬‬
‫ﺍﻟﻌﻴﻞ ﻧﺰﻝ ‪:‬‬ ‫‪‬‬
‫)‪520 ( 500 ringer + 20 syntocinone‬‬ ‫ﺯﻭﺩ ﻛﻤﺎﻥ ‪ 10‬ﺳﻴﻨﺘﻮ‬
‫‪ ‬ﺍﻝ ‪ PLACENTA‬ﻧﺰﻟﺖ ‪ :‬ﺯﻭﺩ‬
‫‪2 ergometrine ( methergine ) I.M. or I.v. drip‬‬
‫) ‪522 ( 500 R + 20 synto + 2 methergine‬‬
‫)‪4 mesotac ( PGE2‬‬ ‫‪ ‬ﻭﰱ ﺍﻻﺧﺮ ﺧﺎﻟﺺ ﺑﻨﺤﻂ‬
‫"ﺍﺳﺘﺄﺫﻧﻚ ﻳﺎﻣﺪﺍﻡ ﻫﺤﻄﻠﻚ ﻟﺒﻮﺱ ﻣﻦ ﻭﺭﺍ ﻋﺸﺎﻥ ﻣﺘﱰﻓﻴﺶ ﳌﺎ ﲣﺮﺟﻰ "‬

‫ﰎ ﲝﻤﺪ ﺍﷲ‬
‫‪WhiteKnightLove‬‬

‫‪18‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

'It is more blessed to give than to receive.

placental ABRUPTION ‫ﻧﻴﺠﻰ ﻟﺴﺒﺐ ﺗﺎﱏ ﺷﻬﲑ ﻭﺧﻄﲑ‬

‫ ﺗﻌﺎﻟﻮﺍ ﻧﺘﻜﻠﻢ ﻋﻦ ﺍﺷﻬﺮ ﺳﺒﺐ ﺑﻴﻌﻤﻠﻪ‬.. ‫ﻗﺒﻞ ﻣﺎﻧﺘﻜﻠﻢ ﻋﻠﻴﻪ‬

PREECLAMPSIA ‫ﻭﻫﻮ ﺍﻝ‬

PRE-ECLAMPSIA

Elevated BP ‫ﺑﺴﻢ ﺍﷲ‬

‫ﺍﳌﺮﺽ ﺩﻩ ﻣﻌﺮﻭﻑ ﻋﻨﺪ ﺍﻟﻌﺎﻣﺔ ﺏ " ﺗﺴﻤﻢ ﺍﳊﻤﻞ " ﻭﺩﻩ ﺍﺳﻢ ﻏﻠﻂ ﺍﻛﻴﺪ‬
preeclampsia ‫ﺑﺎﻟﻨﺴﺒﺔ ﻟﻨﺎ ﺍﺣﻨﺎ ﻳﻌﲎ ﺍﻳﻪ‬

Scientific base ‫ﻫﻨﻘﻮﻝ ﺷﻮﻳﺔ ﻧﻈﺮﻯ ﻋﺸﺎﻥ ﻧﺒﻘﻰ ﺷﻐﺎﻟﲔ ﻋﻠﻰ‬

‫ﺍﻳﻪ ﺍﻟﻠﻰ ﺑﻴﺤﺼﻞ ﰱ ﺍﻝ‬

Proteinuria Non dependent edema

Pre-eclampsia
‫ﺣﺎﺟﺘﲔ‬

‫ﻭﺍﺣﺪﻩ ﺣﻄﻮﳍﺎ ﻧﻈﺮﻳﺔ ﺍﻭ ﺗﻔﺴﲑ‬

‫ﻭﺍﻟﺘﺎﻧﻴﺔ ﻣﻠﻬﺎﺵ ﺗﻔﺴﲑ‬

1- Placental Dysfunction
Normally : fertilized ovum  zygot  morula  blasocyst  2 types of cells
‫ ﻭﺩﻯ‬syncytio-trophoblast ‫ ﻭﺧﺎﺭﺟﻴﺔ‬cyto-trophoblast ‫ ﺩﺍﺧﻠﻴﺔ‬: ‫ﺑﺘﻌﻤﻞ ﻛﺘﻠﺘﲔ ﻣﻦ ﺍﳋﻼﻳﺎ‬
invation of deciduas ‫ﺍﳌﺴﺌﻮﻟﺔ ﻋﻦ‬

Invation of trophoblasts into deciduas  erosion of elstic tissue of Spiral

arteries – so converting them into large blood sinusoids , not responding to
maternal vasomotor changes

‫ﺑﺎﻟﻄﺮﻳﻘﺔ ﺩﻯ ﺭﺑﻨﺎ ﺑﻴﺄﻣﻦ ﻟﻠﺠﻨﲔ ﻛﻤﻴﺎﺕ ﻛﺎﻓﻴﺔ ﻣﻦ ﺍﻟﺪﻡ‬

WhiteKnightLove

19 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

The Successful Man Is Average Man , But Focused
 Freely you have received; freely give.

viscosity ‫ﻭﻣﻊ ﺯﻳﺎﺩﺓ‬ ‫ﻭﻣﻊ ﺍﺳﺘﻤﺮﺍﺭ ﺍﳊﻤﻞ ﻭﳕﻮ ﺍﳉﻨﲔ ﺍﻝ‬

thrombo-embolism ‫ﻳﺰﻭﺩ ﺭﻳﺴﻚ ﺍﻝ‬ metabolic and O2 needs ‫ﺑﺘﺰﻳﺪ ﺍﻝ‬

‫ﻣﻦ ﺩﻩ ﻛﻠﻪ ﻧﻄﻠﻊ ﺑﺎﻳﻪ ؟؟‬ ‫ﻟﻮ ﻓﻀﻞ ﺍﻝ‬

* PLACENTAL INSUFFICIENCY spiral artey

IUGR , IUFD ‫ﺑﻜﻞ ﺑﻼﻭﻳﻬﺎ ﺯﻯ‬ ‫ ﻣﺶ ﻫﻴﻘﺪﺭ ﻳﻮﰱ ﺍﻟﺰﻳﺎﺩﺓ ﺩﻯ‬.. ‫ﺑﺘﻜﻮﻳﻨﻪ ﺯﻯ ﻗﺒﻞ ﺍﳊﻤﻞ‬

GENERALIZED VASOSPASM  ‫ﻭﺍﳌﺸﻜﻠﺔ ﻛﻤﺎﻥ ﺍﻧﻪ ﻫﻴﺒﻘﻰ ﻋﺮﺿﺔ ﻟﻠﺘﻐﲑﺍﺕ ﺍﻟﻠﻰ ﳑﻜﻦ‬
*Hypertension ‫ﲢﺼﻞ ﰱ ﺍﻻﻡ‬

* Hge AND NECROSIS ‫ﰱ ﺍﻝ‬

‫ﻃﺒﻘﻪ ﻋﻠﻰ ﺍﻯ ﺣﺘﺔ ﰱ ﺍﳉﺴﻢ ﻣﺜﻼ‬ PREeclampsia

Kidney  hematuria ,tubular ‫ﺩﻩ ﻣﺒﻴﺤﺼﻠﺶ‬

necrosis  ARF
‫ ﺯﻯ ﻣﺎﻫﻰ‬spiral arteries ‫ﺑﺘﻔﻀﻞ ﺍﻝ‬
EYE  retinal exudates, Hge
=================================
Brain  hpoxia, Hge
preeclmpsia ‫ﺍﳊﺎﺟﺔ ﺍﻟﺘﺎﻧﻴﺔ ﺍﻟﻠﻰ ﺑﺘﺤﺼﻞ ﰱ ﺍﻝ‬
Uterus  accidental Hge
Generalized Segmented Vaso-
* Hypovolemia 2- Spasm
organ ‫ ﺑﺘﺎﻉ ﺍﻯ‬perfusion ‫ﻗﺎﻟﻚ ﺍﻥ ﺍﻝ‬

2 factors ‫ﺑﻴﻌﺘﻤﺪ ﻋﻠﻰ‬ * spastic segmenet  become

hypoxic  permeability  ptns to
‫ ﺍﻟﻠﻰ ﺭﺍﳛﻠﻪ‬Volume extravascular 

‫ ﺩﻩ‬volume ‫ ﺍﻟﻠﻰ ﺭﺍﻳﺢ ﺑﻴﻪ ﺍﻝ‬Pressure edema and ‫ﺍﳌﻴﺔ ﺗﻄﻠﻊ ﻭﺭﺍﻫﺎ ﺗﻌﻤﻞ‬
HYPOVOLEMIA

Hypovolemia more hypoxia

damage of wall  Hge and
‫ﰱ ﺣﺎﻟﺘﻨﺎ ﺩﻯ‬ Necrosis
Dilated segment  disruption of
*endothelium  exposure of C.T.
WhiteKnightLove

20 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

‫‪'It is more blessed to give than to receive.‬‬

‫ﺍﻝ ‪ volume‬ﻗﻠﻴﻞ ﻭﺍﻟﻀﻐﻂ ﻋﺎﱃ ﻓﻤﻤﻜﻦ ﺍﻟﻀﻐﻂ ﺍﻟﻌﺎﱃ ﻳﻌﻮﺽ ﻧﻘﺺ ﺍﻝ ‪volume‬‬

‫ﻣﺶ ﺑﺸﻜﻞ ﻛﻠﻰ ﻃﺒﻌﺎ ﻓﻴﺤﺎﻓﻆ ﻋﻠﻰ ﺍﻝ ‪ perfusion‬ﺷﻮﻳﺔ‬

‫ﺍﻟﻜﻼﻡ ﺩﻩ ﻳﻨﻄﺒﻖ ﻋﻠﻰ ﺍﻯ ‪ organ‬ﻣﺎﻋﺪﺍ ‪Kidney – Uterus‬‬

‫‪BP‬‬

‫ﻃﻴﺐ ﺍﺣﻨﺎ ﺑﻨﻘﻮﻝ ﺍﻟﻜﻼﻡ ﺩﻩ ﻟﻴﻪ ؟؟‬

‫‪Volume‬‬

‫ﻋﺸﺎﻥ ﺍﺧﻠﻰ ﺑﺎﱃ ﻟﻮ ﺣﺼﻞ ‪Drop of BP‬‬

‫ﺳﻮﺍﺀ ﻣﻦ ‪acute loss of blood during labor‬‬

‫ﺍﻭ ‪hypotensive drugs‬‬

‫ﺍﻟﻀﻐﻂ ﻫﻴﻘﻞ ﻭﻳﺒﻘﻰ ﻧﻮﺭﻣﺎﻝ ﺍﻭ ﻗﺮﻳﺐ ﻣﻦ ﺍﻟﻨﻮﺭﻣﺎﻝ ﺑﺲ ﻣﻨﻨﺴﺎﺵ ﺍﻥ ﻟﺴﻪ ﺍﻝ ‪ volume‬ﻗﻠﻴﻞ ‪..‬‬
‫ﻓﺎﻟﻌﻴﺎﻧﺔ ﳑﻜﻦ ﺗﺪﺧﻞ ﰱ ‪SHOCK even with normal BP‬‬

‫ﻓﺄﻧﺎ ﰱ ﺍﻝ ‪management‬‬

‫ﻳﺒﻘﻰ ﺍﻟﱰﻝ ﺍﻟﻀﻐﻂ ﺑﺎﻟﺘﺪﺭﻳﺞ ﻭﺑﻴﻜﻮﻥ ﺍﻝ ‪ target‬ﺑﺘﺎﻋﻰ ﻗﺒﻞ ﺍﻝ ‪ termination‬ﻫﻮ ﺿﻐﻂ ‪ 100/160‬ﻭﻣﱰﻟﺶ ﺍﻛﺘﺮ‬
‫ﻣﻦ ﻛﺪﻩ‬

‫ﻭﻛﻤﺎﻥ ﺍﺧﻠﻰ ﺑﺎﱃ ﻣﻦ ﺍﻝ ‪blood loss‬ﻭﺍﻟﻌﻴﺎﻧﺔ ﻳﺘﺤﺠﺰﳍﺎ ﻣﺶ ﺍﻗﻞ ﻣﻦ ‪ 1000‬ﺳﻢ ﺩﻡ ﻗﺒﻞ ﺍﻝ ‪CS‬‬
‫‪BP‬‬

‫‪BP‬‬

‫‪Acute blood loss,‬‬

‫‪Volume‬‬
‫‪Volume‬‬

‫‪DRUGS‬‬
‫‪WhiteKnightLove‬‬

‫‪21‬‬ ‫‪Trust Your Hopes , Not Your Fears‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
 ‫‪Freely you have received; freely give.‬‬

