For the sake of God Obstetrics Study Guide 2.


106 views
Uploaded on:
Description
For the sake of God Obstetrics Study Guide 2 Mitra Ahmad Soltani 2008 Med-ed-online.org References 1-All India Medicinal Pre PG. Fetal development &length of hatchling. 2007. See: www.aippg.net/discussion/viewtopic.php?t=33005
Transcripts
Slide 1

In the Name of God Obstetrics Study Guide 2 Mitra Ahmad Soltani 2008 Med-ed-online.org

Slide 2

References 1-All India Medical Pre PG. Fetal development &length of embryo. 2007. See: www.aippg.net/discussion/viewtopic.php?t=33005 2-Brinholz J. Gestational age.American Journal of Roentgenography . 1984. 142 (4): 849 3-Cunningham G, Gant N, Leveno K, et al. Williams Obsterics. 22nd Ed . New York : Mc Graw Hill, 2005. 4-Durham J .Transition to Parenthood: How precise is your due date. 2004 see: www.transitiontoparenthood.com/ttp/parented/pregnancy/duedate.htm and www.pregnancy.about.com/library/week by week/aa042197.htm 5-Friedman E. Obstetrical Decision Making. Harvard Medical School. 1981 6-Military Obstetrics and Gynecology. BrooksidePress. Evaluating Gestational age. 2006 See: www.brooksidepress.org/.../Pregnancy/estimating_ gestational_age.htm 7-Mitchell P. A Comparison of Gestational Age Information Derived from the Birth Certificate, 1990 – 1998 . The Frozen North Vital Sign.2000. 8 (1):1-7 See: www.hss.state.ak.us/dph/bvs/PDFs/vitalsigns/avs_0801.pdf 8-Mittendorf R, Williams M, Berkey C, Cotter P. . The Length of Uncomplicated Human Gestation. Obstetrics & Gynecology.1990 . 75(6):929-932 Pictures and material on Breech and C/S are adjusted from emedicine e-Journal with consent: 9-Fischer R. Breech Presentation.emedicine.2006 10-Sehdev H. Cesarean Delivery. emedicine . 2005

Slide 3

Gestational Age Determination

Slide 4

1-Nã¤gele’s Rule This was created in the 1850’s by Dr. Nã¤gele. To figure this, one ought to include 7 days, and afterward subtract 3 months from LMP. ((LMP + 7 days) - 3 months) = Expected Date of Delivery Example: ((the LMP on 1 st April + 7 days) - 3 months) = January 8 This “rule” doesn’t consider the way that numerous ladies are indeterminate of the date of their last menstrual period, not all ladies have 28 day cycles, and not all ladies ovulate on day 14 of their cycle.

Slide 5

2-Mittendorf’s Rule To ascertain “Mittendorf’s Rule”, one ought to include 15 days for first time Caucasian ladies, or include 10 days if non-white or this is not the first child. At that point subtract 3 months. ((LMP + 15 days) - 3 months) = Expected Date of Delivery for first time pregnant Caucasian ladies Example: (( LMP on 1 st April + 15 days) - 3 months) = January 16

Slide 6

3-Ultrasound: Measurement of a Crown-Rump Length amid the first trimester (1-13 weeks) will give a gestational age that is normally exact to inside of 3 days of the real due date. Amid the second trimester (14-28 weeks), estimation of the biparietal distance across will precisely foresee the due date inside of 10-14 days much of the time. In the third trimester, the exactness of ultrasound in foreseeing the due date is less, with a give or take certainty scope of as much as 3 weeks.

Slide 7

FL Femur length estimations can have a connection coefficient of 0.995 with gestational age in a gathering of sound babies with known date of origination. In any case, it still can\'t be utilized solely on the grounds that it might be generally short in the vicinity of development hindrance, or long when development increasing speed has happened, presenting similar lapses in age gauge if the hidden development example is not valued.

Slide 8

4-Heart Tone : Fetal pulse can be heard through Doppler beginning at 9-12 weeks and by stethoscope at 18-20 weeks. This occasion, be that as it may, is less exact in light of the fact that the mother is not for all time connected to a Doppler gadget so the first heart beat can not be educated most likely.

Slide 9

5-MacDonald\'s Rule Fundal Height (the separation from the symphysis pubis joint to the fundus of uterus) can be a harsh evaluation of gestational age. Normally, from week 24 to week 34, fundal tallness in centimeters corresponds with weeks of growth. For instance, at 28 weeks, the fundus is most likely around 28 cm.

Slide 10

If a measuring tape is distracted, some unpleasant rules can be utilized: • At 12 weeks, the uterus is marginally substantial over the pubic bone, utilizing just a stomach hand. • At 16 weeks, the highest point of the uterus is 1/2 route between the pubic bone and the umbilicus.

Slide 11

• At 20-22 weeks, the highest point of the uterus is comfortable umbilicus. • At full term, the highest point of the uterus is at the ribs\' level. (xyphoid process).

Slide 12

6-Quickening Some trust the child will come five months in the wake of reviving, the first run through the mother feels the infant move. This is difficult to assess, as ladies can be pretty much delicate to these sensations, and may see them at distinctive times in their pregnancies. First time moms regularly see development around 18-20 weeks. Moms who have been pregnant before notification it as ahead of schedule as 16 weeks.

