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History First Prenatal Visit
History First Prenatal Visit
THREATENED ABORTION
NON-STRESS TEST
Bloody vaginal discharge or bleeding appears
Test of fetal condition
Closed vaginal os
REACTIVE when:
Low abdominal pain
At least 2 accelerations of the FHR occurs for at least 15 bpm,
lasting for 15 sec w/in 20 min period of observation Bleeding first, cramping follows
NONREACTIVE
May imply that the fetus is acidotic, asleep, or drugs was INEVITABLE ABORTION
administered to the mother Gross rupture of membrane
A. EARLY DECELERATION Leaking amniotic fluid
Head compression Cervical dilatation
B. LATE DECELERATION COMPLETE ABORTION
Utero-placental insufficiency Complete detachment
C. VARIABLE DECELERATION Int. cervical os closes
Cord compression ; Fetal distress INCOMPLETE ABORTION
Most common ; Most ominous Int. cervical os opens and allows passage of blood
Mullerian Anomalies
CONTRACTION STRESS TEST/OCYTOCIN CHALLENGE TEST Segmented mullerian agenensis or hyperplasia
A measure of utero-placental function Unicornuate uterus
Contraction induced by using IV oxytocin Bicornuate uterus
Record FHB Septate uterus
POSITIVE Uterus with internal ___? Changes
Consistent and persistent late deceleration (50%) of the FHB in Induction of labor
the absence of uterine hypertonus or supine hypotension Oxy drip but not in labor
NEGATIVE Augmentation of Labor
@ least 3 contractions in 10 mins, each lasting 40 secs, w/o late Oxy drip however in labor
deceleration
SUSPICIOUS FETAL DEATH
Inconstant late deceleration patterns 1. Tobacco-stained amniotic fluid
HYPERSTIMULATION 2. Spalding’ssign
Uterine contractions occur more frequent than every 2 mins, or o significant overlapping of fetal skull bones
lasting longer than 90 secs, or presence of hypertonus 3. Robert’s sign
UNSATISFACTORY o Demonstration of gas bubbles in the fetus
Frequency of contractions is <3 per minute 4. Exaggeration of fetal spinal curvature
LACERATIONS
MYOMA 1st Degree
causes soft tissue dystocia o Fourchette, perineal skin, vaginal mucosa but not the
etiology: unopposed estrogen stimulation underlying fascia and muscle
types: Subserous, Intramural, Submucous 2nd Degree
ROT-right occiput transverse o Fascia and muscles of the perineal body but not the
Montevideo Units- 200 units or pressure of > 60 anal sphincter
Depoprovera- injectable CP is G1 to HPN patients 3rd Degree
o Extend from vaginal mucosa, perineal skin and fascia
EXCISION OF BARTHOLIN’S CYST up to anal sphincter but not the rectal mucosa
Hyperplasia (uterus) – provera 4th Degree
Endocervical o Encompasses extension up to rectal mucosa
For Functional Curettage
Endometrial
Endometrial for D & C BRAXTON HICKS CONTRACTION
The uterus undergoes palpable but originally painless contractions
AUGMENTATION OF LABOR at irregular intervals from the early stages of gestation
↓ amniotic fluid
Oligohydramnios (causes) SIGNS OF PLACENTAL SEPARATION
o Cord compression Calkin’s Sign (uterus becomes globular and firmer from discoid)
o Macrosomia Sudden gush of blood
o Deformations Uterus rises in the abdomen as the detached placenta drops to
o Fetal distress the lower segment and vagina
Lengthening of the cord
HYOSCINE N-BUTYL BROMIDE (Buscopan) for softening of the cervix
STAGES OF LABOR
NST: Fetal condition “7 days” I: Active labor to full cervical dilatation (4-10 cm)
II: Full cervical dilatation to delivery of baby
CST: Uteroplacental contraction II: Delivery of baby to expulsion of placenta
IV: Delivery of placenta to 1 hour after
ANESTHESIA
Pre-meds:
Cefuroxime (Zegen) 1.5 gms IV
Omeprazole 20mg IV
Metoclopramide (Plasil) 10mg IV
Anesthetic Agent: Bupivacaine 15mg + MgSO4 16mg
Detailed Technique: RA-SAB
X-LLDP, SAS
LA w/ 2% Lidocain
LP at L3 L4
CSF clear and free flowing
Intrathecal administration of anesthetic