Midwifery Obstetrics Notes PDF

OBSTETRICS AND GYNECOLOGY I OB REVIEWER MDs by 2019 MODULE 1 extrauterine), AoG, risk, OB score A 46 yo on her 6th pregnancy came in due to a positive...

OBSTETRICS AND GYNECOLOGY I OB REVIEWER MDs by 2019 MODULE 1 extrauterine), AoG, risk, OB score A 46 yo on her 6th pregnancy came in due to a positive especially Parity Diagnosis of patient: pregnancy test. LNMP (Last Normal Menstrual Period) was Pregnancy Uterine, 13 weeks 6 days, high April 23, 2016. She had 4 term pregnancies, and one preterm risk for age, G6P5 delivery due to triplets. She consulted due to a concern regarding congenital anomalies in babies born to “old Briefly explain the quadruple screening test to the women” and articles she saw on the internet regarding patient. “quadruple screening” and “nuchal translucency”. ▪ Screens for alpha-fetoprotein (AFP), human What is the AOG of the patient? chorionic gonadotropin (hCG), AOG = Age of Gestation unconjugated estriol, and inhibin levels, April 23 -> 30 days in April – 23 = 7 days which if outside normal values, indicates May – 31 congenital diseases June – 30 July – 29 (Date of consult) Categorization of patient according to risk factors: Total = 97 days Or 97/7 = 13 weeks, 6 days Certain diseases occur for certain age - What congenital diseases are associated with determined What is the ob score and index? risk factor? G6P5 (4107) ▪ Example – Down’s syndrome – increased OB score: G6P5 risk at at 35yrs and above G – Gravidity ▪ W/ outliers – 26yr old patient had firstborn ▪ Total # of pregnancies including present boy and second born girl w/ Down’s pregnancy, regardless of outcome of syndrome; patient was not prepared = previous pregnancies. = 6 (4 term abandoned babies for 5 years. pregnancies + 1 triplet pregnancy + 1 ▪ Know alternative cheaper test current) ▪ Prepare patient for any outcome of the test. P – Parity ▪ Total # of pregnancies that has reached age What advice can be given to this patient using the of viability. = 5 (4 term + 1 triplet) article found on PubMed? Viability- if fetus is delivered, it will survive. ▪ Because mother is already 13wks 6days Williams (Chapter 42): threshold of viability are those born at pregnant, use nuchal translucency test as it 22, 23, 24, or 25 weeks has same rate of detection as quadruple screening test for a lower price. OB Index: F4P1A0L7 F–Fullterm=4 CASES P–Preterm=1 CASE 1 A–Abortion=0 29yo L – Living children, total # at the given point in time = 7 PMP – May 1, 2016 Risk factorization: Factors for high risk pregnancy: LMP – June 2, 2016 ▪ Ages 35 and above at time of delivery, or 19 CC – Vaginal Spotting and below Sun Mon Tue Wed Thu Fri Sat ▪ Parity of 5 and above 1 2 3 4 5 6 7 ▪ Multiple pregnancy (triplets) 8 9 10 11 12 13 14 15 16 17 18 19 20 21 What is the complete initial impression for this 22 23 24 25 26 27 28 patient? Initial Impression = initial diagnosis -> 29 30 31 1 2 3 4 changed to avoid litigations 5 6 7 8 9 10 11 Diagnosis is a very final term. a. What is the patient’s menstrual cycle? Other Terms: Admitting impression, working diagnosis, set of 32-day cycle diagnosis with differential diagnosis b. What is the patient’s ovulation date from her ▪ From History and Physical examination previous menstrual cycle? ▪ Used to determine patient management May 19-21, 2016 ▪ Location of pregnancy (uterine, c. What is the next best step in the management of the Transcribed by: ABU, ALIENTO, PELISCO, VILLANUEVA P., VALERIO, VIRADOR, ARBOLEDA, ORINDAY Page 1 of 29  OB-GYN I OB REVIEWER BATCH 2019 case? Monitor the bleeding (amount, characteristics). CASE 2 32yo PMP – April 24, 2016 LMP – May 30, 2016 Consulted for her annual physical examination Sun Mon Tue Wed Thu Fri Sat a. What is the patient’s menstrual cycle? 24 25 26 27 28 29 30 29-day cycle 1 2 3 4 5 6 7 b. When is the expected ovulation day for the current 8 9 10 11 12 13 14 menstrual cycle? 15 16 17 18 19 20 21 July 9-11, 2016 22 23 24 25 26 27 28 29 30 31 1 2 3 4 AGE OF GESTATION a. What is the patient’s menstrual cycle? LMP – February 14, 2016 36-day cycle Date of Visit (Check up) – August 3, 2016 b. What dates would correspond to the proliferative phase? Compute for the Age of Gestation. April 24, 2016 to May 16, 2016 c. What dates would correspond to the luteal phase? So ganito yun, since yung LMP ay last February pa, May 16-29, 2016 magstart tayo ng February until mag-August. d. What is the patient’s follicular phase? Feb April 24, 2016 to May 15, 2016 Mar e. What is the next best step in the management of the Apr case? May Menstrual monitoring June July Aug And then, ilang days ba meron ang Feb this 2016? Diba 29, eh nagstart ng 14 so i-less natin yung 14 sa 29 kasi CASE 3 ang kailangan lang naman nating kuhanin is yung span kung kelan nagstart yung menstruation until 21yo the date of consultation. Here it goes..... Feb (29 - 14) = 15 Mar = 31 Apr = 30 May = 31 June = 30 July = 31 Aug = 03 171 PMP – May 26, 2016 Ayan na, 171 days. And since weeks yung hinahanap natin LMP – June 24, 2016 kailangan natin syang idivide sa 7 (kasi we have 7 CC – missed menses days in a week). Age of Gestation is 24 weeks and 3 days. Transcribed By: ABU, ALIENTO, PELISCO, VILLANUEVA P., VALERIO, VIRADOR, ARBOLEDA, ORINDAY Page 2 of 29  OB-GYN I OB REVIEWER BATCH 2019 OB SCORING AND OB INDEX (+) urinary hesitancy hence consult G (Gravida) – number of pregnancies DIAGNOSIS: P (Parity) – number of viable pregnancies delivered G8P7 (7007) PU, 11 wks 5 days, To consider vaginal regardless of outcome and number prolapse T (Term) – delivered full term per head (38-42 weeks) P (Preterm) – delivered pre term per head (20-37 weeks) Vaginal Prolapse kasi yung isang risk factor is present which is A (Abortion) – per pregnancy (