UR NEXT POSTING OBSTETRICS? COMMONLY USED ABBREVIATIONS 
ANC Antenatal care
LMP Last menstrual period
POG Period of gestation
EDD Expected date of delivery
NSVD Normal spontaneous vaginal delivery
DMPA Depot medroxy progesterone acetate
USG Ultrasonography
UPT Urine pregnancy test
DUB Dysfunctional uterine bleeding
DNC Dilatation and curettage
DNE Dilatation and evacuation
ERPC Evacuation of retained products of conception
MRP Manual removal of placenta
PMS Premenstrual syndrome
PCOS Polycystic ovarian syndrome
CAC Comprehensive abortion care
PROM Premature rupture of membrane
CS Caesarean section
SOME TERMINOLOGIES Gravida : any pregnancy present or past
Primipara: who has given birth to a single baby
Grandpara: who has given birth to more than one baby
Partuient:woman who is in labour
Puerpera:who is in pureperium
Nullipara: who has not given birth to the baby
Nulligravida:who is not now and never pregnant
Show : vaginal discharge of mucus mixed with some blood ;sign of start of labour
Pinard stethoscope: fetoscope , for fetal heart sound
Menstruation
eriodic and cyclical shedding of progestational endometrium accompanied by loss of blood
Braxton Hicks contraction: irregular , infrequent , spasmodic, painless contraction which do not have effect on cervical dilatation.
MUST KNOW BEFORE HISTORY TAKING 
First trimester 1st 12 weeks
Second trimester 13 to 28 weeks
Third trimester 28 to 36 weeks
How to calculate EDD?
Add 9 months and 7 days to the LMP. (NAEGELE'S FORMULA)
How to calculate POG?
Number of weeks till now from LMP.
Quickening is felt in 16-20 weeks
Lightening is felt in 38 weeks
ANC: Systemic supervision of a woman during pregnancy
ANC Visits
4 weekly till 28 weeks
2 weekly from 28 to 36 weeks
1 weekly from 36 EDD
Folic acid is taken till 13 weeks
Iron and calcium taken from 2nd trimester till 45 days postpartum.
Tetanus toxoid taken at 18th and 20th weeks
Why is there frequency in 1st trimester and 3rd trimester?
In 1st trimester due to pressure by uterus when it becomes an abdominal organ and in 3rd trimester due to pressure by head of fetus.
Doses of:
Folic acid 5mg
Iron 60mg
Calcium 500mg
DMPA 150 mg
What is Lochia ?
Vaginal discharge for first fortnight during puerperium .
What is puerperium ?
Period following child birth during which the bodies tissues, specially the pelvic organs revert back approximately to prepregnant state both anatomically and physiologically. (Exception- mammary gland)
Duration of pureperium :
Start as soon as placenta is delivered and last till 6 weeks
Puerpera : Woman in puerperium
Puerperal pyrexia:
Rise of temperature more than 100.4 degree Fahrenheit within 10 days of puerperium measured on two separate occasions 24 hours apart excluding the first 24 hours.
What is Episiotomy?
Surgically planned incision given in the perineum and posterior vaginal wall during second stage of labor to facilitate delivery.
It is given prior to crowing and repaired after expulsion of placenta.
images.jpg LET'S KNOW SOMETHING ABOUT FETAL MEMBRANES.
Consists of 2 layers:-
- Outer Chorion
- Inner Amnion
Chorion
Remnant of chorion laeve and ends at the margin of placenta
Thicker than amnion, shaggy and friable
Amnion
Inner layer of fetal membrane
Internal surface is smooth and shiny and in contact with liquor amnii.
Function of membranes:
Formation of liquor amnii
Prevents ascending uterine infection.
Facilitates dilatation of cervix during labor.
Has got enzymatic activities for steroidal hormone metabolism
Rich source of glycerophospholipids containing arachidonic acid.
LETS KNOW about:
PRETERM LABOUR
Occurrence of regular contractions productive of cervical change (dilatation and effacement ) prior to 37 completed weeks of gestation from the 1st day of last menstrual period.
COLPORRHEXIS
Rupture of the vault of the vagina is called colporrhexis.
It may be primary where only the vault is involved or secondary when associated with cervical tear (common).
It is said to be complete when the peritoneum is opened up.
Posterior fornix usually ruptures; however, cervical tear is usually associated with tear of the lateral fornix.
The tear may be traumatic or spontaneous especially in multiparae.
