Update in obstetrics and gynecology 2 2012
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Update in obstetrics and gynecology 2 2012

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o&g update course 2012 hospital segamat

o&g update course 2012 hospital segamat

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Update in obstetrics and gynecology 2 2012 Update in obstetrics and gynecology 2 2012 Presentation Transcript

  • UPDATE INUPDATE IN OBSTETRICS ANDOBSTETRICS AND GYNECOLOGYGYNECOLOGY SATURDAYSATURDAY 17 NOVEMBER 201217 NOVEMBER 2012
  • REFERRAL /REFERRAL / ISSUES :ISSUES : WHAT ? WHEN ? And HOW ?
  • REFERRAL SYSTEMREFERRAL SYSTEM  CLINIC O&G – PAKAR 1CLINIC O&G – PAKAR 1  EXT NUMBER : 152EXT NUMBER : 152  HOSPITAL NUMBER : 07-9433333HOSPITAL NUMBER : 07-9433333  DAY AND TIME:DAY AND TIME: - MONDAY AND WEDNESDAYMONDAY AND WEDNESDAY ( 2.00PM – 5.00 PM )( 2.00PM – 5.00 PM ) - FRIDAY ( 2.45 PM – 5.00 PM )FRIDAY ( 2.45 PM – 5.00 PM )
  •  CLINIC SCHEDULE:CLINIC SCHEDULE:  MONDAY ( 2.00 PM – 5.00 PM)MONDAY ( 2.00 PM – 5.00 PM) PRE PREGNANCY CLINIC &PRE PREGNANCY CLINIC & COMBINED CLINICCOMBINED CLINIC  TUESDAY ( 8.00 AM – 1.00 PM )TUESDAY ( 8.00 AM – 1.00 PM ) ANTENATAL CLINICANTENATAL CLINIC  THURSDAY ( 8.00 AM – 1.00 PM )THURSDAY ( 8.00 AM – 1.00 PM ) GYNAE CLINICGYNAE CLINIC  FRIDAY ( 8.00 AM – 12 NOON )FRIDAY ( 8.00 AM – 12 NOON ) POSTNATAL CLINICPOSTNATAL CLINIC
  • Cont.Cont.  CONSULTATIONCONSULTATION  WORKING HOURS: MO INCHARGEWORKING HOURS: MO INCHARGE ACCORDING TO CLINICACCORDING TO CLINIC  AFTER WORKING HOURS / PUBLICAFTER WORKING HOURS / PUBLIC HOLIDAY: MO ONCALLHOLIDAY: MO ONCALL  SPECIALIST ONCALLSPECIALIST ONCALL
  • EARLY PREGNANCYEARLY PREGNANCY PROBLEMSPROBLEMS  MISSED MISCARRIAGEMISSED MISCARRIAGE  INCOMPLETE MISCARRIAGEINCOMPLETE MISCARRIAGE  THREATHEN MISCARRIAGETHREATHEN MISCARRIAGE  TRO ECTOPIC PREGNANCY ( ASAP )TRO ECTOPIC PREGNANCY ( ASAP )  MOLAR PREGNANCY ( ASAP )MOLAR PREGNANCY ( ASAP )  MODERATE/SEVERE HYPEREMESISMODERATE/SEVERE HYPEREMESIS GRAVIDARUM ( ASAP )GRAVIDARUM ( ASAP )  RECURRENT MISCARRIAGE ( Clinic )RECURRENT MISCARRIAGE ( Clinic )
  • HYPERTENSION INHYPERTENSION IN PREGNANCYPREGNANCY  BP > 140 / 90BP > 140 / 90  Symptoms and signs of ImpendingSymptoms and signs of Impending EclampsiaEclampsia  Albuminuria 2+ and moreAlbuminuria 2+ and more  Whenever UNSURE, please do referWhenever UNSURE, please do refer  AndAnd REFER EARLY / IMMEDIATELYREFER EARLY / IMMEDIATELY
  • MEDICAL - DIABETESMEDICAL - DIABETES  All known diabetics ( as early as possible )All known diabetics ( as early as possible )  IMGTT with BSP > 7 mmol/lIMGTT with BSP > 7 mmol/l  AS PER PROTOCOLAS PER PROTOCOL  GDM on diet control can be managed inGDM on diet control can be managed in the health side and refered for IOL at EDDthe health side and refered for IOL at EDD
  • ANTENATAL CASESANTENATAL CASES  Parameters in mm ( Growth Chart )Parameters in mm ( Growth Chart )  Twins for chorionicity as early as possible ( 1Twins for chorionicity as early as possible ( 1stst trimester, before 14 weeks )trimester, before 14 weeks )  Dating scan ( as early as possible, 8 weeks – 13Dating scan ( as early as possible, 8 weeks – 13 weeks )weeks )  Symphisiofundal height measurement (serialSymphisiofundal height measurement (serial measurements, diff of 4cm )measurements, diff of 4cm )  Low lying placenta ( PP ) – after 28 weeksLow lying placenta ( PP ) – after 28 weeks  Abnormal Lie ( non cephalic presentation) - afterAbnormal Lie ( non cephalic presentation) - after 36 weeks36 weeks
  • ANTENATAL CASESANTENATAL CASES  Breech – at term ( > 36 weeks )Breech – at term ( > 36 weeks )  Previous scar – at 36 weeksPrevious scar – at 36 weeks  Teenage pregnancy / Single Parents – 36Teenage pregnancy / Single Parents – 36 weeksweeks  Post Date - 40/52 + 6 daysPost Date - 40/52 + 6 days - AFI & CTG at EDD- AFI & CTG at EDD
