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Disorders of Pelvic Division of Labor
Prolonged Deceleration Phase
Instrumental Vaginal Delivery
Interval of 6 12 months of amenorrhea
necessary to establish the diagnosis
Usual age: 45-55 years
C
Phase of the aging process of women during
which they make the transition from
reproductive to non-reproductive stage
Period of declining ovarian function, clinically
apparent over 2-5 years around menopause
Premature menopause menopause of 35 years or
less
Ovarian Changes
Depletion of primordial follicles irregular
__________ failure of progesterone
follicle activity completely ceases lack of
estrogen with total cessation on menstrual
function atrophic ovaries
Endocrine Changes
Several years before menopause there is: 1)
gradual increase in FSH 2) concommital
decrease in estradiol 3) no significant change in
LH 4) slight decrease In progesterone
Increase resistance in remaining follicles to
gonadotrophins plus smaller ovaries
decrease estrogen
Effects of reduced Estrogen
1. Brain hot flashes, depression, sleep
disturbances, inability to concentrate, memory
lapses
2. Heart and Vessel coronary heart disease,
arteriosclerosis
3. Bone - mineral mass, fractures
4. Skin - ___________, slow healing
5. Vagina vaginal atrophy, atrophic vaginitis
Treatment
1. Estrogen replacement therapy
2. Increase calcium intake
3. Weight bearing exercises
ADMITTING ORDERS
(Uncomplicated)
Post-Partum Orders
(NSVD)
DELIVERY TECHNIQUE
(NSVD)
POST-PARTUM BLEEDING
Table of Contents
Admitting Orders
Post-Partum Orders (NSVD)
Delivery technique
Post-partum Bleeding
Preterm Labor
D & C Procedure
Post D & C Order
Puerperal Sepsis
PROM
Pre-eclampsia
Sepsis
Placenta Previa
Abortion, Ruptured Ectopic & DUB
Incomplete Abortion
C/S Orders
For C/S Schedule
C/S Post-Op Orders
Commonly Used Drugs
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Transfer patient to ward
Monitor VS + BP q 30 min until stable, then q 4
hrs thereafter
DAT
Infuse 20 UOxytoxin to present IVF, then
regulate @ 20-30 gtts/min; IWC when no
profuse bleeding is noted
Meds:
Methylergometrine 1 tab TID x 3 D
Mefenamic Acid 500mg 1 cap q 6 hrs PRN
Multivit + FeSO4 500mg cap OD x 30 D
Cefalexin 500mg 1 cap TID x 7 D
Place ice pack over hypogastrium
Self-perineal care EID
Refer for any unusalities
TWC terminate when consumed
Px placed in dorsal lithotomy position
Asepsis / antisepsis done
RMLE done (if any)
Delivered via NSVD, cephalic, alive, Bb
________ BWT_________ AS _______
Placenta delivered spontaneously
Manual uterine cleansing done
RMLE repair done (if any)
Vaginal pack inserted (if any)
Parineal area painted w/ betadine solution
FDx: G_P_ (________), FU ______, AOG _______,
(cephalic or breech), delivered via NSVD, alive, BB
______BWT _______, AS ________
Other Dx (if any): RMLE & repair
Repair of lacerations
Please admit px
Secure consent to care
NPO when in active labor
TPR + BP q 4 hrs
Labs:
CBC diff, HbsAg, U/A, BT
Start venoclysis D5NR 1 L @ 30 gtts/min
Monitor progress of labor
Monitor FHB q 15 mins
Refer accordingly
If leaking BOW: (add)
Cefuroxime
Hyoscine-N-butylbromide 1 amp now,
then repeat dose 4 hrs after
Misoprostol tab PO now
Please admit the px
TPR q 4 hrs
NPO temporarily
Labs: CBC, BT, stat UTZ of lower abdomen
IVF D5LR @ 500cc fast drip the regulate @ 20
gtts/min
Infuse 10 U oxytocin to present IVF after fast
drip
Meds:
Methylergometrine 1 ampIM now
Cefuroxime 750mg q 8 hrs IVTT ANST
Monitor V/S q 4 hrs if (+) profuse bleeding
noted
Refer accordingly
PRETERM LABOR
POST D & C ORDERS
PUERPERAL SEPSIS
Please admit px
TPR q 4 hrs
NPO when in active labor
Labs: CBC, BT, HbsAg
Start venoclysis D5NM 1 L @ 30 gtts/min ff
D5LR 1 L @ slow rate
Meds:
Cefuroxime 750 mg IVTT q 8 hrs ANST
Dexamethasone 4 mg q 6 hrs x 4 doses
Watch and refer for progress of labor
Refer accordingly
D & C PROCEDURE
IV anesthesia given
Px in dorsal lithotomy position
Asepsis done
Anterior tip of cervix clipped with tenaculum
and brought forward
Uterine sounding done
Evaluation started using ovum forceps then
completed by curettage
Gritting sensation was noted
Instruments were removed (clean on IE)
End of operation
Transfer to ward
Monitor VS q 15 until stable then q 4 hrs &
chart
DAT
Infuse 10 U oxytocin to present IVF to run @
20 gtts/min then TWC if no further bleeding
noted
Meds:
1.