HIGH RISK PREGNANCY:
Age more than 35 or less than 18
Primi age over 30 or 18
Grand multipara
Multiple pregnancy
All malpresentations
Previous third stage complication
BOH
Previous C S.myomectomy,hysterotomy
All medical disdorders-Hypertention, heartdiseases, Diabetes, TB, ThyrotoxicosisAnaemia.
H/O Prematurity
Rh-negative
H/O sub fertility
Gynecological operations
Repair of Cx,
PFR
Repair of VVF
Third degree perineal repair
Obesity
OBSTRUCTED LABOUR
Obstructed labor is one where in spite of good uterine contractions, the progressive descent of the presenting part is arrested due to mechanical obstruction.
PEMATURE RUPTURE OF MEMBRANE
Spontaneous rupture of membranes before the onset of labor at any stage of gestation is referred to as prelabour rupture of membranes (PROM).
DIAGNOSIS OF PREGNANCY: FIRST TRIMESTER SUBJECTIVE SYMPTOMS
Amenorrhea
Morning sickness
Increased frequency
Fatigue
Breast discomfort
Breast tingling
Anorexia
OBJECTIVE SIGNS
Jacquemiers (Chadwick )sign 8th week
Goodells sign 6th week
Hegars sign 6-10 weeks
Palmer sign 4-8 weeks
Osainder sign 8th week
Uterus
Non-pregnant pyriform
12 weeks - globular
Size of uterus
6 weeks - hen's egg
8 weeks cricket ball
12 weeks- fetal head
Breast changes
Pigmentation of primary areola
Nipple erect and pigmented
Montgomery's tubercles prominent
Colostrums expressed
Engorged veins on breast
SECOND TRIMESTER SUBJECTIVE SYMPTOMS
Amenorrhea persist
Quickening is felt
Breast changes continue
Nausea/vomiting and frequency subside
OBJECTIVE SIGNS
cholasma
Breast changes
Secondary areola appear
Montgomery's tubercle prominent
Per abdomen
linea nigra present
striae gravidarum
Braxton Hicks contraction
Auscultation
Fetal heart sound 120-160 beats per minute
Fetal parts palpable
THIRD TRIMESTER SUBJECTIVE SYMPTOMS
Pressure symptoms
Dyspnoea
Palpitation
Swelling of knee and ankle
Lightening
Increased frequency
Fetal movements
OBJECTIVE SIGNS
cholasma
Ankle edema
Breast changes
linea nigra
striae gravidarum
fundal height
Braxton hicks contraction
Fetal heart sound
Umbilicus everted
DIFFERENTIAL DIAGNOSIS OF PREGNANCY
Distended urinary bladder
Uterine fibroid
Ovarian cyst
Pseudocyesis
Encysted peritonitis
Hematometra
HISTORY TAKING - ANTENATALg.jpg Particulars of patient
Name
Age
Address
Occupation
Education
Duration of marriage
Husband's name
Husband's occupation
Husband's Education
Religion
Date of admission
Date of examination
Mode of admission
Presenting Complaint
Cessation of menstruation for
weeks
..days
History of Present Pregnancy
According the patient she is amenorrhoeic for
..weeks and
days.
Pregnancy was diagnosed by
. (e.g.: UPT) in
. (e.g.: health post ) after
..weeks of cessation of menstruation.
Then describe the events of Trimesters as given in Diagnosis of pregnancy
.
When were USG done?
give in months/weeks
Obstetric history
Gravida
Para
Abortion
Live birth
(GPAL)
Prepare an obstetric table which includes S.N, date/year, pregnancy events, labor events and baby note . Menstrual history
Menarche
Period
Cycle
dysmenorrhoea
Blood clots
Pads/day
LMP
EDD
Contraceptive history Past history
Medical / surgical
Personal history
Alcohol
BASU
Allergy
Drugs
Family history
DM, Hypertension, TB
Socioeconomic history HISTORY TAKING- POST NATALf.jpg Particulars of patient
Name
Age
Address
Occupation
Education
Duration of marriage
Husband's name
Husband's occupation
Husband's Education
Religion
Date of admission
Date of examination
Mode of admission
Presenting Complaint
.postpartum day of puerperium following
(e.g.: NSVD or CS).
History of Present Pregnancy
According the patient this is her
postpartum day of puerperium following NSVD.
She gave birth to a male/female child yesterday. Today she has
.complain.
Vaginal discharge:
Scanty/excess?
Offensive?
Clots/not?
