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Common Management

1. This document provides management plans for various obstetric conditions including PROM, preterm labor, reduced fetal movement, anemia, and hypertension in pregnancy. 2. Standard management includes admission, monitoring with CTG and pad charting, treatment with antibiotics or tocolytics as needed, and delivery planning. 3. Risks of interventions like induction of labor or operative delivery are explained to obtain consent from patients.

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0% found this document useful (0 votes)
108 views7 pages

Common Management

1. This document provides management plans for various obstetric conditions including PROM, preterm labor, reduced fetal movement, anemia, and hypertension in pregnancy. 2. Standard management includes admission, monitoring with CTG and pad charting, treatment with antibiotics or tocolytics as needed, and delivery planning. 3. Risks of interventions like induction of labor or operative delivery are explained to obtain consent from patients.

Uploaded by

aslan
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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COMMON MANAGEMENT

PROM < 12 HOUR /SROM PPROM


PROM = leaking + cervical
changes AT TERM Biweekly FBC
SROM = leaking + contraction + HVS
cervical changes AT TERM
Plan:
CTG in PAC 1. Admit ward
FBC and GSH in ward 2. Start T.Erythromycin 400mg BD
x10/7 (Oracle study)
Plan: 3. Strict pad charting,to inform stat
1. Admit ward if change in liquor colour or foul
2. Time contraction smelling
3. Review on strong 4. Daily CTG
contraction/bearing down 5. Watch out for signs and
4. Send to labour room for delivery symptoms of chorioamnionitis
after 12 hours at ???? and start (maternal tachycardia, maternal
antibiotics (IV C-Pen 3gm stat and fever, abdominal pain)
1.5gm 4 hourly) 6. Trace HVS
5. Strict pad charting—to inform 7. Monitor vital sign
STAT if there are any changes in
liquor colour or liquor is foul ELECTIVE LSCS
smelling
6. Watch out for s/sx of FBC/GSH in ward
chorioamnionitis
7. FKC and Daptone 4 hourly Plan:
8. Trace FBC 1. Admit to ward
2. CTG in ward
EARLY PHASE OF LABOUR 3. FKC/Daptone 4 hourly
4. For LSCS as planned on (date
CTG in ward given)
5. Check for consent availability
Plan: 6. For Anaest to review in ward
1. Admit ward
2. FKC/ Daptone 4 hourly FETAL SURVEILLANCE (I/V/O
3. Review upon strong IUGR/ OLIGOHYDRAMNIOS)
contraction/SROM/ bearing down
4. VEBS CM if undelivered CTG in PAC

REDUCED FETAL MOVEMENT Plan:


1. Admit ward
CTG AT PAC 2. Daily CTG
3. FKC/Daptone 4hourly
Plan: 4. Repeat scan for AFI and Doppler
1. Admit ward in 1/52 and scan for growth in 2
2. Strict FKC/4hourly daptone weeks
3. Daily CTG 5. IOL at 37 weeks
4. Allow discharge once satisfied
with fetal movement OR IOL CM INDUCTION OF LABOR
(if reduced fetal movement at I/V/O
term) OLIGOHYDRAMNIOS/IUGR/PIH/GD
M ON DIET CONTROL/GDM ON
INSULIN/REDUCED FETAL SYMPTOMATIC ANEMIA IN
MOVEMENT AT TERM PREGNANCY
FBC, GSH at ward
CTG IN WARD
1. Admit ward
2. Trace blood investigations
Consent 3. KIV blood transfusion after review
Explained to patient the indications FBC
of induction of labor for her. Either 4. T. Hematinics I/I OD
induce by insertion of medication
(prostin) at the posterior fornix or GDM ON DIET CONTROL IOL
insertion of a tube to help dilate CTG in ward
further her os. If prostin insertion,
might take up to maximum 3 times 1. Admit ward
to produce effect—thus 3 days stay 2. Monitor V/S
in ward—failure of induction causing 3. FKC/Daptone 4 hourly
emergency caesarean section also 4. Time contraction
explained. Procedures and risk of 5. Review on strong
LSCS explained to patient—risk of contraction/SROM/bearing down
bleeding, infection, adjacent organ 6. IOL/ VEBS CM if undelivered
injury, high risk in next pregnancy,
placenta praevia and placenta INSULIN COMMENCEMENT
accreta explained. Patient BSP normal range: less than 5.3/
understood and keen for IOL. 7 / 7/ 7
MGTT normal range: less than
Plan: 5.6/ 7.8
1. Admit ward
2. FKC/Daptone 4 hourly 1. Admit ward
3. Review upon strong 2. Monitor v/s
contraction/SROM/bearing down 3. FKC/Daptone 4 hourly
4. VEBS/IOL MC if undelivered 4. To repeat BSP today
5. KIV to start insulin if BSP is
PLACENTA PRAEVIA deranged in ward
6. If start insulin to refer pharmacist
Plan: to teach injection technique
1. Admit ward 7. To refer dietician in ward
2. Weekly FBC (every Monday) 8. Nephro tour
3. Strict pad charting, inform stat if
any PV bleeding PRETERM CONTRACTION
4. To repeat scan every 2 weeks for
growth and placenta localisation CTG at PAC
UFEME at PAC
ANEMIA FOR TDI HVS at PAC