Methylergometrine 1 amp IM now then
1 tab TID x 3D
2.
Cefalexin 500mg 1 cap TID x 7D
3.
Mefenamic acid 500mg 1 cap q 6 hrs
PRN
4.
Multivit + FeSo4 1 cap OD x 30 D
Transfuse ___ U FWB w/ proper crossmatching
Refer accorlingly
Please admit px
Secure consent to care
NPO
TPR q 4 hrs
Labs: CBC, BT, HbsAg, ptt, ct, U/A, BUN, Crea
Start venoclysis D5LR 1 L @ 30 gtts/min
Meds:
Piperacillin + tazobactam (___)mg vial
#1 q 8 hrs ANST
Insert NGT
Monitor I & O q shift and record
Monitor VS q hr
Refer accordingly
PROM
PRE-ECLAMPSIA
SEPSIS
Please admit the px
Secure consent to care
TPR q 4 hrs
Labs: CBC, BT, HbsAg, U/A
Meds:
1. Misoprostol tab now, then q4 hrs
2. Hyoscine-N-butylbromide 1 amp 2 hrs after
giving misoprostol then q 4 hrs
3. Cefuroxime 750mg IVTT q 4 hrs
Monitor progress of labor if present
Refer accordingly
Please admit the px
Secure consent to care
TPR + BP q hourly
NPO
Labs: CBC, BT, HbsAg, U/A, BUA, Crea
Start IVF w/ D5LR 1 L @ 30 gtts/min
Meds:
1. __
2. Clonidine drip 1 amp, titrate when BP at
150/90 mmHg
3. MgSO4 4 g IV bolus + 5g IM/buttocks,
then 5 g IM q hr
4. Hydralazine 5 mg IV bolus followed by 5
mg q 30 mins up to total dose of 20 mg
for BP 140/90 mmHg
Insert FBC and attach to urobag
Monitor I & O and record
MIO DTR not less than +2, RR > 1-2 cc/min
Watch for progress of labor
Monitor FHB q 15 min
Refer accordingly
Please admit the px
Secure consent to care
TPR + BP q hourly
NPO temporarily
Labs: CBC, BT, HbsAg, U/A, ppt, ct, BUA, Crea,
Na, K+, UTZ of whole abdomen, CXR, ECG 12
leads
Start venoclysis w/ D5LR 1 L @ 30 gtts/min
Meds:
1. Cefuroxime 750mg IVTT q 12 hrs ANST
2. Metronidazole 500mg syrup q 8 hrs
3. Paracetamol 300mg IVTT q 4 hrs RTC
4. Ranitidine 50mg IVTT q 8 hrs
Monitor I & O q 4 hrs
TSB until afebrile
For critical watch
Refer accordingly
PLACENTA PREVIA
ABORTION, RUPTURED ECTOPIC OR DUB
INCOMPLETE ABORTION
Please admit the px
Secure consent to care
TPR q 4 hrs
NPO
Labs: CBC, BT, HbsAg, U/A, UTZ of lower
abdomen
Start venoclysis w/ PNSS to run @ 500cc fast
drip
Meds:
1. Cefuroxime 750mg IVTT q 12 hrs ANST
2. Tranexamic Acid 1 amp IVTT now
3. Vit K 10mg IVTT now
4. Terbutaline 1 amp IVTT now
For stat C/S
Inform OR/ Pedia/ Anesthesiologist
Secure consent for OR
Monitor V/S w/ FHB
Secure __ U FWB w/ proper crossmatching
Refer accordingly
Please admit the px
Secure consent to care
TPR + BP q 4 hrs
NPO
Labs: CBC, BT, platelet, HbsAg, U/A, BUA, Crea,
HGT now
Start venoclysis w/ D5LR 1 L @ 30 gtts/min
Meds:
1.
