Hackerbiotics

Open Source E-book Series

Obstetrics and Gynecology orders

Version [1] | Sep 2017

hackerbiotic.com

Preface

I find it highly confusing/annoying that all the normal pregnancy symptoms are
also symptoms of pregnancy problems ! so it is better to be safe than sorry. It is
the responsibility of practitioners, relying on their own experience and knowledge
of their patients, to make diagnoses, to determine dosages and the best treatment
for each individual patient, and to take all appropriate safety precautions.

Copyright Sep 2017 hackerbiotic.com

All written content licensed under a Creative Commons Attribution-ShareAlike 4.0
International License.



Contents

Section 1

Septic Abortion
D & C
IUFD
Postpartum
APR
C/S
LP
Out of Bed
ROM
V/B
Mild Pre-eclampsia
Severe Pre-eclampsia
GDM
Hysteroscopy
PLP

Section 2

OPD Patients

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Section 1
Hospitalized Patients

Imp : Septic Abortion
Cond : fair to good

Septic Diet : surgical

V/S : q4h

Abortion Please


1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF 1000 cc ringer / 24 h

3/ BGRH, Cross match
4/ prep 1 bag p.c
5/ PT, PTT, INR
6/ TVS
7/ Abd Pelvic Sono
8/ Abd pelvic X-ray
9/ ECG

10/ CXR

11/ U/A, U/C

12/ Blood Culture
13/ inj ranitidine 1 amp stat
14/ inj ceftriaxone 1gr IV q12h
15/ transfer to ward




Imp : D&C
Cond: fair to good

D & C Diet : NPO

V/S : q4h

Please

1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF ringer 1000 cc / 24 h

3/ BGRH, Cross match


4/ prep 1 bag p.c
5/ inj keflin 2 gr before OR
6/ B-HCG
7/ anesthesiologist consult
8/ Consent letter







Imp : IUFD
Cond : fair to good
Diet : surgical

IUFD v/s : q2h

Please

1/ CBC, BUN, Cr, Na, K, Bs
2/ IVF ringer 1000 cc / 24 h
3/ BGRH, Cross match

4/ prep 1 bag p.c

5/ PT, PTT, INR, FL

6/ misoprostol 800 mg [3 vaginal & 1 sublingual] q3h x 2 dose
7/ transfer to labor





Imp : Postpartum
Cond : fair to good
Diet : regular
V/S : routine

Postpartum Please

1/ cap hematinic acid po qd
2/ cap Ca-D Po qd
3/ cap mefenamic acid 250 po prn

4/ synto 40 unit / 1000 ringer

5/ check V/B & V/S


6/ transfer to ward

7/ if episiotomy has been done :
Cap cefalexin 500 q6h
If it is deep : ampicillin
If allergy to penicillin :
clindamycin












Imp : APR

Cond: fair to good
Diet : NPO 8 hour before OR
APR & V/S : q4h

Posterior please

Repair 1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF ringer 1000 cc / 24 h

3/ BGRH, Cross match

4/ prep 1 bag p.c
5/ check B-HCG
6/ inj Keflin 2 gr before OR
7/ consent letter for surgery & her husband
8/ int foley [ in OR]

9/ anesthesiologist consult

10/ prep for OR

11/ [sometimes] prepare TOT





Imp : C/S

C/S
Cond : good
Diet : NPO 8 hour before OR
v/s : q4h

Please

1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF ringer 1000 cc / 24 h

3/ BGRH, Cross match


4/ prep 2 bag p.c
5/ inj Keflin 2 gr IV before OR [if allergy to penicillin : clindamycin]
6/ consent letter for surgery & her husband
7/ int foley & fix
8/ anesthesiologist consult
9/ prep for OR
10/ transfer to OR






Imp : LP
Diet : surgical
v/s q4h

LP Please

1/ CBC, BUN, Cr, Na, K, Bs
2/ IVF ringer 1000 cc / 24 h or [IV H.L]
3/ BGRH, Cross match