Plan: Plan:
1. Admit ward 1. Admit ward
2. For TDI as planned (how many 2. Trace UFEME and treat
ampoules/day) accordingly
3. Watch out for transfusion reaction 3. VE upon strong contraction/SROM
4. Discharge after completion of TDI 4. Allow labour if progress

VAGINAL
[ ( 14.8−latest Hb ) ( 3 ) ( pre− pregnancy CANDIDIASIS
weight ) +500 ]
IV Cosmofer=
100
CTG at PAC
4. For ECV CM
Plan:
1. T Canneston pessary 200mg ON X PRETERM LABOR (at 28-34 weeks
3/7 gestation)
2. Encourage fluid intake
3. Perineal hygiene HVS and UFEME STAT in PAC
4. TCA STAT if sign and symptoms of FBC, GSH, CTG in ward
labour or PV bleed
5. Allow discharge Plan:
6. Memo to KK to trace swab HVS 1. For IM Dexamethasone 12mg
STAT (given at ????) and OD x 2/7
SURGICAL SITE INFECTION 2. T. Nifedipine 20mg STAT and TDS
x 2/7
Swab C+S 3. Time contraction
4. Review upon strong contraction/
Plan: bearing down
1. Admit ward 5. Admit in PE room for tocolysis
2. To start patient on antibiotics 6. For Iv MgSO4 for cerebral
(IV/T. Cloxacillin) protection
3. Continue observation 7. Watch out for MgSO4 toxicity
4. Encourage breastfeeding in ward, (hyporeflexia, depressed
for baby to room in with patient respiration, reduced urine output)
5. To inform if increasing abdominal
pain/increased discharge over PREGNANCY INDUCED
wound site HYPERTENSION
6. For secondary suturing
7. Daily normal saline/Dermasyn GSH
dressing PE PROFILE (FBC, RP, LFT, LDH, AST,
uric acid , UFEME)
ECV/ BREECH PRESENTATION
Plan:
Consent 1. Admit ward
Patient was counselled for mode of 2. FKC and daptone 4 hourly
delivery, for ECV or ELLSCS. 3. To start t. nifedipine 10mg/ t.
Procedure of ECV explained, success labetolol 100mg STAT if BP
rate 60%, risks of cord >150/100
entanglement, placenta abruption, 4. Watch out for signs and
fetal distress and emergency LSCS symptoms of impending
explained. Risk of reversion if eclampsia ( headache/ blurring of
successful less than 5%. Procedures vision/ epigastric pain/ RHC pain/
and risk of LSCS also explained to vomiting)
patient- risk pf bleeding, infection, 5. Daily CTG
adjacent organ injury, high risk in
next pregnancy, placenta praevia URINARY TRACT INFECTION
and placenta accreta explained.
Patient understood and keen for ECV. UFEME, urine C+S
No further questions asked.
Plan:
FBC, GSH, BUSE, CTG, ECG in ward 1. Allow discharge
2. T. Cephalexin 500mg TDS x 1/52
Plan: OR T. Unasyn 375mg BD x 1/52
1. Admit ward at 36w6d 3. Memo to KK to trace urine C+S
2. NBM at 2AM 4. Continue kk follow up
3. IVD 4 pint NS once NBM
5. TCA STAT if increasing abdominal
pain/signs and symptoms of labor

COMPLETE MISCARRIAGE

FBC, GSH (if persistent bleeding)

