OB-GYN
Maria Veronica C. Cacdac, MD
1st trimester: 0-14 weeks
2nd trimester: 14-28 weeks
3rd trimester: > 28 weeks
PNCU (WHO: 5 PNCU only)
Anytime during the 1st trimester then 1 week after
26 wks
32 wks
38 wks
BASELINE LABS
CBC, FBS (1st trimester), 75g OGTT (2nd trimester > 24 wks),
HbsAg, RPR, ABO, UA
ANEMIA
Category I: Mild Hb: 95-105 mg/dL
Category II: Moderate Hb: 80-94 mg/dL
Category III: Severe Hb: 69-79 mg/dL
Category IV: Very Severe Hb: < 69 mg/dL
*** Physiologic Anemia: 0-12 weeks = 11 mg/dL ; 13-28 weeks = 10.5
mg/dL ; >29 weeks = 11 mg/dL
DISCHARGE IE
Cx soft, admits 1-2 fingertips, uterus well contracted, minimal
non-foul smelling lochial discharge
If w/ RMLE- well coaptated suture, no hematoma
OPD IE
Cx soft, closed, uneffaced, (+) BOW, Cephalic, St -3 / high
presenting part
ADMITTING DIAGNOSIS
Gravida __ Para __ (TPAL) Pregnancy Uterine __ weeks AOG
by LMP / EUTZ / LUTZ, cephalic / breech in presentation,
young primi / elderly primi / grandmultipara
DISCHARGE DIAGNOSIS
Gravida __ Para __ (TPAL) Pregnancy Uterine __ weeks Left
occiput transverse (if < 8 cm dilated) / Left occiput anterior (if
fully dilated) delivered operatively / via NSD to a live
term/preterm baby boy/girl (BW __g , BL __ cm, AS __, __)
Arrest in Cx dilatation secondary to inlet contraction
Arrest in descent secondary to midpelvic contraction (primi
fully dilated)
CPD or persistent occiput posterior (multipara, fully dilated)
CRITERIA FOR ADMISSION
Obstetrics:
Patients in ACTIVE LABOR
Patients not in labor but with the following conditions:
o HTN
o Vaginal Bleeding
o Ruptured membranes
o Scheduled repeat CS
o Medical complications – in patient care:
cardiac disease, DM, ets
o Other high risk conditions
Patients with puerperal complications
Gynecology:
Patients for elective surgery, chemotherapy, blood
transfusion, etc.
Patients with emergency conditions such as profuse
vaginal bleeding, severe abdominal pain
Patients with reproductive tract infection requiring
hospitalizations
Cases of violence and sexual abuse requiring
hospitalization
ADMITTING ORDERS
1. CEPHALIC IN LABOR
To LR
Secure consent for admission
Low residue diet
Diagnostics: CBC, UA
Monitor VS, FHT and progress of labor Q1
Refer
2. PROM
To LR
Secure consent for admission
NPO
IVF: D5LRS 1 L x 8 hrs
Diagnostics: CBC, UA
Medications (if > 8 hrs)
o Ampicillin 2g ()ANST as LD then 1g TIV Q6
o Gentamycin 240 mg in 100 cc PNSS OD to run for
30 mins ()ANST
o Metronidazole 500 mg TIV ()ANST Q8
For IPM
Monitor VS, FHT and progress of labor Q1
Refer
3. PRETERM LABOR
To LR
Low residue diet
IVF: D5LRS 1L x 8hrs
Diagnostics: CBC, UA, wet smear
Medications
o Dexamethasone 6 mg TIV now then Q12 x 3 doses
o Nifedipine 10 mg/capsule, 3 caps , 1 cap Q20 mins