‫ﻳﺎﺭﺏ ﻣﺘﻜﻮﻧﻮﺵ ﺯﻫﻘﺘﻮﺍ ﻣﻦ ﺍﻟﺮﻏﻰ ﺩﻩ‬

‫ﺑﺲ ﺩﻩ ﻛﺎﻥ ﻣﻬﻢ ﺍﻭﻯ ﻋﺸﺎﻥ ﻧﻔﻬﻢ ﺍﻳﻪ ﺍﻟﻠﻰ ﺑﻴﺤﺼﻞ‬

‫ﻃﺒﻌﺎ ﻛﻠﻜﻮﺍ ﺑﺘﻘﻮﻟﻮﺍ ﺩﻟﻮﻗﱴ‬

‫ﻫﺎﺕ ﻣﻦ ﺍﻻﺧﺮ ‪ ..‬ﺯﻫﻘﺘﻨﺎ ‪‬‬
‫ﳔﺶ ﰱ ﺍﳌﻔﻴﺪ‬

‫ﻫﻨﺘﻌﺎﻣﻞ ﺍﺯﺍﻯ ﻣﻌﺎﻫﺎ ؟؟‬

‫ﻫﻨﻘﺴﻢ ﺍﻟﻜﻼﻡ ﺟﺰﺋﲔ‬

‫ﰱ ﺍﻻﺳﺘﻘﺒﺎﻝ‬

‫ﺗﻜﺘﺸﻒ ﻻﻭﻝ ﻣﺮﺓ ﺑﺎﻝ‬ ‫ﻫﻰ ﻋﺎﺭﻓﺔ ﺍ‪‬ﺎ ‪: pre-eclampsia‬‬

‫‪ Routine‬ﺿﻐﻂ ﻭﺯﻻﻝ‬
‫ﺍﻟﺪﻛﺘﻮﺭ ﺑﺮﻩ ﻗﺎﻟﻠﻰ ﻋﻨﺪﻙ ﺗﺴﻤﻢ ﲪﻞ ﻭﺣﻮﻟﲎ ﻉ ﺍﳉﺎﻣﻌﺔ‬
‫ﻭﻏﺎﻟﺒﺎ ﺩﻯ ﺑﺘﻜﻮﻥ ‪:‬‬
‫‪PG , obese , F.H. of‬‬ ‫ﺃﻭ ‪،‬‬
‫‪HTN& DM‬‬
‫ﺍﻧﺎ ﺿﻐﻄﻰ ﻋﺎﱃ ﻭﻣﺎﺷﻴﺔ ﻋﻠﻰ ‪aldomet‬‬

‫ﻭﺟﺎﻳﺔ ﺩﻟﻮﻗﱴ‬

‫‪ -‬ﻣﺶ ﺣﺎﺳﺔ ﺣﺮﻛﺔ ﺍﳉﻨﲔ‬

‫‪ -‬ﻭﺟﻊ ﰱ ﺑﻄﲎ ) ﻃﻠﻖ ﻭﻻﺩﺓ – ‪(abruption‬‬
‫‪Other symptom of severe Pre-eclampsia -‬‬
‫‪Vomiting , headache , epigastric pain ,‬‬
‫‪blurring of vision , hemi-paresis‬‬
‫‪Even blindness‬‬
‫ﻣﺮﺓ ﻋﻴﺎﻧﺔ ﻗﺎﻟﺘﻠﻰ ﺍﻧﺎ ﻣﺶ ﺷﺎﻳﻔﺎﻙ ﻳﺎﺩﻛﺘﻮﺭ ‪‬‬
‫‪WhiteKnightLove‬‬

‫‪22‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

‫‪'It is more blessed to give than to receive.‬‬

‫‪ Pre- eclampsia‬ﻨﻭﻋﻴﻥ‬

‫‪Mild :‬‬

‫‪Bp ≥140/90 , ptnuria +1 ,+2‬‬

‫‪Severe :‬‬

‫‪Bp ≥ 160/100 , ptnuria +3,+4‬‬

‫ﺍﻻﺗﻨﲔ ﺑﻴﺘﺤﺠﺰﻭﺍ‬
‫ﻟﻮ ﺟﺘﻠﻚ ﻋﻴﺎﻧﺔ ‪ mild‬ﻭﺍﻧﺖ ﰱ ﺍﻯ ﻣﻜﺎﻥ ‪ ..‬ﻻﺯﻡ ﲢﻮﳍﺎ ﻣﺴﺘﺸﻔﻰ ‪ ..‬ﻭﻣﻔﻴﺶ ﺣﺎﺟﺔ ﺍﲰﻬﺎ ‪home treatement‬‬

‫ﻃﻴﺐ ﻣﺎﺷﻰ ﲤﺎﻡ ‪ ..‬ﺍﻧﺎ ﺷﺨﺼﺘﻬﺎ ﺍ‪‬ﺎ ‪ .. pre-eclampsia‬ﻫﻌﻤﻠﻬﺎ ﺍﻳﻪ ؟‬

‫ﻓﺼﻴﻠﺔ ﻭﻛﺎﻧﻴﻮﻻ‬ ‫‪-1‬‬

‫ﻗﺴﻄﺮﺓ )‪( monitor U.O.P.‬‬ ‫‪-2‬‬
‫ﺍﺑﻌﺘﻬﺎ ﺍﻟﺴﻮﻧﺎﺭ‬ ‫‪-3‬‬

‫‪+‬‬
‫ﰱ ﺣﺎﻻﺕ ﺍﻝ ‪severe‬‬
‫ﻫﺘﻄﻠﻊ ﻣﻦ ﺍﻟﻜﺸﻚ ﻋﻠﻰ ﺗﺮﻭﻟﻠﻰ‬ ‫‪-4‬‬
‫ﻫﺘﻤﺸﻰ ﻣﻌﺎﻫﺎ ﻭﻣﻌﺎﻙ ‪ airway‬ﻭﺍﻝ‪ neuril‬ﻋﺸﺎﻥ ﻟﻮ ﺩﺧﻠﺖ ﰱ ‪eclampia‬‬ ‫‪-5‬‬
‫ﻭﻣﺘﺴﻴﻬﺎﺵ ﻻ ﻭﻫﻰ ﰱ ﺍﻟﺴﻮﻧﺎﺭ ﻭﻻ ﻭﻫﻰ ﻃﺎﻟﻌﺔ ﺍﻟﻘﺴﻢ‬
‫) ‪ : neuril‬ﺑﻨﺤﻞ ﺍﻻﻣﺒﻮﻝ ﻋﻠﻰ ‪ 10‬ﺳﻢ ﳏﻠﻮﻝ ﻣﻠﺢ ‪ ..‬ﻭﺍﺫﺍ ﺩﺧﻠﺖ ﰱ ‪fits‬ﺑﻨﺪﻳﻬﺎ ‪ 2‬ﺳﻢ ﰱ ﺍﻟﻜﺎﻧﻴﻮﻻ ‪،‬‬
‫ﻻﻳﻌﻄﻰ ﺍﻟﻨﻴﻮﺭﻳﻞ ﺍﻻ ﺍﺛﻨﺎﺀ ﺍﻝ ‪ fits‬ﻟﻮ ﺭﺍﺣﺖ ﻣﻨﻬﺎ ﻣﺘﺪﻳﻬﺎﺵ (‬
‫ﺗﺒﻘﻰ ﺑﺮﻧﺲ ﻟﻮ ﻗﺪﺭﺕ ﺗﺪﻳﻬﺎ ﺍﻟﺴﻠﻔﺎﺕ ‪ loading dose‬ﻗﺒﻞ ﻣﺎﺗﻄﻠﻌﻬﺎ‬ ‫‪-6‬‬

‫‪Mg‬‬
‫‪sulfate‬‬
‫‪N.B.‬‬

‫‪2.5 g‬‬
‫‪ -1‬ﺍﻟﺴﻠﻔــﺎﺕ ‪:‬‬
‫ﺍﻟﺴﻠﻔﺎﺕ ﰱ ﻣﻌﻈﻢ ﺍﻻﺣﻴﺎﻥ ﻣﺶ ﻫﺘﻼﻗﻴﻪ ﰱ ﺍﻟﻜﺸﻚ ‪ ،‬ﺑﺲ ﻟﻮ ﻟﻘﻴﺘﻪ ﺑﻴﺒﻘﻰ ﻋﺎﻣﻞ ﻛﺪﻩ‬
‫‪WhiteKnightLove‬‬

‫ﻫﺘﻔﺘﺢ ﺍﺗﻨﲔ ﻭﺗﺴﺤﺒﻬﻢ ﰱ ﺳﺮﳒﺔ ﻭﺗﺪﻳﻬﻢ ‪slow I.V.‬‬

‫‪23‬‬ ‫‪Who is afraid of doing too much, always do too little .‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
 ‫‪Freely you have received; freely give.‬‬

‫‪ -2‬ﺣﺎﻻﺕ ﺍﻝ ‪ severe‬ﺍﻟﻠﻰ ﺿﻐﻄﻬﺎ ﺿﺎﺭﺏ ﰱ ﺍﻟﺴﻤﺎ ‪ 180‬ﻭ ‪ 190‬ﻭ ﺍﻛﺘﺮ ‪ ،‬ﺣﺎﻭﻝ ﺗﱰﻝ ﺍﻟﻀﻐﻂ ﻋﻠﻰ ﻣﺎﻧﺎﻳﺐ‬
‫ﺍﻟﻘﻠﺐ ﻳﺸﻮﻓﻬﺎ‬
‫) ﻭﺍﺣﺪﻩ ﺑﻠﻊ ﻭﻭﺍﺣﺪﻩ ﲢﺖ ﺍﻟﻠﺴﺎﻥ ( ‪2 Nitroderm patch 5 + Capoten 25‬‬

‫ﺭﻏﻢ ﺍﻥ ﺩﻩ ﰱ ﻣﺼﻠﺤﺔ ﺍﻟﻌﻴﺎﻧﺔ ﺍﻻ ﺍﻥ ﻓﻴﻪ‬

‫ﺍﻋﺘﺮﺍﺽ ﺍﻥ ﺩﻩ ﺷﻐﻞ ﺑﺘﺎﻉ ﺍﻟﻘﻠﺐ ﻣﺶ ﺍﻟﻨﺴﺎ‬

‫‪ -3‬ﻭﻫﻰ ﻃﺎﻟﻌﺔ ﺍﻟﻌﻤﻠﻴﺎﺕ ﻉ ﺍﻟﺘﺮﻭﻟﻠﻰ ‪:‬‬

‫ﻣﺘﻮﻗﻔﻬﺎﺵ ﻋﻨﺪ ﻣﻜﺘﺐ ﺍﻟﺪﺧﻮﻝ ﺍﻃﻠﻊ ﺍﻧﺖ ﺑﻴﻬﺎ ﻭﺣﺪ ﻣﻦ ﺍﻫﻠﻬﺎ ﳜﻠﺼﻬﺎ‬
‫ﺍﺳﺒﻖ ﺍﻟﺘﺮﻭﻟﻠﻰ ﻋﺸﺎﻥ ﺗﺸﻮﻑ ﺍ‪‬ﻰ ﺍﺳﺎﻧﺴﲑ ﺷﻐﺎﻝ ﻭﺗﺴﺘﻌﺠﻠﻪ ‪ ..‬ﺍﻟﺪﻗﻴﻘﺔ ﺑﺘﻔﺮﻕ ﻣﻊ ﺍﻟﻌﻴﺎﻧﺔ‬

‫ﺳﻠﻢ ﺍﳊﺎﻟﺔ ﰱ ﻋﻤﻠﻴﺎﺕ ﺍﻟﻨﺴـﺎ ﻭﻛﺪﻩ ﺍﻧﺖ ﻛﺎﻣﺘﻴﺎﺯ ﻋﻤﻠﺖ ﺍﻟﻠﻰ ﻋﻠﻴﻚ ﻭﺯﻳﺎﺩﺓ ﺷﻮﻳﺔ‬
‫‪Back to the KOSHK‬‬
‫‪‬‬

‫‪WhiteKnightLove‬‬

‫‪24‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

‫‪Do What Is Necessary ,Then Do What Is Possible, Suddenly You Do The Impossible‬‬
‫‪'It is more blessed to give than to receive.‬‬

