Common Management
Common Management
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
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