Neonatology Ward #Simulation is back!

We have arranged another session on 19th March, Sunday - just before HO intake bil 1 start their Hospital orientation soon.


Experience #real in- ward experience as HO;

👉🏻 doing AM & PM #review

👉🏻 presenting & documentation during #rounds with MOs

👉🏻 managing ward #work eg discharge summary

👉🏻 clerking new cases on #admission

👉🏻 attending #unstable newborn


More info for registration here; https://medicorp.onpay.my/order/form/wardsimulationmarch

#Limited seats available - only 12 participants maximum per session 😇

Stages of Labor. Compulsory to know in Obstetrics 👌🏻

🤰Intrapartum management
(during 1st stage of labour)

🌟according to VenOMMS 🌟


1️⃣ Plot #partogram & T/O LR

[Ventilation]


[Oral intake] 🔽🔽🔽

2️⃣ Allow sips of CF (clear fluids)

3️⃣ Insert large bore branula & start IVD NS/HM/Dextrose Saline; 125cc/hour

❗️In PIH patient; only 1cc/kg/hr (risk for APO) & use only NS ‼️

❗️In Diabetic patients; if DXT less than 7mmol/litre, use D5% solution instead of NS ‼️


[Monitoring] 🔽🔽🔽


4️⃣ V/S monitoring hourly

✔️If PIH in crisis, every 15-30 mins
✔️add on GM monitoring in GDM patients


5️⃣ CTG #monitoring (tracing on admission & post ARM), then to repeat accordingly based on risk factor


6️⃣ Time #contraction; aim good contraction (4:10 in primid, 3:10 in multipara)


7️⃣ NRVE in ? hour (according to current V/E findings)


8️⃣ 1 to 1 care (if enough LR personnel)

9️⃣ Husband/#companion to accompany during labour (not available during pandemic 😷 )


[Medication] 🔽🔽🔽


🔟 #Analgesia if strong contraction


1️⃣1️⃣ For Pitocin #augmentation 1 or 2 hour post ARM if contraction inadequate ( <4:10 in primid, <3:10 in multipara)


1️⃣2️⃣ DIK regime (for GDM patients)



[Special Order] 🔽🔽🔽


1️⃣3️⃣ Amniotomy ie #ARM (if membrane intact)


Source; ❤️ Medicorp’s O&G #online course❗️local LR protocol varies

Management of 1st stage of Labour

#Analgesia choices in 1st stage

✅Entonox (inhalation, need to educate patient properly about the technique)

✅Epidural analgesia or CSE (combine spinal epidural anaesthesia)

✅IM Pethidine 50/75/100mg (1mg/kg)
✅IM Nubain
✅IM Tramal

Pudendal block


Non pharmacological measures;
-Aromatherapy
-Calming musing

🔼 Physiology of Labour

Symptoms of Labour;

1️⃣ show

2️⃣ regular contraction pain; frequency (regular contraction - 1 in 10 minutes ▶️ 1:10)

3️⃣ leaking liquor ⤵️⤵️⤵️⤵️

🎀🎀🎀🎀🎀🎀🎀🎀🎀

How to confirm leaking (liquor)? 🤔

1st step; History - suggestive or not?

✅ Gush of fluid
✅ Dribbling
✅ soaked her sarung/bed sheet (if leak during sleeping)

❗️ask about recent SI ie sexual intercourse (<12hour), as patient might confuse leaking with seminal fluid

⁉️ask also about;

✅ onset of leaking
✅ color of liquor
✅ FM
✅ symptoms of chorioamnionitis;
⚠️maternal fever
⚠️maternal & fetal tachycardia
⚠️foul smelly liquor
⚠️tender abdomen & irritable uterus

🔽🔽🔽🔽🔽🔽🔽🔽🔽

2nd step; Clinically - demonstrable or not?

During per speculum examination, S/E;

✅ Pooling of liquor
✅ Cough impulse positive
✅ Amniocater (if available)


🔽🔽🔽🔽🔽🔽🔽🔽🔽

If confirm leaking 💦 (ie suggestive history & demonstrable clinically),

Then the 🔺 diagnosis could be either;

✅ true labour; Leaking + spontaneous regular contraction

✅ PROM; term + leaking + NO spontaneous regular contraction

✅ PPROM; preterm + leaking + NO spontaneous regular contraction

PROM;

Mx;
IV Ampicillin at 12 or 18hour from onset of leaking (local protocol may varies)

Dose;
(Non GBS mother) 1g stat & 500mg QID

(GBS mother) 2g stat & 1 g 4 hourly

PPROM- Plan of Mx;

✅ Admit ANW
✅ Monitor SSx of chorioamnionitis
✅ Strict pad chart; inform if change of liquor color
✅ Start T. EES 400mg BD x 10/7
✅ Repeat TAS, FBC, CRP biweekly


Indication for IOL in PPROM;
❗️in presence of chorioamnionitis symptoms
❗️at 34-36 week if continuous leaking
❗️severe oligohydromions or anhydromions

At 10pm, you just finished tagging at Labour room, and went to collect your bag at PAC before going back home.


A senior HO noticed you;

“Tagger ya? Ok, great I need your help. I need to go to OT for standby, they just posted an EMLSCS for FD.

I already #clerk this new case, active phase of labour, not much issue.

Our MO will come from LR anytime. You present the case to Dr Y, you know her right? The #famous one.

Sorry ya, I really need to go to OT now, Tq ya”


Can you #present the case the the oncall MO? 🙃

(Hint; your presentation should not exceed 3 minutes ‼️)