Transvaginal scan

Transabdominal scan
 Uterus is normal in size
 Normal endometrial thickness
 Both ovaries are normal
 Adnexa free
 No free fluid in POD
All explained to the patient
GDM
To see dietitian (pre-authorization sent)
Advised to have strict diet control and regular exercise.
BSS monitoring.

To increase Levemir to 2 units every night until the FBS become normal (93 mg/dl).

PERINEAL REPAIR

Cc: heaviness from down

o/e deficient perineum and rectocele grade 3

For posterior perineal repair on ____________

Consent for hospital services and procedure signed by patient.

Preauthorization sent.
To be seen by anaesthesiologist on _______ plus pre-op blood test.

POSTNATAL (NSVD)

She is well.
Lochia is minimal.
Breastfeeding.
Healed and clean wound.

Cc: itching
For LFT and bile acids.
Chlorpheniramine and elocom cream was given.

Cc: smelly vaginal discharge with itching

Dx: vaginitis / cervical erosion

Vaginal swabs and cervical smear were taken.

ANC

Bedside ultrasound done.

Prescription was given.

Internal vaginal examination done.

CTG done- Normal. Patient informed.
Advised to attend if there is any leaking, contractions, less fetal movement or bleeding.
OPD discharge form was given to the patient.

USS

Single viable fetus in cephalic presentation.

FHR: positive
Placenta
AFI (Amniotic fluid index) largest pool: Adequate
BPD:
HC:
AC:
FL:
EFW:

All explained to the patient.

Booking blood + MSU today.

Bedside ultrasound done.
Clinic appointment after ___
Prescription given.

POSTPARTUM:

The uterus is bulky subinvoluted gravid, of normal echotexture.

With thick endometrium multiple echogenicity.
Both ovaries are normal in size and outline with a normal follicular texture.
The adnexa appear slightly enlarged.
Pouch of Douglas: Free.

Conclusion:

Postpartum subinvoluted uterus.

HORMONAL TEST:

Follow up day 2 or 3 of period for hormonal test.

For serum progesterone on ___.

Follow up day 12 of period for follicular scan.

PREGNANCY TEST:

For BHCG today and after 48 hours.

For BHCG today if negative for withdrawal bleeding and to come day 2 or 3 of period for hormonal test.

Transvaginal scan
Transabdominal scan
Single viable fetus
FHR positive
CRL (Crown rump length):
US GA (Ultrasound gestational age):
EDD by scan:

All explained to the patient.

MEDICATIONS:

For Primolut injection 500 mg once weekly.

For dostinex twice weekly for 4 weeks.

For ovitrelle injection.

For dexamethasone injection today and tomorrow.

GBS positive – need intrapartum antibiotic prophylaxis

For IV Zofran, savtac and ringer lactate 1 liter for 2 hours.

Unsatisfactory for evaluation duet to scan squamous cell component.

For IV paracetamol 1 g followed by Syntocinon 20 units with 500 ml NS over 2 hoursand methergine.

IUCD Insertion:

Patient requested for IUCD insertion.

All possible side effects and complications explained to the patient.
Failure rate explained.
Consent signed.
IUCD inserted easily.

Follow up appointment after 6 weeks.

ADMISSION:

Observation for bleeding.

Keep NPO.
IV augmentin after admission.
Booked for ERPC.
To be seen by anesthesiologist after admission.

ADMISSION FOR OBSERVATION:

 Dexamethasone injection 12 mg every 24 hours for 2 doses

 4 points BSS
 To be seen by dietitian.
 CTG per shift.
 Type and screen, cbc
 Inform if any concern.
Pre-op Diagnosis: Rectocele
Post-op Diagnosis: Same
Anesthesia: GA

Procedure:
Lithotomy position.
Cleaned and draped.
Posterior perineal repair done.
V/E and PR done.
Minimal blood loss.

ADMISSION FOR MISOPROSTOL

Observation for bleeding

Misoprostol 800 mcg vaginally followed by 400 mcg every 4 hours total of 3 doses.
Normal diet.
Type and screen, cbc and serology
Inform if any concern.

Post-op orders:
Vitals every 4 hours.
Watch for bleeding.
Soft diet.
Catheter out after 6 hours.
Early mobilization.
Clexane after 24 hours.

PRE-OP DIAGNOSIS: INCOMPLETE MISCARRIAGE

POST-OP DIAGNOSIS: SAME

Anesthesia: GA
Procedure: ERPC/Suction evacuation
Lithotomy position
Cleaned and draped
ERPC and suction evacuation done.
Minimal blood loss.