Nota Perubatan

Category: O&G

  • Induction of Labour (IOL)

    Prior to IOL

    • Indication (and the plan should have been decided by specialist)
    • FBC: Hb, platelet count
    • GSH availability
    • Presence of previous scar (note: 1 previous LSCS scar is not an absolute contraindication, but Prostin dose is halved, i.e. 1.5 mg / Foley catheter insertion is more preferable)
    • Latest CTG result – CTG must be normal prior to IOL
    • Latest vital signs of mother

  • Terminology in O&G

    TermDescription

    First trimester

    1st day of LMP to 13w6d

    Second trimester

    14w0d to 27w6d

    Third trimester

    28w0d to 40w6d

    Post-term pregnancy

    42 weeks of gestation or more

    Post-dated pregnancy

    Period of gestation beyond 40 weeks

    Term pregnancy

    37w0d onwards

  • Pregnancy & Puerperium  VTE Risk Assessment

  • Management of Labour

    Q&A

  • Miscellaneous – O&G

    Commonest direct causes of maternal death in Malaysia

    1. PPH
    2. Pregnancy induced hypertension
    3. Pulmonary embolism

  • External Cephalic Version (ECV)

    Q&A

  • GSH & GXM Guideline in O&G

    Indications for GSH & GXM in O&G. Different hospitals may have different protocols

  • Common Workups in O&G

    Biweekly blood

    Biweekly blood (e.g. FBC, CRP, PE profile) = blood is taken 2 times per week
    In the hospital I’m working currently, we take biweekly blood on Mondays & Thursdays

    PE profile

    Initial tests

    • FBC
    • LFT, AST
    • RP
    • UFEME
    • Coagulation profile (depends on center)
    • Uric acid (depends on center)

    Subsequent test:

    • Urine protein creatinine ratio (PCI)

    Unbooked & unscreened mothers

    • FBC
    • HIV Combo Ag/Ab
    • HBsAg
    • Anti HCV
    • Rapid plasma reagin (for syphilis)
    • GSH (if in labour)

    Routine investigations for the following diagnosis

    • PPROM: FBC & CRP biweekly (2 times per week, e.g. Mondays & Thursdays)
    • Placenta praevia major: FBC & GSH weekly
    • Pre eclampsia: PE profile biweekly

  • Paediatric Standby Referral Checklist

    One of the important jobs for O&G doctors would be referring certain cases for Paediatric standby during delivery (e.g. vacuum assisted delivery, lower segment Caesarean section), due to further resuscitation for the newborn is anticipated

    Checklist before calling Paediatric doctors

    • Gestational age — resuscitation is different for term and preterm babies
    • Estimated fetal weight (EFW)
    • Antenatal issues
    • Liquor colour — clear / LMSL / MMSL / TMSL
    • Risk of sepsis — leaking liquor for how many hours? mention if mother has fever intrapartum
    • CTG finding
    • If Caesarean section / Vacuum-assisted delivery / Forceps assisted delivery, mention the indication(s)
    • Additional details if baby already delivered:
      • Birthweight
      • APGAR score
      • Vital signs: HR, RR, SPO2
      • Under room air / on oxygen supplementation?
      • Suction: colour of aspirate

  • Chorioamnionitis

    Features

    • Temperature ≥38 °C
    • Maternal tachycardia ≥120 bpm
    • Fetal tachycardia ≥160 bpm
    • Malodorous (foul-smelling liquor)
    • Uterine tenderness
    • Leucocytosis
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