‫ﰱ ﺍﻟﻌﻤﻠﻴﺎﺕ‬
‫ﺯﻯ ﺍﻯ ﺣﺎﻟﺔ ﺑﺘﻄﻠﻊ ‪Re-evaluation :‬‬ ‫‪-1‬‬
‫‪Sonar‬‬ ‫ﺿﻐﻂ ‪ ،‬ﻭﺯﻻﻝ‬ ‫‪History‬‬
‫ﺍﻟﺴــﺮﻳﺮ ‪:‬‬ ‫‪-2‬‬
‫‪ ‬ﲨﻴﻪ ‪ o2‬ﻭﺷﻔﺎﻁ‬
‫‪ ‬ﻓﻮﻗﻪ ‪Chart‬‬
‫ﺍﺳﺤﺐ ﲢﺎﻟﻴﻞ ﻛﺎﻣﻠﺔ ‪( see later ) :‬‬ ‫‪-3‬‬
‫ﺃﻋﻠﻘﻠﻬﺎ ﺍﻟﺴﻠﻔﺎﺕ ‪ :‬ﻣﻊ ﻣﺘﺎﺑﻌﺔ ﺍﻟﻀﻐﻂ‬ ‫‪-4‬‬
‫‪: Loading‬‬ ‫‪-‬‬
‫ﻟﻮ ﻣﻜﻨﺘﺶ ﺍﺩ‪‬ﺎ ﰱ ﺍﻻﺳﺘﻘﺒﺎﻝ‬
‫‪: Maintainence -‬‬
‫‪500 Ringer‬‬

‫‪4-6g Mg-sulfate‬‬

‫ﻋﻠﻰ ‪ 500‬رﻧﺠﺮ‬ ‫‪ 40‬ﻧﻘﻄﺔ ﻓﻰ اﻟﺪﻗﯿﻘﺔ‬

‫‪ 10‬ﻧﻘﻂ ﻓﻰ اﻟﺮﺑﻊ دﻗﯿﻘﺔ‬

‫‪ : CTG‬ﺍﺗﺎﺑﻊ ﺑﻴﻪ ﺍﳉﻨﲔ ) ﻣﺎﺗﻌﺘﻤﺪﺵ ﻋﻠﻴﻪ ‪ ،‬ﺍﲰﻊ ﺑﺎﻝ ‪ Pinnard‬ﺃﺣﺴﻦ (‬ ‫‪-5‬‬

‫ﻛﻞ ﺍﻟﻠﻰ ﻓﺎﺕ ﺑﻴﺘﻌﻤﻞ ﻟﻞ ‪ mild‬ﻭﺍﻝ ‪severe‬‬

‫ﺑﺲ ﰱ ﺣﺎﺟﺎﺕ ﺑﺘﺘﻌﻤﻞ ﳊﺎﻻﺕ ﺍﻝ ‪ severe‬ﺯﻳﺎﺩﺓ ‪..‬‬
‫‪WhiteKnightLove‬‬

‫‪25‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

 ‫‪Freely you have received; freely give.‬‬

‫ﺍﻝ ‪ severe‬ﺑﱰﻭﺩ ‪:‬‬

‫‪SEVERE PE‬‬

‫ﻋﺮﺽ ﺭﻣﺪ‬ ‫ﲨﺒﻬﺎ ﺻﻨﻴﺔ ﺍﻝ‬

‫ﻋﺮﺽ ﻗﻠﺐ‬ ‫ﻧﻮﺭ ﻫﺎﺩﻯ‬
‫‪Papilledema‬‬ ‫‪eclampsia‬‬ ‫ﻭﺻﻮﺕ ﻭﺍﻃﻰ‬
‫ﰱ ﺍﳌﻼﺣﻈﺔ‬
‫ﺍﺧﺘﺼﺮ ﺍﻧﺖ‬ ‫‪airway , -‬ﻭﺭﺑﺎﻁ‬
‫ﻭﺍﻛﺘﺐ‬ ‫‪-capoten‬‬ ‫ﺷﺎﺵ‬
‫‪oral‬‬
‫)‪NAD :‬‬ ‫‪- nitroderm‬‬ ‫‪neuril -‬‬
‫‪patch‬‬
‫‪- if Diastole‬‬ ‫‪ -‬ﺍﻣﺒﻮﻝ ﺳﻠﻔﺎﺕ‬
‫‪> 110 :‬‬
‫‪ -‬ﺍﻣﺒﻮﻝ ‪ca‬‬
‫)‪Tridil (VD‬‬
‫‪gluconate‬‬
‫)‪(antidote‬‬
‫‪TRIDIL :‬‬

‫‪ -‬ﺑﻴﺘﻌﻠﻖ ﻋﻠﻰ ﺟﻬﺎﺯ ﺳﻠﻮﺳﺖ ) ‪ ( slow set‬ﲟﻌﺪﻝ ‪ 5‬ﻧﻘﻂ ﰱ ﺍﻟﺪﻗﻴﻘﺔ ﻭﻣﻀﺎﻋﻔﺎ‪‬ﺎ ‪ ،‬ﻣﻊ ﻣﺘﺎﺑﻌﺔ ﺍﻟﻀﻐﻂ‬
‫‪ -‬ﻟﻮ ﻫﺘﻌﻠﻖ ‪ tridil‬ﺷﻴﻞ ﺍﻯ ﺑﺎﺗﺶ ﻭﺍﻻ ﺍﻟﻀﻐﻂ ﻫﻴﻘﻊ‬

‫‪OPERATIVE‬‬

‫ﺑﺎﺳﺜﻨﺎﺀ ﺍﳊﺎﻻﺕ ﻛﺎﻧﺖ ﺟﺎﻳﺔ ﰱ ﺍﻻﺳﺘﻘﺒﺎﻝ ‪ fully dilated‬ﻭﺑﺘﻮﻟﺪ ﻃﺒﻴﻌﻰ ﻻﻥ ﻣﻔﻴﺶ ﻭﻗﺖ ﺗﻄﻠﻊ ﻓﻮﻕ ‪ ..‬ﻛﻞ ﺣﺎﻻﺕ ﺍﻝ‬
‫‪PE‬ﺍﻟﻠﻰ ﺷﻔﺘﻬﺎ ﻛﺎﻧﺖ ‪CS‬‬

‫‪ ‬ﺍﻟﻌﻴﺎﻧﺔ ﺑﺘﻨﺎﻡ ‪ spinal anasth.‬ﻭﺩﻩ ﺑﻴﱰﻝ ﺍﻟﻀﻐﻂ ﺷﻮﻳﺔ ﺃﺛﻨﺎﺀ ﺍﻝ ‪CS‬‬

‫‪ ‬ﰱ ‪‬ﺎﻳﺔ ﺍﻟﺴﻜﺸﻦ ﺑﻴﻄﻠﺒﻮﺍ ﻣﻦ ﺍﻟﺘﺨﺪﻳﺮ ﺍﻧﻪ ﻳﺮﻓﻊ ﺍﻟﻀﻐﻂ ﻋﺸﺎﻥ ﻳﺸﻮﻓﻮﺍ ﺍﻥ ﻛﺎﻥ ﺍﻝ ‪sutures‬‬
‫ﺑﺖ ‪Ooze‬ﻭﻻ ﻷ ‪ ..‬ﻭﻏﺎﻟﺒﺎ ﺑﺘﻄﻠﻊ ﺑﺪﺭﻧﻘﺔ ‪..‬‬
‫‪ ‬ﰱ ﺣﺎﻻﺕ ﺍﻝ ‪severe‬ﺍﻝ ‪ skin‬ﺑﻴﺘﻘﻔﻞ ‪Transverse Mattresse‬‬

‫‪ ‬ﺳﻮﺍﺀ ‪ : mild or severe‬ﻻ ﻣﻴﺜﺮﺟــﲔ‬

‫‪WhiteKnightLove‬‬

‫ﺑﻨﺤﻄﻠﻬﺎ ) ‪ 4 mesotac ( PG‬ﻗﺒﻞ ﻣﺎﺗﻄﻠﻊ ﻣﻦ ﺍﻟﻌﻤﻠﻴﺎﺕ‬

‫‪26‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

‫‪'It is more blessed to give than to receive.‬‬

‫‪POST-OPERATIVE‬‬
‫ﻣﻬﻢ ﺟﺎﺍﺍﺍﺍﺍﺍﺍﻣﺪ ﺟﺪﻯ ‪‬‬

‫‪post-opertaive‬‬

‫ﺣﺎﺟﺘﯿﻦ ﻣﺘﺮﻛﺒﯿﻦ ﻓﻰ‬

‫‪BP‬‬ ‫اﻟﻌﻤﻠﯿﺎت‬
‫ﺣﺎﺟﺘﯿﻦ ﺑﺒﺺ ﻋﻠﯿﮭﻢ‬

‫‪uterus‬‬
‫‪Vaginal‬‬
‫اﻟﻘﺴﻄﺮة‬ ‫‪drain‬‬ ‫‪contracted‬‬
‫‪bleeding‬‬
‫‪or not‬‬
‫ﻃﺒﻌﺎ اھﻢ ﺣﺎﺟﺔ‬
‫‪----‬‬
‫ﻟﻮ ﻟﻘﯿﺘﮫ ﺑﯿﻌﻠﻰ ‪:‬‬
‫* ﺑﺰود اﻟﺴﻠﻔﺎت ‪٥٠ --‬‬ ‫ﻣﮭﻢ ﺟﺪا ﻻن‬
‫ﻧﻘﻄﺔ ﻓﻰ اﻟﺪﻗﯿﻘﺔ او اﺧﻠﻰ‬ ‫اﻟﻌﯿﺎﻧﺔ ﺑﺘﺎﺧﺪ‬
‫‪ UOP‬ﻣﻊ اﻟﺴﻠﻔﺎت ﻻزم‬ ‫‪Post-partum‬‬
‫اﻟﺠﺮﻋﺔ ‪ ٦‬ﺟﻢ ﻋﻠﻰ ال‬ ‫ﺳﻠﻔﺎت وھﻮ‬
‫ﻣﯿﻘﻠﺶ ﻋﻦ ‪30cc/hour‬‬ ‫‪hge‬‬ ‫اﺻﻼ‬
‫‪ ٥٠٠‬رﻧﺠﺮ ﺑﺪل ‪٤‬‬
‫‪-‬ﻣﺶ ﺑﺸﯿﻞ اﻟﻘﺴﻄﺮة اﻻ‬ ‫) ‪( HTN - Atony‬‬ ‫‪tocolytic‬‬
‫* ‪epilate cap.‬‬ ‫ﺑﻌﺪ ‪ ٢٤‬ﺳﺎﻋﺔ ﺣﺘﻰ ﻟﻮ‬
‫)ﻋﻦ ﺗﺠﺮﺑﺔ ﺑﻼش‬ ‫اﻟﻌﯿﺎﻧﺔ اﺗﻤﺸﺖ ﻻﻧﮭﺎ ﺑﺘﺎﺧﺪ‬
‫اﯾﺒﻼت ﺧﺎﻟﺺ ﺣﺎول‬ ‫اﻟﺴﻠﻔﺎت ﻟﻤﺪة ‪ ٢٤‬ﺳﺎﻋﺔ‬
‫ﻣﻌﺎھﺎ ﺑﺎﻟﻜﺎﺑﻮﺗﯿﻦ ﻣﺮة‬
‫واﺗﻨﯿﻦ وھﺘﯿﺠﻰ ﻣﻌﺎك (‬

‫ﺍﻟﺴﻠﻔﺎﺕ ‪post-operative‬‬
‫‪ 4 ‬ﺟﻢ ﺳﻠﻔﺎﺕ ﻋﻠﻰ ‪ 500‬ﺭﳒﺮ ﲟﻌﺪﻝ ‪ 40‬ﻧﻘﻄﺔ ﰱ ﺍﻟﺪﻗﻴﻘﺔ‬
‫‪ 6 ‬ﺯﺟﺎﺟﺎﺕ ‪ :‬ﻛﻞ ﺯﺟﺎﺟﺔ ﻭﻗﺘﻬﺎ ‪ 4‬ﺳﺎﻋﺎﺕ‬
‫‪ ‬ﻟﻮ ﻓﺎﺗﺖ ﺍﻝ ‪ 4‬ﺳﺎﻋﺎﺕ ﻭﺍﻻﺯﺍﺯﺓ ﻟﺴﻪ ﻓﻴﻬﺎ ﺷﻮﻳﺔ ﺑﻐﲑﻫﺎ ﺑﺮﺿﻪ ﻭﺃﻋﻠﻖ ﺍﳉﺪﻳﺪﺓ‬
‫‪WhiteKnightLove‬‬

