Bear in mind,
O&G is a surgical based department..
so...
what do you have in mind?
as a 1st poster in this department??
These are the things you need to learn before going into this department, especially as a first poster !!
Based on priority, of course !!
1) Clerking O&G cases
- As all department has their template for clerking cases, O&G has several addition to the regular clerking template
- Remember since you're dealing with pregnant lady (obstetric), or women with menstrual problem (gynae),
always remember to add-in (or ask) about their :-
- Menstrual Cycle : Menarche at what age, how long does the "period" last, the duration of each cycle, does the cycle comes regular or irregular (in terms of duration), any history of dysmenorrhea or any usage of contraception drug/device.
- Sex life : Married or not (if not married, we call them "Single Parent or Single Mom", if they are not married, ask about their sex partner (do they change sex partner? bangladesh? singapore?)
- Previous complicated delivery : Any prolonged labour, history of caesarean section, still birth, rhesus positive baby (delivered by rhesus negative mother), multiple pregnancy (twins/triplet)
- Pregnancy-induced disease : Anemia in pregnancy, Pregnancy-induced hypertension, Gestational Diabetis Mellitus
- Screening Status : HIV, Hep B, Hep C, VDRL, TPHA (normally done in the 1st trimester at Klinik Kesihatan). If they come without screening (as in single parent, or foreigner), we call them "unscreened". So we have to do the screening for them regardless the age of their pregnancy.
- 4 Sign & Symptom of Labour : Contraction, Leaking of liquor, Show (blood + mucus) and Fetal Movement
- If you never learn how to set an IV line in medical school, its better to learn it before you start working as houseman !!!
- This is the department where 99% of their patients need branulla, even an expected delivery without any complication will need branula
3) Vaginal Examination
- This is very very important !!
- You need to be able to tell, whether the cervix is dilated and the opening is large enough to proceed with delivery or not. Sometimes your MO is too busy, get help from senior HO or staff nurses, as large cervix opening can deliver in the matter of seconds.
- Imagine what will happen, if you fail to identify the large opening of the cervix, the next minute, the baby head is delivered but the body is stuck and you're not in the labour room !!!
- If you're not sure, don't be shy to ask senior HO or staff nurses to reconfirm your findings. Everyone will be busy, but just open your mouth and ask, better save your ass first
4) CTG (Cardio-Tocography)
- Basically this is the monitoring of the baby's heart rate and mother's uterus contraction time
- Normally done at term (> 37 week of pregnancy) lady who shows sign of labour
- You need to identify the pattern of CTG : reactive (good) or non-reactive (bad)
- If its bad, theres a chance the baby is dying inside, this may be an emergency/complicated delivery !!!
Pregnant lady with ongoing CTG
5) Scrub In
- Surgical based department will always need HO to assist in the operating theater
- Most hospital will arrange 1st poster for a briefing on how to scrub into operation properly
- Watch and learn !!
6) Common cases in O&G
- Urinary tract infection (UTI) : May cause false labour or threatened preterm labour. Check the urine biochemistry (any leukocyte or nitrate found in the patient's urine)
- Placenta Previa (low lying placenta) : Causing bleeding per vagina , check the mother & the baby !!
- Pre-eclampsia : Check the blood pressure, blood workout for Pre-eclampsia, look for protein in urine biochemistry, careful patient may develop seizure !!
- Chorioamnionitis : Mother comes with fever must be taken care immediately as this may be a sign of infection in the amniotic fluid. Check the CTG, any other source of infection, inform your MO as this is an emergency, they will definitely ask for CTG and will proceed with ultrasound scan
7) Common Drug used in O&G department
- T. Cefuroxime (zinnat) 250mg bd : use to treat UTI
- IV Cefuroxime (zinnacef) 750mg tds : use to treat UTI in threatened preterm labour mother
- T. FeSo4 400mg bd : for anemia in pregnancy
- T. Folate 5mg od : supplement to prevent spina bifida / folate insufficiency
- Ural sachet II/II tds or potassium citrate 15mls tds : use to alkaline the urine, in case of UTI
- T. Papase II/II tds : to reduce swelling at vagina, after delivery / episiotomy done
- IM Pethidine 50mg (or 75mg) stat + IM phenergan 25mg stat : to reduce labour pain
- IM tramal 50mg (or 75mg) stat : to reduce labour pain, if the cervix opening is more than 6cm, do not use pethidine, use tramadol !!!
- T. metoclopromide (maxolon)10mg tds : to reduce nausea / vomitting
- IV metoclopromide (maxolon) 10mg tds : to reduce nausea / vomitting
- T. Amlodipine 10mg stat : to reduce high blood pressure for pregnancy induce hypertension or pre-eclampsia
- IV Magnesium Sulfate 4mg (8ml) stat then IVI Magnesium sulfate 1mg/kgBW/hour : to treat Pre-eclampsia or eclampsia or prevent fitting. Monitor urine output, respiratory rate and knee jerk reflex during the infusion intravenous injection to look out for mgso4 toxicity
REMEMBER THAT... Generally it took ONE HOUR for the cervix to dilate 1 CENTIMETER...
will be faster in Multipara mother !!!
No comments:
Post a Comment