University of Shendi-faculty of medicine and surgery

‫بسم هللا الرحمن الرحيم‬

University of Shendi
Faculty of medicine and surgery
OSCE stations
1. Focus history.
2. Physical examination.
3. Procedures.
4. Counseling.
5. Data interpretation.

Obstetrics &
gynecology
Prepared by:
Dr: A7med 3bedia Al_5yrabi
Batch 2005—Group {D}
Tel: Zain 0915310678- MTN 0926820120
A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 1
University of Shendi-faculty of medicine and surgery

h) Postnatal complication for

History stations
mother or her baby.
1. Obstetrical hx.
i) If there Miscarriage:
2. Gynecological hx.
1. Is it spontaneous or
3. Bleeding in early pregnancy
induced.
4. Hypertensive disorders
2. GA.
5. APH
3. Is it …… or by intervention
6. Infertility.
4. At home or hospital.
7. Other should be add:
5. Evacuated or not.
1. Preterm labour
6. Transfused or not.
2. Amenorrhea
7. Ask about fever.
3. Dysmenorrheal
-Current pregnancy:
4. D.V.T
LMP, EDD & GA.
1st trimester:
1. Morning sickness.
{1} Obstetric hx
2. Vaginal bleeding.
-Introduction.
3. Vaginal discharge.
-Gravid, Parity & Abortion.
4. Febrile illness.
-Previous pregnancy(s):
5. Exposed to medication.
a) Is it spontaneous or induced.
6. Tonic.
b) Complication during pregnancy.
7. U/S.
c) DM, HTN, febrile illness, anemia.
2 trimester:
nd
d) Mode of delivery.
1. Quacking
a. Vaginal:
2. Vaginal bleeding.
1. Spontaneous or not.
3. Vaginal discharge.
2. At home or hospital.
4. Febrile illness.
3. Duration of labour.
5. Vaccination.
4. Assisted or not.
6. ANC.
5. Presentation of baby.
7. Tonic.
b. If C/S:
3 trimester:
rd
1. Indication.
1. Abbreviation of fetal
2. Type or…….
movement.
3. Compl…… C/S.
2. Vaginal bleeding.
e) GA of baby.
3. Vaginal discharge.
f) Outcome.
4. Febrile illness.
Sex.
5. Continuation in tonic or not.
Age.
6. U/S
Alive or not.
7. Complain or not.
g) Cry and start breast feeding or
not.

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University of Shendi-faculty of medicine and surgery

-if Menorrhagia:
{2} Gynecological history
-analsis
-Introduction. 1. Amount (duration)
-Menarche. 2. Color of the blood.
-Katamina: if regular.if not regular ask 3. Odor
about the menstruation in the last 6 4. Clot
months. 5. Change of temperature.
-Amount of the cycle  if large let the 6. Stay at home.
analysis at the end. 7. Restriction of activity.
-Dysmenorrhea. 8. Trauma.
-Contraception use. (IUCD). 9. Pelvic pain….
-Intermenstrual bleeding. 10. Relation to the cycle.
-Postcoital bleeding& dyspareunia. 11. Backache & malaise.
-Gynecological operation. 12. Symptoms of anemia, blood
-Vaginal discharge  if present let the transfusion..
analysis at the end. 13. PH of Cervical smear.
If vaginal discharge: -FH:
-analysis  similar condition.
1. Duration.  Gynecological caner.
2. Amount.  DM.
3. Onset. -DH:
4. Color.  Immunosuppressant
5. Odor, time of odor peak.  Tamoxifin
6. Staining with blood.  HRT.
7. Associated with itching or not?
8. Relation menstrual cycle.
9. Recurrent or for fist time.
10. Associated with pelvic
pain.(genital ulcer)
-History STI  mal urethral discharge
& suprapubic pain.
-Post-menopausal bleeding if she were
menopause.
-Associated with weight loss.
-Genital ulcer.
-Urinary symptoms of her husband.
Recent history of antibiotics.
Urinary symptoms of patient.

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 3

University of Shendi-faculty of medicine and surgery

medication.
{3} Focus history of -FH:
bleeding in early similar condiotion.
-SH:
pregnancy 1. Smoking.
2. Class.
-Introduction.
-Age.
-Gravida , Para , abortion, PTL , EP {4} HTN disorder
or mole pregnancy
-GA. -Introduction.
-Analysis decrease vaginal bleeding: -Age.
1. Duration &frequency. -Occupation.
2. Amounts & clots. -Marrital status.{new hasband}
3. Color. -Parity.
4. Continuous r stop.
-HPI/duration
5. Recurrent or for first time. 1. LL edema.
6. Passage of product or vesicles. 2. Headeche.
-Associated withlower abdominal pain or 3. Blurring vision.
not. If yes the pain is it before or after 4. Convulsion.
the bleeding. 5. Epigastric pain.
-Associated with fever of trauma.(febrile 6. Nousea.
illness) 7. Vomiting.
-Symptoms of anemia: 8. Amount of urine & frquency.
1. Syncope. -Obstetrical history:
2. Fatigability. 1. Is it hypertension before or newly
3. Palpitation. discovered.
4. S.O.B 2. Previous pre-eclampsia.
-Gynecological history: 3. Fetal movement.
1. Intermenstrual bleeding. 4. Vaginal bleeding.
2. Post-coital bleeding. 5. Morning sickness.
3. Bleeding from other site. 6. U/S & ANA single or multiple &
4. Operation. amount of liquer.
5. D&C.
7. Abdominal growth. ‫انت حاسة انو نمو بطنك‬
6. Fibroid. ‫مازي الحمل الفات‬
7. Uterine anomalies. -PMH:
-PMH: 1. DM.
1. APS. 2. Multiple pregnancy.
2. DM. 3. Polyhydromenous.
3. HTN. 4. Renal disease.
4. Thyroid. 5. APS. ‫عندك اجسام مضادة للتجلط‬
5. Bleeding disorder. -FH:
-DH:

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University of Shendi-faculty of medicine and surgery

1. Similar condition especially in sister a. Fetal movement either

and mother. increased (MP) or
2. HTN,DM. decreased(IUFD).
3. Multiple pregnancy. b. Vaginal bleeding.
4. DH:
c. Lower limb edema.AP
-Any medication.
5. 3 trimester:
rd
-SH:
- Smoking.
a. Fetal movement. AP IUFD.
b. Growth of the abdomen.
IUGR
{5} Focus history of APH -HPI:
1. Onset of bleeding.
-Personal data: 2. Amount.
1. Name. 3. Frequency.
2. Age. 4. Color. Fresh  PP
3. Recidence. 5. Clots.
4. Blood group. 6. Timing. early morning  PP
-P/C 7. Present of abdominal pain. 
Duration. AP.
-Past obs history: 8. History of trauma AP.
1. Para. 9. Bleeding from other site.
2. Abortion. AP APL (bleeding tendancy).
3. Pervious C/S  PP -SR
4. APH. 1. Symptoms of anemia:
5. Manual removal of placenta. 1. Palpation.
6. Evacuation PP 2. Syncope.
7. Multiple pregnancy PP.AP 3. S.D.B.
8. Preterm labor APL 4. Fatigability.
-Current pregnancy: 5. Lower limb edema.
1. GA  already in scenario. 2. Symptoms of HTN  AP
2. Assisted pregnancy. MP  1. Headache .
PP/AP 2. Blurring vision.
3. 1st trimester: 3. Epigastric pain.
a. Exagrated morning -PMH
sickness MPAP 1. HTN. AP
b. Vaginal bleeding. PP 2. DM  AP&PP
c. U/S. 3. Renal disease.  AP
4. 2 trimester:
nd 4. Anti-phospholipid
syndromeAP.
-FH:

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University of Shendi-faculty of medicine and surgery

1. DM 2. Hairstism
2. HTN 3. Thyroid disorder
3. Multiple pregnancy. 4. Galactorrhoae
-DH: 5. Osteoporosis
anti-coagulants.. aspirin 6. Psychological disorders
SH: -PMH:
smoking AP. 1. DM.
-Gynecological history: 2. PCOs
1. Menorrhagia bleeding 3. PID
tendency. -DH:
2. Intermestrual bleeding  local Ovulation induction
cause. Male hx:
3. Myomectomy. -Age
4. Vaginal discharge.show. -Occupation
5. Gynecological operation. -Fathering of other any pregnancy.
6. Post coital bleeding. -PH of;
1. DM
2. Mumps
{6} Focus hx of infertility 3. Injury of genitalia
Female hx: 4. Operations;
-Age a. Varicocele
-Occupation b. Hernia
-Duration of marriage c. Prostatectomy
-Gynecological hx: Both parents:
1. Menarche -Availability of husband.
2. Regularity of cycle. -Sexual performance:
3. Amount (oligoPCOs) 1. Frequency
4. Inter-menstrual bleeding. 2. Ability of male for penetration
5. Dysparunia and ejaculation in the upper
6. Use of contraception vagina.
7. Vaginal discharge or dryness. 3. Volume of ejaculation.
8. Operation. 4. Time of coitus in relation to
9. Mid-cyclic pain. ovulation.
-Obs hx;
1. LMP.
2. PPH, D&C, or ectopic
pregnancy 2ry
-Systemic review:
1. Wt gain.