4/ prep 1 bag p.c

5/ NST, FHR

6/ CST [labor day]
OCT or NST [if pt doesnt feel pain]
7/synto in 1000 cc ringer :
nullipara : [Augmentation : 10] [induction :5]
multipara : [Augmentation : 5] [induction 2 .5]

8/ check contraction

9/ caster oil [if needed]

10/ OB Sono

11/ BPP, AFI
12/ Transfer to labor





1/ OOB

2/ Diet surgical if tolerate : regular

NPO till gas passing then surgical [for Alborzi M.D.]

Out of Bed 3/ ivf 1000 cc in 24 hour

Ivf 3000 till gas passing in 24 hour then 1000 cc

in 24 hour [for Alborzi M.D.]


4/ syrup MOM 30 cc TID
5/ tab dimethicone 1 tab PRN
6/ supp bisacodyl 10 PRN
7/ cap hematinic qd

8/ D/C int foley [for C/S]

8/ clamp int foley [for AP repair]






Imp : ROM
Cond : fair to good
V/S : q4h

ROM Please

1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF ringer 1000 cc / 24 h + [ if needed 10 unit synto]

3/ if synto administered : OCT

4/ BGRH, Cross match

5/ prep 2 bag p.c
6/ FHR, FAD
7/ fern test [ if needed]
8/ poud
9/ Amp Ampicillin 2gr Q6h
10/ pad count
11/ if > 18 h :

CBC,diff
Amp Ampicillin 2gr Q6h

If allergy :
Gentamicin 80 mg q8h

Clindamycin 300 mg q8h
Or
Clindamycin 900 mg stat then 300 mg q8h


Imp : V/B

V/B
1/ CBC, BUN, Cr, Na, K, Bs
2/ BG,RH, Cross match
3/ PT, PTT, INR, FL
4/ prep 2 bag p.c
5/ IVF 1000 cc ringer in 24 hour

6/ TVS
7/ HCG (if not pregnant)
8/ FHR & NST (if pregnant)











Imp : Pre-eclampsia
Cond : fair to good

Diet : regular

V/S : q4h

Mild 1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF ringer 1000 cc / 24 h
Preeclampsia 3/ BGRH, Cross match
4/ prep 2 bag p.c

5/ U/A, urine pro 24 hour

6/ LFT

7/ LDH, Uric Acid
8/ PT, PTT, INR, FL
9/ urine volume 24h + urine pro. 24h






Imp:GDM

Cond : fair to good


Diet : Diabetic
V/S : q4h

GDM Please

1/ CBC, Bun, Cr, Na, K, Bs
2/ check FBS, 2hpp
3/


2hpp < 120

FBS < 95














Imp : Severe Pre-eclampsia
Cond : fair
Diet : NPO
V/S : q 20 min

Severe Activity : CBR

Pre-eclampsia 1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF ringer 2000 cc / 24 h
3/ heart monitoring
4/ U/A
5/ LFT

6/ Hydralazine 5 mg IV stat in 2 min

7/ OB-GYN specialist consult

8/ MgSO4 4 gr in 100 cc ringer in 15-20 min IV
9/ MgSO4 10 gr IM ( 1/2 , in each buttock)
10/ MgSO4 5 gr IM q4h
11/ MgSO4 Check (DTR & RR & urine Output)
[Urine output should be > 30 cc/hour]
12/ int Foley
13/ FHR Monitoring

14/ OB Sono

15/ BPP

16/ if GA <= 34 wk : inj betamethasone
17/ NST
18/ Bedside elevation
19/ if plt < 100 : D/C MgSO4 IM and start IV
20/ MgSO4 20 gr in 1000 cc ringer [max rate : 2 gr/hour]
21/ if Cr= 1-1.5 : MgSO4 | if Cr > 1.5 : D/C MgSO4
22/ Bedside CPR Set




a/ BGRH, Cross match
b/ prep 2 bag p.c
c/ U/A, urine pro 24 hour
d/ LDH, Uric Acid
e/ PT, PTT, INR, FL
f/ urine volume 24h + urine pro. 24h








