Pelvic Masses/Uterine Fibroid

https://www.glowm.com/pdf/BookCh-Differential%20Diagnosis%20for%20Female%20Pelvic
%20Masses-InTech-CC%20BY.pdf
VBAC discussion
1. Depends on the indication of previous C-Section. (Hx of previous obstetrics)
2. Permanent? Or Non?
3. Antenatal care- to plan mode of delivery as the pregnancy progresses.
4. To reduce maternal and foetal mortality
5. Antenatal care aims to provide a planned program of observation, education,
and medical management of pregnant women directed toward making
pregnancy and delivery a safe and satisfying experience.
6. Planned VBAC is appropriate for and may be offered to the majority of women with a singleton
pregnancy of cephalic presentation at 37+0 weeks or beyond who have had a single previous
lower segment caesarean delivery, with or without a history of previous vaginal birth.
7. Antenatal scoring for predicting success of VBAC;

8. How to see fetal distress in Partogram?

9. Why can’t do external version if fetal in transverse lie in a previous C-sec mother? – risk of
uterus rupture.
10. If history of previous classical C-sec, thus VSD is not done. Because classical c-sec scar is a weak
scar.
11. Uterus has pacemaker at its fundus towards down. Strongest contraction at fundus, thus
classical c-sec scar will burst first if a vaginal delivery attempted.
12. Antenatal care- once a week after 28 weeks, two times a month, once a month, once a week
after 34th week.
13. Check for suprapubic pain- the location of previous scar. If Pain is present, sign of impending
uterine rupture- take to emergency c-section.
14. Induction of labor (amniotomy or Foley’s catheter )can’t be done in VBAC usually, unless under
expert supervision. Risk of uterine rupture.
15. Done when there is no pain, no contraction, no suprapubic tenderness
16. Uterine rupture managed by uterine repair. Mostly uterine unable to be repaired. Advise on
BTL, she should not get pregnant again.
17. Uterine rupture baby comes out via the rupture.
18. Uterine dehiscence is stretching of the scar, causing pain.
19. A scar of LSCS, usually gives way during labor. Classical C-sec scar will give way during
pregnancy.
20. Admit patient at 36 weeks.
Pre-eclampsia

1. Classification
2. Teenage pregnancy- thus if uterus is larger than date, it could be wrong dates, or multiple
pregnancy,
3. Why auscultate the lungs? – to check for pulmonary edema, hypertension causes
vasoconstriction, fluid goes EC tissues.
4. Symptoms of impending eclampsia-
5. Clinical sign of impending eclampsia- edema of optic disk

6.

7.
8. Multiple fetal pole- twins, confirm by ultrasound
Management Diabetes in Pregnancy-Dr.Ganesh lecture video

1. Gestational diabetes, and pre-existing diabetes.

2. Diagnosis – Gestational DM is made via MGTT, fasting glucose, 2hr post MGTT
3. Screen all pregnant women, diabetogenic state- High risk of Diabetes., screen women with high
risk of DM
4. Fasting level is less than 5.6/ 2hr post glucose- less than 7.8
5. Mother and Fetal outcome in Diabetes.
6. Mother have higher risk in UTI, fungal infections, pre-eclampsia,
7. Fetal- hyperinsuliniemia- big baby, Intrauterine death, fetal sbnormality, polyhydroamniosis,
8. Macrosomic baby- shoulder dystocia, birth trauma, hypokalemia,hypoglycemic, risk of jaundice,
neonatal death
9. Delivery- ideally c-section
10. Folic acid before and in trimester- 5miligram per day to prevent neural tube dys
11. HbA1c- less than 6.5% before pregnancy
12. Diet control, insulin rapid acting
13. Deliver at 38 weeks, planned C-Sec, or VSD but high risk of instrumental delivery
14. During labour, insulin is readjusted on sliding scale based on blood glucose level
15. Post labour- if PED- continue old regime. If GDM stop medications.
16. GDM must be followed up post 6 months.
17. High risk for CNS,CVS,
18. PED- diabetes must be well controlled before conceiving. HbA1c-
19. Antenatal scans- for fetal wellbeing.
20. High risk of hypertension, so prophylactic aspirin is started.
21. Advise on contraceptive measures if family is complete.