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 6

University of Shendi-faculty of medicine and surgery

3. Length of the cervical

Examinations
canal(cm)
1. PV examination
a) More than 2 --------------- 0
2. Measurement of BP
b) 2-1 ---------------1
3. Others should be add:
c) 1- 0.5 ------------2
a. Obstetrical examination
d) Less than 0.5 --------------3
4. Dilatation of the cervix:
a) 0 --------------- 0
{1} PV examination
b) 1-2 cm -----------1
-Great the patient. c) 3-4 cm -----------2
-Introduce yourself. d) 5 or more -------3
-Take permission & explain. 5. Station of the presenting part:
-Adequate exposure & privacy. a) -3 -------------0
-Hand washing. b) -2 --------------1
-Wear sterile gloves. c) -1 or 0 ---------2
-Inspection of the vulva for normal d) Below spine ----------- 3
healthy skin:
1. Blood or fluid discharge. {3} Measurement of BP
2. Ulceration or skin changes.
3. Scars(episiotomy or partial - Introduction.
surgery). - Put the patient in sitting position .
4. Odor& colour consistency - Check the devices:
-Sterilization the vulva. 1. Sphegnomometer. Select the
-Apply the Vaseline for 2 fingers. suitable cuff.
-Examine perianal area. 2. Steasoscope.
-Separate the labia by the left hand, - Cover two third of the arm by
and introduce two finger of right hand cuff.
one by one. - Check the pulse at cubital fossa.
-Place the left hand the abdomen. - Put the stesoscope over the medial
-Assess the cervix for bishop score: site or cubital fossa.
1. Position of the cervix: - Inflate the cuff above the systolic
a) Posterior 0 BP.
b) Central 1 - Slowly deflate the cuff and
c) Anterior 2 comment in:
2. Consistency: i. Systolic BP.
a) Frim 0 ii. Diastolic BP……
b) Medium 1 - Release the cuff.
c) Soft 2 - Reduction the cuff .
- Thanks the patient.

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University of Shendi-faculty of medicine and surgery

-Dispose the speculum, gloves and any

Procedures
equipments of procedure.
1. Speculum examination
-cover & Thanks the patient.
2. Clinical pelvic assessment
-Documentation of procedure.
3. Others should be add:
1. Urinary catheter
{2} Clinical pelvic
{1} Speculum examination assessment
-Introduction.
-Introduction.
1. Great the patient.
-Position.
2. Introduce yourself.
-Wear sterile gloves.
3. Take permission & explain what
-Sterilization of the vulva.
you are going to do.
-Now I am going to examine 6 points in
4. Position in ……
one PV.
5. Adequate Exposure with patient
1) I am introduce by finger and try
privacy.
to reach the sacral promontory,
6. Source of light.
if reach this mean contracted
-Wash your hands.
inlet.
-Wear sterilized gloves.
2) Then I am going to assess the
-Inspection of the vulva for:
sacral curvature for mid-cavity.
1. Discharge.
3) Now going laterally to assess the
2. Blood.
sacrospinal ligament by
3. Ulcer & warts.
introducing by fingers through
-Sterilization of vulva.
great sciatic foramina for mid-
-Choose suitable size of speculum test
cavity.
-Lubricate the speculum by Vaseline.
4) Now I am going to assess iscial
-Separate the labia by your left hand.
spine for mid-cavity.
-Insert the speculum in correct way
5) Now I am going to assess the
and very gently .
subpubic arch by two fingers&
-Rotate the speculum after complete
for Outlet.
insertion then open and fix it.
6) Lastly I am going to assess the
-Inspect the cervix:
distance between two ischial
1. Degree of dilatation.
tubersities for pelvic outlet by
2. State of membrane & leak of
fist of my hand from out side.
fluid.
-Dispose the glove.
3. Ulcer & polyp.
-Thanks & cover the patient.
4. Then take swab if needed.
-Document the procedure.
-remove it gently.

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 8

University of Shendi-faculty of medicine and surgery

2. For explanation to te mother

Emergency stations
and reassurance.{eg you
1. PPH
have PPH and all of them
2. Retain placenta
come to help you}
3. Eclampsia
3. Documentation of an thing
4. Retain 2nd twin
done
5. Others should be add:
e.g BP.pulse.syntocinon.
1. Cord prolapse
b- At the level of the hands:
2. Shoulder dystocia
{helper I and helper II}
1. Insertion of two wide bore
{1} Management of PPH cannulae {14gg}
2. Withdraw blood for blood
-Call for help: whom call grouping and cross matching,
1. Midwife. coagulation profile,
2. Nurse. Hct,RFT,Lft
3. House-officer 3. Prepare 4-6 units of blood.
4. Registrar. 4. Put apart of blood in tub
5. Consultant. {5ml}{bedside test} for 5
6. Anesthesia. minutes if not clot indicate
-Alert the theatre and blood bank, and clotting problem.
hematologist. 5. Start to give any available
-I need 3 persons with me and are going fluid until blood come, but if
to act at same time:- all fluid available give
1. One at the level of her head. crystalloid at least 2Ls and
2. One at one hand. then given blood.
3. One at the other hand. 6. Start to give oxytocin 10
4. One at the level of units direct IV and 30 units
pelvis(leader). in infusion. Do not exceed 40
a- At the level of the head: units (S/E hypotension).
elevate the bed from the feet 7. If the placenta deliverd give
site. ergometrine 0.25 mg I.V no
1. For A & B. countraindications.
Airways patently and 8. Prostaglandin injection 0.25
breathing should be check by mg intramyometrium.
the RR and chest movement c- At the level the pelvis:
and even auscultation. 1. Evacuate the bladder
Give her oxygen by rate of 6- because the bladder
8 litters/minute. precipitate to uterine atonia.

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 9

University of Shendi-faculty of medicine and surgery

2. Uterine massage :right hand

{2} Retained placental
inside the vagina and other
hand in the
**-Call for help: whom call
fundus((abdominally)face
1. Midwife.
each other to compress and
2. Nurse.
doing massage.{bimanual
3. House-officer
compression}
4. Registrar.
3. If the blood not stop look for
5. Consultant.
tear and look for blood is it
6. Anesthesia.
clot or not.
-Alert the theatre and blood bank, and
- If the cause the uterus
hematologist.
usually contracted well.
** ABC :
- If there was tear should
1. airway should be patent.
repaired under general
2. O2 by mask
anesthesia.
3. two wide bone 14 … cannulae , one
4. If rupture uterus , the
for I.V until blood available and 2nd
treatment depend on:
for blood groping & cross matching
a) Site of rupture(Ant.
& prepare blood at least 4- 6 units.
Post.)
**confirm the diagnosis by control
b) Gravidity of the patient.
cord traction.
c) Hemodynamic status
** Insert urinary catheter to empty the
either repair or
bladder.
hysterectomy.(Posterior
** Then synticinon 10 unit I.V then 30
rupture  repair).
unit in I.V infusion.
** again control cord traction.
5. Other:
**uterine massage (fundal)
a. Uterine artery or
**If delivered give ergometrin I.M.
internal iliac artery
***If not proceed to the following :
ligation.
1- Take the pt to the theater .
b. Uterine artery
2- Do manual removal of placental
emboloism.
under GA.
6. If coagulopathy:
***Method:
a. FFP
During anesthesia empty the bladder
b. RBCs
with left hand in the abdomen & RT
c. Cryoprecipetate
hand in side the uterus and separate
d. Platelet concentrate.
the placenta and gently remove it.
**if delivered give ergometrine and
examine the placenta and IV
antibiotics .

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 10

University of Shendi-faculty of medicine and surgery

**IF fail : ( morbid adhesion) If the fit still give 2gm per hrs
Do Piece mental removal and then instead of one gram.
ergometrine and antibiotics and If still  diazepam.
examine the placenta. 2. Give intravenous anti-
** IF fail: internal iliac artery ligation hypertensive, usually hydralyzine
and if fail hysterectomy . 20 mg slow I.V initially followed
-Cover the pt by antibiotic to prevent by 5 mg very 20 minutes until the
endometritis diastolic BP is 100-110mmHg
** follow up the pt .. Other options:
**document the procedure: Sublingual adalat.
1- What happened?? Labetolol.
2- What are the action done? 3. I.V fluid therapy.{maintain the
3- Give a card as high risk pt. hydratyion}.
-Monitoring: {vital signs}
{3} Management of 1. Pulse.
2. BP.
Eclampsia 3. Temperature.
4. RR.
5. MgSO4 toxicity
-Resuscitation:
6. Fluid intake & UOP
1. Call for help.
7. FHS
2. Put the patient to the recovery
-Mode of delivery:
position {left lateral position}.
1. If she in labor and cervix was
3. Check the airways , do suction
favorable and pelvis is adequate
and put airway if necessary.
and in active phase immediately
4. Insert two wide bore cannulae
start oxytocin + AROM.
and collect the blood sample
2. If cervix fully dilated  forceps
for CBC, RFT and LFT and
or ventose.
coagulation profile.
3. If above not present or failed or
5. Fix the urinary catheter to
there was any indication foe C/S
empty the bladder and chick
 emergency C/S.
UOP.
4. Oxytocin to prevent PPH.
-Medication:
5. Keep her in hospital for few
1. Give anti-convulsant the best is
days.
MgSO4 and we start by
-Post-partum:
therapeutic dose in 5gm slow I.V
1. Continue in the MgSO4
in 20 minutes and then 1gm per
maintenance for 24 hrs.
hr until to 24 hrs from the last
2. I.V fluid restriction.
fits event.
3. Continue in monitoring.