‫‪27‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

‫‪Not just ' GO ' through life, but better ' Grow ' through life .‬‬
 ‫‪Freely you have received; freely give.‬‬

‫اﻟﺘﺤﺎﻟﯿﻞ‬
‫اﻟﻜﺎﻣﻠﺔ‬

‫‪CBC‬‬ ‫‪PT‬‬ ‫اﻟﻜﯿﻤﯿﺎء‬

‫زﻣﻦ وﺗﺮﻛﯿﺰ‬ ‫‪liver‬‬ ‫‪kidney‬‬ ‫‪LDH‬‬ ‫‪RBS‬‬

‫ﺑﺮوﺛﺮوﻣﺒﯿﻦ‬
‫ﻓﻰ اﻟﺪم‬
‫= ﺳﻤﻌﺖ‬
‫ﻣﺮة دﻛﺘﻮر‬ ‫‪3‬‬ ‫‪3‬‬
‫اﻟﺘﺨﺪﯾﺮ ﺑﯿﻘﻮل‬ ‫ﻟﻮ ﻋﺎﻟﻰ‬
‫ان اﻗﻞ ‪pT‬‬ ‫ده ﻣﻌﻨﺎه ان‬
‫ادﺧﻞ ﺑﯿﮫ‬ ‫ﻓﯿﮫ‬
‫اﻟﻌﯿﺎﻧﺔ‬
‫ﻋﻤﻠﯿﺎت ھﻮ‬ ‫‪Hemolysis‬‬
‫‪60%‬‬
‫!!!!‬ ‫)‪(HELLP‬‬

‫‪LIVER‬‬
‫‪ ‬ﺍﻟﺒﻴﻮﻣﲔ ﰱ ﺍﻟﺪﻡ ‪ :‬ﻗﻠﻴﻞ ‪‬ﳏﺘﺎﺝ ﺑﻼﺯﻣﺎ ﻟﻮ ‪ ) human albumin‬ﺍﻟﻌﻠﺒﺔ ﺏ ‪200‬‬
‫ﺟﻨﻴﻪ (‬
‫‪ ‬ﺑﻴﻠﲑﻭﺑﲔ ﻛﻠﻰ ﻭﻣﺒﺎﺷﺮ‬
‫‪SGOT , SGPT : HELLP syndrome ‬‬
‫‪KIDNEY‬‬
‫‪renal impairment : Urea ‬‬
‫‪renal impairment : Creatinine ‬‬
‫‪ ‬ﲪﺾ ﺍﻟﻴﻮﺭﻳﻚ ‪ :‬ﻻﺯﻡ ﻳﻌﻠﻰ ﰱ ﺍﻝ ‪PE‬‬
‫ﺩﻩ ﺑﻔﺮﻕ ﺑﻴﻪ ﺑﲔ ﺍﻝ ‪chronic HTN and PE‬‬
‫‪WhiteKnightLove‬‬

‫ﰎ ﲝﻤﺪ ﺍﷲ‬

‫‪28‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

'It is more blessed to give than to receive.

PLACENTAL ABRUPTION - CONCEALED TYPE

‫ ﺑﻴﻌﻤﻞ ﻣﺸﻜﻠﺔ ﻛﺒﻴﺮة‬، ‫ ﺳﺒﺒﻪ ﻣﺸﻜﻠﺔ ﻛﺒﻴﺮة‬، ‫ﻫﻮ ﻣﺸﻜﻠﺔ ﻛﺒﻴﺮة‬

( Premature separation of placenta from the uterine side-wall )

High risks with :

 Severe PE ( more than 50% )

 Poly-hydramnios ( sudden ROM  sudden drop of
intra-uterine pressure )
 Trauma
Abruption‫ﺎ‬‫ﻫﻌﺮﻑ ﺍﺯﺍﻯ ﺍ‬

ABRUPTION

‫ﺍﻟﻔﺤﺺ‬ History

‫ﺍﻳﺪﻳﻚ ﻋﻠﻰ‬ SUDDEN

PV ‫ﺍﲰﻊ ﺍﻟﻌﻴﻞ‬ SEVERE
‫ﺑﻄﻨﻬﺎ‬ Abd. PAIN

Only if continous hardness

‫ﻣﺶ ﻣﺴﻤﻮﻉ‬ history of
NO ‫ﺑﻄﻨﻬﺎ ﺷﺎﺩﺓ ﻭﻣﺒﺘﻔﻜﺶ‬
PE, HTN
bleeding ‫ﺍﻭ ﻣﺴﻤﻮﻉ‬
cont ‫ﻣﺎﺑﲔ ﺍﻝ‬ ‫ﺍﺣﺴﺎﺱ‬
‫ﺿﻌﻴﻒ ﺍﻭﻯ‬
tone ‫ﻭﺍﻝ‬
WhiteKnightLove

29 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

Knowledge speaks , But wisdom listens .
 ‫‪Freely you have received; freely give.‬‬

‫‪N.B. Uterine tenderness suggests for Couverlaire uterus ( extra-vasation of blood into‬‬
‫) ‪myometrium‬‬

‫ﰱ ﺍﻻﺳﺘﻘﺒـﺎﻝ‬
‫‪Vitals & Resuscitation :‬‬ ‫‪-1‬‬
‫ﻛﺎﻧﯿﻮﻻ ﯾﻤﯿﻦ وﺷﻤﺎل ‪+‬‬
‫ﻟﻮ ‪ 500 :shocked‬رﻧﺠﺮ‬
‫ﻟﻮ ﺿﻐﻄﮭﺎ ﻋﺎﻟﻰ ﺑﺎﺗﺸﺎﯾﺔ وﻛﺎﺑﻮﺗﯿﻦ ﺗﺤﺖ اﻟﻠﺴﺎن‬

‫‪ -2‬ﺿﻐﻂ وزﻻل ) اﺷﮭﺮ ﺳﺒﺐ ‪(PE‬‬

‫ﻣﻤﻜﻦ ﺗﻼﻗﻰ ﺿﻐﻄﮭﺎ ﻣﺶ ﻋﺎﻟﻰ – ده ﻣﺶ ھﯿﺴﺘﺒﻌﺪ ال ‪PE‬‬
‫‪Retro-placental bleeding  Shock‬‬
‫ﻟﻮ ﻟﻘﺘﮭﺎ ‪ PE‬اﻣﺒﻮل ﻧﯿﻮرﯾﻞ ﻋﻠﻰ ‪ 10‬ﺳﻢ ﻣﻠﺢ وﻣﻌﺎك ال ‪ airway‬ورﺑﺎط ﺷﺎش‬

‫ﻓﺼﯿﻠﺔ وﺗﻮاﻓﻖ ) ﻣﮭﻢ ﺟﺪاااااااااا( ‪ :‬ﺣﺠﺰ ‪ 1500‬ﺳﻢ دم ﻣﻦ ﻧﻔﺲ اﻟﻔﺼﯿﻠﺔ‬ ‫‪-3‬‬

‫) ﻟﻭ ﻓﺼﻴﻠﺘﻬﺎ ﺴﺎﻟﺏ ﺍﺴﺄل ﻓﻰ ﺒﻨﻙ ﺍﻟﺩﻡ ﻓﻴﻪ ﻜﺎﻡ ﻜﻴﺱ ﻤﻨﻬﺎ ﻭﻟﻭ ﻤﺵ ﻤﻭﺠﻭﺩﺓ ﺍﺒﻌﺕ ﺍﻫﻠﻬﺎ ﻴﺴﺄﻟﻭﺍ ﻓﻰ ﺍﻟﻘﺼﺭ (‬

‫‪ -4‬ﻗﺴـــﻄﺮة ‪for UOP , Urine sample for Ptnuria and urine analysis :‬‬

‫اﺑﻌﺘﮭﺎ اﻟﺴــﻮﻧﺎر ﻋﻠﻰ اﻟﺘﺮوﻟﻠﻰ ) ﻗﺒﻞ ﻣﺎﺗﻄﻠﻊ ﯾﻜﻮن دﻛﺘﻮر اﻟﺴﻮﻧﺎر ﻧﺰل (‬ ‫‪-5‬‬

‫ﻫﺘﺮﻭﺡ ﻣﻌﺎﻫﺎ ﺍﻟﺴﻮﻧﺎﺭ ‪ ..‬ﻭﻟﻮ ﻟﻘﻴﺖ ﺣﺎﻻﺕ ﻫﻨﺎﻟﻚ ﻣﺘﺴﺘﻨﺎﺵ ﺍﻃﻠﻊ ﺑﻴﻬﺎ ﻋﻠﻰ ﺍﻟﻘﺴﻢ ﻋﻠﻰ ﻃﻮﻝ ﻭﺣﺘﲎ‬
‫ﻣﺘﺴﺘﻨﺎﺵ ﺗﻌﻤﻞ ﺩﺧﻮﻝ ‪ ..‬ﺍﻃﻠﻊ ﺑﻴﻬﺎ ﻭﺍﺑﻘﻰ ﺍﻧﺰﻝ ﺍﻭ ﺍﺑﻌﺖ ﺣﺪ ﻣﻦ ﺍﻫﻠﻬﺎ ﻳﻌﻤﻠﻬﺎ ﺍﻟﺪﺧﻮﻝ‬
‫ﺍﻩ ﻃﺒﻌﺎﺍﺍﺍ ‪ ..‬ﻗﺒﻞ ﻣﺎﺗﻄﻠﻊ ﺍﻟﻘﺴﻢ ﺗﻜﻮﻥ ﻣﺒﻠﻎ ﺑﺎﳊﺎﻟﺔ‬

‫ﰱ ﺍﻟﻌﻤﻠﻴﺎﺕ‬
‫‪ ‬ﺍﻭﻝ ﻣﺎﺗﺒﻠﻐﻬﻢ ﻓﻮﻕ – ‪ call‬ﺃﳘﻴﺔ ﻗﺼﻮﻯ ﻋﻠﻰ ﻧﺎﻳﺐ ﺍﻟﺘﺨﺪﻳﺮ‬
‫‪ ‬ﺍﻟﻌﻴﺎﻧﺔ ﺩﺧﻠﺖ ﻉ ﺍﻟﺘﺮﻭﻟﻠﻰ – ‪ history : Reevaluation‬ﻭﺿﻐﻂ ﻭﺯﻻﻝ – ‪US‬‬
‫‪WhiteKnightLove‬‬

‫‪ ‬ﻳﺘﺴﺤﺒﻠﻬﺎ ﲢﺎﻟﻴﻞ ﻛﺎﻣﻠﺔ ‪ :‬ﺍﻟﻠﻰ ﻳﻬﻤﲎ ﺩﻟﻮﻗﱴ ‪CBC , PT‬‬

‫‪30‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬
‫‪'It is more blessed to give than to receive.‬‬

‫‪ECTOPIC PREGNANCY‬‬
‫ﻓﻴﻪ ﻣﻨﻪ ﺍﻧﻮﺍﻉ ‪disturbed and undisturbed‬‬

‫) ‪Disturbed ( acute , subacute,chronic‬‬

‫ﺍﻟﻠﻰ ﻫﻴﺠﻴﻠﻰ ﻣﻌﻈﻢ ﺍﻻﺣﻴﺎﻥ ﰱ ﺍﻻﺳﺘﻘﺒﺎﻝ ﻛﻄﻮﺍﺭﺉ ‪acute disturbed EP‬‬

‫ﰱ ﺍﻻﺳﺘﻘﺒـﺎﻝ‬
‫‪Uni-Lat. Sudden Severe Abd. Pain‬‬
‫‪Vitals : Bp , Pulse‬‬
‫‪UNSTABLE‬‬
‫ﻛﺎﻧﻴﻮﻻ ﳝﲔ ﴰﺎﻝ ﻭ ‪ 500‬ﺭﳒﺮ‬ ‫‪-1‬‬
‫ﻓﺼﻴﻠﺔ ﻭﺗﻮﺍﻓﻖ ) ﺣﺠﺰ ‪1500‬ﺳﻢ ﺩﻡ ﻣﻦ ﻧﻔﺲ ﺍﻟﻔﺼﻴﻠﺔ (‬ ‫‪-2‬‬
‫ﻗﺴﻄﺮﺓ ‪ :‬ﻫﻌﻤﻞ ﻣﻨﻬﺎ ﺍﻝ ) ‪ baby chek +ve ( medicolegal‬ﻭﻋﻴﻨﻪ ﺗﺒﻌﺘﻬﺎ ﲢﻠﻴﻞ ﺑﻮﻝ ﻭﻛﻤﺎﻥ ﺑﺘﺎﺑﻊ‬ ‫‪-3‬‬
‫‪UOP‬‬
‫ﺍﺳﺤﺐ ﻋﻴﻨﺔ ﻭﺍﺑﻌﺖ ﺣﺪ ﻣﻦ ﺍﻫﻠﻬﺎ ﻟﻠﻤﻌﻤﻞ ﺑﺮﻩ ‪Quantitaive β-hCG‬‬ ‫‪-4‬‬
‫‪URGENT US : empty uterus , adnexal mass , internal hge‬‬ ‫‪-5‬‬
‫ﺩﺧـــــﻮﻝ‬ ‫‪-6‬‬

