#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 ⤵️⤵️⤵️⤵️

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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

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2nd step; Clinically - demonstrable or not?

During per speculum examination, S/E;

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


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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 ‼️)

🔼 Tips to memorize common medication #dosage during tagging 👍🏻

10/10 ⭐️ Tq Dr Rasyidah for re-joining our Clinical Skills Workshop ❤️


She attended 1st time as paid participant, then come again FOC as #facilitator to revise & practice again - just before starting HOship soon


👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻👍🏻

All session for Clinical Skills Workshop are fully booked for March ‼️


We will resume the workshop in mid May, with;

✅ more procedures,
✅ longer practice time (8 am - 10 pm)
🎁 more exciting FREE gift pack 🛍️,


and 3️⃣ time #installment option 👍🏻 (with revised fee, of course)


🔽🔽🔽🔽🔽🔽🔽🔽🔽🔽🔽


Grab few final seats for #Neonatology ward simulation & #Episiotomy workshop on 19th March;

https://medicorp.onpay.my/order/form/clinicalskill_suturingworkshop

Jadual PTM HO intake bil 1/23

Has anyone tried to #present this case?

This is actually one of many #case discussion from Medicorp's #Mentorship_revision ❤️


Listen to my full presentation for above case in the audio notes below;

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What do you think?

How does this #differ from the way you were taught to #present case during medical school? 🤔

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Macam ni lah kalau dkt O&G 😅

Macam-macam SN inform to #attend, tak kiralah kita tagging lagi ke apa ke 😳


Sebab tu ramai yg akan kena #start 1st posting O&G dept;

patients ramai, turn over cepat, lots of obstetrics emergencies - jadi semua kena buat cepat2 😫

Kedah O&G protocol

Sabah O&G protocol