Slide 13

7 - Length of baby a-Crown-Rump Length : CRL is measured in first a large portion of pregnancy; that is, up to 20 weeks measure from the Vertex to Coccyx. The fetal length is more useful in rashness than in post development, on the grounds that after term the certainty interim for estimation surpasses 3 weeks.

Slide 14

CHL-Hasse’s principle b-Crown-Heel Length : CHL in the first a large portion of pregnancy is the quantity of lunar months x 4 . The CHL of a 4 month hatchling is 16cm : 4x4=16 cm From the end of 20 weeks in the second a large portion of pregnancy, CHL in cm is the aftereffect of duplication of the quantity of lunar months at the evaluation\'s season by 5 . The CHL of a 8-month hatchling is 40 cm: 8x 5 =40 cm

Slide 15

Normally, toward the accompanying\'s end weeks incubation: Before 20-24wks, the fundus\' tallness from pubic symphysis to umbilicus increased by 2/7 rises to span of pregnancy in lunar months or x 8/7=duration of pregnancy in weeks. Following 20 weeks, the fetal length in inches is equivalent to a large portion of the quantity of gestational age in weeks. For instance at 28wk the fundus\' stature from pubic symphysis to umbilicus is 14 inches.

Slide 16

8-Estimation of fetal weight in grams: Johnson’s Formula (relevant just in Vertex presentation): Fundal tallness (cm) over the pubic symphysis short 12 if Vertex above Ischial Spine or less 11 if beneath Ischial Spines-ought to be duplicated by 155. This will be fetal weight in grams. e.g., 32(fundal stature)- 12(constant) x155( consistent) => 20 x 155=3100gms

Slide 17

9-Changes in Weight Gain: Normally there is an enduring increment in weight of a pregnant lady until the last 2-3 weeks of pregnancy. The lady quits putting on weight at about term. It may stay stationary or may start to fall which implies that pregnancy is at any rate full grown.

Slide 18

Weight put on In typical pregnancy –the weight addition ought not surpass 2 ½ kilograms in any one month or 0.9 kg in a week. The most extreme admissible weight pick up all through the entire time of pregnancy speaks the truth 10 or 11 kg (around 24 lbs) in spite of the fact that 12 ½ kg is allowed—1/third of this weight—increases in the initial 20 weeks, and another 1/third in the following 10 weeks. The Remaining 1/third would be picked up between 30 weeks to term.

Slide 19

10-The age from origination : The date of origination from a basal body temperature diagram or known time of intercourse is the best measures for gestational age determination. In any case, generally couple of ladies can express the occasions.

Slide 20

Algorithm of indeterminate date administration

Slide 21

LNMP known Unknown or questionable Gathering other information: 1-Date of intercourse 2-Date of positive Pregnancy test 3-Signs of pregnancy 4-First heard FHR 5-Quickening 6-Rate of uterine development Nagele Rule Matches clinical gestational age Accepted Doesn’t match with clinical gestational age Ultrasound US doesn\'t coordinate clinical gestational age. Either wrong gauge of gestational age or IUGR

Slide 22

ROM

Slide 23

SROM Membrane break without unconstrained uterine compressions happens in 8% of term pregnancies. At Parkland Hospital work is empowered with oxytocin when burst films are analyzed at term and work does not suddenly follow.

Slide 24

Which is an inconsistent sign for chorioamnionitis ? A-T=>38 c B-maternal and fetal tachycardia C-fundal delicacy D-maternal leukocytosis Answer:d

Slide 25

Sample Chorioamnionitis Order General: condition/position/diet=NPO Lab: CBC diff, MP, WW, B/C X2, U/A , U/C,CXR,BUN/Cr IV : 1000cc Ringer +10 units of oxytocin begin at 2 drops/min, include 2 drops each 15 min if FHR and withdrawals are ordinary Amp ampicillin 2gr iv qid + gentamicin im 80mg detail then 60 mg TDS AMP clindamycin 900 mg iv TDS for unfavorably susceptible ladies to penicillin(continue anti-microbials after conveyance until the mother is a febrile OTHER: Control of fundamental sign hourly

Slide 26

Induction Indications Membrane crack without unconstrained onset of work Maternal hypertension Nonreassuring fetal status Postterm incubation Elective prompting for the comfort of mother or the professional is not prescribed.

Slide 27

Induction contraindications Classical entry point or uterine surgery Placenta previa Appreciable macrosomia, hydrocephalus, Mal presentations Non consoling fetal status CPD Active genital herpes in mother

Slide 28

E2 gel (dinoprostone) Dosage: Intracervical gel(Prepidil ):2.5 mL/0.5 mg Vaginal insert(cervidil) 10 mg The supplement gives slower arrival of drug

Slide 29

E2 organization A perception period going from 30 minutes to 2 hours for uterine movement and FHR may be reasonable. Oxytocin prompting ought to be postponed for 6 to 12 hours. Alerts in patients with glucoma, serious hepatic or renal impedance, or asthma are required.

Slide 30

E1 misoprostol(cytotec) Oral , intravaginal however not intracervical Possibly better than E2 gel Dosage: 25 mcg intravaginal measurements 100 mcg oral

Slide 31

Bishop Scoring System max=13, min=0

Slide 32

O

Recommended
View more...