SOLVING OF EXPECTED DATE OF CONFINEMENT(EDC) PELVIC EXAM

By Last Menstrual Period (LMP) Inspection

o Nigels Rule (-3,+7, +1) Grossly N external genitalia
Example: LMP May 2,2014 or 5/2/14 Masses, discharges, bleeding
5 2 14
-3 +7 +1 Speculum
2 9 15 or Feb 9,2015=EDC Cervix hyperemic/nonhyperemic;
Fish-mouth deformity/ping pong
SOLVING OF AGE OF GESTATION
By Last Menstrual Period IE
Example: Today is April 5, 2015, LMP is Feb 10, 2014 Cervical dilatation
Feb 28-10 =18 days Cervical effacement
March =31 days Station
April = 5 days BOW (intact/leaking)
54 days/7(7days a week)= Amniotic membrane PROM x days/hours
7 weeks and 5/7 days Presenting part

By Ultrasound Clinical pelvimetry

Example: UTZ result AOG is 23 4/7 days(convert to days)=165 days. Inlet
Today is April 16 2014. Utz is taken last March 12 2015. Midplane
April 30 days-16 =14days Ischial spines
March 31 days-12=19 days Sacrum
33 days + 165 days = 198 days Sidewalls
Outlet
198/7(convert to weeks)=28 weeks 2/7 days
Bimanual Examination(BME)
I (introitus) admits 2 fingers with ease/snugly
C (cervix) open/closed,; firm, doughy
U (uterus) level of umbilicus
A (adnexae) firm/fullness; w/ adnexal masses
D (discharges) (+) (-); scanty or minimal bleeding
E (episiotomy) with blood/well coaptated wound

Rectal Vault Exam(RVE)

Intact rectovaginal septum
Good sphincter tone
Abdomen
Inspection: globular/gravid; linea nigra, striae
Auscultation: NABS
Palpation: Leopolds
FH, FHB R/L

BIOPHYSICAL SCORING PARAMETERS

1. Fetal Breathing Movements
2. Gross Body Movement
3. Fetal Tone
4. Reactive FHR(not included in Modified BPS)
5. Amniotic Fluid
*Perfect Score is 10/10 or 8/8
STAGES OF LABOR *DYDROGESTERONE (Duphaston)
I: Active labor to full cervical dilatation (4-10 cm) Orally active progesterone
II: Full cervical dilatation to delivery of baby Promotes pregnancy in case of luteal insufficiency for maintaining
II: Delivery of baby to expulsion of placenta pregnancy in threatened and habitual abortions
IV: Delivery of placenta to 1 hour after
Indications:
CARDINAL MOVEMENTS Dysfunctional uterine bleeding, irregular cycles, threatened and
Engagement-Pelvic Inlet habitual abortion, infertility, premenstrual syndrome, endometriosis,
Descent dysmenorrheal
Flexion Side effects:
Internal rotation Breakthrough bleedings, hemolytic anemia, edema, asthenia or
Extension malaise, jaundice and abdominal pain
External rotation
Expulsion
*METOCLOPRAMIDE (Plasil)
ASYNCLITISM such lateral deflection of the head to a more anterior or Stimulates motility of the upper GIT w/o stimulating gastric, biliary or
posterior position of the pelvis pancreatic secretions
Sensitization of tissues to action of acetylcholine

MEDICATIONS Indications:
For disturbances of GIT motility, GERD, diabetic gastroporesis, nausea,
*CaMg (CALMAG) vomiting, migraine HA
Calcium:
Regulates heartbeat and prevents heart disease Side effects:
Aids the growth and contraction of muscles Restlessness, drowsiness, fatigue, lassitude
Combats cholesterol by increasing HDL
Reduces the occurrence of kidney stones *PIPERACILLIN TAZOBACTAM
Reduces high blood pressure Highly active against piperacillin-sensitive microorganisms as wells as
B-lactamase-producing piperacillin-resistant microorganisms
Prevents muscle cramping
Transmits nerve impulses
Indication:
For UTI, lower resp tract, intraabdominal & skin infections &
Magnesium:
septicemia
Assists calcium metabolism
Helps maintain arterial health, normal blood pressure Side effects:
and normal heart rhythm Upset stomach, vomiting, unpleasant or abnormal taste, diarrhea, gas,
Works with calcium to form the structure of the bone headache, constipation, insomnia, rash, itching skin, swelling,
Indication: shortness of breath, unusual bruising or bleeding
Calcium deficiency, nutritional supplement to prevent osteoporosis
*MAGNESIUM SULFATE DOSES (Eclampsia)
Side effects: Loading dose:
Diarrhea 4gms slow IV
5gms each buttocks deep IM
*ISOXUPRINE HCl (Duvadilan) Maintenance dose:
Mode of Action: 5gms IM/IV q 6hrs
beta-adrenergic agonist that causes direct relaxation of uterine and Monitor BP, U/O, DTRs hyporeflexia
vascular smooth muscle via beta-2 receptors Monitor RR
Indication: MgSO4 drip:
Treatment of circulatory disorders and uterine hypermotility 1-2gms/hr
1L = 10gm given 100cc/hr
Side effects: 10meq/L(about 12mg/dL) respiratory depression
Transient palpitations, fall in BP, dizziness 12meq/L respiratory paralysis and arrest
Antidote: Calcium gluconate 1g IV

*HYOSCINE N-BUTYL BROMIDE (Buscopan) for softening of the cervix