10th Batch MBBS IIUM Blog

Long Case :

1. Post Date (EDD+8/7).e/a for bishop score and IOL.K/C/O Bronchial asthma.Last attack 2 years ago.Not on medications currently

a. MOGTT- How to do MOGTT

b. Interpretation MOGTT/HbA1c

c. How to manage GDM

d. Weight gain-N weight gain in pregnancy

e. IUGR/SGA

f. Post date

i. Complications of post date

ii. Why the fetus get complication

iii. Types of IOL

iv. IX before IOL( more on U/S)

2. (dr nurhazinat) Leaking liquor w underlying asthma, PIH ,anemia w resolved UTI

a. TX PIH

b. Dif MX of LL (preterm/term)

c. Advice b4 pt goes home (if preterm)

d. Sx of UTI

e. Cx of LL

3. Epilepsy in pregnancy w rash (housewife,32,g4P3 presented w epilepsy tx started at 24 w POA,already had 5 attacks during this pregnancy,no significant antenatal HX

1. DDX of epilepsy

2. Differential o rash +investigation

3. Describe the rash

4. Scenario-pt has herpes infection, already term, will you allow delivery?

5. This pt, contraction already 2:10 moderate, now EDD how would you manage?

4. 35+ y/o Malay lady/G6P5 @EDD +3/7 Hx of anemic during pregnancy (current) .no other med illness

1. How to tx IDA –Types,route

2. Mx-PT postdate ,having contraction, still in ward.Would you send her to LR? Yes.bcz risk of stillbirth,IUD,etc.placental insufficiency (term)

5. GDM

1. Cx of GDM

2. MX obstructive labour-big baby,shoulder dystocia mx

3. IOL

4. Sugar control-BSP

6. 25, G1p0 @28 W

1. Preterm labour w UTI sx

2. Came w contraction +show

3. From definition till mx

7. (dr hazinat)27 y/o Malay : contraction pain +show at 33 weeks.POA-no LL,white discharge (vaginal) for 1 week .No other significant HX.DX: preterm labour 2dary to genital tract

a. Ddx

b. Ix-explain reason

c. Mx-dr tekankan yg ni .die tanye mx after discharge sekali.eg u/s b4 dischrge-make sure amniotic fluid cukup.no SI,No douching, come asap if S&S of chorioaminiotis etc

1. Dr tanye more on clinical ,xde BMS

8. 30 y/o Chinese/malay/g2 p0 +1 @26 w POG admitted due to high bp

a. Cx of metyldopa

b. Cx of PIH

c. How to ix

d. How to manage PIH

9. 36Y/O teacher e/a for expectant mx for asx pp.basically no sx.accidentally dx during reg antenat check up @ 28 weeks POA.Type III PP.Referred fm KK to HTAA @ 34 w.plan for CS at? Not sure how many week

a. If bleeding at 36w-w ,no pain.wait or not?no .directly do cs

10. 30 y/o mom @ 34 w w bronchial asthma and GDM (dr khaled)

a. Asthma control

b. Medication

c. Mx of delivery

d. GDM

i. How to dx GDM

v. Types

vi. How

11. 25+yr malay G3P2 at 26 w dx w persistent protenuria since booking.2-3+ no sx of IE. presented w epigastric pain, n/v/ headache EXCEPT HIGH BP.treated at PE room .given medication.sx resolved.but BP Stable .NEVER rise.plan for U/S next week.otherwise pt had no signs –no edema,no urti sx,no family hx of renal,hpt ,connective tssue dx like SLE (dr suhaiza)

a. What ix to proceed?

b. KUB u/s?

c. Normal value of creatinine?

d. C3?c4?

1. Same pt (dr sudesan)

a. Causes of protenuria in pregnancy

b. How do you manage (ix and tx)

c. Show how you check for hyperreflexia

12. Pt with type 1 DM admitted for IOL @ 38 weeks with Hx of undiagnosed PCOS, 3x APH, UTI symptoms, candidiasis

13. 30/Malay/G2P1@ 39 week + 2 days PIH on PGE p/with HPT during antenatal f/up, admitted for further Mx of HPT.

1. Classification o HPT during pregnancy

2. Management

3. IOL-Types and Cx

14. 35/Malay/G3P2 @ 37 weeks POA complaint of sudden gushing of fluid 9 hrs PTAAntenatally: anemia, asthma, previous Hx of C-sec, GDM diet, transverse lie

1. Mx of asthma

2. Causes of transverse lie

3. Cx in PROM and Mx

15. 25/Malay/ G2P1 @ 35 weeks POA with GDM, complaint on and off contraction pain with no show/LL ONLY whitish vaginal discharge n itchy

1. Calculate POA

2. Causes of prem ©

3. Dx

4. Ix

5. GBS

6. Mx of prem ©

16. 23/Malay/ G1P0 @ 32 weeks, PPROM, with LL for 14 days

1. Cx

2. How to Dx

3. What to do when pt come

4. What to do if No labour

5. Can it be chorioamnionitis

17. GDM on insulin, plan for ELLSCS. Antenatally: anemic. Previous Hx of GDM on diet, C-sec (prolonged labour)

1. How to Dx GDM

2. When to do BSP

3. Insulin storage/medication

4. Pre-op medication and preparation

5. Iron requirement in pregnant women

D: zanaridah- LONG CASE- with Dr bahyah

Patient is 37 years old housewife, G7P3+3(history of abortion for the 2nd, 4th, and 6th pregnancies at 2-3 months), diagnosed having diabetes mellitus 4 years ago on OHA (metformin).… some question yang dr tanya are,

1. Apa definition of recurrent abortion? Patient ni recurrent abortion ke?

-patient ni bukan recurrent abortion.. sebab recurrent abortion is the occurrence of repeated (three or more consecutive) pregnancies that end in miscarriage of the fetus.. the keyword is CONSECUTIVE… , patient ni tak..

