Professional Documents
Culture Documents
W3case Objectives and Learning Objectives
W3case Objectives and Learning Objectives
Learning Objectives
Obstetric
Mild, intermittent
symptoms at varying times
Morning sickness
throughout the day,
(uncomplicated
primarily during the 1st Diagnosis of exclusion
nausea and
trimester
vomiting)
Normal vital signs and
physical examination
Frequent, persistent
nausea and vomiting with
Urine ketones, serum
inability to maintain
electrolytes, Mg, BUN,
adequate oral intake of
Hyperemesis creatinine
fluids, food, or both
gravidarum If the condition persists, possibly
Usually, signs of
liver function tests, pelvic
dehydration (eg,
ultrasonography
tachycardia, dry mouth,
thirst), weight loss
Larger-than-expected
uterine size, absent fetal
heart sounds and BP measurement, quantitative
Hydatidiform mole movement hCG, pelvic ultrasonography,
Sometimes elevated BP, biopsy
vaginal bleeding, grapelike
tissue from the cervix
Nonobstetric
accompanied by diarrhea
Normal (benign) abdomen
(soft, nontender, not
distended)
Urinary frequency,
urgency, or hesitancy, with
UTI or pyelonephritis Urinalysis and culture
or without flank pain and
fever
3. Physiology of Pregnancy!
1
Gestational age or menstrual age: 28 days = 40 weeks = 9 months from first
3
day of the last menstrual period. Due date can be calculated using “Nagele’s
rule” = (day) + 7, (month) – 3 40 weeks.
Untuk menilai usia kehamilan / gestational age dapat menggunakan 3 cara yaitu
berdasarkan HPHT (hari pertama haid terakhir), pemeriksaan USG trimester 1
(14 minggu pertama), dan juga dengan Ballard score.
Kehamilan sendiri terdiri atas 3 trimester yaitu trimester 1 adalah usia 0 – 14
bula, kemudian trimester ke-2 adalah usia 14 – 28 bulan dan trimester ke-3
adalah usia 28 bulan sampai bayi lahir. Bayi yang lahir preterm adalah mereka
yang lahir dengan usia kehamilan <37 minggu (bayi premature). Kelahiran aterm
adalah kelahiran pada usia kehamilan 37 – 42 minggu. Pada usia >42 minggu
dikatakan postterm.
6. Embryology of Placenta
Uterine changes
o Position: 12th week the
uterus rises above the
symphysis pubis and should
reach the xiphoid process
by the 36th week of
pregnancy
o Size: increases in width and
length app 5 times its
normal size increases from 60 grams to 1000 grams
Abdominal enlargement corresponds to changes that occur in the uterus,
as the uterus grows, the abdomen gets larger
Cervical changes: formation of a mucous plug due to hyperplasia of the
cervical glands as a result of increased hormones to seal the cervix of the
pregnant uterus and to protect it from contamination by bacteria in the
vagina
Persistent temperature elevation spanning over 3 weeks since ovulation is
noted
Fetal palpation
8. GnPnAn Definition
G = Gravida (number of pregnancies)
P = Para (number of births of viable offspring)
A = Abortus (number of abortions)
Nullgravida no pregnancies
Primigravida 1 pregnancy
Secundigravida 2 pregnancies
12. Doppler Foetal Heart Rate *kapan kedengeran detak jantung bayi*
Ovulation
Ovulation occurs from day-7 to day-22 of the menstrual cycle. Women may
experience spotting in the middle of their menstrual cycle.
Health Conditions
Others
Other causes that may need immediate attention are:
Open cervical os
Vaginal bleeding, symptoms of early pregnancy
(nausea, fatigue, breast tenderness) that decrease
Evaluation as for ectopic
Missed abortion with time
pregnancy
Closed cervical os
Gestational Larger-than-expected uterine size, often elevated
Evaluation as for ectopic
trophoblastic BP, severe vomiting, sometimes passage of
pregnancy
disease grapelike tissue
Localized abdominal pain, vaginal bleeding
Ruptured corpus Evaluation as for ectopic
luteum cyst Most common during the first 12 wk of pregnancy
pregnancy
Nonobstetric disorders
Clinical evaluation
Apparent from history (eg, laceration of the
cervix or vagina due to instrumentation or
Trauma Questions about possible
abuse, sometimes a complication of chorionic
domestic violence if
villus sampling or amniocentesis)
appropriate
Only spotting or scant bleeding with vaginal
Diagnosis of exclusion
discharge
Vaginitis
Cervical cultures
Sometimes dyspareunia, pelvic pain, or both
Only spotting or scant bleeding
Diagnosis of exclusion
Cervicitis
Sometimes cervical motion tenderness,
Cervical cultures
abdominal pain, or both
Clinical evaluation
Scant bleeding, no pain
Cervical polyps
Obstetric follow-up for
(usually benign)
Polypoid mass protruding from cervix further evaluation and
removal
β-hCG =β subunit of human chorionic gonadotropin.
b. Vaginal bleeding during late pregnancy
More than 20 weeks of gestation, but before birth occurs in 3 to 4% of
pregnancies. Some disorders can cause substantial blood loss, occasionally
enough to cause hemorrhagic shock or disseminated intravascular
coagulation.