Remedial O&G CT3 & 6 [note to myself]

CT 6 teaching with Dr. Hoo

Pt is a 32y/o lady G2P1 came in with Placenta Previa Type III Posterior for observation at 34w + 5d.
She had previous hx of Placenta Previa Type IV in her first pregnancy and had done elective Cesarean section at 2013 which is 3 years ago. She also had a past surgical history of cystectomy at 2012 which is 4 years ago. She denied any APH such as PV bleed or abd pain. The dx was made based on ultrasound findings at 30w.

In this pt, the risk factor for her recurrent PP in second pregnancy is previous C-sec.
To clerk history of a previous C-sec, must exclude cx such as any blood transfusion? any injury to bladder, bowel, ureters? any post-partum hemorrhage? any wound infection? endometritis? UTI?
Importance is to detect any presence of placenta accreta in her next pregnancy...as C-sec is a risk.

C-sec is also planned for her second pregnancy.
Must know how to plan a C-sec,
Inform and get consent,
Large bore IV access, catheterize bladder,

Pre-op: Take blood for FBC (ensure Hb level >10g/dl), PT/PTT, GXM (4-6units of blood), urea/creatinine.
consider ECG/CHEST XRAY

Neutralize gastric contents to prevent aspiration pneumonia if GA is used.
Elective C-sec, NBM + Ranitidine

Emergency C-sec: sodium citrate and metoclopromide

Thromboprophylaxis
low-risk: early mobilization, hydration
moderate: IV heparin and TED stockings
high: IV heparin until 5-d post-op and TED stockings

Antibiotic prophylaxis
IV cefazolin. given after cord is clamped

Also don't forget to revise all the risk factors that could cause PP.

Learning Point:
C-sec cx and planning
GXM and GSH difference
PP type, risk factors, mx
Rubella=german measles, effect on fetus?
ATT to prevent emergency delivery at non sterile environment
Hepatitis B vaccine? can be given during pregnancy or not?
Primary vs secondary dysmenorrhea
Pap smear done because need to remove pre-malignant lesion if there is.
Find out about Diabetic diet and ensure GDM mother follow
Results for MOGTT 5.6-7.8

CT3 with Dr. Fauziah

Know what is abnormal progress of labour, the hour...
Know partogram, and how to detect abnormal progress by partogram and how to mx to avoid fetal distress

what can a 1st U/S tell us?
-viability,
-dating
-location of gestational sac (ectopic: abdomen, cervix, broad ligament)
-fetal number, MCDA, DCDA
-Pregnancy of unknown location need beta-hCG test
-exclude uterine abnormalities
-exlude fibroid, ovarian mass

Ovarian cyst in pregnancy, cystectomy can only be done less than 18w, more than 18w might cause abortion, so planned cystectomy only after delivery

MOGTT HOW TO DO, RESULTS, WHEN TO DO, RISK FACTOR