as LD then 1 cap Q8
Monitor VS, FHT Q1
Refer
4. PRE ECLAMPSIA WITHOUT SEVERE FEATURES
To LR
Secure consent for admission
NPO
IVF: D5:RS 1L x 8hrs
Diagnostics: CBC, RBS, BUN, Crea, SGPT, SGOT, Na, K, Cl,
UA (if w/ severe features, add PT, PTT)
Medications:
o Hydralazine 5 mg TIV prn for BP >/= 150/100
o If with severe features, add MgSO4
Monitor VS, FHT and progress of labor Q1
Refer
POST PARTUM ORDERS
1. NSD
To Ward 4 via stretcher
DAT, ↑ OFI
Diet if with PES: LSLF diet, limit OFI to 1.5L/day
IVF: D5LRS + 10 u oxytocin (optional) x 8 hours
Medications:
o Amoxicillin 500 mg/cap, 1 cap Q8 x 7 days
o Mefenamic Acid 500 mg/tab, 1 tab Q6 prn
for pain
o FeSO4 tablet, 1 tab BID x 2 months
*Additional meds:
If with PES: Amlodipine 5-10 mg/tab 1 tab BID,
Metoprolol 50 mg / tab, 1 tab BID
If with Hypokalemia: KCl drip 40 meqs in 100 cc PNSS
per soluset to run for 4-6 hrs
Pain meds if with PES: Celecoxib,
Paracetamol+Tramadol
Breastfeeding and hygiene
Keep uterus well contracted
WOF: profuse vaginal bleeding
Refer to Family planning
Monitor VS Q4 then record
Refer
2. CS
To Ward 3 via stretcher
NPO
IVF as previously ordered
Medications:
o Co Amoxiclav 624 mg/cap, 1 cap Q8 x 7 days
o FeSO4 tab, 1 tab BID x 2 months
o Mefenamic Acid 500 mg/tab, 1 tab Q6 prn
for pain
o Ascorbic acid 500 mg/tab, 1 tab OD x 1
month
May remove IFC (if > 8 hrs post op)
Ambulate gradually with tight binder
Encourage breastfeeding and hygiene
Monitor Vs q4 then record
Refer
*Post op day 3: change of dressing, MGH (Home meds,
Daily wound care, ff up, well advised)
Follow up after discharge:
At 1 week and 6 weeks
3. Post D&C
To gyne ward
DAT, ↑ OFI
IVF: D5LRS + 10 u oxytocin x 8 hours
Medications:
o Doxycycline 100 mg/cap BID x 7 days
o FeSO4 tablet, 1 tab BID x 2 months
Monitor VS Q4 then record
Refer
OPD
Balanced diet
↑ OFI
Meds: MV, FeSO4, Folic Acid
1 glass of milk BID
For Pre-natal work up
CBC, UA, RPR, Anti-HIV, HbsAg, FBS / 75 g OGTT,
UTZ, ABO
Secure 3 blood donor
Fetal movement monitoring QID
Family planning, Breastfeeding, Hygiene Advised
OPD follow up on ____
Advised
MEDICATIONS
1. MgSO4
Tocolysis: 4 g SIVP x 30 mins as LD then 10 g in 1L PNSS
to run for 100 cc/hr
Pre eclampsia: 4 g SIVP then 5 g deep IM on alternating
buttocks for 2 doses as LD then 5 g deep IM on
alternating buttocks Q6 x 4 doses
Neuroprotective (threatened preterm 24-27 weeks): 6 g
SIVP as LD then 2 g/hr for at least 12 hrs (Williams 24th
ed)
WOF Toxicities (UO <30cc/hr, RR<12, DTR < ++)
Antidote: Cagluconate
2. Ampicillin 2g TIV ( ) ANST
3. Gentamycin 240 mg in 100 cc PNSS x 30 mins () ANST as LD
then OD
4. Amikacin 750 mg in 100 cc PNSS x 30 mins as LD then OD
*** 2,3,4 shift to oral: Co amox 625mg/tab, 1 tab Q8 PO to
complete 7 days.