‫‪STABLE‬‬
‫‪ ‬ﻛﺎﻧﻴﻮﻻ ﺑﺮﺿﻪ ‪ :‬ﻣﺶ ﺿﺎﻣﻨﲔ ﳑﻜﻦ ﺗـ ‪ collapse‬ﻣﻨﻨﺎ ﻓﺠﺄﺓ‬
‫‪ ‬ﻟﻮ ﺗﻘﺪﺭ ﺗﻌﻤﻞ ﲪﺎﻡ ﺧﻠﻴﻬﺎ ﲡﻴﺐ ﻋﻴﻨﺔ ﺑﻮﻝ ﺍﻋﻤﻞ ﺑﻴﻬﺎ ﺍﻻﺧﺘﺒﺎﺭ ‪ +ve‬ﻭﺑﻘﻴﺘﻬﺎ ﺍﺑﻌﺘﻬﺎ ﺗﺘﺤﻠﻞ ﺑﺮﻩ‬
‫‪ ‬ﻫﺘﺴﺤﺐ ‪ Quantitaive β-hCG‬ﺑﺮﺿﻪ ﻭﺗﻌﻤﻠﻬﺎ ﺳﻮﻧﺎﺭ‬
‫‪ ‬ﺑﺲ ﻟﻮ ﺍﻟﻮﺟﻊ ﳝﲔ ‪ :‬ﺍﻋﺮﺿﻬﺎ ﺟﺮﺍﺣﺔ ‪To exclude appendicitis‬‬
‫‪ ‬ﳑﻜﻦ ﺗﺴﺄﳍﺎ ﻋﻦ ‪ risk factors‬ﻭﺍﳘﻬﺎ ﻃﺒﻌﻌﺎ ﺍﻝ ‪PID‬‬
‫ﻗﺒﻞ ﻛﺪﻩ ﺳﺨﻨﱴ ﻭﻛﺎﻥ ﻓﻴﻪ ﻭﺟﻊ ﰱ ﺑﻄﻨﻚ ﻣﻦ ﲢﺖ ﻭﻧﺰﻝ ﻋﻠﻴﻜﻰ ﺍﻓﺮﺍﺯﺍﺕ ﺻﻔﺮﺍ ﺭﳛﺘﻬﺎ ﻭﺣﺸﺔ ‪.‬‬
‫ﻛﻞ ﺩﻩ ﺍﻧﺖ ﺷﺨﺼﺘﻬﺎ ﻭﻋﻤﻠﺘﻠﻬﺎ ﺍﻟﻼﺯﻡ ﻣﻦ ﻏﲑ ﺍﻝ ‪PV‬‬
‫ﺑﺲ ﳑﻜﻦ ﺗﺴﺘﺨﺪﻡ ﺍﻝ ‪PV‬ﺑﺮﺿﻪ ‪ :‬ﺗﻌﻤﻞ‬
‫‪Bimanual : unilat adnexal tenderness ,‬‬
‫‪WhiteKnightLove‬‬

‫ﺣﺮﻙ ﺍﻝ ‪ cx‬ﳝﲔ ﻭﴰﺎﻝ ﻫﺘﻼﻗﻰ ﺍﻟﻌﻴﺎﻧﺔ ﺑﺘﺘﻮﺟﻊ ﻋﻠﻰ ﻧﺎﺣﻴﺔ ﻭﺍﺣﺪﻩ ‪Cervical motion tenderness :‬‬

‫‪31‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

‫‪Let us not look back in anger or forward in fear but look around for awareness‬‬
 Freely you have received; freely give.

ECTOPIC PREGNANCY

Sever lower abdominal pain ± vaginal bleeding

Baby check  +ve

Quantitaive β-
subunit
TVUS  empty
‫ ﻣﻮﺟﻮد‬.. ‫ﯾﻌﻨﻰ ﯾﺪﯾﻨﻰ رﻗﻢ‬
‫ﻗﺪ اﯾﮫ‬

Quantitaive β-subunit Qualitative

‫ وﻻ ﻻ‬hCG ‫ﯾﻘﻮﻟﻰ ﻣﻮﺟﻮد‬

< 1500 > 1500

Repeat after 48 hs Pulsating adnexal mass

+ empty uterus

Marked
>66% Suboptimal 


Early Complete EP -
n0rmal aborion
IUP - Unhealthy IUP

TTT

STABLE UNSTABLE
2 canula ‫ ﺳﻢ ﺩﻡ‬1500 ‫ﺗﻮﺍﻓﻖ ﻭﺻﺮﻑ‬

Methotrexate Laparoscope  salpingeCTomy

Salpingostomy : ‫ ﻣﻦ ﻏﯿﺮ ﺧﯿﺎﻃﺔ‬tube ‫ﺑﻔﺘﺢ واﺳﯿﺐ ال‬
WhiteKnightLove

Check  CBC- Salpingostomy : sutures ‫ ﺑﺎل‬tube ‫ﺑﻘﻔﻞ ال‬

liver - kidney

32 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

'It is more blessed to give than to receive.

Rupture Uterus

During Pregnancy During Labor

Spontaneous
Traumatic * spontaneous : obst.
labor
* Truama : forceps ,
manual removal of
placenta
Rupture direct
surgical
trauma
* improper use of Ecbolics
trauma : e.g.ergometrine
Uterine antepartum
Scar
Most
Common

Rupture During
Pregnancy

classic type silent type

(scar dehiscence)

STABLE ‫اﻟﻌﯿﺎﻧﺔ‬
minimal symptoms
, minimal Int. hge
picture of
Sudden internal hge
sever
abd. u/s : fetus intrauterine ,
Vitals : SHOCKED
pain collection in Douglas pouch
WhiteKnightLove

‫ھﺘﺤﺲ اﻟﻌﯿﻞ ﺗﺤﺖ اﯾﺪك ﺳﮭﻞ وﺑﺎﯾﻦ‬

‫ ﺗﺴﻤﻌﮫ ﻣﻔﯿﺶ ﺣﺎﺟﺔ‬- ‫اوى‬
rigid - tender Rebound -
shifting dullness For laparotomy
33 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬
 Freely you have received; freely give.

Rupture scar Scar opened , membranes ruptured , fetus Extra- utrine

Dehiscent scar Scar opened , membranes intact , fetus Intra – utrine

‫ ﻓﻘﻂ ﻭﺗﺴﻠﻤﻬﺎ ﰱ ﺍﻟﻘﺴﻢ‬Resuscitation .. ‫ﺩﻭﺭﻙ ﻛﺎﻣﺘﻴﺎﺯ ﻓﻴﻬﺎ‬

‫ﻛﺎﻧﻴﻮﻻﺕ ﻭﺭﳒﺮ ﻭﺣﺠﺰ ﺩﻡ ﻭﻗﺴﻄﺮﺓ‬

‫ﻟﻮ ﺍﳊﺎﻟﺔ ﺿﺎﻳﻌﺔ ﺍﻃﻠﻊ ﺑﻴﻬﺎ ﻉ ﺍﻟﻌﻨﺎﻳﺔ ﺍﻷﻭﻝ‬

‫ ﻣﺶ ﻓﺎﺿﻠﻨﺎ ﺍﻻ ﺍﻝ‬adbominal pain with pregnancy ‫ﻳﺒﻘﻰ ﰱ ﺍﻝ‬

Extragenital causes

 UTI __________see below

 GIT __________see “ Vomiting with Pregnancy “

WhiteKnightLove

34 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

'It is more blessed to give than to receive.

UTI WITH PREGNANCY

UTI ‫ﻃﺒﻌﺎ ﻣﺶ ﳏﺘﺎﺟﲔ ﻧﺸﺮﺡ ﻭﻧﻘﻮﻝ ﺍﺯﺍﻯ ﻧﻌﺮﻑ ﺍﻥ ﺩﻯ‬

. ‫ ﺍﱁ‬.. ‫ ﻭﺗﻌﻤﻠﻬﺎ ﲢﻠﻴﻞ ﺑﻮﻝ‬dysuria ‫ ﻭﻣﻌﺎﻩ‬suprapubic ‫ ﺍﻭ‬loin to groin ‫ﺯﻯ ﻣﺜﻼ ﺍﻥ ﻓﻴﻪ ﻭﺟﻊ‬

‫ ﰱ ﺍﳊﺎﻣﻞ ﻋﻦ ﺍﻟﻠﻰ ﻣﺶ ﺣﺎﻣﻞ ؟؟‬UTI ‫ﺍﻣﺎﻝ ﺍﻳﻪ ﺍﻟﻔﺮﻕ ﺑﲔ ﺍﻝ‬

preterm labor ‫ﳑﻜﻦ ﺗﺪﺧﻞ ﺍﻟﺴﺖ ﰱ‬ : ‫ﺎ ﺍﻳﻪ ﰱ ﺍﳊﻤﻞ‬‫ ﺧﻄﻮﺭ‬-1

‫ ﺍﺳﺒﻮﻉ‬16 ‫ﺎ ﺑﺘﺤﺼﻞ ﻏﺎﻟﺒﺎ ﺑﻌﺪ‬‫ ﻭﻟﻮ ﺍﻥ ﺍﻟﻜﺘﺐ ﻛﺎﺗﺒﺔ ﺍ‬1st trimester ‫ ﻟﻮ ﻫﻰ‬abortion ‫ﺃﻭ‬
anti-biotic safe in pregnancy ( penicllins , Cephalosporines ) : ‫ ﺍﻟﻌﻼﺝ‬-2

: ‫ ﻻﺯﻡ ﺗﺴﺘﺒﻌﺪ ﻭﺟﻮﺩ‬UTI ‫ﻋﺸﺎﻥ ﻛﺪﻩ ﺑﻌﺪ ﻣﺎﺷﺨﺼﺘﻬﺎ‬

Uterine cont. (* preterm labor )
Vaginal bleeding ( *abortion in 1st trimester )

PUS cells in Urine analysis ‫ﺍﻟﻌﻼﺝ ﻫﻴﺒﻘﻰ ﻋﻠﻰ ﺣﺴﺐ ﺍﻝ‬

 0-5 / HPF : Normal

 5-30 :
urinary antiseptic + antispasmodic+ ‫ ﻓﻮﺍﺭ ﻋﻠﻰ ﺣﺴﺐ ﺍﻻﻣﻼﺡ ﺍﻟﻠﻰ ﻣﻮﺟﻮﺩﻩ‬+ analgesic
 Rx : Uvamine retard cap. ‫ ﺳﺎﻋﺔ‬12 / ‫ﻛﺒﺴﻮﻟﺔ‬
 Rx : urenix cap. ‫ ﺳﺎﻋﺔ‬12/ ‫ﻛﺒﺴﻮﻟﺔ‬
 Rx : Urosolvine (urate) or Epimag (oxalat)
‫ ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ‬3 ‫ﻛﻴﺲ ﻋﻠﻰ ﻧﺺ ﻛﺒﺎﻳﺔ ﺑﻌﺪ ﺍﻷﻛﻞ‬
 Rx : Coliurinal  alkalinization of Urine ( majority of cases
due to E.coli )‫ ﻣﺮﺍﺕ ﻳﻮﻣﻴﺎ‬3 ‫ﻣﻌﻠﻘﺔ ﻛﺒﲑﺓ ﻋﻠﻰ ﻧﺺ ﻛﺒﺎﻳﺔ ﻣﻴﺔ ﺑﻌﺪ ﺍﻷﻛﻞ‬
 Rx : Profenid rectal supp. ‫ ﺳﺎﻋﺔ ﳌﺪﺓ ﻳﻮﻣﲔ ﻓﻘﻂ‬12 ‫ﻟﺒﻮﺳﺔ ﺷﺮﺟﻴﺔ ﻛﻞ‬

 30-100 : same drugs + Oral Anti-biotics ( 2nd generation cephalosp.)

