Remedial O&G Group 1 teaching with Dr. Rahimah [note to myself]

Dr. Rahimah stressed on knowing definition of gravida, parity and knowing how to count LMP and EDD. In case patient is USOD, we can give roughly estimated LMP by subtracting 40 weeks from REDD.

eg if this is patient 5th pregnancy, she had a molar, ectopic, a miscarriage and an IUD so it should be?

G5P1+3 (where there is 1 molar, 1 ectopic and 1 miscarriage)

In a case of SGA/IUGR, I put 'or' because a SGA case(suspected constitutionally small because of smaller mother's size with previous hx of small fetus) must be managed as TRO IUGR as if causes failed to be identified and patient was discharged and if a IUGR was not detected and managed, it will lead to IUD.

3 important factors lead to IUGR:
1. Placental insufficiency, which could be caused by
-pre-eclampsia (usually early onset which start to affect during formation of placenta)
-chronic medical illness which affect placenta formation
-smoking
-autoimmune disease such as SLE
-placenta previa, as placenta attach to lower segment of uterus with thinner myometrium--> less blood supply--> less nutrients--> baby smaller
(thats why we opt for lower segment c-sec as lesser blood supply there)

2. fetal infection
rule out TORCHES

3. fetal anomalies
oligohydramnios suspect renal agenesis

symmetrical IUGR: early onset, caused by Chromosomal anomalies, infection
asymmetrical IUGR, late onset, caused by placental insufficiency, thus have head-sparing

GDM will cause fetal macrosomia
however pre-existing DM in mother more likely --> congenital anomalies--> fetal microsomia

as this patient has a previous hx of small baby, ask if there is oligohydramnio in the previous pregnancy, chances are the patient has intrauterine infection in the previous pregnancy which continue to the next...

find out about percentile on growth chart for SGA, IUGR

if at district hospital, need to refer to tertiary centre if there are two abnormal plotted growth charts
usually the gap between 2 serial scans is about 1 week

however normal growth scan is 2 weeks

1 previous scar is already a criteria for admission

If Doppler U/S is abnormal, need to do CTG daily

If leaking of liquor, need to do U/S every 1w or 3d

HOPI for IUGR must rule out any CX such as
abnormal CTG, reduced fetal movement,doppler u/s findings, leking of liquor any PV discharge

Also diet hx to assess whether mother malnourish

VE assess Bishop score, if cervix favourable, deliver
if not, do induction, however previous scar, so do not do Induction as risk of uterine rupture...
if fetal distress, abnormal CTG, doppler, then c-sec
if no fetal distress, opt for vaginal delivery

Plan and management:
1. monitoring
2. timing of delivery
3. mode of delivery

investigations:
1. Blood: anemia, TWC, torches screening, group screen hold, High vaginal swab if leaking of liquor
2. U/S doppler: fetal BPP, placenta (any redding calcification), head and abd circumference, any fetal anomalies such as renal agenesis
3. CTG daily, fetal heart monitoring,

what to revise:
growth chart
causes and mx of IUGR
fetal BPP
torches
redding calcification