5. Cefazolin 2g TIV ( ) ANST 30 mins prior to induction of
anesthesia
6. Cefuroxime 1.5 g/amp TIV () ANST as LD then 750 mg TIV Q8
7. Pip-Tazo 4.5g () ANST as LD then 2.5 TIV Q8
*** Pip-tazo to oral Cefixime 400 mg/tab 1 tab OD x 7 days
OR 200 mg/tab 1 tab BID x 7 days
8. Ceftriaxone 1g TIV () ANST Q12
9. Clindamycin 900 mg TIV () ANST Q8
*** Clindamycin to oral Clindamycin 300 mg/cap, 1 cap Q8
x 7 days
10. Hydralazine 5mg TIV prn for BP >/= 160/100
***Hydralazine max dose 30 mg. 5 mg initial dose, 15-20
mins interval
11. Labetalol 10 mg IV initially then 20-40 mg every 10-15 mins.
Tmax= 220 mg/treatment
12. Nicardipine 90 mg in 10 cc D5W in soluset to run initially at 5
cc/hr, titrate increments/decrements of 5cc/hr to maintain
MAP of ____
13. Amlodipine 5/10 mg OD/BID
14. Metoprolol 50 mg/tab 1 tab OD/BID
15. Nifedipine
For acute pregnancy HTN: 10 mg/tab 1 tab PO then 10
mg/tab after 30 mins if necessary
For tocolysis: 10mg/tab x 3 (30 mg) as LD then Q8
16. Dexamethasone 6 mg TIM Q12 x 4 doses (24-34 weeks AOG)
17. Betamethasone 12 mgTIM OD x 2 doses
18. Insulin sliding scale
0-120 = no humulin
121 – 160 = 2 units
161-200 = 4 units
201 – 250 = 6 units
251 – 300 = 8 units
> 300 = refer
19. Tetanus toxoid
1 1st visit, no protection
2 4 weeks post TT1, 3 years protection
3 6 months post TT2, 5 years protection
4 1 year post TT3, 10 years protection
5 1 year post TT4, all child bearing years
20. Isoxuprine 10 mg/tab, 1 tab TID x 3 days
OPERATIVE TECHNIQUE
Patient in supine position after induction of anesthesia.
Bladder catheterization and perineal swabbing done.
Speculum examination done revealing cervix pinkish, smooth,
no erosions, with minimal bleeding per os, soft
Asepsis and anti sepsis done. Sterile drapes applied.
Incision done on the subcutaneous and carried down to fascia
Recti muscles were split longitudinally. Peritoneum entered
A gravid uterus was exposed with well formed lower uterne
segment
Moistened visceral pack placed on the gutterson each side of
the uterus. Bladder retracted downward.
Transverse curvilinear incision done on the vesicouterine fold.
Bladder flap created.
Transverse curvilinear incision done on the lower uterine
segment layer by layer until bag of water ruptured with clear
amniotic fluid.
An alive baby ___ in left occiput transverse / anterior position
was delivered by scooping the head followed by gentle
traction of the body. Umbilical cord doubly clamped and was
cut in between. Ballard Score ___, Apgar score __ , __
CRITERIA FOR REFERRAL TO MIDWIFE MANAGED CENTER
18-35 yo
37-39 weeks AOG
G2- G4
Cephalic presentation
Fundic height 28-30 cm
Normal past and present medical and obstetric history
CRITERIA FOR REFERRAL TO PERINATOLOGY
Age </= 17, >/= 35
Poor OB Hx
Placenta previa, Abruptio placenta
Patients with diagnosed medical condition
Patients with malignancies undergoing treatment
Patients with gynecologic tract disorders
Patients with psychiatric consitions (esp with medications)
Patients with problems in fetal age, size, structure, number,
amniotic fluid, infertility
Pre term labor, PPROM
CRITERIA FOR SENDING PLACENTA FOR HISTOPATHOLOGIC EXAM
Stillbirth > 22 weeks / < 500g
Multiple gestations
Fetuses with multiple congenital anomalies
Babies were depressed upon delivery (low APGAR score)
Abruptio placenta
IUGR
Abnormally adherent placenta (accreta, increta, percreta)
Clinical chorioamnionitis
Prolonged 3rd stage of labor
True post term fetus (>42 weeks by ballards score)
History of GTD, APAS
Maternal syphilis
