OB-guide-1.doc

NSVD Admitting Notes  Side notes TPR BP Weight LMP (Last Menstrual Period) EDC (Expected Date of Confinement) AOG (Age of Gestation) FH (Fundic Height) FHB (Fetal Heart Beat) CD (Cervical Dilatation) Effacement Station BOW (Bag of Water) Leopold’s

 Please admit to ROC under the service of _____  TPR q 4 hours and record  Full diet, NPO once in active labor  Labs:  CBC  HBsAg  Urinalysis  IVF: D5LR + 10 “u” oxytocin to run at 1015 gtts/min  Meds:  Ampicillin 2g IV ANST if PROM  None if no OB complications  Special Order:  Monitor FHB and progress of labor  Puboperineal shave please  Inform NROD  Will inform service consultant on deck  Refer prn

CS ADMITTING NOTES  Please admit to ROC under the service of _____  TPR q 4 hours and record  Full diet, NPO post-midnight  Labs:  CBC, APC  CT, BT, PT  Urinalysis  Venoclysis:  Meds:  Cefazolin 500mg IVTT q8H x 3 doses then shift to      Special Order:        

Co-Amox 625mg/tab, 1 tab BID Famotidine 20mg IVTT q8H x 3 doses Ketomed 30mg IVTT q8H x 3 doses Ketomed 10mg q8H to start if px is on soft diet Inform OR Secure signed consent Abdominoperineal prep please Request 500cc FWB of patient’s blood type as standby Dr. ___ for anesthesia Inform NROD Refer accordingly Thank you

POSTPARTUM ORDERS  Back to room/ward  Full diet once full awake  Present IVF to run at 30 gtts/min, D/C if with minimal VB  IVF to ff: D5LR + 10 “u” Oxy to run at 30 gtts/min  Meds:  Antibiotics  Mefenamic Acid 500 mg/cap q 8 H RTC x 24 H, then prn for pain  Methergine 1 tab TID x 3 days  Vitamins  SO:  Monitor VS q 15 min until stable  Massage uterus prn  Ice pack on hypogastrium  Perilight x 15 min OD  Routine perineal care  Watch out for profuse vaginal bleeding  Refer accordingly  Thank you

DISCHARGE ORDERS (Normal OB)  MGH  Home Meds  OPD follow-up on Saturday @ OB service clinic with photocopy of D/S  Discharge IE and summary c/o ___  TCB anytime if with profuse VB, HA, blurring of vision, any untoward s/sx

TRANS-OUT ORDERS Side notes the ff:  Stable VS  Able to flex both legs  (-) vomiting  Blurring of vision

Orders  May refer back to room  D/C O2 and pulse oximeter  Monitor V/S q 15 min until stable  MIO q Hly (+ FC) or shift (- FC) and refer if UO 70%

-1 Anterior

+1/+2 -----

soft

-----

 ↓ amniotic fluid  Oligohydramnios (causes)  Cord compression  Macrosomia  Deformations  Fetal distress

1st Degree

Induction of labor  Oxy drip but not in labor

4th Degree

Augmentation of Labor  Oxy drip however in labor

BRAXTON HICKS CONTRACTION  The uterus undergoes palpable but originally painless contractions at irregular intervals from the early stages of gestation  20 weeks-primigravida  18 weeks-multipara INDICATIONS FOR CESAREAN SECTION  Prior CS  Labor dystocia (most frequent indication for 1’ CS)  Fetal distress  Breech presentation POST OP COMPLICATIONS OF CS DELIVERY  Hysterectomy  Operative injury to pelvic structures  Infection  Puerperal fever  Transfusion

MYOMA  causes soft tissue dystocia  etiology: unopposed estrogen stimulation  types: Subserous, Intramural, Submucous EXCISION OF BARTHOLIN’S CYST  Hyperplasia (uterus) – provera  Endocervical  Endometrial  Endometrial for D & C PLACENTA PREVIA Placenta increta invades Placenta percreta penetrates Placenta accrete attaches PLACENTA PREVIA Types:  Totalis placenta covers cervical os completely  Partialis internal os partially covered by placenta  Marginal edge of the placenta is at margin of internal os Etiology: (P2ALM2)  Previous CS  Puerperal Endometritis  Advancing age  Multiparity  Multiple induced abortions Diagnosis:  Painless third trimester bleeding  UTZ for placental localization  Placental Migration (placenta close to the internal os during 2nd trimester migrate to fundus as pregnancy advances PLACENTA ABRUPTION  premature separation of the normally implanted placenta after the 20th week of pregnancy and before birth of fetus  Etiology: (PECSS)  Pre-eclampsia  External trauma  Chronic hypertension  Short umbilical cord  Sudden uterine decompression LACERATIONS



2nd Degree



Fourchette, perineal skin, vaginal mucosa but not the underlying fascia and muscle Fascia and muscles of the perineal body but not the anal sphincter

3rd Degree

 

Extend from vaginal mucosa, perineal skin and fascia up to anal sphincter but not the rectal mucosa Encompasses extension up to rectal mucosa

STAGES OF LABOR  I: Active labor to full cervical dilatation (4-10 cm)  II: Full cervical dilatation to delivery of baby  II: Delivery of baby to expulsion of placenta  IV: Delivery of placenta to 1 hour after CARDINAL MOVEMENTS  Engagement-Pelvic Inlet  Descent  Flexion  Internal rotation  Extension  External rotation  Expulsion ASYNCLITISM such lateral deflection of the head to a more anterior or posterior position of the pelvis

DELIVERY OF PLACENTA SHULTZE MECHANISM  Peripheral  Shiny portion DUNCAN MECHANISM  Central  Dirty part Normal Rotation of Umbilical Cord:  Counter clockwise or Left-handed maneuver SIGNS OF PLACENTAL SEPARATION  Calkin’s Sign (uterus becomes globular and firmer from discoid)  Sudden gush of blood  Uterus rises in the abdomen as the detached placenta drops to the lower segment and vagina  Lengthening of the cord SIGNS OF MALIGNANCY UTZ:  Septations  Internal echoes  Ascites  Multiple daughter cysts 