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 11

University of Shendi-faculty of medicine and surgery

4. Documentation of the  Due to large placenta site and

procedures. excessive uterine distention the
5. BP every 4 hrs. risk of PPH is increase, so
6. UOP. ergometrine + oxytocin infusion
is given prophylactically in the 3rd
{4} Delivery of 2nd twin in stage labour.
-Indication for elective C/S in multiple
multiple pregnancy pregnancy
1. Mono-amniotic twins
2. When 1st twin is breach{risk of
 The first twin proceeds as for
interlocking}
single one.
3. those with a previous C/S.
 The cord is clamped To prevent
4. high order multiple pregnancy.
the hage.
5. Relative indication if multiple
 Then check the lie and
pregnancy associated with other
presentation of 2nd twin.
obstetric problem eg: PIH OR
 If it is oblique or transverse
DM.
should be converted to
6. Second twin larger than 1st.
longitudinal.
7. Evidence of IUGR in one or
 The membrane should be left
both twins.
intact to facilitate the version.
 If it remain breach , the delivery
-Ideal criteria for twin delivery:
can be achieved by assisted
1) Spontaneous onset.
breach delivery.
2) Cephalic presentation of the
 No urgent to delivery the 2nd
twin 1.
twin within a set time period
3) Twin 1 large than twin 2.
providing both mother and baby
4) Dichorionic twin.
remain well.
-Complication of multiple pregnancy:
 Interval of > 30 min is
1) Hyper-emesis gravidarum
acceptable.
2) Increase risk of miscarriage.
 Oxytocin may add if uterine
3) Increase risk of congenital
contraction decrease.
malformation.
 Fetal distress can be managed by
4) 1st trimester resorption of one
ventose delivery even if the head
twin {vanishing twin}.
is high or breach extraction if
5) PIH- 5 times.
breach presentation.
6) When twin die in utero in mid
 C/S for 2nd twin is rarely
trimester{papyraceous fetus}.
indicated for disproportion{2nd
7) Gestational diabetes.
big baby}
8) Anaemia.

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University of Shendi-faculty of medicine and surgery

9) APH.
Data interpretation
10) DVT.
11) IUGR. station
12) Preterm labour.
1. Malaria with pregnancy
13) In monochorionic twin the
2. Anemia with pregnancy.
chances of miscarriage & PIL is
3. Hyperemesis gravidarum
more than dichorionic twins.
4. Others should be add:
14) Increase perinatal mortality rate.
1. UTI
15) Twin to twin transfusion
syndrome.
16) Malpresentation.
17) Cord prolapse. {1}Malaria with
18) Retained 2nd twin.
pregnancy
-C/F:

A. Uncomplicated malaria: {simple}

1. Fever.
2. Shivering/chills/rigors.
3. Headache.
4. Muscles and joints pains.
5. Nausea and vomiting.
6. False labour pain.
B. Complicated {sever} malaria:
Symptoms of uncomplicated
malaria + one or more of
features of sever malaria.
-Clinical and laboratory criteria of
sever malaria:
1. Cerebral malaria.
2. Severe anemia HB<7.
3. Hypoglycemia RBG<40
4. Repetitive convulsion.
5. Hyperpyrexia T>40 C.
6. Hyperparsitemia, more than 5%
of RBCS are parasitized.
7. Jaundice.
8. Black water fever.

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University of Shendi-faculty of medicine and surgery

9. Non-cardiogenic pulmonary - Ideally the patient should be

edema. admitted.
10. Algid malaria. - Assess the severity of
condition by general
-Complication of malaria:
examination and
 During pregnancy:
investigations.
1. Increase frequency and severity.
- Monitoring the maternal and
2. Sever anemia.
fetal vital parameters 3-4 hrly.
3. Hypoglycemia.
- Monitoring the fluid intake
4. Congenital infection lead
and fluid output to avoid
congenital malaria  neonatal
over or under hydration.
death.
- Chose the drug according to
5. Fetal distress.
the GA and severity of the
6. Hyperpyrexia leading to:
distress.
A. Miscarriage.
b- Management of UM in
B. Preterm labour.
pregnancy:
C. IUFD (fresh stillbirth –
1st trimester:
macerated).
The safe and first line f
D. IUGR.
treatment is oral quinine.
 During labour:
Dose: 10mg salt/Kg body wt/dose
1. Precipitated labour.
8 hry for 7 days tab= 600mg.
2. PPH.
The maximum dose 600 mg.
 During puerperium:
2nd & 3rd trimester:
1. Puerperial pyrexia.
3 options:
2. Difficulty in lactation.
1. Oral quinine 10
 Fetal complication:
mg/kg/8hrly for 7 days .
1. Increase mortality rate.
2. Oral quinine 10/kg/8hrly
2. Congenital malaria.
for 3 days.
3. Anemia.
Followed by sulfaduxine-
4. Increase rate of other
pyriethamine to
infection.
complete full treatment.
5. Under nutrition Low birth
3. Combination of
weight.
artesunate tabs (AS)
-Management of malaria in pregnancy:
(4mg/kg) and
1. Management of malaria.
sulphadoxine-
2. Management of complication.
pyrimethamine(SP) (tabs)
3. Management of labour.
in first day followed by
a- Management of malaria:
AS further 2 days.
a- General
puerperium

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University of Shendi-faculty of medicine and surgery

AS + SP c- Anemia:
-Management SM with pregnancy: Blood transfusion if Hb less than
Three options 5gm.
1- Quinine: 10mg/kg/dose 8 hrly. d- Renal failure:
-In infusion either 10% or 5%  Careful fluid management.
dextrose {each mg dilute into one  Diuretics.
one ml of dextrose}run in four hrs.  Dialysis.
-For any reasons that make quinine e- Algid malaria:
can not given by infusion give the  3rd generation
same dose bi I.M injetion diluted cephalosporin.
into 60mg/ml given in both thighs.  Monitoring of vital
-RBGs should by done before and parameters.
after quinine administration.  Fluid replacement when
2- Quinine injection: the sysltolic BP <90 mmHg.
Either I.V infusion or I.M at least -Manag ment of labour:
for 3 days and the shift to {AS+SP} - High grade fever induce the
as soon as the patient can take uterine contraction.
orally. If this can in 2nd or 3rd - The pregnancy and intensity of
trimester or oral quinine if in the uterine contraction is related to
first trimester to complete 7 days degree of fever.
of ttt. - Use fair from both preterm
3- Artmether I.M labour and precipitated labour.
1.6 mg/kg /dose BD in the first day - So the T should lowered by using
as 12 hrs a part followed by 1.6 …… sponging or anti-pyretic
mg/kg every day for 6 days {8doses} such as paracetamol.
to complete 7 days of treatment. - Adequate fluid management.
-Management of complications: - Careful monitoring in labour is
a- Pulmonary oedema: mandatory.
- Rest on …….. bed.{back rest -Intermittent preventive treatment:
elevation} - This recommended only in high
- Careful fluid management. transmission areas like south &
- Ventilation with oxygen. some irrigated area in sudan.
- Diuretics. - When women will have
b- Hypoglycemia: asymptomatic placental
25 -50% dextrose 50 -100 ml parasitemia ….. will have
I.V{1ml/kg} followed by 10% consequences on both
dextrose as continuous infusion. mother&fetus.
BG should be monitored every 4-6 - If entails giving 2 presumptive
hrs as possible. therapeutic doses SP regardless

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University of Shendi-faculty of medicine and surgery

of parasitemia status of women Systemic review:

under directed observation of CPS;
ANC provider. S.O.B
- The first dose giving in first Palpitation
ANC visit after quickening (16- Syncope
20) and the 2nd dose in the next LL edema
ANC visit but at least 4 wks G.I.T:
apart from first dose. Hematemsis
Malena
{2} Anemia e pregnancy Epigastric pain
Hemorrhoid.
CNS:
-Definition:
Lack of concentration
Hemoglobin below 11gm/dl in 1st
Headache
and 3rd trimester and below
US:
10.5gm/dl in second trimester.
Hematouria
-focus hx:
PMH:
Personal data:
Similar condition
Age
Hemoglobinopathy
Consanguinity
Blood transfusion
Blood grouping
FH:
P/C:
Similar condition
Pallor
DH:
Fatigue
Antifolate
Palpitation
SH:
S.O.B
Nutrition.
Headache
Pica.
OBS hx:
Tannin.
Parity
Social class.
Inter-pregnancy interval
Normal Iron Requirements
Hx of multiple preg
-Iron requirement for normal
LMP- GA (2nd tri or 3rd {advance
preg} blood transfusion) pregnancy is 1gm
- 200 mg is excreted
Regular ANC
- 300 mg is transferred to fetus
Last Hb reading
- 500 mg is need for mother
Tonics
-Total volume of RBC inc is 450 ml
Febrile illnesses {malaria}.
1 ml of RBCs contains 1.1 mg of
Gyn hx:
iron . 450 ml X 1.1 mg/ml = 500 mg
Amount & regularity.
-Daily average is 6-7 mg/day
Intermentrual bleeding.