Constipation
Urinary complaints
Burning sensation
Frequency
Urgency
Hesitancy
Breast changes
Engorgement
Pain
Sore nipple
Hardening
Discharge
Failure to lactation
Pain abdomen (after pain)
Pain on perineum
Fever
Brief of Pregnancy- Major Events Baby note:
Sex
Birth weight
Cried immediately after birth
Breast fed easily after
.hours
Bladder habit
Bowel habit
Fever
Jaundice
Obstetric history
Gravida
Para
Abortion
Live birth
(GPAL)
Prepare an obstetric table which includes S.N, date/year , pregnancy events, labor events and baby note .
Menstrual history
Menarche
Period
Cycle
dysmenorrhoea
Blood clots
Pads/day
LMP
EDD
Contraceptive history Past history
Medical / surgical
Personal history
Alcohol
BASU
Allergy
Drugs
Family history
DM, Hypertension, TB
Socioeconomic history NOTE: IN CASE OF CS PRESENTING COMPLAINT =
post operative day of emergency/ elective LSCS for
(reason for doing CS) MUST KNOW BEFORE EXAMINATION Lie: The relation of the long axis of the fetus to the long axis of the centralised maternal uterus or the spine.
Presentation: The part of the fetus which occupies the lower pole of the uterus
Presenting part: The part of presentation which overlies the internal os
Attitude : Relation of different parts of fetus to one another
Labor:Series of events that take place in genital organs in an event to expel the viable product of conception out of the womb , through vagina into the outer world
Normal labor :
-spontaneous in onset
-at term
-vertex presentation
-without undue prolongation
-terminated by means of normal aids
-no maternal and fetal complications
Caesarean Section: Operative procedure where by the fetuses at the end of 28th week are delivered through an incision in abdominal and uterine wall.
Moulding : Alteration in shape of forecoming head while passing through resistant birth passage
Caput succedaneum:Formation of swelling due to stagnation of fluid beneath layers of scalp , beneath the girdle of contact .
Delivery:Expulsion of fetus out of the womb
Eutocia: Normal labour
Mechanism of labor:Series of movement that occur on head of the fetus while passing through the birth passage
Crowning: Biparietal diameter stretches the vulval outlet and does not recess even after contraction is over
Denominator: Arbitary bony fixed part on the presenting part that comes in relation to diffrent quadrants of maternal pelvis
Position: Relation of denominator to different quadrants of maternal pelvis
Abortion: Termination of pregnancy before the period of viability
EXAMINATION OF A PREGNANT d.jpg
Introduction
Permission and Privacy
Position
GENERAL EXAMINATION
Appearance
Breathlessness
Conscious/ cooperative
Height
Weight
PILCCOD
VITALS
Pulse
Temperature
Respiratory rate
Blood pressure
ABDOMINALEXAMINATION
-Take consent
-ask her to uncover abdomen
INSPECTION
Shape of abdomen
linea nigra
striae gravidarum
umbilicus-everted? Central?
Movements with respiration of all quadrants
Visible veins
PALPATION
Temperature
Fundal height
-use ulnar border of left hand
Grips
fundal grip
Lateral grip
1st pelvic grip
2nd pelvic grip
Fetal movements
PERCUSSION AUSCULTATION
With the help of fetoscope : 120-160 beats per minute
PUERPERAL EXAMINATION GENERAL EXAMINATION
Pallor
Edema
VITALS SYSTEMIC EXAMINATION
A. RESPIRATORY
B. CARDIOVASCULAR
C. BREAST
Flat/retracted/not well formed
Crack
Sore nipple
Engorgement/abscess
axillary tail
axillary lymph nodes
D. LOCAL EXAMINATION INSPECTION
Scars, linea nigra, stria albicants
PALPATION
superficial: temperature/ tenderness
Deep: uterus (for contraction), bladder
PERCUSSION
Bladder
AUSCULTATION
Bowel sound
E. PERINEAL EXAMINATION
Pad used?
Stitches
Edema
Vulvas hematoma
Foul smelling discharge
F. NEWBORN EXAMINATION
History of feeding, stool, urine
EXAMINATION
a. color: pink , cyanotic, yellow
b. cord: signs of inflammation
c. Head : fontanelle , caput succedeanum, cephal hematoma
d. vertebral column
e. limbs
f. congenital malformations
GOD COULDN'T BE EVERYWHERE AND THEREFORE HE MADE MOTHERS.a.jpg
SUMAN PRASAD ADHIKARI
KATHMANDU MEDICAL COLLEGE
Ur Next Posting Obstetrics? -
15-08-2007, 09:17 PM
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