Here are the key points to consider in managing a patient presenting with vaginal bleeding at 28 weeks gestation:1. Differential diagnosis includes placenta previa, placental abruption, cervical lesions, and vasa previa. 2. Placenta previa is characterized by painless bleeding and normal fetal movements. Abruption presents with painful bleeding and reduced fetal movements. 3. Investigations include FBC, coagulation profile, renal function, ultrasound, and CTG to assess placental location, fetal wellbeing, and maternal status.4. Ultrasound will show placenta location and signs of abruption like retroplacental clots. CTG monitors fetal heart
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The document discusses the causes, diagnosis, and management of vaginal bleeding in a 30-year-old patient at 28 weeks gestation, outlining possible conditions like placenta previa, placental abruption, and vasa previa that can cause bleeding, how they are differentiated based on history, examination and ultrasound findings, and the treatment approach including monitoring or early delivery depending on the severity of bleeding and gestational age.
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Similar to Here are the key points to consider in managing a patient presenting with vaginal bleeding at 28 weeks gestation:1. Differential diagnosis includes placenta previa, placental abruption, cervical lesions, and vasa previa. 2. Placenta previa is characterized by painless bleeding and normal fetal movements. Abruption presents with painful bleeding and reduced fetal movements. 3. Investigations include FBC, coagulation profile, renal function, ultrasound, and CTG to assess placental location, fetal wellbeing, and maternal status.4. Ultrasound will show placenta location and signs of abruption like retroplacental clots. CTG monitors fetal heart
Similar to Here are the key points to consider in managing a patient presenting with vaginal bleeding at 28 weeks gestation:1. Differential diagnosis includes placenta previa, placental abruption, cervical lesions, and vasa previa. 2. Placenta previa is characterized by painless bleeding and normal fetal movements. Abruption presents with painful bleeding and reduced fetal movements. 3. Investigations include FBC, coagulation profile, renal function, ultrasound, and CTG to assess placental location, fetal wellbeing, and maternal status.4. Ultrasound will show placenta location and signs of abruption like retroplacental clots. CTG monitors fetal heart (20)
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Here are the key points to consider in managing a patient presenting with vaginal bleeding at 28 weeks gestation:1. Differential diagnosis includes placenta previa, placental abruption, cervical lesions, and vasa previa. 2. Placenta previa is characterized by painless bleeding and normal fetal movements. Abruption presents with painful bleeding and reduced fetal movements. 3. Investigations include FBC, coagulation profile, renal function, ultrasound, and CTG to assess placental location, fetal wellbeing, and maternal status.4. Ultrasound will show placenta location and signs of abruption like retroplacental clots. CTG monitors fetal heart
- 1. DR NAJEE MEQ TRANSVERSE LIE 1. Cause of transverse lie -grandmultipara- pendulousabdomen,lax uterus -polyhydramnios -placentaprevia -fibroidinlowersegment -uterine anomalies- sepatatearcuate uterus -multiplepregnancy -fetal anomalies:hydrocephalus -cpd 2.How to diagnose transverse lie - transverse distensionof abdomen -SFH< POG -fundal grip - smooth,curved,broadstructure suggestingfetalback -emptylowerpole -lateral grip:headandbuttock 3. Complicationof transverse lie - obstructedlabour - umbilical cordprolapse -rupture of uterus 4.Management: - 36/37 weeks- doECV ,followupat 38 weeks - If remaintransverse:c-sec - If successful ECV : NVD 5. ContraindicationsinECV - placentaprevia - past csec-uterinescar
- 2. DR MYO 1. Ddx abdominal painin3rd trimester: - on& off:pretermlabour -continuospain:abruptio -epigastricpain:signof impendingeclampsia
- 3. DR NAJEE MEQ GDM - 28 yo motherg4p3 pog24 weeks - Comesto antenatal clinic - Bloodsugar 11.0 mmol - Previousrecordnormal 1. What isyour diagnosiswithjustification - Gestational diabetesmellitus - Justification o All isnormal previously o Sugar >10 mmol 2. What are maternal complication Antenatal intrapartum Puerperium - Preeclampsia - Polyhydramnios - Pprom/prom - Infection - Pretermlabour - Prolonged labour/obstructed labour - Pph - Birthcanal injury - Perineal tear - Instrumental delivery - PPH - Lactational failure - sepsis 3. fetal complication Antenatal Intrapartum Postpartum - miscarriage - anomaly - macrosomic - suddeniud - preterm - shoulder dystocia - birth asphyxia - MAS - Hypoglycaemia/hypomagnesemia (electrolyte imbalance) - RDS - Jaundice (D4-D5) 4. Planof management a. Control glycemia a. DietMNT, 40% cho,40%protein,20% fat b. Exercise c. Drugs,metforminandinsulin b. Detectcomplicationanditmanagement c. Time of delivery a. Withdietonlyat 40 b. Withdrug withoutcomplicationat38 c. Withdrug withcomplicationat37 Pre-existingdm 1. Withoutcomplicationat38 2. Withcomplicationat37