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University of Shendi-faculty of medicine and surgery

Treatment a. Ante-partum:
Prophylactic: i. Poor wt gain
Supplement Fe – 60 mg elemental ii. PTR & PPROM.
Fe with e Folic Acid 0.4 mg. iii. AP.
Choice of therapy depends on: iv. Pre-eclampsia.
1. Severity. b. Intra-partum:
2. Duration of pgy. i. Dysfunctional labour
3. Associated factors. ii. Hage
Options iii. HF.
1. Oral iron. c. Post-partum:
2. Parental iron i. PPH.
3. Blood transfusion. ii. P.sepsis
Indications of admission: iii. Subinvolution
1. Hb<7gm%. iv. Thrombo-emblolism.
2. Other associated medical b- Fetal:
condition. a. Prematurity.
Oral b. IUGR.
200mg FeSo4 3 times daily till c. IUFD.
Hb level becomes normal, then d. LBW.
maintenance dose of 1 tab for e. Anemia.
100 days
Parental: (not faster than oral)
Indications: {3} Hyperemesis
1. Intolerance to oral iron. gravidarum
2. Poor pt compliance
3. Near term (‫)ما مقنعه طبعا‬ Definition
Forms: Excessive nausea and
1. I.M sorbitole citrate vomiting with pregnancy to the
2. I.V dextrane. extend that ,the woman is un
Indication of blood transfusion; able to maintain adequate
1. Severe anemia Hb <7 gm% (‫بهاء‬.‫)د‬ hydration and nutrition eighther
2. Symptomatic anemia {HF}. because of severity or duration
3. Advance pregnancy 37th wk & of symptoms.
above. Associated factors:
4. Refractory anemia. 1. Primigravida
5. Anemia due to blood loss. 2. Multiple pregnancy
Complications of anemia e 3. Thyrotoxicosis
pregnancy: 4. Molar pregnancy
a- Maternal: Clinical features:

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University of Shendi-faculty of medicine and surgery

1. Weight loss
Static stations
2. Muscle wasting
1. CTG
3. Ketonurea
2. Partograph
4. Dehydration
3. C/S
5. Electrolytes disturbance
4. D.V.T
Differential diagnosis:
5. Others:
1. Hyperemesis gravidarum may be
1. Any instrument
as a result of underlying disease.
2. Any OSPE picture
2. Pyelonephritis
3. Hydatidiform Mole
4. Multiple pregnancy {1} CTG
5. Red degeneration of fibroids
6. Increased Intracranial pressure -components
7. Peptic ulcer 1. Basic patterns
8. Acute abdominal emergencies a) Baseline heart rate.
9. Hysterical vomiting b) Variability.
Investigations: 2. Periodic change:
1. MSU a) Acceleration.
2. FBC b) Deceleration.
3. Urea and electrolytes :Na+, K+ -Question when considering CTG:
,Ca+ 1. Baseline rate?
4. TFT 2. Baseline variability.
5. LFT 3. Any acceleration?
6. U/S 4. Type of delelation if any?
Management: 5. Uterine activity?
1. Admission 6. Most probable cause?
2. Bed rest. 7. Treatment or/and intervention?
3. Iv fluids : Saline with K CL not Baseline rate:
Dextrose normal
4. Vitamines: B1 , B6 110 - 150 peats per minute.
5. Antiemetics: Metoclopramide Tachycardia: > 150
10 mg , Domperidone 10 mg 150 -170 non-reassuring.
,Promethazine 25 mg Cyclizine 50 > 170 abnormal.
mg ,Chlorpromazine 10-25mg Bradycardia: < 110
6. Psychological support. 110 -100 non-
7. If no respond termination of reassuring.
pregnancy. < 100 abnormal
Baseline Variability:

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University of Shendi-faculty of medicine and surgery

 This degree to which the baseline 3. Variable deceleration:

varies with in a particular band This is variable in shape, size and
width. Good indicator for integrity occurrence. Because they are
of ANS. usually due to cord compression.
 Classification of variability: They may indicate hypoxia or
1. Silent 0 -5 bpm may not.
2. Reduced 6 – 10 bpm 1) start of contraction
3. Normal 11 – 25 bpm veins close and arteries
4. Salutatory above 25 bpm still open.
Acceleration: 2) Increase in contraction
It is a transient increase in the heart both veins and arteries are
rate of 15 bpm or more lasting 15 or close.
more. 3) Decrease contraction
Should be there at least two arteries are open and veins
acceleration in a 20 minute. If not still closed.
present not indicate pathology if alone -Classification of FHR features
{were not happy if no acceleration}. According to the FIGO-sub-committee
Deceleration: 1) Normal Reassuring.
It is a transient slowing of FHR below 2) suspicious non-reassuring.
baseline level by 15 bpm lasting for 3) pathological Abnormal.
more than 15 sec or more.
Types: a- Reassuring
1. Early deceleration: 1. Baseline rate 110 – 150 bpm.
This synchronous wiht 2. Variability 5 – 25 bpm.
contraction and are usually but 3. Acceleration present.
not always due to head 4. Deceleration abscent.
compression. b- suspicious Non- reassuring
Often appear late in 1st stage of 1) Baseline rate
labour due to descend of head 100 - 110 bpm or 150 - 170 bpm
head compression ICP 2) variablilty:
vagal stimulation Less than 5 bpm for more than
deceleration. 40 minutes and less than 90
2. Late deceleration: minutes.
Implies … respect to contraction 3) Acceleration:
and they usually pathological. Absent of acceleration alone an
Due to restriction of retro other normal CTG are of
placental space(RPS) hypoxia uncertain significance.
start after contraction. 4) Deceleration:
1. Single early deceleration.

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 University of Shendi-faculty of medicine and surgery

2. Single typical variable

{2} Portogragh
deceleration.
{More details in lecture}
c- Abnormal
1) Baseline rate: < 100 bpm or > 170
-Definition:
bpm / minutes.
It is graphical record of the
2) Baseline variability: <5 bpm for
observation made of woman in
more than 90 minutes.
labour.
3) Acceleration: alone not
-Aim:
significant.
To determine progress of labour
4) Deceleration: {periodically
and salient conditions of the
recurring and repeated
mother & fetus.
deceleration at any type}
-Objective:
- Atypical variable deceleration .
1. Early detection of abnormal
- Late dceleration.
progress of labour.
Categorization of FHR pattern:- 2. Prevention of prolonged labour.
a- Normal: 3. Recognized the CPD long
A CTG when all 4 features fall into before obstructed labour.
the reassuring category. 4. Assist early decision on
b- Suspicious: transfore , augmentation or
A CTG whose features fall into termination of labour.
one of non-reassuring categories 5. Increase the quality and
and the reminder of features are regularity of all observation of
reassuring. mother & fetus.
c- Pathological: 6. Early recognition of maternal &
A CTG whose features fall into fetal problems.
two or more non-reassuring 7. Reduced the complication of
categories, or one or more abnormal prolonged labour for
categories. mother{PPH, sepsis &uterine
-Classification of FBS results: rupture& it is sequalae}and for
1- 1- >7.25 FBS should be repeated newborn { death, anorexia &
if the FHR abnormality persist infection & etc…}
2- 7.24 – 7.21 repeated FBS with in -Component:
30 minutes and consider delivery 1. Part I (on top) fetal condition.
if rapid pathology persistent. 2. Part II (at middle) progress of
3- 7.2 or less delivery is indicated. labour.
3. Part III (at bottom) maternal
condition.
4. Out-come.

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University of Shendi-faculty of medicine and surgery

Fetal part: - In these section of portogramas it

-Used to monitor & assess fetal central feature as graph of cervical
condition: dilatation against time.
1. FHR. - Divided into latent & active phase.
2. Membrane . Latent phase:
3. Moulding the fetal skull/bones. - From onset of labour  3 cm
a- FHR: - Once 3 cm reaches  active
normal phase.
110 - 150 peats per minute. - Last for 8 hrs or less.
Tachycardia: > 150 - Contraction: each lasing for
150 -170 non-reassuring. >20second.
> 170 abnormal. - At least 2/10 minutes.
Bradycardia: < 110 Active phase:
110 -100 non- - Contraction at least 3/10 min
reassuring. (3-4).
< 100 abnormal - Each lasting for > 40sec.
b- Membrane & liquer - Dilatation at rate of 1 cm/hr
a- Intact membrane  I or faster.
b- Rupture + clear liquir  C Alert line: (health facility line)
c- Rupture + meconium stained - - Drawn from 3 cm dilatation
> M represent the rate of dilatation
d- Rupture + blood stained  of 1 cm / hrs.
B - Moving right means referral to
e- Rupture + abscent liquir  hospital of extra vigilance.
A Active line {hospital line}
c- Moulding - Drown 4 hrs {right of alert line
a- Suture flet easily.  0 and parallel to t}.
b- Just touching each others  - This is critical line at which
+1 specific management decision
c- Overlapping reducible  +2 must be made at hospital.
d- Severely overlapping (not a- Cervical dilatation:
reducible)  +3 record against time.
b- Descent of fetus:
progress of labour: - Assessed by abdominal
1. Cervical dilatation. examination immediately bfoere
2. Descent of fetal head. doing PV using rule of fifth.
3. Uterine contraction. - When 2/5 or less of fetal head is
felt above the symphesis pubis,
this mean that the head is

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University of Shendi-faculty of medicine and surgery

rngaged & by PV examination the 1. If in health centre  hospital

lowest part of vortex has pass or with facilities decrease C/S.
at the level of ischial spine. unless the cervix full dilated.
c- Uterine contraction: 2. Observe labour progress for
- Obsetvation every 1 hr in latent short period before tranfere.
phase and every ½ hr in active 3. Continue record observation.
phase. 4. ARM if still intact.
- Assess no. & duration. c- At or beyond the active line:
- Each square represent one 1. Conduct full medical
contraction: assessment.
o Less than 20 second 2. Consider I.V infusion – bladder
o 20-40 second catheter &…….
o >40 seconds 3. Option:
C/S if fetaus distress or
maternal condition: obstructed labour.
a- Name gravida para Augment with oxytocin by I.V
b- Date of admission , time of infusion if ther are no
rupture of membrane. contraindication.
c- Drugs.
d- I.V flid. Abnormal progress:
e- Oxytocin, if labour is
augemented . 1. Prolonged latent phase.
f- BP / pulse – RR – T 2. Prolonged active phase.
g- Urine volume , protein , acetone. 3. secondary arrest of cervical
dilatation.
Management of labour using 4. Secondary arrest of head
partogram: descent.
a- Laent phase in less than 8 hrs & 5. Precipitate labour
progress to active phase. Remains -Duration of stages:
on or at left to alert line. 1st stage:
Treatment: duration
1. Donot augment with 1. 8-12hrs NP
oxytocin if latent & active 2. 3-8hrs MP
phase go ……. Latent phase (2/3):
2. No intervention unless Not more than 8hrs.
complication occurs. Active phase:
3. ARM  not in latent phase 1. 1cm/hr NP
can be active phase. 2. 2cm/hr MP
b- Between alert & active lines: 2nd stage:

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University of Shendi-faculty of medicine and surgery

1. 1hr MP
{3} c/s
2. 2hr NP
3 stage:
rd Preoperative preparation:
5-15min but Up to 30 minutes. a- Hx:
1. Confirm the date.
Patterns of abnormal progress of 2. Past obstetrical hx.
labour: 3. Previous scar.
a- Prolonged latent phase: 4. PH of chronic illness.
- >8hrs 5. Blood transfusion.
- Avoid AROM & oxytocin. 6. Allergy to anasethesia.
- If no mechanical obstruction b- examination:
treated by 1. obstetrical examination.
a- simpe analgesia. 2. BP.
b- Mobilization 3. FHR.
c- and reassurance. 4. Pericordium examination.
b- Primary dysfunctional labour. c- investigations:
{prolonged active phase} - routine:-
- Progress less 1cm /hr. 1. Hb.
- Commonely caused by 2. U/G.
insufficient uterine contraction. 3. Blood grouping & cross
But also it may result from CPD matching.
& malposition . - Special:
- If no mechanical obstruction 1. Late U/S for localization of
treatment of choice the placenta.
a. AROM 2. CTG if there is fetal risk.
b. + oxytocin infusion. if 3. If age > 40 yrs do ECG and
multipare only AROM. CXR.
c- 2ndary arrest: d- procedures:
- When progress was start good. 1. I.V cannula
- Up to 7 cm (usually) then slow or 2. Urinary catheter
stop. e- others:
- Like pry dysfunctional labour. 1. counseling about operation
a. type of incision.
b. Anasethesia
c. Post-operative discomfort
d. Complication
2. Informed written consent about
operation and fore
hestroectomy if there was risk.

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University of Shendi-faculty of medicine and surgery

3. Prepare 2 units of blood and if c. Early mobilization.

there is risk prepare 4 – 6.
4. Fasting of at least 4-6 hrs.
5. Give preoperative medications
{4} D.V.T
like antacid.
Intraoperative preparation: -Differential diagnosis of lower limb
1. 2 drip NS. swelling:
2. Oxytocin 10 units in infusion. 1. D.V.T (commonest of causes).
3. Observation of urinary cath. 2. Lymphatic obstruction (painless)
lymphedema.
Posoperative instructions:
3. Trauma.
1. NPO for at least 8 hrs (appearance
4. Insect bit(hypersensitivity) e.g
of bowel sound).
cellulitis.
2. Don’t remove the urinary for at
5. Myocysitis muscle.
least 8 hrs.
6. Arthritis.
3. I.V fluid (D5%) 2 drips 8hrly.
7. Thrombophlebitis.
4. Oxytocin 1 ampoule in 2nd & 4th drip.
-Investigation:
5. Prophylactic antibiotics:
1) CBC.
a. Maxil inj one vial (750mg) 8hrly
2) Urine general.
for 2-3 days then converted
3) Blood groub.
to cephalaxin caps 500 mg
4) U/S (realtime.doppler)
6hrly for 5 days.
5) Venography contraindicated
b. Flagyl infusion 500mg 8hrly for
with pregnancy.
1-2 days then tabs 500mg 8hrly
-management:
for 5 days.
A. Supportive treatment.
6. Observations:
1. Admission.
a. PB every ½ hr foe 2 hrs.
2. Bed rest.
b. UOP
3. Elevation of the leg to
c. Abd pain.
decrease the swelling.
d. Vaginal or incisional bleeding.
4. Rehydration.
7. Analgesia:
5. Stocking.
Voterx inj 1 amp (75mg) 8hrly on
6. Treat the infections.
need
7. Correction of anemia.
8. Prophylactic dose heparin 5000 iu
8. Analgesic for pain.
started 12hrs after operation then
B. Pharmacological therapy:
BD for 5 doses.
1. If she was pregnant: HMWt
9. After 8 hrs:
heparin{unfractionated} 25-
a. Start oral feeding.
50 sound units/days.
b. Remove the urinary cath.
40.000/day I.V

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University of Shendi-faculty of medicine and surgery
10.000 units/6hrly for 3days
then 7500 IU BD SC as
maintenance dose(‫صالح الهدى‬.‫)د‬.
2. If not pregnant start heparin
10.000 unit/6hrly from 3 day
with warfarin. And after 3
days stop the heparin and
continuous in warfarine for 6
months.
Warfarin 4-6 mg BD
- After pregnancy continuous in
heparin for 6 wk and then
converted to warfarin to complete
6 months ttt . If 6 months finish &
pregnancy still continuo as
prophylactic dose heperin until 6
wks postpartum.
- Give prophylactic dose heparin
{5.000 Sc BD} in the subsequent
pregnancies.
- Antidote of the heparin is
Protamine sulfate.
- Antidote of warfarin is active Vit
K.
-NSAIDs: is not used in pregnancy
because:
a) They cause GI upset for mother.
b) Have teratogenic effect on fetus.
c) Cause necrotizing interocollitis of
the baby.
d) Cause bleeding in the baby lead to
cerebral hage .
e) Cause early closure of ductus
arteriosus.
-NB:-
-Non-pregnant woman with high risk
for thrombo-embolic disease (prothetic
valve  on warfarin  pregnancy
convert the warfarin into heparin
A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005
infusion as early as possible, before 6
wks of gestation 1st trimester  on
heparin infusion (high therapeutic
dose) 2nd trimester  on warfarin
until 36wks of gastation  at 36 again
convert warfarin into heparin infusion
 stop heparin 6 hrs before labour or
c/s labour or C/S  start heparin
after delivery with warfarin until to
3days then stop heparin & convert it to
warfarin for life.
-Reasons for convertion of warfarin to
heparin at 36 wk:
1. Heparine has short life span can
be easily stopped just 6 hrs
before delivery with out any risk
for bleeding{with holding
further dose}
2. Heparin has injectable antidote.
-Preparation of labour room to delivery
of pregnancy women with cardiac
problem:
1. Cylinder of O2 .
2. Oxytocin  agumintation.
3. Lasix  HF.
4. Digitalis  HF.
5. Forceps  2nd stage.
6. Aminophylline  pulmonary
oedema.
-Complication of prolonged uses of
heparin:
1. Thrombocytopenia.
2. Idiopathic reaction.
3. Osteoporosis.
-Adverse effect of warfarine during
pregnancy:
1st trimester: facial & limb defect.
2nd: intracranial hage.
-Monitoring of anti-coagulants:
25
University of Shendi-faculty of medicine and surgery

Warfarin : By INR 2-3

Counseling stations
High molecular wt heparine : by
1. DM with pregnancy
APTT.
2. VBAC
Low molecular wt heparine : anti
3. COCP
factor X activity. 0.6-0.4
4. IUFD
Stop heparin:
5. Heart disease
Prophylactic  12 hrs.
6. Epilepsy
Therapeutic 24 hrs.
7. HIV
8. Thyroid disease

{1} DM e pregnancy

-pre-conception management:-
- If she control DM she can pass the
pregnancy as non diabetic women
- Best result obtained when
antenatal care done in combined
clinic where physician and
obstetrician can see pt together
- Not to be pregnant at least 3
months control and don’t use
contraceptives containing estrogen
{the best IUCD}.
- Control done by diet and drugs:
Diet :
1. cHO
2. more protein
3. less fats
drugs:
1- shifting from oral
hypoglycemic to insulin
because some obstetrian said
to be teratogenic.
2- If she on insulin increase the
dose.
3- Use high dose folic acid 5mg
dialy.

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University of Shendi-faculty of medicine and surgery

-ante- partum management:- 1. Up to 40ws (never beyond this)

- More frequent visits ,..every 2ws till
28 ws and then weekly after
- Any complication arise best admit
pat. To hospital for assessment
- In IDDM the insulin requirement
increased progressively so frequent
adjustment to dose (50-100% at
term). Aim ..pre-prandial glucose 4-
6mmol/l
- In gestational DM, diet control
limit patient calorie intake to 1800-
2000 kcal daily. If she is overweight
(BMI >29) further restriction is
advised (1500-1800)
IF diet control fail in GD start
insulin
-Monitoring treatment:
1. Self monitoring using BM strips
2. pre-prandial measures /week
3. or fasting +post-prandial
measure once/week
4. Other test
1. HBA1c every month……<8%
2. renal test every month
3. Fundoscopy every visit
-Antenatal visit every 2ws up to 28ws
then weekly
a. U/S scan
a. Booking visit……accurate GA
b. At 20-24ws……..congenital
malformation
c. Every 2ws from 28ws…..fetal
growth and amniotic fluid
volume
b. Urine analysis every
week….proteinuria
c. BP every visit……pre-eclapmsia
-Delivery-time
1. normal pregnancy
2. good glucose control
3. average fetal
4. average liquor volume
2. 38ws
1. difficulty with plasma glucose
control
2. macrosomia
3. maternal complication
3. Preterm delivery
1. sever complication…PET
2. fetal compromise
-Delivery-mode:
- -Anticipate vaginal delivery..if all is well
and pregnancy allow to continue to
term.
-Indication for C/S
1- need for urgent delivery
2- pt not suitable for IOL (PG
+unfavorable Cx)
3- other obstetric complication 
abnormal presentation
4- Age ,previous infertility and
previous pregnancy loss, can
influence decision.
-Intra- partum management:-
- Managed the usual way
- I.V. infusion 500ml 10% glucose
100ml/h
- Hourly BG
- Infusion of rapid-acting insulin in
normal saline I.V. Given in sliding
scale manor according to the BG
….to keep BM 4-6mmol/l
- Low threshold for C/S
- Possibility of shoulder dystocia
- Delivery with 12 hours…difficult
control after

