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Mohammed Kamal

Ahmed MA`

Gestational diabetes









Screening test >>> 50 mg 1h test ( GCT ).
Confirmatory test >>> 100 mg 3h test ( GTT ).
Fasting blood sugar above 95 alone is diagnostic.
Fasting normal, two of readings should be high.
If only one …. Impaired glucose tolerance.
Insulin
o Production increase
o T1/2 does not change
o R increase.
At 22w U/S to detect cardiac anomalies
If blood sugar well control >>> No delivery before 38.
Monitor Pt during labor to avoid hypoglycemia
12w U/S nuchal translucency >>> accumulation of fluid posterior to neck.
When obstructive labor occurs don’t put your hand because you well tear the cervix
so >>>> CS.

Chorioamnionitis




Maternal fever more than 38, lecocutosis
Maternal tachycardia
Fetal tachycardia
Uterine tenderness
Malodorous vaginal discharge

Placenta previa:


Recurrent
Painless
Causeless

Ante D and kleihauer betke test
1. Indications
1.Measures fetal cells in maternal circulation
2.Used in assessing for Rh Sensitization

Mohammed Kamal Ahmed MA` 1. Technique 1.Fetal RBC darkly stained. Mechanism 1. Interpretation 1.Blood Film stained with acid elution 2.5 ml bleed 4. more than 80% will deliver . Maternal RBC "ghosts" 3.Rh Immune Globulin (RhoGAM) Dose 1. General management • Each day vital signs • Each 3 days CBC • Fetal tachycardia occurs before maternal tachycardia If occurred before 36 weeks: • Give dexamethasone if before 34 weeks • Cover with erthromycin • Do your best to reach 36 weeks then deliver the baby If occurred after 36 weeks: • Give the patient 24 hours for spontaneous delivery. Large antepartum bleed 2.Five cells per 50 (lpf) = 0. PPROM is defined as rupture of membranes (amniorrhexis) before 37 weeks gestation.Count Fetal cells per 50 low power fields 2. Maternal blood Rh negative 2.Fetal Hgb more acid resistant 3. Give 300 ug per 30 ml fetal whole blood or 15 ml pRBC Cytotec dose: For IOL: ¼ tablet every 6 hours For induction of abortion 1 tablet every 4 hours 1tablet = 200 ug PROM Definition: rupture of the membranes prior to the onset of labor.

Mohammed Kamal • Ahmed MA` If delivery doesn’t happen. . induce the labor and cover the patient with AB Ectopic pregnancy   More than 1500 to 2000 mIU/mL of hCG without gestational sac by transvaginal US More than 5200 to 6000 mIU/mL of hCG without gestational sac by abdominal US Imperforated hymen     Abdominal pain Amenorrhea Urine retention Haematocorpus Vaginal discharge Clue cells are epithelial cells of the vagina that get their distinctive stippled appearance by being covered with bacteria.

Amniotic fluid Before 16w Maternal source: Firstly water-like fluid originates from the maternal plasma. and passes through the fetal membranes by osmotic and hydrostatic forces After 16w fetal source: first as transudation from non-keratinized skin till 25 weeks – when skin keratinization is complete then urination and swallowing take place Umbilical cord • 30-100 cm • 8 coils • 2 artery and 1 vein Placenta • 500 gm or 1/6 weight of the baby Presumptive signs and symptoms of pregnancy • • • • Amenorrhea Nausea and Vomiting (Morning Sickness). the corpus luteum is the main producer of progestin. .Mohammed Kamal Ahmed MA` Abortion No role of progestin in threatened abortion  Before 8 weeks. Breast Changes. (a) Darkening of the areola. Frequent Urination. after that the placenta takes place We can distinguished between complete and in complete abortion by thickness of the endometrium if more than 15mm it incomplete.

000 grams Hegar's sign. This is called the "Mask of Pregnancy.   Positive signs of pregnancy Fetal Heart Sounds . (e) Presence of colostrum. Skin Changes. Linea nigra." It is seen after the sixteenth week of pregnancy. The vaginal walls have taken on a deeper (2) Leukorrhea. At booking – to confirm pregnancy 22w detailed scan 34w check the growth Palpation of the Entire Fetus. the uterus rises above the symphysis pubis and it should reach the xiphoid process by the 36th week of pregnancy  Size. This can be expressed during the second trimester. It is audible with a doppler by 10 weeks of pregnancy and with a fetoscope after the 16th week Ultrasound Scanning of the Fetus.Mohammed Kamal Ahmed MA` (b) Enlargement of Montgomery (c) Increased firmness or tenderness of the breasts. This is softening of the lower uterine segment just above the cervix. Probable signs of pregnancy  Position. Chloasma. . (d) More prominent and visible veins. This is demonstrated during the bimanual exam at the 16th to 20th week. This is an increase in the white or slightly gray mucoid discharge that has a faint musty odor. Ballottement. The uterine increases in width and length approximately five times its normal size. Striae gravidarum (stretch marks). Palpation of Fetal Movement. Its weight increases from 50 grams to 1. (1) Chadwick's sign. • Vaginal Changes. after the 24th week of pregnancy if the woman is not obese. By the 12 week.

Ask the patient about smoking and coffee drink. Raise the pressure about 20mmhg above her last blood pressure value. The size of cuff must cover about two third of arm. arm Ahmed MA` Denominator Occiput (O) Occiput (O) Mentum (chin) (M) Frontum (forehead) (Fr) Sacrum (S) Sacrum (S) Scapula (Sc) Engaged Diameter Suboccipitobregmatic (9.5 cm) mento-vertical diameter l (13. First sound is systolic and the fourth sound (when the sound becomes muffled) is diastolic.Mohammed Kamal Presenting Part Vertex (occiptoanterior) occipitoposterior Face Braw Buttocks Feet Shoulder. Put the cuff about 1-2 cm above the cubital fossa. Common sites for edema:         Shin of the tibia “most important” Lateral malleolus Medial malleolus Navicular bone Periorbital Sacrum Abdomen “ascites” Anasarca .5 cm) Occipitofrontal (11 cm) Submentobregmatic (9. The position of patient is supine or upright position.5 cm) Inter-trochantric (10cm) Inter-trochantric (10 cm) Bi-acromial (12 cm) How to examine blood pressure • • • • • • • Rest the patient for 10 mint.