  • MEDICAL – RHESUSMEDICAL – RHESUS NEGATIVENEGATIVE  SENSITISED MOTHERS ( Coombs testSENSITISED MOTHERS ( Coombs test positive )positive )  HISTORY OF HYDROPS FETALISHISTORY OF HYDROPS FETALIS  ALL RHESUS NEGATIVE MOTHERSALL RHESUS NEGATIVE MOTHERS (BEFORE 28 WEEKS For IM Rhogem)(BEFORE 28 WEEKS For IM Rhogem)
  • MEDICAL - ANAEMIAMEDICAL - ANAEMIA  Severe anaemia – Hb < 8g/dlSevere anaemia – Hb < 8g/dl  Not tolerating oral iron supplementsNot tolerating oral iron supplements  Not responding to oral iron supplementsNot responding to oral iron supplements  THALASSAEMIA ( especially if bothTHALASSAEMIA ( especially if both parents are carriers )parents are carriers )  Kindly pls do anaemia work out beforeKindly pls do anaemia work out before referring patient ( Ferritin, Iron, TIBC,referring patient ( Ferritin, Iron, TIBC, FBP )FBP )
  • MEDICAL - CARDIACMEDICAL - CARDIAC  Known cardiac diseaseKnown cardiac disease  Heart murmur and symptomsHeart murmur and symptoms  Symptoms and signs suggestive ofSymptoms and signs suggestive of cardiac pathology ( ECHO )cardiac pathology ( ECHO )  Kindly pls arrange for ECHO prior to apptKindly pls arrange for ECHO prior to appt in Combine Clinicin Combine Clinic
  • MEDICAL - ASTHMAMEDICAL - ASTHMA  Uncontrolled bronchial asthma (CombineUncontrolled bronchial asthma (Combine Clinic )Clinic )  Well controlled asthma can be managed inWell controlled asthma can be managed in health sidehealth side
  • MEDICAL – THYROIDMEDICAL – THYROID DISORDERSDISORDERS  Patients on treatment for thyroid disordersPatients on treatment for thyroid disorders  Kindly pls don't do TFT in first trimesterKindly pls don't do TFT in first trimester unless very suggestive symptoms.unless very suggestive symptoms. (Difficult to interpret )(Difficult to interpret )  If abnormal in first trimester, can repeat inIf abnormal in first trimester, can repeat in second or third trimestersecond or third trimester  Patients can breast feed if on low dosePatients can breast feed if on low dose treatmenttreatment  T4 drops as pregnancy progressesT4 drops as pregnancy progresses
  • MEDICAL – CONNECTIVEMEDICAL – CONNECTIVE TISSUE DISEASETISSUE DISEASE  REFER ALL PATIENTS IMMEDIATELYREFER ALL PATIENTS IMMEDIATELY ( SLE / RA / NEPHROTIC SYNDROME )( SLE / RA / NEPHROTIC SYNDROME )
  • POSTPARTUMPOSTPARTUM  Episiotomy wound breakdown – pls refer to clinicEpisiotomy wound breakdown – pls refer to clinic ( No need admission unless symptomatic )( No need admission unless symptomatic )  LSCS wound breakdownLSCS wound breakdown  Postpartum high blood pressurePostpartum high blood pressure  Urinary retentionUrinary retention  SECONDARY PPHSECONDARY PPH  POSTPARTUM PYREXIAPOSTPARTUM PYREXIA  HEART DISEASE WITH SYMPTOM OFHEART DISEASE WITH SYMPTOM OF FAILUREFAILURE  POST PARTUM BLUES/ DEPRESSION/POST PARTUM BLUES/ DEPRESSION/ PSYCHOSISPSYCHOSIS
  • MENSTRUAL DISORDERSMENSTRUAL DISORDERS  Menorrhagia ( > 40 years old, nulliparous,Menorrhagia ( > 40 years old, nulliparous, DM, Obesity)DM, Obesity)  Menorrhagia not responding to treatment (Menorrhagia not responding to treatment ( < 40 years old )< 40 years old )  Post menopausal bleeding (ASAP)Post menopausal bleeding (ASAP)  Amenorhoea ( primary and secondary )Amenorhoea ( primary and secondary )  Dysmenorhoea ( especially failedDysmenorhoea ( especially failed treatment like NSAIDS )treatment like NSAIDS )
  • GENERALGENERAL GYNAECOLOGYGYNAECOLOGY  ABNORMAL PAP SMEARSABNORMAL PAP SMEARS  INFERTILITYINFERTILITY  PELVIC MASSPELVIC MASS
  • ANY QUESTIONS ??? ?
  • THANK YOUTHANK YOU