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University of Shendi-faculty of medicine and surgery

- Paediatrician present at delivery. ** the main aim of this process to

-Intra- partum management:- reduce the un necessary c/s and it
IDDM complication.
as soon as the patient resume oral ** the success rate is about 75% and if
feeding ,re adjust insulin dose back
the pt was delivered vaginally before
to pre-pregnancy regimen
or after c/s the success rate increasing
GD
continue monitoring and stop to 90% .
insulin once glucose tolerance ** the factor that decrease the
revert to normal success rate as the following:
The baby 1- Macrosomic baby > 4 kg.
should be observed for 24hours for 2- Post date even spontenues.
check re complications
3- Male baby.
hypoglycaemiaRDS.
4- If previous c/s due to failure to
-Postnatal visit
progress.
- Control of plasma glucose.
- Discuss contraception 5- If previous c/s done before term
1- avoid combined pill or before onset of labour.
2- POP ,IUCD, barrier method or **Advantage of VBAC :
sterilization 1- Avoid c/s & it complication.
- Patient education
2- Decrease the duration of
1- further pregnancy
hospital stage.
2- pregnancy counseling
3- control around the time of 3- Decrease financial stress & load.
conception to prevent 4- Decrease psychological stress .
congenital abnormality 5- Encourage bonding bt mother &
the baby .
6- Impact on fertility is good.
{2} Counseling of VBAC: 7- Normal process and the
interventions will improve fetal
introduction: lung maturation.
**You had PH of one c/s and we are **Disadvantages :
going give you a chance to deliver 1- Increase risk of uterine rupture.
vaginally . 2- Formation of scar dehiscence.
**your cause of past c/s it is one of 3- Failure of procedure lead to
non-repetitive cause eg: pp. emergency c/s.
4- Risk for blood transfusion.

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University of Shendi-faculty of medicine and surgery

5- Risk for hysterectomy . 3. Acne often improve.

6- Risk of IUFD. 3) Principal risk:
**Advantage of elective c/s: 1. Increase of DVT & PE.
2. Icrease risk of MI.
1- No risk for emergency c/s .
3. Icrease risk of breast cancer
2- No risk for IUFD .
and adenoma of cervix.
3- Avoid stress of labor. 4) Principal adverse effects:
4- Pt know the exact day of 1. Headache.
delivery . 2. Nausea.
5- Avoid risk of uterine rupture & 3. Dizziness.
hysterectomy. 4. HTN.
5. Breast tenderness.
** Disadvantage of elective c/s :
6. Wt gain.
1- Complication of c/s 7. Depression.
2- Complication of blood 5) Principal contraindication:
transfusion . a) Absolute:
1. Thrombophilpitis,
thrombolytic disorder,
{3} COCP counseling thromboembolism.
2. Stroke.
-Before starting
3. IHD.
1. Introduce your self to the
4. Kidneys disease.
patient.
5. Liver disease.
2. Ask for her name & age.
6. Pregnancy.
3. Confirm the reason for her
7. History of breast cancer
attendance.
or other estrogens
4. Has she consider other method
dependent cancer of
for contraception.
reproductive organs
-Explanation the COCP-items to
b) Relative:
cover:
1. Uncontrol HTN.
1) Efficacy:
2. Migraine.
- 99.9% if used correctly 97% in
3. Smocking mother 15
practice.
cigarettes /day over 35
- It is important to ……. That the
years.
pills not protect against STDs.
4. Abnormal vaginal bleeding.
2) Principal benefits:
5. Breast feading.
1. More regular period, less
6. SLA.
blood & fewer period pain.
2. Decrease the risk of ovarian
& endometrial cancer.

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 29

University of Shendi-faculty of medicine and surgery

7. FH of hyperlipidemia, 1. Summarize & check

heart disease & kidney understanding.
disease. 2. Tell the patient to report any
Remember take quick drug sever symptoms or unexpected
history because many symptoms.
drugs can affect the 3. After finishing 28 days pack,
effectiveness of the pill eg start on other on immediately or
carbamazepine & if 21 day pack stop for the 7 days
ampicilline. , and the start another pill.
-How to take pills 4. If she develop vomiting or
1. Start taking pill in the first diarrhea use barrier
Sunday after period begin. contraceptive for next period.
2. Take one pill a day at the same
time every day for either 21 or 28
days depending on the number {4} Councelling about
of pill in the pack.
missed miscarrieg & IUFD
3. After finishing 28 days pack,
start on other on immediately or
-Introduction
if 21 day pack stop for the 7 days
-Explain the result of U/S:
, and the start another pill.
 The good news the pregnanvcy is
4. Use barrier contraceptive during
intrauterine but is not
the first month if pill.
progressive {wait for her
-What if pill missed:
response}
1. If one pill missed
 The fetal gross has ceased and
a) Take a pill as soon as you can
his size less than expected and
remember to do so.
by this age we have to listen to
b) Take the next pill at regular
for heart beat we didn’t find it
time.
{wait}.
c) Use barrier contraceptive for
 Now I am going to discus with
7 days.
you the option of ……to avoid
2. If two pill missed:
complication.
a) Take two pill a day for 2 days.
-There are 3 optons for management
b) Use barrier contraceptive for
and I am going to explain each one for
7 days.
you:
3. If 3 pills are missed:
a- Wait and see (up to 2 wks)
Stop to take the pill & start on
Advantages:
other pack in 7 day time.
a- Cheep.
-Before finishing:
b- Natural.
c- Non-invasive.

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 30

University of Shendi-faculty of medicine and surgery

d- With out need for 1. Hospitalization.

interventions. 2. Expansive.
e- No risk for surgery, 3. Complication: of surgery &
anesthesia and other anesthesia.
complications. 4. Risk of infection but we will give
Disadvatages: you prophylactic antibiotics.
a- Some product will e remain in Doxycycline against chlamydia
the uterus which can cause infection.
bleeding it can be sever that -Have you any question?
need …… by evacuation and -What your decision?
also may cause intrauterine -Patient can ask you what the best
infection. option?
b- We cannot be sure about -Answer her that there is no option
time by end of which the that better than other’s you can
evacuation can occur. choose any one according to that you
-Wait for her and ask her if she has any just weight the advantages against
question. disadvantages.
-Complication of the option -Thanks the patient.
(infection).
b- Medical Treatment:
 Induction through
{5} Heart disease during
prostaglandins tabs that initiate pregnancy
the uterine contraction which
lead to delivery of fetus. These -Salwa ,known case of RHD, counsel
maintained by oxytocin. her about heart disease during
 Advatages: pregnancy?
o Sae of the frist option. ‫طبعا إنتي عندك واحدة من أكتر األمراض القلبية شيوعا‬ -
 Disadvantage: .‫في الحمل والثانية هي عيوب خلقية في القلب‬
a- The same of 1st option but ‫طبعا أي إمرأة عندها مرض قلبي فيها أخطار عليها‬ -
here we can control the time ‫وبعداك تحدد‬.‫وعلى جنينها المفروض تعرفن قبال تحمل‬
:‫الحمل يؤثر على القلب في إنو‬.‫خيارها‬
of evacuation.
‫ يزيد من معدل وفيات األمهات وممكن يكون‬.1
b- Can need evacuations. .)HF(‫سبب في موتها‬
c-Surgery: evacuation ‫ يزيد من إلتهاب غشاء القلب الداخلي‬.2
Advantages: infective SBE
1. Control the time of evacuation. .‫ إجهاضات بتزيد‬.3
2. Everything will be well prepared. :‫وكمان القلب أثناء الحمل ممكن يعمل لينا‬ -
3. Complete evacuation & it is the IUGR ‫ ينقص حجم الطفل ويبقى وزنو شوية‬.1
end of story. IUFD. ‫ يكون سبب في وفاة الطفل‬.2
Disadvantages: preterm. ‫ والدة طفل قبل مواعيده‬.3

