Teaching obstetrics in English

1
Teaching obstetrics in English

• Xuming Bian, M.D.
• Department of Obstetrics Gynecology
• Peking Union Medical College Hospital

2
New challenge

• Lack the exposure and concept in terms of
  lecturing in English

3
How can do it better

• Find the difference

prepare
4
Main difference of teaching medicine

• In Chinese
• Only new knowledge
• In English
• New medical knowledge and Language ability

5
Goal

• Learn new knowledge
• Improve English

6
Prepare most important

• New medical term
• Outline
• Discussion

7
Pregnancyembryofetusplacentaamniotic fluid
New term
8
Gestation week and gestation age

• 1st trimester
• 2nd trimester
• 3rd trimester

9
Documentation of gestation age

• Menstrual history
• Reliable last menstrual period
• Date of first positive pregnancy test
• Pelvic examination prior to 12 wk
• Fetal movement (quickening) at 16 wk
• Ultrasound exam prior to 20 wk
• Uterine fundus reaching the umbilicus at 20 wk

10
Antenatal check normal pregnancy

• Before 28 wk once / month
• 28 - 36 wk once/ 2 wks
• After 36 wk once / 1 wk

11
Special examination

• U/S in 1st trimester 20wk 32wk 38wk
• Screening test for chromosome abnormalities and
  NTD
• Amniocentesis
• Pap smear (TCT)
• Screening test for GDM
• Vaginal culture

12
Normal labor and delivery

• 1st stage
• 2nd stage
• 3rd stage

13
Exam during labor

• Vaginal exam
• - cervix
• - fetal presentation
• - amniotic membrane
• Fetal monitoring

14
Operative delivery

• Vacuum extraction
• Forceps
• Cesarean section

15
Complication of pregnancy

• Spontaneous abortion
• Hyperemesis gravidarum
• Ectopic pregnancy
• Preterm labor
• Premature delivery
• Prolonged pregnancy
• Premature rupture of membranes (PROM)

16
Complication of pregnancy

• Pregnancy induced hypertension (PIH)
• Gestational diabetes mellitus (GDM)
• Fetal growth restriction (FGR)
• Small for gestational age (SGA)
• Placenta previa
• Placental abruption

17
Abortion

• Definition termination of pregnancy when
  g.a.?28wk,fetal weight?1000g.
• Stage
• early late
• g.a. 12 28
• 10?15 of all of the pregnancy are miscarriage.
• 80 of miscarriage is in early stage.

18
Classification of abortion

• Induced abortion
• Spontaneous abortion (miscarriage)
• Threatened abortion
• Inevitable abortion
• Incomplete abortion
• Complete abortion
• Missed abortion
• Habitual abortion
• Septic abortion

19
Etiology of miscarriage

• Embryo factors abnormal chromosome
• Maternal factors
• Systemic disease (high fever, heart failure,
  anemia, hypertension, malnutrition)
• Endocrinology (Luteal Phase Deficiency,
  hypothyroidism, DM)
• alloimmune (Rh isoimmunization, ACL)
• Incompetent internal cervical os, uterine
  malformation
• Psychological factors, operation, trauma,
  alcohol, drug
• Environmental factors

20
Ectopic pregnancy

• Fertilized ovum implants on any other than the
  endometrium, 80?90 occur in the fallopian tube.
• Symptomamenorrhea, abdominal pain and abnormal
  vaginal bleeding
• Natural courseabortion, rupture, persistent and
  abdominal pregnancy

21
Diagnosis of ectopic pregnancy

• Ultrasound no g.s in the uterus, adnexal mass,
  fluid in the cul-de-sac.
• Quantitative assays of ?-hCG
• culdocentesis
• Uterine curretage
• Pay attention to the atypical EP

22
Management of ectopic pregnancy

• Volume resuscitation
• Salpingectomy or salpingostomy via laparoscope or
  by laparotomy
• Nonsurgical methods, MTX 50mg/m2, mass?3cm, ?-hCG
  ?2000IU/L, no heart beat, no contraindication