WhiteKnightLove

 Rx : zinnat 500 cap. ‫ﺳﺎﻋﺔ‬12/ ‫ﻛﺒﺴﻮﻟﺔ‬

35 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

 Freely you have received; freely give.

: ‫ﰱ ﻛﻞ ﺍﳊﺎﻻﺕ ﺍﻟﻠﻰ ﻓﺎﺗﺖ‬

‫ أزاﯾﺰ‬3 ) – ‫ﺗﺸﺮﺑﻰ ﻣﯿﺔ ﻛﺘﯿﺮ‬ 
.( ‫ﻣﯿﺔ ﻛﺒﺎر‬ . ‫ﺍﻟﻌﻼﺝ ﰱ ﺍﻟﺒﻴﺖ ﳌﺪﺓ ﺃﺳﺒﻮﻋﲔ‬ -1
‫اﻟﻤﻼﺑﺲ اﻟﺪاﺧﻠﯿﺔ ﺗﺒﻘﻰ ﻗﻄﻦ‬ 
. ‫وﺗﻐﯿﺮﯾﮭﺎ ﻛﻞ ﯾﻮم‬
. ‫ﻳﻌﺎﺩ ﲢﻠﻴﻞ ﺍﻟﺒﻮﻝ ﺑﻌﺪ ﺍﻻﺳﺒﻮﻋﲔ‬ -2
‫ﻟﻤﺎ ﺗﺤﺴﻰ اﻧﻚ ﻋﺎوزة ﺗﻌﻤﻠﻰ‬  Instructions to prevent recurrence : ‫ﻣﻊ ﺍﻟﻌﻼﺝ‬ -3
‫ وﺗﻔﻀﻰ‬.. ‫ﺣﻤﺎم ﻣﺘﺄﺧﺮﯾﮭﺎش‬
. ‫اﻟﻤﺜﺎﻧﺔ ﻛﻠﮭﺎ‬
‫ﺗﻐﺴﻠﻰ ﻣﻦ ﻗﺪام ﻟﻮرا ﻣﺶ اﻟﻌﻜﺲ‬ 
. ‫ ﺍﻣﱴ ﺗﺘﺤﺠﺰ ؟؟‬
Pus cells > 100 / HPF -1
Severe case : severe pain,with fever and rigors -2

: ‫ ﻟﻴﻪ ؟؟‬
septic shock – PTL ‫ ﺧﺎﻳﻒ ﻣﻦ ﺍﻝ‬، ‫ﻋﺸﺎﻥ ﻻﺯﻡ ﺗﺒﻘﻰ ﲢﺖ ﻋﻨﻴﺎ‬
: ‫ ﻫﻌﻤﻠﻬﺎ ﺍﻳﻪ ؟؟‬
I.V. Fluids : 2-3 litres/ day 
I.V. AB : 
Cefotax i.v. ( 3rd generation Cephsp.) till pt. afebrile ( at least
48 hs ) then oral AB for 2 weeks
Symptomatic ttt ‫ ﺍﻝ‬+
‫ ﺑﺘﺎﺑﻊ ﲢﻠﻴﻞ ﺍﻟﺒﻮﻝ ﻳﻮﻣﻴﺎ ﻭﺑﻌﻤﻠﻬﺎ ﻣﺰﺭﻋﺔ‬
. ‫ ﻭﻳﻄﻠﻌﻮﺍ ﻓﺮﻯ‬- 1 wk interval – ‫ﺑﻌﺘﱪﻫﺎ ﺧﻔﺖ ﲤﺎﻣﺎ ﳌﺎ ﺍﻋﻤﻠﻬﺎ ﻣﺰﺭﻋﺔ ﻣﺮﺗﲔ‬
N.B. s

1- follow Up after Delivery :

urine analysis .. if persistent infection  full uroogical investigation ,
.. Others say wait at least 12 week after delivery to allo anatomical changes
related to pregnancy to resolve .

2-NSAIDs : *****
 Don’t use more than 48 hs : prolonged use  oligohydramnios
 Don’t use after 32 wks gestation  premature closure of Ductus Arteriosus
WhiteKnightLove

 Pulmonary HTN in newborn .

36 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

A drug per definition must be toxic or it cannot be labeled as a drug.
'It is more blessed to give than to receive.

RUPTURE OF MEMBRANES
- Introduction :

Term ROM : ROM at onset of labor

PROM : ROM a er completed 37w but before onset of labor

PPROM : Rom before completed 37w

Prolonged ROM : ROM of more than 24 h dura on

 ‫ ﺍﻟﻘﺮﻥ ﻃﺶ ﻗﺒﻞ ﻣﻌﺎﺩﻩ‬.. ‫ﺑﺎﻟﺒﻠﺪﻯ ﻛﺪﻩ‬

‫اﯾﮫ اﻟﻤﺸﻜﻠﺔ ؟‬
‫اﻧﺎ ﺧﺎﯾﻒ ﻣﻦ اﯾﮫ ؟‬

amniotic fluid ‫ھﻔﻘﺪ ﻣﻤﯿﺰات ال‬ INFECTION

‫ودى ﻣﺸﺎﻛﻞ ﻣﺮﺗﺒﻄﺔ اﻛﺘﺮ ﺑﺎﻟﻮﻗﺖ‬
prolonged ROM
MATERNAL Fetus
‫ﻣﺒﻘﺎش ﻓﻴﻪ اﻟﺒﺤﺮ‬
lung maturity : ‫اﻟﻠﻰ ﺑﻴﻌﻮم ﻓﻴﻪ‬
AF contain growth neonatal sepsis
factors help in lung cord compression
maturity --> RDS -> neonatal
asphyxia

skeletal
deformities
dec. skeletal ms
development

* ROM--> release of PG --> high risk for Preterm labor .

* Vaginal infections are great risk of infection in cases of ROM .
WhiteKnightLove

* if UTI present  must be treated to avoid risk of Preterm labor .

37 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

 ‫‪Freely you have received; freely give.‬‬

‫‪Maternal‬‬
‫‪Infections‬‬

‫ﻗﺒﻞ اﻟﻮﻻدة‬ ‫ﺑﻌﺪ اﻟﻮﻻدة‬

‫‪Chorio-amnionitis‬‬ ‫‪Peurperal sepsis‬‬

‫ﰱ ﺍﻻﺳﺘﻘﺒــﺎﻝ‬

‫ﻋﻴﺎﻧﺔ ﺟﺎﻳﺔ ﺗﻘﻮﻟﻚ ﻧﺰﻟﺖ ﻋﻠﻴﺎ ﻣﻴﺔ ﺍﻭ ﺍﻟﻘﺮﻥ ﻃﺶ ‪‬‬

‫ﻫﻨﺎﺧﺪ ﻣﻨﻬﺎ ﺷﻴﺖ ﻛﺎﻣﻞ ﻋﺎﺩﻯ ﺧﺎﻟﺺ ﺯﻯ ﻣﺎﺗﻔﻘﻨﺎ ﰱ ﻛﻞ ﺍﳊﺎﻻﺕ‬

‫‪complaint‬‬ ‫‪SHEET‬‬

‫ﺍﻝ ‪ 6‬ﺣﺎﺟﺎﺕ ﺍﻟﺜﺎﺑﺘﻪ ﰱ ﻛﻞ ﺷﻴﺖ‬

‫‪confirm‬‬ ‫‪ask abt‬‬

‫‪diagnosis‬‬ ‫‪complications‬‬ ‫ﺑﺲ ﺍﻳﻪ ﺍﻟﻨﻘﻂ ﺍﻟﻠﻰ ﻧﺎﺧﺪﻫﺎ ﻭ‪‬ﻤﻨﺎ‬
‫ﰱ ﺍﳊﺎﻟﺔ ﺩﻯ ‪:‬‬

‫ﻣﯿﺔ دﻓﻘﺖ ﻋﻠﯿﻜﻰ‬ ‫‪ ‬ﺃﺧﺮ ﺩﻭﺭﺓ ﺟﺘﻠﻚ ﺍﻣﱴ ؟؟‬

‫‪Infection‬‬ ‫‪Preterm labor‬‬
‫ﻛﺘﯿﺮ ﻏﺮﻗﺘﻚ‬
‫وﻏﺮﻗﺖ اﻷرض‬ ‫ﺳﺨﻨﺘﻰ ‪ -‬ﺑﯿﻨﺰل‬ ‫ﻓﯿﮫ وﺟﻊ او ﺑﻄﻨﻚ‬ ‫ﻻﻥ ﺍﻝ ‪ GA‬ﻫﻮ ﺍﻟﻠﻰ‬
‫ﻋﻠﯿﻜﻰ اﻓﺮازات‬ ‫ﺑﺘﺤﺠﺮ ﻋﻠﯿﻜﻰ‬ ‫ﻫﺘﻌﺘﻤﺪ ﻋﻠﻴﻪ ﺍﻝ‬
‫ﺻﻔﺮا رﯾﺤﺘﮭﺎ‬ ‫ﻃﯿﺐ ﻓﯿﮫ ﺣﺮﻗﺎن‬
‫وﺣﺸﺔ‬ ‫ﻓﻰ اﻟﺒﻮل ‪Risk‬‬ ‫‪management‬‬
‫‪WhiteKnightLove‬‬

‫‪factor‬‬

‫‪38‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

'It is more blessed to give than to receive.

‫ ﻃﻴﺐ ﺍﻟﺴﺆﺍﻝ ﺍﳌﻬﻢ ﺑﻘﻰ‬.. ‫ ﻓﻌﻼ‬ROM ‫ﺎ‬‫ ﻓﻜﺮﺕ ﰱ ﺍ‬history ‫ﻣﻦ ﺍﻝ‬

‫ﺃﻓﺤﺼﻬﺎ ﻭﻻ ﻷ ؟؟‬

GA ‫ﺣﺴﺐ ﺍﻝ‬

‫ﻗﺒﻞ‬
completed
completed
37 w
37 w

‫ﻓﯿﮭﺎ وﺟﻊ‬
‫ﻣﻔﯿﮭﺎش وﺟﻊ‬ ‫اﻓﺤﺼﮭﺎ ﺑﻘﻠﺐ‬
‫) ﺗﻘﻮﻟﻚ ﺑﻄﻨﻰ ﺑﺘﺤﺠﺮ ﻋﻠﯿﺎ‬
No TRUE cont. cont. ‫ او اﻧﺖ ﺗﻌﺪ ال‬- ‫ﺟﺎﻣﺪ‬
( ‫ دﻗﺎﯾﻖ‬١٠ ‫ﻓﻰ‬

No P.V. TRUE cont. = Preterm

or Sterile Cusco with labor
Sterile Gloves --> Cx ‫اﻓﺤﺼﮭﺎ واﯾﺎ ﻛﺎن ال‬
leakage of fluid
‫ﻛﺪه ﻛﺪه ھﺘﺘﺤﺠﺰ‬
AFI ?? : ‫ﻫﺘﻄﻠﺒﻬﺎ ﺳﻮﻧﺎﺭ‬

EXIT ENTER

‫ ﺣﺎﺟﺎﺕ ﺩﻯ‬3 ‫ﻣﻔﻴﻬﺎﺵ ﺣﺎﺟﺔ ﻣﻦ ﺍﻝ‬ ‫ﺃﻯ ﻭﺍﺣﺪﻩ ﻣﻦ ﺩﻭﻝ‬

‫ﻫﻨﻌﻤﻞ ﺍﻳﻪ ؟‬ 1- Sure ROM

infection ‫ ﻫﻨﻌﺎﰿ ﺍﻯ‬-1 2- AFI : <5 or low normal

e.g. 6 , 7
UTI or Vaginal infection
3- not sure ROM but in
WhiteKnightLove

instructions ‫ ﻧﻘﻮﳍﺎ ﺍﻝ‬-2 labor ( preterm )