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 31

‫‪University of Shendi-faculty of medicine and surgery‬‬

‫‪ .4‬الطفل ممكن يولد بأمراض قلب يعني عيوب‬ ‫ماحتكوني راقدة زي مصنقرة كدى ومركبين ليك‬ ‫‪-‬‬
‫خلقية في القلب ‪CHD‬‬ ‫اوكسجين (ما تكوني راقدة)‬
‫‪ .5‬وكمان ممكن يزيد من رقادك للمستشفى (‬ ‫نقلل زمن الوالدة (وحاتكون بالمهبل طبيعيا) بالججفط او‬ ‫‪-‬‬
‫عشان العالج)‬ ‫‪forceps.‬‬
‫‪ -‬إذا حصل حمل من المفروض تعملي اآلتي عشان تقلل‬ ‫عشان ما يحصل نزيف حانديك سينتوسينون ماحانديك‬ ‫‪-‬‬
‫من المضاعفات القلتها ليك‪:‬‬ ‫ارجو مترين عشان يزيد الضغط‪.‬‬
‫‪ .1‬الحضور والمتابعة المتكررة طول فترة الحمل‪.‬‬ ‫نديك مضاد حيوي‪.‬‬ ‫‪-‬‬
‫‪ .2‬المتابعة المستمرة لحالتك وحالة الجنين‪.‬‬ ‫المراقبة واالشراف لمدة ‪ 48‬ساعة بعد الوالدة‪.‬‬ ‫‪-‬‬
‫‪ .3‬تأخدي راحة ماتتعبي نفسك بمجهود شاق‪.‬‬ ‫بعد اليومين تتحركي عشان تقللي من الجلطات‪.‬‬ ‫‪-‬‬
‫‪ .4‬تاكلي فواكه وحديد وفيتامنات وماتسمني‪.‬‬ ‫لو حصلت عواقب وخيمة (‪ )HF‬ممكن نربط ليك‬ ‫‪-‬‬
‫‪ .5‬تأخدي الحديد والفوليك‪.‬‬ ‫العرق‪.‬‬
‫‪ .6‬حانديك مضاد للتجلط أثناء الحمل‬ ‫في امراض مافيها حمل ‪:‬‬ ‫‪-‬‬
‫‪-‬ما تشاركينا في اتخاذ القرار ممكن نديك ‪:‬‬ ‫‪-sever aortic stenosis-‬‬
‫‪ .1‬هيبرين على طول فترة الحمل‬ ‫‪-sever M.S / sever‬‬
‫‪ .2‬وارفارين على طول فترة الحمل وقبل الوالد‬ ‫‪pulmonary HTN‬‬
‫نديك هيبارين ‪ 3 ،‬شهور االولى هيبارين‬ ‫‪- Eeisenmenger’s‬‬
‫ونواصل بوارفارين وقبل الوالدة بشهر نديك‬ ‫‪syndrome/AF‬‬
‫هيبارين‬ ‫الطلق في الوالدة في حالة الفشل القلبي الحاد‪.‬‬ ‫‪-‬‬
‫‪-‬أهم شي نديك مضاد حيوي على طول الحمل‪.‬‬ ‫الرضاعة طبيعية إال اذا حصل فشل قلبي حاد‪.‬‬ ‫‪-‬‬
‫‪-‬ونعالج أي التهابات أثناء الحمل او أي زيادة في الضغط‪.‬‬
‫‪-‬إذا حصل ليك أي حاجة تجي المستشفى أو المحولة او العيادة‬
‫‪ ،‬ماتتأخري ( مثال حركة الجنين قلت) او انتي حصل ليك‬
‫‪{6} Epilepsy‬‬
‫زيادة في ضربات القلب‪.‬‬
‫‪-‬نوريك اذا جاتك كحة‪ ،‬ضيق نفس‪،‬ورم في الجسم والتعب‬ ‫‪-30 years primigravida married 2 months‬‬
‫وإذا اتحركتي وزاد التعب‪ >--‬تجي المستشفى ‪.‬‬ ‫‪ago. Known case of epilepsy, come to‬‬
‫‪-‬إذا حصل ‪heart failure‬‬ ‫‪clinic for your advise about pregnancy‬‬
‫‪ .1‬ديكوكسين ومدررات للبول وأدوية بتقفل المستقبالت‬ ‫?‪& antiepilepsy‬‬
‫في القلب وهيبارين وامينوفلين (تقلل ضيق النفس) ‪،‬‬ ‫‪-‬أنا بقرا في ‪....... 12‬‬
‫اوكسجين‪.‬‬
‫‪ .2‬اذا حصل جاك موية في الرئة حنديك العالج‬ ‫طبعا زي ما عارفة انتي عندك صرعى‪ ،‬وهي‬ ‫‪.1‬‬
‫المناسب‪:‬اوكسجين ومورفين وديجوكسين‬ ‫مرض يكون فيهو االشارات العصبية زايدة‪ ،‬في‬
‫وامينوفيلين وتقلل الدم بالسحب‪.‬‬ ‫معظم األحيان اسبابو مامعروفة‪ ،‬في كثير من الناس‬
‫‪ .3‬اذا جاكي ضيق نفس من الدرجة الثالثة او الرابعة‬ ‫ماأسألك شوية اسألةعشان اقدر اساعدك‪.‬‬
‫حانخلصك من الحمل ونجهضو ليك‪.‬‬ ‫داير اسألك سؤال عندك صرعى ليها كم سنة؟ من‬ ‫‪.2‬‬
‫‪ .4‬ممكن اذا احتجتي لعملية صمام نعملها ليك‬ ‫صغيرة بتجيني لكن مامشيت لدكتور إال في السنة‬
‫‪ -‬الوالدة في المستشفى‬ ‫الفاتت‪.‬‬
‫‪ -‬غرفة الوالدة جاهزة فيها اوكسجين ومورفين وامينوفيلين‬ ‫أخر مرة جاتك متين؟ ليها سنة ماجاتني‪.‬‬ ‫‪.3‬‬
‫ويجوكسين جفظ ‪ forceps‬وسينتوسينون‬ ‫قاعدة تاخدي في شنو (عالج)؟ ‪ 3‬انواع من‬ ‫‪.4‬‬
‫‪ -‬اثناء الوالدة نديك مسكن يثدين او مورفين او‬ ‫الحبوب‪.‬‬
‫‪epidural anesthesia.‬‬ ‫بعد ده ممكن تستفسره عن أي حاجة ماعارفاها‪.‬‬ ‫‪.5‬‬
‫‪ -‬اثناء الوالدة الزم نديك سوائل عشان ماتتعبي وممكن‬ ‫يادكتور انا هسي متزوجة لي شهرين ودايرة اشوف‬ ‫‪.6‬‬
‫نديك فيتامين وبالزما (‪ )FFP‬ووارفارين‪.‬‬ ‫عالقة المرض ده بحملي اذا حملت مع انون انا لسه‬
‫‪ -‬وجع الوالدة يحصل تلقائيا ‪ ،‬حأنحاول مانديك طلق‪.‬‬ ‫ماعارفة نفسي حامل أم ال؟‬

‫‪A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005‬‬ ‫‪32‬‬

 ‫‪University of Shendi-faculty of medicine and surgery‬‬

‫‪ .7‬طيب يا آسيا عندنا نحن مشكلتين للصرع مع الحمل‪:‬‬ ‫ومفروض تجينا زيارات كثيرة وتحرصي على‬
‫االولى‪ :‬عالجات الصرعى بتعمل تشوهات في‬ ‫المتابعة ألنو مفروض تكون زياراتك اكتر لمتابعة‬
‫الجنين زي ممكن تعمل مثال‪ :‬تشوهات في العمود‬ ‫الحمل وممكن نعمل موجات صوتية نشوف بيها اذا‬
‫الفقري والجهاز العصبي وتشوهات في الوجه‬ ‫في تشوهات‪ .‬وبعد تلدي نواصل في العالجات‬
‫والشفة األرنبية وتشوهات في القلب‪.‬وممكن النمو‬ ‫وحاترضعي طبيعي مافي مشكلة وحاندي الولد بعد‬
‫بتاعو يبقى ضعيف ومشاكل في األظافر‪.‬وبرضو‬ ‫الوالدة طوالي فيتامين ‪ K‬عشان مايحصل نزيف‪.‬‬
‫ممكن تعمل نقص في عوامل التجلط المعتمدة ع‬ ‫اذا جاتك صرعى تمشي لناس الباطنية عشان يغيرو‬
‫فيتامين ‪K‬‬ ‫العالج‪.‬‬
‫‪-Maternal complication:‬‬ ‫‪ .B‬إذا ماطلعتي حامل‪ :‬حانديك موانع حمل عشان ما‬
‫‪1. Sever morning sickness.‬‬ ‫تحملي لمدة سنتين عشان تتمي سنتين ‪،‬النو اذا‬
‫‪2. Anemia.‬‬ ‫سنتين ماجاتك ممكن تاني ماتجيك نهائي‪.‬بس ‪%25‬‬
‫بتجيهم اثنا ما يتوقف العالج‪.‬وحانديك فوليك قبل‬
‫‪3. Vaginal bleeding during & after‬‬
‫الحمل وتواصل فيهو أثناء الحمل‪.‬‬
‫)‪(APH –PPH‬‬ ‫‪-‬يادكتور عندي جارتنا حامل ولدت النو جاتها تشجنات؟ وما‬
‫‪4. A.P-PET‬‬ ‫قالوا عندك صرعى؟ يكون دسو عليها؟‬
‫‪5. Preterm birth.‬‬ ‫ما أي تشنجات أثناء الحمل صرعى ممكن تكون‬
‫‪6. LBWt‬‬ ‫صرعى او‪:‬‬
‫‪a. Complications of AED:‬‬ ‫‪ )1‬كلبشت مع ارتفاع ضغط الجنين‬
‫‪7. Neural tube defect.‬‬ ‫‪ )2‬التهاب سحايي او في المخ‬
‫‪ )3‬ممكن تكون اورام في المخ‬
‫‪8. Facial clefts.‬‬
‫‪ )4‬جلطة في المخ‬
‫‪9. Cardiac anomaleys.‬‬
‫‪ )5‬سببها عالجات‬
‫‪10. developmental delay.‬‬ ‫‪ )6‬نقص السكر‬
‫‪11. Nail hypoplasia.‬‬ ‫‪ )7‬مالريا تطير في الراس‬
‫‪-‬والمشكلة الثانية ‪ :‬الزول بخاف منها وعشان كدة بنعمل‬
‫احتياط حدوث تشنجات أثناء الحمل ألنو فيها خطورة عليك‬
‫وعلى الجنين اكثر من األعراض الجانبية بتاعت العالجات ‪،‬‬
‫ممكن تؤدي للوفاء‪.‬‬ ‫‪{7} Councelling of‬‬
‫‪-‬يعني يادكتور اقعد باقي حياتي بال أوالد؟ ال ما كدى لكن‬
‫نحن حانعمل ليك فحص للحمل‪:‬‬ ‫)‪thyroid (thyrotoxicosis‬‬
‫‪ .A‬إذا طلع في حمل‪ :‬بنديك فوليك(فيفول بجرعة عالية‬ ‫‪-This lady known case of‬‬
‫وبنتشاور مع ناس الباطنية عشان نقلل ليك الحبوب‬ ‫‪thyrotoxicosis, TFT show elevated free‬‬
‫‪a-Maternal complication‬‬ ‫‪T4 & T3 and reduced TSH. Now she is‬‬
‫‪Arrhythmia& heart failure‬‬ ‫‪pregnant in her 4th months, talk to her‬‬
‫‪Vomiting& diarrhea & abdominal pain‬‬ ‫& ‪about the disease ,complication‬‬
‫‪Psychosis,miscarriege‬‬ ‫‪option of management.‬‬
‫‪b- fetal‬‬ ‫‪-‬انا عندي شنو وسببو شنو؟‬
‫‪IUGR, IUFD , still birth‬‬ ‫عندك زيادة غير طبيعية في هرمونات الغدة الدرقية‪ ،‬ممكن‬
‫‪Preterm labour,‬‬ ‫تكون نتيجة مرض مناعي او تضخم في الغدة او الحمل بدون‬
‫‪Fetal tachycardia‬‬ ‫جنين( أكياس)‬
‫‪-‬المشاكل الممكن يعملها إذا ماعالجناهو‪:‬‬
‫لنوع واحد إذا امكن وكمية الدواء في الدم ممكن‬
‫‪-‬مشاكل لألم‪:‬‬
‫نزيد الجرعة اذا احتجنا ونقيسها وبنستخدم‬
‫‪ -‬فشل او اعتالل في عضلة القلب‪،‬اسهال واستفراغ‬
‫‪phenotoin - phenoparbital.‬‬ ‫ووجع بطن‪.‬‬