2. Tell me all the symptoms of UTI?

3. What are the sites of skin infection that we should look for in diabetic patient?

4. after history, dr suruh examine patient depan dia..

5.then discussion mainly on diabetes and its complications in both mother and fetus.

- complication tu, kena list elok2.. divide kepada maternal and fetus… during antepartum, intrapartum and postpartum

6.then dr tanya pasal future plan of the patient.. dh complete family or not.. and the method of contraception.

-lesson I learnt: don’t ever tipu dr.. if xbuat or tak tanya patient certain things.. mengaku je.. if tak tahu nak jawab.. pun mengaku je.. jangan merepek..

Short case:

1. Uterus smaller than date+ 1 prev scar

a. Causes

b. How to investigate (more on u/s)

c. How to manage –IUGR, sga, 1 prev scar

2. Dr Roszaman- Big baby (4.2 KG) for ELSCS

a. Difficult to palpate the fetal head.y?patient contracted that time.(true) .fetal head engaged (false)

b. What is ur plan (ELSCS ->y? dx early,can plan LSCS

c. What will you do if patient goes to spont labour?to assess CPD by History and clinical.Hx- how big baby ,how prolonged labour prev,shoe size,height

d. Clinical-sacral promontory,ischial spine,ligament,subpubic angle,etc

3. Uterus larger than date

a. Ddx

b. Method to determine EDD

c. Parameters to observe in fetal scan

d. How to trace result

4. Examine abdomen (young women with prev scar going to OT.Refuse Trial of scar (reason y pt going to OT For csec

5. Breech +LSCS scar

a. Scar tenderness

b. Causes breech most prob + scar

c. Cx of PP

6. Obese, 35 yo G2P1 @ 32 w POA

a. Examination :clinically 36 w fundal height SFH 35 cm

b. Larger than date.causes

c. Details about macrosomic baby

i. Weight

ii. Complications

iii. Etc

7. Prof mokhtar.transverse lie -TL

a. How do you manage

b. Option of tx

c. Expectant mx

i. What ?

ii. Pros n cons

d. Cx of TL

e. Btw TL & breech in which ECV has high chance of success

8. PPROM

a. How to manage

i. Ix and mx in ward

9. Pregnant lady @term for cs (dr suhaiza).Exam:scar-csec,laparotomy scar

a. Indication for csec & laparotomy

b. What is her current csec for?

10. Pregnant lady w scar

a. Trial of scar

b. Contraindication

c. How to check /confirm date? Book/u/sound

11. Uterus larger than date

1. Causes/DDx

2. Cx-shoulder dystocia, fetal distress

3. Mx of shoulder dystocia

12. Uterus smaller than date

13. Unstable lie

1. Defn

2. Causes

3. Mx

4. Cx

14. Transverse lie with underlying PP type 2

1. Causes of abnormal lie

2. When to do C-sec

3. Cx of PP with 1 previous scar-placenta accrete

4. Is the position of the baby back important in C-sec case?- Yes, easier to take out the baby during C-sec if the back facing the mother (easy to grab the legs)-Dr Sudesan

15. 1 previous untried scar

1. How to examine the scar

2. Cx of PP with 1 previous scar-placenta accreta

16. Transverse lie in PP type III.+Pfannenstiel scar

a. Tell me diff types of PP

b. What is the risk this pt has?placenta accreta

c. How do you manage placenta accreta?

d. How to deliver the baby

e. How do you prepare for C Sec

D:
Zanaridah: SHORT CASE-with Dr Raja Ariff

(patient was at bed 24, near the ward entrance.. wearing the white gown for OT)dr: This patient, 28 year old, Gravida 2 para 1… LMP: etc,

1.calculate the patient’s POA and EDD
2. examine this patient’s abdomen..

Me: (start examining the abdomen)- buat running commentary.. I noticed there was a Pfannenstiel scar.. so, cerita pasal scar tu.. 16 cm. well healed , no evidence of hypertrophy or keloid formation. When measure SFH is was 4 weeks larger than date… clinically pun dh besar… singleton fetus, longitudinal lie, the head was 4/5 etc

3. Pfannenstiel scar is due to? Me: caesarean section, myomectomy , etc
4.., what is the important thing here?Me: uterus larger than date
5. what are the possible causes of uterus larger than date in this patient?
6. what are u going to do? How do u manage this patient?
7. possible indication of C-sec in this patient?