SCRIPT OBSTETRIK

1.       Reduce Fetal Movement

• Usually completed 10 kick by 2 pm, however

• today just 4 kicks until 2 pm

• Claimed reduce in intensity and frequency

• No h/o trauma or abdominal massage

2.       Leaking Liqour (PROM or PPROM)

• Feeling gushing of fluid

• Dribbling along thigh

• During sleeping

• 2 episode

• Soaked Sarung/ soaked 2 pad

• Clear fluid

• Not foul smelly

3.       Risk Of GDM (Age factor, Family History)

• Mogtt at 14 week : normal  - 4.3/5.1

• Mogtt at 28 week : normal - 4.2/4.4 4. GDM on insulin/ Diet Control

• Mogtt at ? Week : 4.2/ 7.8

• HBA1C at ? Week 5.3%

• BSP (Blood Sugar Profile) latest on 20/6/18 at 38w optimised

• Detail scan done at ? Week - Grossly normal fetus

                

4.       Gestational Hypertension  

• Booking BP 120/80  

• Dx at 30 w

• No impending eclampsia symptom

• Urine albumin negative

5.       Preeclampsia

• Noted BP at KK today 160/100

• Urine albumin 2+

• Given Tab Labetolol stat dose

• Repeated BP 140/90

• PE Profile at KK Hb/ PLT/ AST/ALT/UA

• No Impending Eclampsia symptoms

• Reflex present, not brisk

6.       Severe Pre- Eclampsia

• preeclampsia with impending eclampsia symptom (headache, epigastric pain, vomiting, blurring of vision) 8. Anaemia in pregnancy

• Hb booking 12

• Hb lowest at 20 w 9.0

• Hb latest at 38 w 10

• Compliance on T. Zincofer 1/1 OD, T. Iberet, T. Obimin, T. Maltofer. T hematinic



7 . Beta Thallasemia trait carrier  

• Dx since 1st pregnancy

• Hb 8-9 througout pregnancy

• Husband not investigated

• No history of blood tranfusion

• No history of Hosp admission for anaemia

7.        1 previous scar for acute fetal distress

-          EMLSCS (emergency lower segment caeserean section) in 2010 for fetal distress at Hosp X • Done under spinal anaest - uneventful

• Intraoperative - uneventful

• Followed by 2 VBAC (vaginal birth after caeserean section)

• Keen for VBAC 11. History of instrumental delivery (vacuum or forcep) in 2012 for fetal distress

• Done at Hosp Y

 • BW 3.8 Kg

• Complicated with extended tear

• Need blood tranfusion 1 pint pack cell 12. History of macrosomic baby in 2014

• Bw 4.2 Kg

• Delivered SVD • No history of PPH, no history of shoulder distocia • Uncomplicated



13. History of retained placenta in 2016

 • Done under General Anaesthesia at Hospital

• Uncomplicated

 • No PPH 14. Primary subfertility for 6 years

• married since 2012

• Not on contraception

• Spontaneous conception

• Ist child 1st union

14.   H/o treated Urinary Tract Infection

 • Completed T. Cephalexin for 1/52



15.  H/o treated vaginal candidiasis at 30w POA

• Completed Cannestan Pessary 200mg ON x 3/7



 17. History of excessive weight gain at 32 w POA

• Increase 2 kg in 2week

• Moggt x 2 normal

• Urine albumin negative

• No Impending Eclampsia sx

• EOD BP normotensive



18. Constitutional SGA( Small Gestational Age)

• Parameter 34-36w (39POA)

• Growth chart growing

• Doppler normal waveform • H/o BW 2.4Kg



19. H/o premature delivery at 36 week

• Bw 2.0 kg

• Baby healthy and well



20. Preterm labour

• Completed IM dexamethasone 2 dose on 20/6/18

• EFW 2.5kg

• os 3 cm

• Regular contraction • Ventilator booked