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Teaching obstetrics in English

Teaching obstetrics in English. Xuming Bian, M.D. Department of Obstetrics & Gynecology Peking Union Medical College Hospital. New challenge. Lack the exposure and concept in terms of lecturing in English. How can do it better. Find the difference. prepare.

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Teaching obstetrics in English

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  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. New term Pregnancyembryofetusplacentaamniotic fluid

  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. • Symptom—amenorrhea, abdominal pain and abnormal vaginal bleeding • Natural course—abortion, 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 S:D 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, PT+A, 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!

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