‫‪A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005‬‬ ‫‪33‬‬

‫‪University of Shendi-faculty of medicine and surgery‬‬
‫‪ -‬اجهاضات وممكن يكون سبب في انو يعمل ليك‬
‫نفسيات‪.‬‬
‫‪-‬مشاكل للطفل‪:‬‬
‫حجمو بكون ناقص او يموت داخل الرحم او اثناء‬
‫الوالدة ‪ ،‬ممكن يتولد ناقص قبال ماتتمي‪ ،‬وزيادة‬
‫ضربات قلب الجنين(نبضات)‪.‬‬
‫خيارات العالج كاآلتي‪:‬‬
‫‪ .1‬حبوب بجرعات صغيرة ممكن نستخدم‬
‫‪ propylthiouracil‬النو الجرعات العالية‬
‫ممكن تنقص هرمونات الطفل ويعمل ليهو مشاكل‬
‫لكن إذا حالتك اتدهورت واحتجتي زيادة الجرعة‬
‫حانزيدها حفاظا على صحتك‪.‬‬
‫‪ .2‬عالج جراحي نشيل جزء من الغدة اذا ما استجبتي‬
‫للحبوب‪.‬‬
‫‪ .3‬العالج باليود المشع ممنوع اثناء الحمل ألنو بعمل‬
‫قفل تام لغدة الطفل‪.‬‬
‫‪{8} Counseling of HIV‬‬
‫‪women‬‬
‫اسلم على المريضة واعرفها على نفسي ‪ ،‬عايز اوضح ليك‬
‫مخاطر مرضك عليك وعلى طفلك والهدف من كالمي معاك‬
‫انو نقلل خطر انتقال المرض لطفلك ونحافظ على صحتك‬
‫طبعا الحمل ما يأثر على صحتك لكن لو تغذيتك ضعيفة ده‬
‫حيأثر صحتك وصحة طفلك وبرض مرضك ده بزيد خطر‬
‫انو يحصل ليك اجهاض او تلدي قبل مواعيدك او انو طفلك‬
‫يكون وزن قليل شديد لكن مابزيد خطر انو طفلك يكون‬
‫طبيعي او عنده عيب خلقي‪.‬‬
‫في حالتك دي بنحتاج لفريق مكون من اخصائي باطنية او‬
‫اخصائي ايدز و اخصائي اطفال واخصائي نساء وتوليد‪.‬‬
‫من فترة ما قبل الحمل تتاتعي مع اخصائي الباطنية حيعمل‬
‫ليك فحوصات عشان يتأكد انك ما مصابة بمرض آخر او لو‬
‫مصابة تتعالجي باالضافة لعالج االيدز عشان تقلل نسبة‬
‫الفيروس في الجسم وتتحسن مناعتك ونديك فيتامينات والزم‬
‫تستخدمي موانع حمل في الفترة دي وتكون طبيعية النو‬
‫الحبوب بتداخل مع عالج مرضك وتقلل تأثيرها‪.‬‬
‫اول ما يحصل حمل تجي نعمل ليك كشف كامل وفحوصات‬
‫ونديك فيتامينات وفيتامين او الفيفول ونوقف عالج اإليدز‬
‫الثالثة شهور االولى ونديك عالج وقائي ضد السل‬
‫وااللتهاب الرئوي وبرضو نديك كرت موضحة فيهو حالتك‬
‫عشان لو قابلتي أي طبيب تاني توريه الكرت عشان في‬
‫بعض العمليات يتفاداها في حالتك النها بتزيد خطر انتقال‬
‫المرض لطفلك وتكوني مهتمه بصحتك وتغذيتك جيدا‪.‬‬
‫‪A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005‬‬
‫بعد الثالثة شهور االولى نبدا عالج االيدز حتى الوالده اذا‬ ‫‪-‬‬
‫حسيتي بأي اعراض تانية تجي المستشفى او أي موية نازلة‬
‫برضو الزم تجي عشان احتمال تكون كسرتي الهادي‬
‫والوالدة لسه وتحصل ليك اصابة بمرض وتعرضي صحتك‬
‫وطفلك للخطر‪.‬‬
‫بالنسبة للوالدة حنولدك بعملية قيصرية وماترضعي طفلك‬ ‫‪-‬‬
‫رضاعة طبيعية عشان نقلل خطر انتقال المرض لطفلك نسبة‬
‫‪ %10‬ونديه عالج وقائي لمدة ‪ 6‬اسابيع بعد الوالدة ودي‬
‫حيتابعه اخصائي االطفال وشكرا‪.‬‬
‫‪ )1‬خطر انتقال الفيروس للجنين ممكن نقللو بنسبة كبيرة‬
‫كبيرة‪.‬‬
‫‪ )2‬حانديك حبوب عشان نقلل بيها خطر انتقال المرض‬
‫للطفل‪.‬‬
‫‪ )3‬اسم طريقة الوالدة قيصري عشان نقلل خطر االنتقال‬
‫للطفل‪.‬‬
‫‪ )4‬حانحاول نبعد عن الرضاعة الطبيعية(‪)10%‬‬
‫‪ )5‬زوجك دايرين نفحص ليهو‪ :‬اذا ماعندو موانع‬
‫حمل(حواجز كوندم)‬
‫‪ )6‬تجي تتابعي دوري وأي مشكلة تحصل ليك‪.‬‬
‫‪-‬‬ ‫‪Notes‬‬
‫‪-Causes of delay the 2nd stage of labor:‬‬
‫‪1. Secondary uterine …… is the‬‬
‫‪commonest cause it‬‬
‫‪exacerbated by epidural‬‬
‫‪analgesia, dehydration & ketosis‬‬
‫‪if no mechanical problem‬‬
‫‪-‬‬ ‫‪anticipated the treatment of‬‬
‫‪-‬‬ ‫‪choice rehydration intravenous‬‬
‫‪oxytocin.‬‬
‫‪2. Persistence OP position of fetal‬‬
‫‪head. Either delivered in OP or‬‬
‫‪undergo rotation to OA‬‬ ‫‪if‬‬
‫‪contraction are not strong,‬‬
‫‪-‬‬
‫‪oxytocin infusion may be speed‬‬
‫‪up the process.‬‬
‫‪3. Narrow the mid-pelvic, head‬‬
‫‪cannot rotate lead to deep‬‬
‫‪transverse arrest. Treated by‬‬
‫‪Rotational forceps, or ventose‬‬
‫‪34‬‬
University of Shendi-faculty of medicine and surgery

extraction, but frequently the 1. Epidural analgesia.

C/S is required. 2. Spinal analgesia.
-Risk factor for poor progress in labor: 3. Combination between 1 & 2.
1. Small women. 4. Pudendal nerve block.
2. Big baby. c) Opioid:
3. Malpresentaton. 1. Pethidine.
4. Malposition. 2. Morphine.
5. Early ROM. -Types and definition of C/S:
6. Soft tissue /pelvic malformation. 1) Emergency C/S:
-Criteria of normal labour: It is immediate to save the life of
1. Spontaneous. women and /or her baby.
2. Single. 2) Urgent C/S:
3. Variable. Maternal or fetal compromise that
4. Term {37 -42 wks}. not immediately life threatening.
5. Vortex. 3) Scheduled C/S:
6. whin in reasonable time{less than Needing early delivery but no
12 hrs in nillparus and less than 8 maternal or fetal compromise.
hrs in multiparus}. 4) Elective:
7. E out complication to the At time to suit the woman .
mother and fetus.
8. No artificial intervention.
Dr: A7med 3bedia
9. Retrospective diagnosis. Al_5yrabi
-Method of relieving pain during Batch 2005 - Group {D}
labour:
1. Physiological technique: this relieve
Tel:
mild to moderate pain such as: Zain 0915310678
a) Positive attitude. MTN 0926820120
b) Prenatal education. Sudani 0112855185
2. Physical metods: s
1. Massage.
2. Relaxation and breathing Email:
exersice. ahmedabedia@hotmail.com
3. Transcutaneous electrical nerve
stimulation{gate theory}
3. Pharmacological therapy: facebook:
a) Inhalation anesthesia: nitrous ‫أحمد عبيدية ألخيرأبى‬
oxide (NO).
b) Regional analgesia:

A7hmed 3bedia El-5yrabi-- Shendi University --- batch 2005 35