Normal age of menarche
- Between 10-16 years
Normal age of menopause
- Between 45-55 years
Component in monitoring fetal growth
> Ultrasound scan
- Fetal parameter (eg: head circumference, biparietal diameter, occipito-frontal diameter, abdominal circumference, femur length)
- EFW
- AFI
Component in monitoring fetal well-being
> Umbilical artery doppler
- Placental function
- Umbilical artery flow velocity
> Fetal kick chart
CTG
> Biophysical profile
- Amniotic fluid volume
- Non-stress CTG
- Limb body movement
- Fetal tone
- Fetal breathing
Component of modified Bishop score
- Dilatation (cm)
- Length of cervical canal (cm)
- Station of presenting part (cm)
- Consistency
- Position
Amniotic fluid index and its normal range
- Summation of the deepest cord free pool in the 4 ultrasound quadrant of the uterus
- In 3rd trimester, between 10-25cm
AFI <10cm = reduced volume
AFI <5cm = oligohydramnios
AFI >25cm = polyhydramnios
Management of oligohydramnios
- Serial growth scan 2 weekly: sign of IUGR, monitor AFI
- Umbilical artery doppler: r/o placental insufficiency
- FKC: fetal well-being
> Timing and mode of delivery
- IUGR: if severe fetal compromised -> C-section
- No IUGR: monitor AFI, delayed pregnancy if not compromise
- Preterm: IM dexamethasone 2 doses 12mg 12hourly
Complication of polyhydramnios
- Preterm delivery
- Malpresentation (more space for movement)
- Cord prolapse
- Placental abruption
- PPH
Rough estimation of blood loss
Fully soaked
- Tampon: 30ml
- Vaginal pack: 80ml
- Sanitary pads: 100ml
- Kidney dish: 500ml
- Sarong: 700ml
Full provisional diagnosis sentence for OnG
Madam X, _ years old, G_P_, at _ weeks POA, presented with _, most likely is _
Suggested ultrasound schedule for singleton pregnancy
- At booking (< 20 weeks)
- Detailed scan (18-24 weeks)
- Low risk pregnancy -> around 28-32 weeks: assess growth and liquor volume + verify the placenta location
- High risk pregnancy -> serial growth scan +- umbilical artery doppler 2-4 weekly from 24 weeks POA
What to look for during booking scan
- To confirm pregnancy
- To rule out ectopic pregnancy
- To establish viability
- To rule out multiple pregnancy
- To date the pregnancy
3 commonest cause of maternal death in Malaysia
- Postpartum hemorrhage
- PIH
- Pulmonary HPT
Cause of hypercoagulable state in pregnancy
- Increase in factor VIII, IX, X and fibrinogen promotes clot formation
- Decrease in fibrinolytic activity (eg: anti-thrombin and protein S)
What is deepest vertical pocket method in ultrasound
- Method of assessing amniotic fluid volume on ultrasound
- Pocket of maximal depth of amniotic fluid free of umbilical cord and fetal part
- <2cm: indicative of oligohydramnios
- 2-8cm: normal
- > 8: indicative of polyhydramnios
Normal birth weight of newborn
- 2.5-3.5kg
Causes of miscarriage
- Chromosomal abnormalities
- Maternal anatomic anomalies (eg: fibroid, polyp, adhesion or septa)
- Trauma
- Others: infection, cervical insufficiency, abruption, PPROM
How to follow up after hematinic supplement + expect to increase how much
<28 weeks
- Recheck Hb after 4 weeks (expect to rise by 0.3-1.0g per week)
> 28 weeks
- Recheck every 2 weeks