Cefuroxime 750mg IVTT q 12 hrs ANST
Place on left decubitus position
CBR
For elective secondary to _________________
Inform OR, Pedia, Anesthesiologist
Secure consent for OR
Monitor V/S q 4 hrs w/ FHB
Secure 2 units FWB w/ proper crossmatching
Refer accordingly
CESARIAN SECTION ORDERS
Please admit the px
Secure consent to care
Labs: CBC, BT, Crea, ct, preg test, U/A
Start venoclysis w/ PNSS 1 L @ KVO rate
Meds:
1. Cefuroxime 750mg IVTT q 8 hrs ANST
For culdocentesis
Secure _____ U FWB w/ proper crossmatching
Monitor V/S hourly & chart
Monitor I & O & chart
Refer accordingly
Please admit the patient
Secure consent to care
TPR q 4 hrs
Labs: CBC, BT, HbsAg, U/A
Start venoclysis w/ D5LR 1 L + 10 u oxytocin to
present IVF to run @ 25 gtts/min
Meds:
1. Misoprostol tab q 4 hrs (if cervix is
closed)
Prepare meds for D & C
Secure consent for D & C
Refer if w/ profuse bleeding
D & C meds:
1. Butorphanol tartrate (Staldol) vial #1
2. Midazolam (Dormicum) 15mg/3ml amp
#1
3. Promethazine (Phenergan) amp #1
Inform OR, pedia, anesthesiologist
Secure consent for OR
Monitor V/S w/ FHB
Secure ____ U FWB w/ proper crossmatching
Refer accordingly
FOR CESARIAN SECTION SCHEDULE
CESARIAN SECTION POST-OP ORDERS
Inform consent
NPO
Meds;
1. Cefazolin (stance) 1 g IVTT ANST, then
500 mg q 6 hrs
Left lateral decubitus position
Monitor V/S + FHB q 30 mins
Change IVF to PLR @ 40 gtts/min
Keep sterile D5LR w/ oxytocin
Watch for progress of labor
Inform Or, pedia, anesthesiologist, assit surgeon
Refer accordingly
To recovery room
O2 inhalation 2-3 L/min until fully conscious
Monitor V/S q 15 min until stable and chart
Present IVF to 30 gtts/min (PLR)
1. D5Lr 1 l 30 gtts/min incorporate
oxytocin 10 U ti IVF
2. D5NR 1 L 30 gtts/min
3. D5NM 1 L 30 gtts/min
Meds:
1. Bupivacaine 0.25% + (morphine
0.02%) 10 ml q 12 hrs thru epidural
catheter by anesthesia PGI x 4 doses
2. Cefazolin 500 mg IVTT q 8 hrs
3. Methylergometrine 200mg IM q 4 hrs
x 3 doses
Morphine precaution
Monitor I & O q hr and chart
Flat in bed x 8 hrs
NPO
Refer accordingly
If fever: PCM 300mg IM now; cooling measures
For asthmatic: nebulizer ventolin 2.5 cc now
-
Misoprostol 4 tabs per rectum c/o ROD
CESAREAN SECTION POST-OP ORDERS
COMMONLY USED DRUGS
First Hospital Day
Check for flatus or defecation, urination (urobag)
May have general liquids
Encourage to turn to sides, sit upon bed,
ambulate
Supply abdominal binder
Shift to mefenamic acid 500mg tab, 1 tab PO q 6
hrs after meals
IVFTF D5Nm 2 L @ 25 gtts/min
(optional) regulate piggy bank @ 30 gtts/min
Give stresstabs 1 cap OD
Remove FBC after 12 hrs of morphine +
bupivacaine dose
If no urination w/in 6-8 hrs reinsert catheter
Refer accordingly
Ampicillin 500mg IV q 6 hrs
Cefazolin (Stancef) 1 g IVTT ANST, then 500mg q
6 hrs
Cefuroxime 1.5g IV q 8hrs then 250 mg PO BID
Ciprofloxacin 250mg IV q 12 hrs
D5W 500cc + 2 amp aminophylline @ 15
gtts/min
Gentamycin 7.2 mg/kg IV loading dose +
1.5mg/kg q 8 hrs
Hydrocortisone (solucortef) 250mg IV stat the
100mg IV q 4-6 hrs (4 doses continuous if
condition persist)
Imipenem 500mg IV q 8 hrs
Ipatropium bromide + slbutamol (combivent) 1
vial q 6 hrs
Isosorbide dinitrate 20 mg tab
Meperidine (100-150 mg) IM q 3-4 hrs PRN
Methylergometrine (Methergen) 1 amp IM now
then 1 tab TID x 3 days
Metronidazole 500mg IV q 6 hrs
Mezlocillin 3 g IV q 4 hrs
Multivit + FeSO4 (imefer) 1 cap BID
NaHCO3 650mg before and after meals
Omeprazole 20-60 mg/day
Ranitidine 150mg cap BID
Salbutamol 1 nebule now, then q 3-6 hrs
Salbutamol inhaler 2-4 puffs q 3-6 hrs
Spironolactone (aldactone) 80mg 1 tab OD
Tramadol150mg cap q 12 hrs
Tramadol 50 mg IM
Tranexamic Acid (hemostan) 500mg 1 cap TID