- 4. DR MASYA GDM 1. Come for anc checkup, whatis anc use 1. Screening a. Compulsoryscreening i. Bloodpressure ii. Proteinuria iii. Glycosuria iv. Ogtt v. Vdrl/hiv/syphilis vi. Abo/rhesus vii. Fbc viii. Bw,bmi ix. Renal profile b. Dependonriskfactor screening i. Thalassemia ii. Hepb 2. Monitoring 3. Complication 4. Intervention 2. How to prepare motherforogtt 1. Askmotherto fastfor 8 hr, startingafter10 2. No allowedevenwater 3. Come earlymorning,toavoidbecome tiredorlethargyandeasy to swallow sugarwater 4. Come at morning,we take firstbloodforfastingplasma glucose level 5. Thendrink75gm in250ml or prefixedsolution 6. Kalauvomitrepeatagain 7. After2 hr, measure 2hr postglucose loadplasmaglucose value 8. Interpretasdm isfasting>5.1 and 2hr >7.8 3. Mogtt risk factor 1. Previousgdm 2. Macrosomic baby 3. Boh 4. Comorbidity inpregnancy 5. Familyhistory 6. Polyhydramnions 7. Obesity>27.5 8. Age >25 9. glycosuria 4. Mx 1. Dieticianrefer/mnt 2. Call againfor bsp(fasting>5.4, 2hr >6.8) 3. Abnormal startmetformin500mg od,bd, td 4. Counsel riskof hypoglycaemia
- 5. 5. Insulin 1. Must admitto 2. monitorcomplication, 3. hypoglycaemia, 4. optimize sugarcontrol, 5. injectionteknik 6. monitorfetal inside/pregnancy 6. Timingdelivery 1. 40 2. 38 3. 37 7. Hx 1. Whendx 2. Medication 3. Signand symptoms 4. Obstretriccomplication,whenisfollow up 5. Neurocomplication 6. Nephrocomplication 7. Retinoscopy 8. Knowcase,medical problem a. Hypercho,lipid,candidiasis b. Uti 9. Hba1c value 10. Usg report 11. Bsp value
- 6. DR NAJEE OBS CASE SCHEME 1. Openingsentences a. Name;mrs fatin b. Age;28 year c. Occupation;teacher d. Parityindex;g2p1 e. LMP; X f. EDD; X g. POG; X 2. Why she come;CC 3. Presentpregnancy a. 1 trimester i. Whenbookingvisit ii. Ix done iii. Datingscam iv. complication b. 2 trimester i. Date of quickening ii. Anomalyscan iii. Oral fe supplement(compliance,takenregularly) iv. TT c. 3 trimester 4. Past obs a. P1. P2… b. Pregnancy/labour/postpartum c. Birthweight d. Feedinghistory 5. Menstrual history a. Cycle;regular/prolonged 6. Gynae history a. Contraception b. Pap semar 7. Past medical andsurgical history
- 7. DR NAJEE OBS EXAMINATION Inspection 1. Abdomenuniformlydistended 2. Lineanigra/striagravidarum 3. If examgive dummy – mentioninnormal human‘Ican see fetal movement’ Palpation 1. Clinical fundal height a. Umbilical;22 week b. Xiphi;38/40 c. Antara bothtu 36 Differentdrdifferentmazhabweyh,Iisscared! 2. SFH a. From pubicsymphysis b. Answer SFH is_________cm, correspond or< or > to gestation! 3. Fundal grip a. Don’tpush hard,nanti uteruscontract b. Answer Softto firm Broad Irregularstructure Suggestive fetalbuttock/fetal breech 4. Lateral grip a. Right,answer Broad Curve Smoothstructure Suggestive fetalback/spine b. Left,answer Knobby Irregularstructure Suggestive fetallimb 5. Pelvicgrip a. Answer Round Firm Smoothstructure Suggestive fetalhead
- 8. 6. Head a. How muchis palpable Engagedis2/5 palpable 7. FHR-mentionrate 8. EFW- average Malaysianbaby3-3.5kg 9. Liquorvolume is adequate 10. Summary a. Single fetus b. Longitudinal lie c. Cephalicpresentation d. Headis engaged e. Weightis3kg f. Liquoris average
- 9. DR NAJEE MEQ APH 30 y/o G3P2 @ 28w pogcame withvaginal bleeding/spotting 1) what are possible causes -placentaprevia -placentaabruptio - local causesof cervix : cervical polyps : cervical ectropian : ca of cervix - vasa previa - indeterminate causes(unknowncause) 2) PP vsPA Placentaprevia placental abruptio -hx: painlessbleeding fetal movementnormal - abd examination: Soft,nontender Fetal part easilypalpable FHS easilyaudible Hx: - painful bleeding, -babymovementreduced Perabdomen: - uterusirritable,tender,woodyhard tense - fetal partdifficulttopalpate - FHS isreduced 3) investigation -FBC: tro anemia - bloodcrossmatch,bloodgrouping -coagulationprofile -usg -ctg
- 10. 4) usg finding Pp- - placentainlowerpole - fetal isnormal - malpresentationbaby PA- - placentainuplersegment - separationof placenta - retroplacental clot - babywell beingisaffected - babymovementisreduced/absent - FHR reduced/absent 5) vasa previavsshow Vasaprevia -bloodvesselrunningacrossinternal os - can rupture withARMand PPROM - h/oliquorleaking+abd paincontraction - babyis the one whobleed - ctg altered- babydistress - * baby blood: 180 ml * Show - * CTG NORMAL* 6) complications PP -recurrentbleeding -bleedingthroughoutpregnancy -iugrbaby - pretermlabour - pph Abruptio -Iugr -pretermlabour -pph -DIC -acute tubularnecrosis
- 11. 7) Investigation - FBC - gxm - coag profile - renal profile - usg,see placentaandfetal well being - ctg 8) planof management - mustsetup iv line - ivsteroid - determine onamountof bleeding 1. if little- justmonitor 2. if heavy- take babyout - PP2 cm outside os 1. bleedingwill stop 2. nothingwill happen - within2cm 1. dependingravide a. mustkeepinward b. mustobserve