23
Hyperemesis gravidarum

• Excessive nausea and vomiting before 20 wk
• Ketonuria, dehydration, Vitamine B1 deficiency
• Admit to the hospital, parenteral nutrition

24
Pregnancy induced hypertension-1

• Hypertention, edema and proteinuria after 20 wk.
• Pathophisiology generalized vasospasm
• Classification mild PIH, preeclampsia,
  eclampsia, superimposed PIH, chronic essential
  hypertension

25
Pregnancy induced hypertension-2

• Symptom and sign Hypertention, edema, headache,
  visual blurring, epigastric pain
• Test CBC, liver and renal function, urine
  protein, 24-hour urine protein, optic fundi, U/S,
  NST,

26
Pregnancy induced hypertension-3

• Treatment bed rest, monitoring, magnesium
  sulfate (MgSO4), antihypertensive medication,
  prompt delivery
• MgSO4 4g loading dose followed by a maintenance
  dose of 1-1.5g/hr.
• Magnesium toxicity patellar reflex, respiration,
  urine output, serum Mg level, calcium gluconate
  is the antidote

27
Pregnancy induced hypertension-4

• HELLP syndrome
• Hemolysis
• Elevated Liver enzyme
• Low Platelet syndrome
• Eclampsia convulsion, coma

28
Preterm labor

• Regular uterine contractions accompanied by a
  change in effacement or dilatation of the cervix
  before 37 wk
• Tocolysis beta-agonist drugs ritodrine, MgSO4,
  calcium agonist, indomethacin, lidocaine
• Glucocorticoids dexamethasone in four doses of
  6mg im Q12h

29
Prolonged pregnancy

• Truly extends beyond 42 wks of confirmed
  gestational age
• Fetal well-being NST/CST/OCT, U/S
  (oligohydramnios)
• Cervical ripening followed by induction of labor,
  C/S

30
Premature ruptured membranes

• PROM the rupture of membrane prior to the onset
  of labor at term
• PPROM ? 37 wk
• Intrauterine infection (chorioamnionitis)
• Expectant management, pregnancy termination

31
Gestational diabetes mellitus-1

• Screening test 50-g glucose, 1-hour interval,
  7.8mmol/L
• Diagnosis test 3-hour glucose tolerance test,
  5.6, 10.3, 8.6, 6.7 mmol/L
• Impaired glucose tolerance (IGT) one value, GDM
  two or more values exceeding these levels

32
Gestational diabetes mellitus-2

• Glucose control diet, exercise, insulin
• Macrosomia, fetal anomalies, shoulder dystocia,
  fetal distress
• Delivery before 40 wk because of fetal lung
  maturation and fetal distress

33
Fetal growth restriction -1

• Fetal birth weight ? 10th percentile
• Symmetric, asymmetric
• Etiology abnormal karyotype, intrauterine
  infections, maternal condition, placental
  abnormalities
• Small for gestational age (SGA)

34
Fetal growth restriction - 2

• U/S estamination of fetal weight,
  oligohydramnios, elevated Doppler SD ratios
• Treatment bed rest in the left lateral position,
  oxygen, intravenous nutrition, fetal assessment

35
Placental previa

• Abnormal implantation of the placenta
• Total, partial, marginal, low-lying placenta
• Vaginal bleeding without uterine contraction,
  anemia, abnormal lie
• Expectant management, tocolysis, fetal
  monitoring, C/S

36
Placental abruption-1

• Vaginal bleeding, uterine hypertonia, fetal
  distress
• Maternal hypertension, trauma
• Mild, moderate and severe
• Back pain, uterine tenderness
• U/S retroplacental hematoma

37
Placental abruption-2

• Complication hemorragic shock, DIC, ischemia
  necrosis of vital organs
• Lab CBC, PTA, liver and renal function
• Treatment oxygen, Foley catheter, blood and
  volume replacement, fetal monitoring, timing and
  mode of delivery

38
Discussion

• How much you can understand
• Advantage and disadvantage
• How to improve

39
Thanks for your attention!