39 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

 ‫‪Freely you have received; freely give.‬‬

‫ﻫﻨﻌﻠﻤﻬﺎ ﻛﻞ ﺍﻟﻠﻰ ﺑﻴﺘﻌﻤﻞ ﻟﻠﺤﺎﻻﺕ ﺍﻟﻠﻰ ﻫﺘﺘﺤﺠﺰ ) ﻛﺎﻧﻴﻮﻻ ﻭﻓﺼﻴﻠﺔ ﺿﻐﻂ ﻭﺯﻻﻝ ‪( ....‬‬

‫ﺍﻣﺎﻝ ﺍﻳﻪ ﺍﻟﻔﺮﻕ ﻫﻨﺎ‬

‫ﻫﻨﺪﻳﻬﺎ ‪prophylaxis AB‬‬

‫‪ 2‬ﺟﻢ ﺍﻣﺒﻴﺴﻴﻠﻠﲔ ) ﻭﺗﻜﺘﺐ ﻋﻠﻰ ﺍﻟﺘﺬﻛﺮﺓ ﺍ‪‬ﺎ ﺃﺧﺪ‪‬ﻢ (*‬

‫‪ :‬ﻛﻨﺖ ﺑﻌﻤﻠﻪ ﰱ ﺍﻷﻭﻝ ﺑﺲ ﺑﻄﻠﺖ ﻭﻗﻠﺖ ﻧﻌﻤﻠﻬﺎ ﺳﻮﻧﺎﺭ ﺍﺣﺴﻦ ﻫﻮ ﺍﻧﺎ ﺧﺴﺮﺍﻥ ﺍﻳﻪ ‪(:‬‬ ‫ﺑﺎﻟﻨﺴﺒﺔ ﳌﻮﺿﻮﻉ ﺍﳊﻔﺎﺿﺔ‬

‫ﳑﻜﻦ ﻗﺒﻞ ﻣﺎﺗﻮﺩﻳﻬﺎ ﺍﻟﺴﻮﻧﺎﺭ ﲢﻄﻠﻬﺎ ﺣﻔﺎﺿﺔ ﻭﺗﺘﻤﺸﻰ ﺷﻮﻳﺔ ﻧﺺ ﺳﺎﻋﺔ ﻛﺪﻩ ﻭﺗﻴﺠﻰ ﻭﺩﻯ ﻃﺮﻳﻘﺔ ﻋﺸﺎﻥ ﺍﻋﺮﻑ ﻫﻰ ‪ sure ROM‬ﻭﻻ ﻷ‬

‫ﻟﻮ ﺍﳊﻔﺎﺿﺔ ‪ Soaked‬ﻭﺗﻌﺼﺮﻫﺎ ﺗﱰﻝ ﻣﻴﺔ ﻭﺗﺸﻤﻬﺎ ﻋﺸﺎﻥ ﻣﻴﻜﻮﻧﺶ ﺩﻩ ‪ )  urine‬ﺑﻮﻳﺴﱴ ﺑﻮ ﺧﺎﻟﺺ (‬

‫ﻟﻮ ﻣﺶ ‪ soaked‬ﺗﺘﻤﺸﻰ ﺷﻮﻳﺔ ﻛﻤﺎﻥ ‪ ..‬ﻟﻮ ﻣﻔﻴﺶ ﺑﺮﺿﻪ ﺗﺸﻮﻑ ﺍﻥ ﻛﺎﻥ ﻓﻴﻪ ﺍﻓﺮﺍﺯﺍﺕ ﺻﻔﺮﺍ ﻭﺗﺴﻤﻊ ﺍﻟﻌﻴﻞ ﻭﺗﻄﻤﻨﻬﺎ ﻭﺗﺪﻳﻬﺎ ﺍﻝ‬
‫‪instructions‬‬

‫ﰱ ﺍﻟﻌﻤﻠﻴﺎﺕ‬

‫ﺯﻯ ﻣﺎﻗﻠﻨﺎ ﻓﻮﻕ ﺍﻥ ﺍﻝ ‪ GA‬ﻫﻮ ﺍﻟﻠﻰ ﻫﻴﺤﺪﺩ ﺍﻟﻌﻼﺝ‬

‫‪Term > 37 w‬‬ ‫‪Preterm >24 w & < 37 w‬‬ ‫‪Pre-viable < 24 w‬‬

‫ﺩﻯ ﻃﺎﻟﻌﺔ ﻓﻮﻕ ﺗﻮﻟﺪ‬ ‫ﳓﺎﻓﻆ ﻉ ﺍﻻﻡ ﻭﻋﻠﻰ ﺍﳉﻨﲔ ﳊﺪ‬ ‫‪IN EGYPT : age of viabliity‬‬
‫‪is 28 w , so this pt for‬‬
‫ﻣﺎ ﺗﻜﻤﻞ ‪ 37‬ﺍﺳﺒﻮﻉ ﻛﺎﻣﻠﲔ‬
‫‪induction of abortion‬‬

‫‪Term > 37 w‬‬

‫* ﻃﻴﺐ ﻃﺒﻴﻌﻰ ﻭﻻ ﻗﻴﺼﺮﻯ ؟‬ ‫*ﻫﻨﺪﻳﻬﺎ ﺍﻣﺒﻴﺴﻴﻠﲔ ‪prophylaxis‬‬

‫‪ -‬ﻟﻮ ﻋﻨﺪﻫﺎ ﻣﺸﻜﻠﺔ ﺗﺎﻧﻴﺔ ‪ :‬ﺯﻯ ﺍﳊﻮﺽ ﺿﻴﻖ ﺃﻭ ﺍﻟﻌﻴﻞ ‪ breech‬ﺩﻯ ‪ CS‬ﻋﻠﻰ ﻃﻮﻝ ‪.‬‬
‫‪ -‬ﻟﻮ ﻣﻔﻴﺶ ﻏﲑ ‪ : ROM‬ﻫﻨﻌﻤﻠﻬﺎ ‪Induction‬‬
‫‪ 4/1 ‬ﻗﺮﺹ ‪ monomac 2 + cytotic‬ﻛﻞ ‪ 4‬ﺳﺎﻋﺎﺕ‬
‫‪ ‬ﺍﲰﻊ ﺍﻟﻌﻴﻞ ﻛﻞ ﻧﺺ ﺳﺎﻋﺔ‬
‫‪Cyto c ll Cx = 4cm , then Synto-cinone ( 505 ) ‬‬
‫‪ -‬ﻟﻮ ﺍﺳﺘﺠﺎﺑﺖ ﻭ ﺑﺘﻔﺘﺢ ﻣﻌﺎﻙ – ﻫﻨﻜﻤﻞ ﻣﻌﺎﻫﺎ ﳊﺪ ﺍﻻﺧﺮ ﺑﻮﻻﺩﺓ ﻃﺒﻴﻌﻴﺔ ) ‪( Cx is favorable‬‬
‫‪ -‬ﻟﻮ ﻣﺶ ﺑﺘﻔﺘﺢ – ‪( Cx not favorable ) : Cs‬‬
‫‪WhiteKnightLove‬‬

‫‪Cytotic : PG Monomac : nitrate Synto : Oxytocin‬‬

‫‪40‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

‫‪The Greatest Truth Are The Simplest , And So Are The Great Men‬‬
‫‪'It is more blessed to give than to receive.‬‬

‫‪Preterm >24 w & < 37 w‬‬

‫‪Fetal infection‬‬
‫‪RDS‬‬ ‫‪Fetal Hge‬‬

‫‪induction of lung‬‬ ‫‪Ampicilline for 1‬‬

‫‪maturity‬‬ ‫‪week‬‬
‫ﺣﻘﻨﺔ ﻛﻮﻧﺎﻛﻴﻮن ﻋﻀﻞ ﻛﻞ‬
‫‪DEXA‬‬
‫‪ ١٢‬ﺳﺎﻋﺔ‬
‫‪1.5‬ﺳﻢ ‪ ١٢ /‬ﺳﺎﻋﺔ‬
‫‪Erythromycine for‬‬ ‫‪ -‬ﺟﺮﻋﺘﻴﻦ ﺑﺲ ‪-‬‬
‫ﻟﻤﺪة ‪ ٢٤‬ﺳﺎﻋﺔ‬
‫‪10 days‬‬

‫ﻣﻌﻠﻮﻣﺔ ﻋﻦ ﺍﺳﺘﺨﺪﺍﻡ ﺍﻝ ‪Steroids in induction of lung maturity‬‬

‫‪-‬‬ ‫‪Used only betw. 24 – 34 wks , after that not effective and not decrease RDS incidence .‬‬
‫‪-‬‬ ‫‪Target : give pt. 24 mg in 24 h  DEXA start acting 24 h after last injection and action continue for 7‬‬
‫‪days .‬‬
‫‪-‬‬ ‫‪We don't use Prednisone as it not crossing Placenta‬‬

‫‪Target: 24 mg --‬‬ ‫اﻣﺒﻮل اﻟﺪﻳﻜﺴﺎ ﻓﯿﻪ ﻣﻨﻪ ‪ 6‬و ‪ 8‬ﻣﺠﻢ ﻓﻰ ‪ 2‬ﺳﻢ‬ ‫‪‬‬
‫ﻓﻰ ﻤﻌﻅﻡ ﺍﻟﺤﺎﻻﺕ ﻴﻔﻀل ﺍﻨﻙ ﺘﺩﻯ ﺍﻟﺠﺭﻋﺔ ﻋﻠﻰ ﻴﻭﻤﻴﻥ‪:‬‬ ‫‪‬‬
‫اﻣﺎ أﻣﺒﻮل ‪ 6‬ﻛﻞ ‪ 12‬ﺳﺎﻋﺔ ‪،‬‬ ‫‪‬‬
‫أو ‪ 1‬ﺳﻢ وﻧﺺ ﻣﻦ اﻷﻣﺒﻮل ‪ 8‬ﻛﻞ ‪ 12‬ﺳﺎﻋﺔ ) ﻷن اﻷﻣﺒﻮل ال ‪ 8‬ﻓﯿﻪ ‪ 2‬ﺳﻢ ﻳﻌﻨﻲ ﻛﻞ ﺳﻢ‬ ‫‪‬‬
‫ﻋﺒﺎرة ﻋﻦ ‪ 4‬ﻣﺠﻢ ﻳﻌﻨﻲ ﻟﻤﺎ أﺧﺪ ﺳﻢ وﻧﺺ ﻳﻌﻨﻲ ﺑﺪي اﻟﻌﯿﺎﻧﺔ ‪ 6‬ﻣﺠﻢ (‬

‫‪ ..‬اﻧﺖ ﺣﺮ اﻟﻤﮫﻢ ﻓﻰ ﻧﮫﺎﻳﺔ ﺗﻜﻮن ﺧﺪت ‪ 24‬ﻣﻠﻠﻰ ﺟﻢ‬

‫ﺍﻟﻠﻰ ﻋﻤل ﺍﻟﻠﺨﺒﻁﺔ ﺩﻯ ﺍﻨﻬﻡ ﻤﻜﺎﻨﻭﺵ ﺒﻴﻼﻗﻭﺍ ﺍﻻﻤﺒﻭل ‪6‬‬

‫ﻃﻴﺐ ﻭﻫﻰ ﳏﺠﻮﺯﺓ ﻋﻨﺪﻧﺎ ﻫﻨﺘﺎﺑﻌﻬﺎ ﺍﺯﺍﻯ ؟؟‬

‫‪ -1‬ﲢﻠﻴﻞ ﺑﻮﻝ ﻛﺎﻣﻞ ‪ +‬ﻋﻼﺝ ‪UTI or any infection‬‬

‫‪ -2‬ﻭﺿﻊ ﺣﻔﺎﺿﺔ ﻣﻌﻘﻤﺔ ﺃﺳﻔﻞ ﺍﳌﺮﻳﻀﺔ ﺑﺎﺳﺘﻤﺮﺍﺭ ‪.‬‬
‫‪ -3‬ﻗﻴﻠﺲ ﺣﺮﺍﺭﺓ ‪4 /‬ﺳﺎﻋﺎﺕ ﻣﻊ ﺍﻟﺘﺴﺠﻴﻞ‬
‫‪ -4‬ﺻﻮﺭﺓ ﺩﻡ ﻛﺎﻣﻠﺔ ﻳﻮﻡ ﻭﻳﻮﻡ‬
‫‪ -5‬ﺳﻮﻧﺎﺭ ﻋﺸﺎﻥ ﺍﻝ ‪ AFI‬ﻣﺮﺗﲔ ﰱ ﺍﻷﺳﺒﻮﻉ‬
‫‪WhiteKnightLove‬‬

‫‪ -6‬ﺗﺒﻠﻐﻚ ﻓﻮﺭﺍ ﻟﻮ ﺑﺪﺃ ﳚﻴﻠﻬﺎ ﻭﺟﻊ ﺃﻭ ﺍﳊﻔﺎﺿﺔ ﺑﻘﻰ ﻓﻴﻬﺎ ﺍﻓﺮﺍﺯﺍﺕ ﺻﻔﺮﺍ‬

‫‪41‬‬ ‫اﻟﺪﻓﻌﺔ ‪ – 24‬اﻣﺘﯿﺎز ‪2011‬‬

 Freely you have received; freely give.

