October 08, 2013 - Gynecology -2- 9-11:30

Nervous, I showed up 30 minutes earlier than the appointed time.
While waiting, I try to read a book, unsure of things I'm supposed to do.




Quarter past, Dr.T came. He asked if I could run in my shoes. I answered yes.
We run past people, bypassing elevators, using stairs and running through the secret underground passage. During this brief morning exercise, I can feel my brain being picked at and learn about Dr.T's clinical philosophy.

We arrive just in time for the delivery.

In absolute awe, I'm not sure if I introduced myself properly to the parents. I'm not sure how I'm perceived, but I'm there, looking at the whole labor and delivery process with my own eyes, real-time.
The baby almost looks alien as his head peeks out, blue and purple.
umbilical cord cut, baby's first cry is heard, he turns to red and the neonatal unit measures baby's birth weight. Numbers I would often ask parents of the ped patients at Dr.J's office.

Placenta comes out and blood is drawn.
I wonder if any genetic tests are done with those blood?




After the delivery, we go back to the clinic. Everything is electronic and surreal.
The awe of birthing process still not washed away. I noticed sweat marks on back of Dr.T's shirt.
And I take notes on things that I don't understand.

Hereditary spherocytosis

Description:

• inherited, clinically heterogeneous red blood cell membrane disorder characterized by spherical erythrocytes, hemolysis, and anemia(1, 2, 3)

Intrauterine device (IUD)

• expulsion most common in first year of use(1, 3)
• intrauterine devices (IUDs) are a type of long-acting reversible contraceptive (LARC) method (along with implantable contraceptives)(1)

Postdates pregnancy

Description:

• pregnancy lasting ≥ 42 weeks (294 days)(1, 2, 3)
• inaccurate dating can contribute to increased rate of perceived postdates pregnancies(1, 2)

Also called:

• postterm pregnancy
• prolonged pregnancy
• overdue

Dating of pregnancy

Last menstrual period (LMP):

• LMP is most reliable clinical estimator of gestational age if known with certainty
• Naegele's Rule: estimated date of delivery (EDD) = LMP + 7 days - 3 months + 1 year
• assumes 28-day cycle, ovulation on day 14 and average length of pregnancy 280 days (40 weeks)
• accuracy within 2 weeks in 85% with optimal menstrual history and 70% with suspect menstrual history (Obstet Gynecol 1985 May;65(5):613)

*For >40 y.o deliver at 39 weeks the LATEST. 

September 28th Ob/Gyn Shadowing

Wow, so many visits to my small blog.
I was surprised by the number of visits and no comments. I guess my writing still does not elicit any response of readers.



But if you are regular, welcome and I hope my notes are helpful.




*





Some terminologies

hemotypsis: hemo- blood + ptysis - act of spitting
nulliparous: nullus -not any + para>20 wks births; no pregnancy
Gravidity: gravis - heavy; # of times a woman has been pregnant

Some concepts

Gravida (# of pregnancy including current one)/Para (>20 wk births including viable and stillbirths)/Abortus (miscarriage or abortion)

• G5P1: pregnant 5X 1 birth
• G1P1: That of a woman who has had one pregnancy of twins with successful outcomes  

Fetal Non-Stress Test (NST)
- measures heart rate of fetus and its typically higher. Look for deceleration and acceleration. Deceleration means fetal head compression-- good indicator for whether c-section is required or not.

Why ASA and tylenol is ok for pregnant women but not advil? advil (Ibuprofen) has an effect on prostaglandin system. That is why it is not recommended - as with any anti-inflmmatory.


*


Some facts

you can get acute tubular necrosis from prolonged surgery via hypoperfusion due to vasodilating anesthetic

Prolonged nulliparity is a risk factor for breast cancer (think too much hormone!)

no anti-inflammatory/antibiotics for pregnant woman