Plan:
1. Allow discharge
2. For MC 2/52
3. TCA STAT if increased PV
bleeding/abdominal pain
MISSED MISCARRIAGE risks: hypoxia, brachial plexus injury,
fracture of clavicle and humerus.
FBC, GSH (if persistent bleeding) Maternal risks: PPH, uterine rupture,
risks of need for laparotomy if PPH +
Plan: Uterine atony, severe perineal tear.
1. Allow discharge If opt for ELLSCS - risks of bleeding,
2. TCA EPAU 2/52 for reassessment thrombosis, injury to bladder /
3. TCA STAT if increased PV bowel / ureter explained and need
bleeding/abdominal pain/passed for LSCS + BTL in next pregnancy
out POC explained.
Patient understood all risks and keen
for…….
1. Allow discharge with reassurance
2. TCA STAT if PV bleeding/ Plan:
abdominal pain 1. To post case as EMLSCS for
3. T. Duphaston 40mg STAT, 10mg suspected macrosomic baby in
TDS X 2/52 labor
4. Continue TCA KK for regular 2. Consent form
follow up 3. Keep NBM
4. To start IVD once NBM
RUPTURED ECTOPIC PREGNANCY 5. Trace investigations
6. Inform Paediatrics team
FBC STAT, GSH
Hyperemesis gravidarum
Consent
Couple explained regarding patient’s Plan:
current condition—ruptured ectopic 1. Hyperemesis regime (500ml
pregnancy and the risk of Hartmann’s solution in 30
bleeding/maternal death if no minutes, then in 1 hour, then in 2
immediate intervention. Explained to hours) until urine ketone negative
couple regarding the procedure of 2. T. Maxolon 10mg TDS
diagnostic laparoscopy KIV open, 3. T. pyridoxine 10mg TDS
risks explained as per consent form, 4. Strict I/O chart
couple understood, consented and 5. Encourage frequent small oral
no further questions asked. intake

Plan:
1. For diagnostic laparoscopy KIV CONSENT TEMPLATES
open
2. Trace investigations LAPAROSCOPIC BTL CONSENT
3. Keep patient NBM Explained to patient BTL is
4. For IV Drip maintainance permanent irreversible method of
5. Consent form sterilization. Failure rate 0.5% and
risks of ectopic pregnancy explained.
SUSPECTED MACROSOMIC BABY Also explained on risks of
IN LABOR (FOR EMLSCS) laparoscopy - injury to aorta, bowel,
bladder, uterine perforation. If injury
FBC, GSH, CTG in PAC might proceed with laparotomy to
repair injury. Also explained on risks
Explained about weight discrepancy of failure to perform operation
due to scan can be up to +/- 500g laparoscopically, then might proceed
and is operator dependent. to laparotomy.
Risks of fetal macrosomia and risks Offered other options of
of shoulder dystocia explained: fetal contraception such as OCP, IUCD,
implanon. Patient is not keen and LSCS: risks: bowel / bladder injury,
keen to proceed with BTL. Consent risks of bleeding, infection,
taken. thrombosis,hysterectomy, risks of
placenta previa in next pregnancy
VBAC and need for LSCS + BTL in next
Counselled on mode of delivery: pregnancy. Patient understood, keen
VBAC: benefits: more natural, faster for ____
recovery, risks of uterine rupture
0.5%, 2-3% if induction /
augmentation of labour.
When to do;
Per-speculum VE Pap smear
- PV bleed - Contraction at term - Cervix contact
- Pprom/ srom - SROM with contraction bleeding
- Preterm contraction at term - “funny looking”
- Bearing down cervix/ cervical
ectropion

Intrauterine demise
*explained to patient regarding
diagnosis of intrauterine demise.
Possible causes include chromosomal
abnormality , diabetes mellitus ,
intrauterine infection . as for now we
are unable to determine the duration
of the fetal demise. Given options to
either admit today or next week. She
is keen to admit today.
Several blood investigations baby
will be assess upon delivery,
induction may take longer than
expected depending on the self
response. Method of delivery will be
vaginally for now. We will avoid lscs
as it carries more risk of
complicationand will be more
traumatic to the patient. She
understood and agreed with the
induction. She consented for
intracardiac blood. All these
investigations will be helpful in her
next pregnancy.

1. Admit ward
2. For induction with prostin
tomorrow once daily
3. For intracardiac blood
sampling ( karyotyping), placenta
swab C+S and HPE after fetus
delivered
4. Thrombophilia screening and
MGTT 6 weeks postpartum

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