Unfortunately 50 % WITHIN 12 H
75 % WITHIN 24 H
They Enter Into Spontaneous Onset Of 85 % WITHIN 48 H
Labor 95% WITHIN 72 H

Pre-viable <24 w I T CONSIDERED I NEVITABLE ABORTION  FOR TERMINATION

510 OR 520 ‫ ﳊﺪ ﻣﺎﺗﻔﺘﺢ ﻭﺑﻌﺪﻳﻦ ﻋﻠﻖ‬CYTOTIC ‫ ﻗﺮﺹ‬1/2

N.B. : ‫ ﻗﺮﺹ‬2\1 ‫ ﻗﺮﺹ ﻋﺸﺎﻥ ﺧﺎﻳﻒ ﻉ ﺍﳉﻨﲔ ﺍﳕﺎ ﻟﻮ ﺑﺴﻘﻄﻬﺎ ﺑﺪﻯ‬4/1 ‫ﻟﻮ ﻭﻻﺩﺓ‬

،، ‫ﰎ ﲝﻤﺪ ﺍﷲ‬

WhiteKnightLove

42 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

'It is more blessed to give than to receive.

Vomiting With Pregnancy

Early In
Late
Preg.

Mild Severe should exclude

PE ,
vomiting may
be the 1st
symptom of
GIT disorder SEVERE PE
emesis gravidarum Hyper-emsis
e.g. gastro- Gravidarum
(morning sickness )
enteritits

Emesis Gravidarum : ( morning sickness )

 ‫ ﻣﻦ ﺍﻟﺴﺘﺎﺕ‬% 50 ‫ﰱ ﺃﻛﺘﺮ ﻣﻦ‬

 N & V at morning
 ‫ﻳﺒﺪﺃ ﳜﺘﻔﻰ ﺑﻨﻬﺎﺓﻱ ﺍﻟﺸﻬﺮ ﺍﻟﺘﺎﻟﺖ‬
‫ﻃﻴﺐ ﺩﻩ ﻓﻴﻪ ﻣﺸﻜﻠﺔ ؟‬
‫ ﺷﻬﻮﺭ‬3 ‫ﻻ ﻣﻔﻴﻬﻮﺵ ﻣﺸﻜﻠﺔ ﺧﺎﻟﺺ ﻭﻫﺘﻄﻤﻨﻬﺎ ﺍﻧﻪ ﺩﻩ ﻃﺒﻴﻌﻰ ﰱ ﺍﳊﺎﻣﻞ ﻭﺑﻴﺨﺘﻔﻰ ﺑﻌﺪ‬

‫ﰱ ﺍﻻﺳﺘﻘﺒﺎﻝ‬
‫ ﻋﻀﻞ‬Cortigen B6 ‫ﻫﺘﺎﺧﺪ ﺣﻘﻨﺔ‬
( NO prempiran in 1st Trimester )
‫ﻫﺘﺮﻭﺣﻬﺎ ﻋﻠﻰ ﺍﻳﻪ ؟‬
‫ ﻟﺘﺮ ﻟﱭ ﻓﺮﻳﺶ ﻛﻞ ﻳﻮﻡ‬، ‫ ﺯﺑﺎﺩﻯ‬، ‫ ﺍﻛﻞ ﺧﻔﻴﻒ‬: ‫ﺍﻷﻛﻞ‬
Rx NAVOPROXIN tab. 1x3 : ‫ﺍﻟﻌﻼﺝ‬
( Navodoxine,Emetrex )
WhiteKnightLove

43 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

“Experience is the name every one gives to their mistakes.”
 Freely you have received; freely give.

HYPEREMESIS GRAVIDARUM
severe and persistent vomiting in first trimester , affecting general condition
100
، ‫ ﰱ ﺑﺪﺍﻳﺔ ﺍﳊﻤﻞ‬β-hCG ‫ﺩﻩ ﳑﻜﻦ ﻳﻜﻮﻥ ﻟﻴﻪ ﻋﻼﻗﺔ ﲟﺴﺘﻮﻯ ﺍﻝ‬
80 allergic re-action to the hormone ‫ﺑﻴﺤﺼﻞ‬
hCG (X1000 mIU/ ml

60 Peak at 10-12 wks  100.000 mIU : ‫ ﻭﺑﻴﻮﺻﻞ‬، ‫ ﺳﺎﻋﺔ‬48 ‫ﺑﻴﺘﻀﺎﻋﻒ ﻛﻞ‬

40
‫ﺎﻳﺔ ﺍﳊﻤﻞ‬ ‫ ﻭﻳﻔﻀﻞ ﻛﺪﻩ ﳊﺪ‬10.000-20.000 ‫ﻭﺑﻌﺪ ﻛﺪﻩ ﻳﱰﻝ ﳊﺪ ﻣﺎﻳﻮﺻﻞ‬

20 ( emesis graviadarum ‫) ﻭﺩﻩ ﳑﻜﻦ ﻳﻔﺴﺮ ﻛﻤﺎﻥ ﺍﻝ‬

0 10 20 30 40

Gestational age ( weeks ) ‫ﻣﺸﺎﻛﻠﻪ ﺍﻳﻪ ؟‬

* Severe vomiting  dehydration  Hypovolemia  electrolyte disturbance & ischemic

changes in different organs

e.g elevated liver enzymes, fatty degeneration, degeneration of renal tubules ,

Ketoacidosis, brain ischemia , retinal hge .. etc.

‫ﰱ ﺍﻻﺳﺘﻘﺒﺎﻝ‬

Confirm Diagnosis Search for

complications
Hyperemesis is different from emesis, must affect
the general condition of the patient = ‫ﻋﻨﺎﻳﺔ ﻣﺮﻛـﺰﺓ‬

Shock Dehydration - Liver : Jaundice ( ‫) ﺧﻄﺮ ﺟﺪا‬

Rule of 100 - sunken eye ‫ﺧﺎﺻﺔ إن ﺣﺎﻻت ﻛﺜﯿﺮة ﺑﺘﺒﻘﻰ‬
misdiagnose
/dry tongue ..
fulminant ‫ وﺑﻘﻰ‬hepatitis ‫وﺑﺘﺘﻄﻠﻊ‬
liver failure
* above 100 pulse, - DKA : disturbed consciousness
* less than 100 pressure, , ‫ﺷﺮﯾﻂ اﺳﯿﺘﻮن‬
- Renal : oliguria , ‫ﺷﺮﯾﻂ زﻻل‬
* more than 100 F
temperature (about 38.3)

 you first should check for vital signs and presence of any complication (if found the
WhiteKnightLove

patient may need to be managed in ICU) ‫ﻋﻠﻰ ﺍﻟﻌﻨﺎﻳﺔ ﻋﺪﻝ‬

44 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

'It is more blessed to give than to receive.

‫ﻟﻮ ﻣﻔﻴﺶ ﻳﺒﻘﻰ ﻫﺘﻄﻠﻊ ﺍﻟﻘﺴﻢ ﺑﻌﺪ ﻣﺎﺗﻌﻤﻠﻬﺎ ﺍﻟﻼﺯﻡ ﰱ ﺍﻻﺳﺘﻘﺒﺎﻝ‬

‫ﺍﻳﻪ ﺑﻘﻰ ﻫﻮ ﺍﻟﻼﺯﻡ ؟؟‬

‫ﺳﻮﻧﺎﺭ‬ ‫ﻗﺴﻄﺮﺓ‬ ‫ﻛﺎﻧﻴﻮﻻﺕ‬

viability ‫ﻋﻴﻨﺎﺕ‬ ‫ﳏﺎﻟﻴﻞ‬

- baby check -->
medico-legal Medicolegal
- acetone : DKA Never Glucose

- urinnalysis : ptnuria
. ‫* ﻓﺼﻴﻠﺔ ﻭﺗﻮﺍﻓﻖ‬
- UOP ‫ﻣﺘﺎﺑﻌﺔ‬
ABG *
. ‫* ﲢﺎﻟﻴﻞ ﻛﺎﻣﻠﺔ‬
. K,Na ‫* ﻳﻌﻤﻠﻮﻩ ﺑﺮﻩ‬
.β-hCG *

We don't give glucose as this may lead to encephalopathy , only Saline & Ringer

‫ﰱ ﺍﻟﻘﺴﻢ‬

‫ﻣﺘﺎﺑﻌﺔ‬ Drugs Feeding

Lab. clinical
primpran ‫ﻭﺗﺎﺧﺪ ﳏﺎﻟﻴﻞ ﳊﺪ ﻣﺎ ﺍﻝ‬
cortigen B6 ‫ﻳﻮﻗﻒ‬vomiting
* ‫ﻛﺎﻣﻠﺔ‬ ‫ﲢﺎﻟﻴﻞ‬
Vitals ‫ﻟﻮ ﺷﺎﻛﻚ‬:: zantac ‫ ﺑﻌﺪﻫﺎ‬، (‫ ﺃﻳﺎﻡ‬٣ ‫ ﺃﻭ‬٢ ‫)ﻳﻔﻀﻞ‬
* Electrolytes
* Urinalysis : Vomiting gastritis ‫ﰱ‬ ‫ﻳﺒﺘﺪﻯ ﺍﻟﻜﻞ ﻭﺍﻟﺸﺮﺏ ﺑﺎﻟﺘﺪﺭﻳﺞ‬
Ptn,Aceton U.O.P ‫ﻟﻮ ﻣﻔﻴﺶ ﺇﺳﺘﺠﺎﺑﺔ ﻳﺒﻘﻰ‬ oral fluids .. then
U/S : Viablity zofran semisolid .. then solid
Fundus Exam
WhiteKnightLove

45 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬

 Freely you have received; freely give.

upper endoscopy ‫ ﻳﺒﻘﻰ ﻻﺯﻡ‬hematemesis ‫ ﻟﻮ ﻣﻔﻴﺶ ﺍﺳﺘﺠﺎﺑﺔ ﺃﻭ ﻓﻴﻪ‬.. zofran ‫ﺑﻌﺪ ﺍﻝ‬

‫ ﻫﻮ ﺍﳋﻄﻮﺓ ﺍﻷﺧﻴﻴﻴﻴﻴﻴﲑﺓ‬termination ‫ﺍﻝ‬

‫ ﻭﺑﺘﺮﺗﺎﺡ ﳌﺎ ﺗﺘﺤﺠﺰ ﺑﻌﻴﺪ ﻋﻦ ﺍﻟﺒﻴﺖ‬psychological ‫ﻭﺑﺎﳌﻨﺎﺳﺒﺔ ﻣﻌﻈﻢ ﺍﳊﺎﻻﺕ ﺑﺘﺒﻘﻰ‬

======================================================================================================

GIT Disorder

Gasritis : ( Epigastric pain + vomiting )

- Give Cortigen B6 to stop vomiting now , and when needed + Zantac as home ttt ( safe in 1st trimester )

( Reflux is common complaint in pregnant female  as Progesteron hormone causes relaxation of sphincters .)

Gastro-enteritis : ( Epigastric pain + vomiting + diarrhea )

Stop vomiting as above + Antinal cap. ( no Metronidazole during 1st trimester ).

 If bacterial ( + fever )  give Anti-biotic safe in pregnancy .. ( see UTI )

 ‫ﶈﱮ ﺍﻟﻘﺮﺍﺀﺓ ﻓﻘﻂ‬

 inputs from blood-borne drugs or hormones reaches CTZ that communicates with the vomiting center, to
initiate vomiting
Vomiting center
CTZ : CHEMORECEPTOR TRIGGER ZONE

CTZ in
Dopamine Medulla

Histamine
Circulation
Serotonin
SO THE A NTI -EMETIC DRUGS WILL BE :

DRUG SCINTEFIC NAME TRADE NAME SAFE WITH PREGNANCY

D2 Receptor METOCLOPRAMIDE PREMPIRAN
Antagonists DOMPERIDONE MOTILIUM, MOTINORM X
MECLOZINE NAVOPROXINE , NAVODOXINE
Anti-Histamines
C YCLIZINE EMETRIX

Serotonin Receptor
Antagonists
ONDESTERON Z OFRAN ‫ﻏﺎﱃ ﺟﺪﺍﺍﺍﺍﺍﺍﺍﺍﺍﺍﺍﺍﺍ‬ 
WhiteKnightLove

Steroids C ORTIGEN B6 

46 “Life is the art of drawing without an eraser.” 2011 ‫ – اﻣﺘﯿﺎز‬24 ‫اﻟﺪﻓﻌﺔ‬