Update in obstetrics and gynecology 2 2012
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UPDATE IN UPDATE IN OBSTETRICS AND OBSTETRICS AND
GYNECOLOGYGYNECOLOGY
SATURDAYSATURDAY
17 NOVEMBER 2012 17 NOVEMBER 2012
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REFERRAL / ISSUES REFERRAL / ISSUES ::
WHAT ? WHEN ? And HOW ?
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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 WEDNESDAY MONDAY 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 )
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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 CLINIC COMBINED 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
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Cont.Cont. CONSULTATIONCONSULTATION WORKING HOURS: MO INCHARGEWORKING HOURS: MO INCHARGE
ACCORDING TO CLINICACCORDING TO CLINIC AFTER WORKING HOURS / PUBLIC AFTER WORKING HOURS / PUBLIC
HOLIDAY: MO ONCALL HOLIDAY: MO ONCALL SPECIALIST ONCALLSPECIALIST ONCALL
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EARLY PREGNANCY EARLY PREGNANCY PROBLEMSPROBLEMS
MISSED MISCARRIAGE MISSED MISCARRIAGE INCOMPLETE MISCARRIAGE INCOMPLETE MISCARRIAGE THREATHEN MISCARRIAGE THREATHEN MISCARRIAGE TRO ECTOPIC PREGNANCY ( ASAP )TRO ECTOPIC PREGNANCY ( ASAP ) MOLAR PREGNANCY ( ASAP )MOLAR PREGNANCY ( ASAP ) MODERATE/SEVERE HYPEREMESIS MODERATE/SEVERE HYPEREMESIS
GRAVIDARUM ( ASAP )GRAVIDARUM ( ASAP ) RECURRENT MISCARRIAGE ( Clinic )RECURRENT MISCARRIAGE ( Clinic )
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HYPERTENSION IN HYPERTENSION IN PREGNANCYPREGNANCY
BP > 140 / 90BP > 140 / 90 Symptoms and signs of Impending Symptoms and signs of Impending
EclampsiaEclampsia Albuminuria 2+ and moreAlbuminuria 2+ and more Whenever UNSURE, please do referWhenever UNSURE, please do refer And And REFER EARLY / IMMEDIATELYREFER EARLY / IMMEDIATELY
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MEDICAL - DIABETESMEDICAL - DIABETES
All known diabetics ( as early as All known diabetics ( as early as possible )possible )
IMGTT with BSP > 7 mmol/lIMGTT with BSP > 7 mmol/l AS PER PROTOCOLAS PER PROTOCOL GDM on diet control can be managed GDM on diet control can be managed
in the health side and refered for IOL in the health side and refered for IOL at EDDat EDD
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ANTENATAL CASESANTENATAL CASES Parameters in mm ( Growth Chart ) Parameters in mm ( Growth Chart ) Twins for chorionicity as early as possible ( Twins for chorionicity as early as possible (
11stst trimester, before 14 weeks ) trimester, before 14 weeks ) Dating scan ( as early as possible, 8 weeks Dating scan ( as early as possible, 8 weeks
– 13 weeks )– 13 weeks ) Symphisiofundal height measurement Symphisiofundal height measurement
(serial measurements, diff of 4cm )(serial measurements, diff of 4cm ) Low lying placenta ( PP ) – after 28 weeks Low lying placenta ( PP ) – after 28 weeks Abnormal Lie ( non cephalic presentation) Abnormal Lie ( non cephalic presentation)
- after 36 weeks - after 36 weeks
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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 Teenage pregnancy / Single Parents
– 36 weeks– 36 weeks Post Date - 40/52 + 6 days Post Date - 40/52 + 6 days
- AFI & CTG at EDD- AFI & CTG at EDD
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MEDICAL – RHESUS MEDICAL – RHESUS NEGATIVENEGATIVE
SENSITISED MOTHERS ( Coombs test SENSITISED MOTHERS ( Coombs test positive )positive )
HISTORY OF HYDROPS FETALISHISTORY OF HYDROPS FETALIS ALL RHESUS NEGATIVE MOTHERS ALL RHESUS NEGATIVE MOTHERS
(BEFORE 28 WEEKS For IM Rhogem)(BEFORE 28 WEEKS For IM Rhogem)
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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 Not responding to oral iron
supplementssupplements THALASSAEMIA ( especially if both THALASSAEMIA ( especially if both
parents are carriers )parents are carriers ) Kindly pls do anaemia work out before Kindly pls do anaemia work out before
referring patient ( Ferritin, Iron, TIBC, referring patient ( Ferritin, Iron, TIBC, FBP )FBP )
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MEDICAL - CARDIACMEDICAL - CARDIAC
Known cardiac diseaseKnown cardiac disease Heart murmur and symptomsHeart murmur and symptoms Symptoms and signs suggestive of Symptoms and signs suggestive of
cardiac pathology ( ECHO )cardiac pathology ( ECHO ) Kindly pls arrange for ECHO prior to Kindly pls arrange for ECHO prior to
appt in Combine Clinicappt in Combine Clinic
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MEDICAL - ASTHMAMEDICAL - ASTHMA
Uncontrolled bronchial asthma Uncontrolled bronchial asthma (Combine Clinic )(Combine Clinic )
Well controlled asthma can be Well controlled asthma can be managed in health sidemanaged in health side
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MEDICAL – THYROID MEDICAL – THYROID DISORDERSDISORDERS
Patients on treatment for thyroid disordersPatients on treatment for thyroid disorders Kindly pls don't do TFT in first trimester Kindly 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 in If abnormal in first trimester, can repeat in second or third trimestersecond or third trimester
Patients can breast feed if on low dose Patients can breast feed if on low dose treatmenttreatment
T4 drops as pregnancy progressesT4 drops as pregnancy progresses
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MEDICAL – CONNECTIVE MEDICAL – CONNECTIVE TISSUE DISEASETISSUE DISEASE
REFER ALL PATIENTS IMMEDIATELYREFER ALL PATIENTS IMMEDIATELY
( SLE / RA / NEPHROTIC SYNDROME )( SLE / RA / NEPHROTIC SYNDROME )
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POSTPARTUMPOSTPARTUM Episiotomy wound breakdown – pls refer to Episiotomy wound breakdown – pls refer to
clinic ( No need admission unless clinic ( No need admission unless symptomatic )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 OF FAILUREHEART DISEASE WITH SYMPTOM OF FAILURE POST PARTUM BLUES/ DEPRESSION/ POST PARTUM BLUES/ DEPRESSION/
PSYCHOSISPSYCHOSIS DVTDVT
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MENSTRUAL DISORDERSMENSTRUAL DISORDERS
Menorrhagia ( > 40 years old, Menorrhagia ( > 40 years old, nulliparous, DM, Obesity)nulliparous, DM, Obesity)
Menorrhagia not responding to Menorrhagia not responding to treatment ( < 40 years old )treatment ( < 40 years old )
Post menopausal bleeding (ASAP)Post menopausal bleeding (ASAP) Amenorhoea ( primary and secondary )Amenorhoea ( primary and secondary ) Dysmenorhoea ( especially failed Dysmenorhoea ( especially failed
treatment like NSAIDS )treatment like NSAIDS )
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GENERAL GYNAECOLOGYGENERAL GYNAECOLOGY
ABNORMAL PAP SMEARSABNORMAL PAP SMEARS INFERTILITYINFERTILITY PELVIC MASSPELVIC MASS
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ANY QUESTIONS ????
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THANK YOUTHANK YOU