Wednesday, April 14, 2010

Post Natal Presentation

Unlike antenatal case,post obs case flow de mmg akan go back still flow kena cantik

Scenario 1:pt yg masuk2 dari PAC trus ke LR n undergo SVD,selalunya pt ne xde antenatal problem sgt

Opening statement:

Madam who,a (age n occupation,x silap kalo de known case problem time antenatal kn mention here jgk),para what,currently day what post SVD (if de ada vaccum assisted ke o forceps mention here,n why was it assisted,poor progress?CPD?) at what POA(SVD 2 at what POA,EDD ke,post date maybe).trus sambung,she came to PAC when because complain of what.

Pas2 at PAC…tgk no 7 blk,n sambung>>
She reached d LR at what time(kdg2 dr xnk tau pun,n if bagi dlm bentuk how many hours ago lagi cantik),with Os dilatation of what,n progress to active phase of labour within how many hours,if de dtg da active phase of labour ckp she reached to LR already in active phase pf labour with Os…if ada something happen in between PAC n labour,cthnya ARM,augmentation,antibiotic administration,jgn lupe mention,yg ne tgk partogram.if da ckp ARM kena la ckp liquor de camne kan,n kalo ckp antiobiotic kena la bgtau naper,if augment pun kn bgtau nape,always have reason for everything that is done.yg ne lebih kpd mcm nk summarizekan partogram.

>>so diikuti dgn,1st stage bape lame,2nd stage bape lame,baby boy or girl,weight,apgar score,EBL…n ikut la skema yg slalu guna.da abis 2 trus pegi ke step 10,currently patient camne

>>kat sini da maybe ada yg miss,correct me if I’m wrong,cakap pasal:
Pt is well,with no acute complain
Tolerating orally,ambulating well,had passed urine n bowel (more to ceasar case)
Lochia is normal
Any other complain if ada
Establish breast feeding?
Baby is well?
Family size?
Pap smear?
P.E? uterus contracted?at how many weeks?
If ada pape investigation yg dibuat berkaitan dgn labour 2 mention,cthnya,baby 2 ada G6PD,bilirubin level n pape la.tgk tiket.
Followed by plan,selalunya plan for discharge la.xpun awaiting peads..

Pas2 if dr tanya antenatally???jgn la xtau,go back to step 2,seriously,I’ve been there,phew!serius panjang…most of d time dr is interested to know jgk,sbb de x kenal dgn pt most of d time kes camni,antenatal history de straight forward je

Scenario 2: pt yg dulu pernah present antenatal skang ne present post natal lak,cthnya pt yg electivly admitted n had undergo SVD

Sama je opening statement,Cuma xde part came to PAC to la,ganti dgn electively admitted for xpernah present pt IOL,tp If ikut logic I would start off,after ckp electively admitted for IOL,trus masuk,berofe labour,Bishop score was assessed and it was ( favorauble o not),if not,how many prostin was inserted,after how many prostin become favourable,how much was the Bishop’s score dat time,pas2 trus sambung reached to LR n ikut di atas

Scenario 3: elective caesarean

Opening statement mcm sy ckp kat atas.pas2 trus p intaoperatively.lagi senang

Scenario 4: emergency caesarean

Opening statement maybe sama mcm scenario 1 or 2 tp bila time reached to LR 2 pandai2 la citer knp de sampai kena ceasar…poor progress after how long,or maybe CTG show fetal distress,yg ne tgk tiket pun bole…y len kira sama la

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