Imp : Hysteroscopy
Cond : good
Diet : NPO 8 hour before OR
V/S : as routines
Hysteroscopy
1/ CBC, BUN, Cr, Na, K, Bs

2/ IVF ringer 1000 cc / 24 h

3/ BGRH, Cross match

4/ B-HCG
5/ prep 2 bag p.c
6/ Syrup MOM 30 cc at 21 & 24
7/ supp bisacodyl stat
8/ tab dimethicone 1tab stat
9/ amp ranitidine 150 mg IV BID
10/ inj keflin 2 gr before OR

11/ int foley & fix

12/ consent letter for surgery & her husband

13/ anesthesiologist consult

14/ prep for OR

15/ transfer to OR

Imp : PLP
Cond : fair to good
v/s : as routine
PLP
Please
1/ CBC, BUN, Cr, Na, K, Bs
2/ IVF ringer 1000 cc / 24 h
3/ BGRH, Cross match

4/ prep 1 bag p.c

5/ NST

6/ inj ampicillin 2gr q6h
7/ inj betamethasone 1 amp q12 x2
8/ prematurity consent letter
9/ MgSO4 4gr stat then 2 gr/hour
10/ inj phenobarbital 1 amp stat

Section 2


OPD Patients

CBC, BGRH
BUN, Cr
FBS
TSH
ICT
VDRL
First Visit U/A , U/C
HBS Ag, HCV Ab, HIV Ab
Vit 25 OH D3 level

TG Chol HDL LDL
AST, ALT alk p , bili t & d

CBC

GTT
3rd Trimester U/A, U/C

Tests ( 7 month)


If a pt can not tolerate GTT : FBS, 2hpp

OB sono
NT
11-13 wk


OB sono for anomaly
Sonography
18-22 wk



OB sono

AFI


FSH LH TSH PRL AMH Testosterone DHEAS

17 OH progesterone
Infertility

Rx:

1. Conjugated estrogen 0.625 mg vag. Cream #1,2

Hx: 55 y/o menopause woman with
severe itching and burning
P/E: pale mucous membrane without
any discharge
Hx: itching, burning
PE: Caseous discharge without
malodor
Hx & PE: Previous case with malodor
Dx: B.V. or Trichomonas
2. Lactovag vag tab #7,14
2. Camilin vag cream #1
2. Vagisan moisturising vaginal cream #1
Rx:
1.Clotrimazole vag cream 1% #1
2. Clotrimazole vag tab #7
If recurrent or for treatment of partner
3. Fluconazole cap 150mg #6 (3 for each one of them)
Rx
If recurrent or for partner treatment:
1.Metronidazole tab 250mg #60 (30 for each one of them)
If lactating or pregnant:
1.Metronidazole vag tab 500 mg #7
1.Clindamycin vag cream #1
1.Clindamycin tab 150mg #20

Hx and PE: OCD woman with
Destruction of normal flora
Hx and PE: External burning sensation
with small vesicular rashes
Dx: Herpes
Dx: Wart
Dx: Fungal infx
Rx
1. Vagisan Lactic Acid vag tab #7
2. Vagisan moisturising vaginal cream #1
2. Lactovag vag tab #7,14
Rx
1. Acyclovir tab 400mg #30
2. Acyclovir cream #1
3. Zinc Oxide cream #1
3. Camilin Solution #1
The only acceptable treatment for wart in pregnancy is S.A.
New water base POP Smear with HPV typing
PAP Smear each 6 Month
Rx
1.Lactovag Vag Cream #1
1.Leukorex Vag Cream #1


1.Cefixime cap 400 mg #20
Hx And P/E:

Redness and dyspareunia 2.Azithromycin cap 250mg #6


3.Doxycycline cap 150mg #20



4.pop smear