OB-Reviewer With Algorithm

OBSTETRICS AND GYNECOLOGY I
OB REVIEWER
MDs by 2019
MODULE 1 extrauterine), AoG, risk, OB score

A 46 yo on her 6th pregnancy came in due to a positive  especially Parity Diagnosis of patient:
pregnancy test. LNMP (Last Normal Menstrual Period) was Pregnancy Uterine, 13 weeks 6 days, high
April 23, 2016. She had 4 term pregnancies, and one preterm risk  for age, G6P5  
delivery due to triplets. She consulted due to a concern
regarding congenital anomalies in babies born to “old • Briefly explain the quadruple screening test to the
women” and articles she saw on the internet regarding patient. 
“quadruple screening” and “nuchal translucency”.   ▪ Screens for alpha-fetoprotein (AFP), human
• What is the AOG of the patient? chorionic gonadotropin (hCG),
AOG = Age of Gestation   unconjugated estriol, and inhibin levels,
April 23 -> 30 days in April – 23 = 7 days which if outside normal values, indicates
May – 31   congenital diseases
June – 30
July – 29 (Date of consult) • Categorization of patient according to risk factors:
Total = 97 days  Or 97/7 = 13 weeks, 6 days   Certain diseases occur for certain age - What
congenital diseases are associated with determined
• What is the ob score and index? risk factor?
G6P5 (4107) ▪ Example – Down’s syndrome – increased
OB score: G6P5   risk at at 35yrs and above
G – Gravidity ▪ W/ outliers – 26yr old patient had firstborn
▪ Total # of pregnancies including present boy and second born girl w/ Down’s
pregnancy, regardless of outcome of syndrome; patient was not prepared =
previous pregnancies.  = 6 (4 term abandoned babies for 5 years.
pregnancies + 1 triplet pregnancy + 1 ▪ Know alternative cheaper test  
current)   ▪ Prepare patient for any outcome of the test.
P – Parity  
▪ Total # of pregnancies that has reached age • What advice can be given to this patient using the
of viability.  = 5 (4 term + 1 triplet)   article found on PubMed?
Viability- if fetus is delivered, it will survive.  ▪ Because mother is already 13wks 6days
Williams (Chapter 42): threshold of viability are those born at pregnant, use nuchal translucency test as it
 22, 23, 24, or 25 weeks has same rate of detection as quadruple
screening test for a lower price.
OB Index: F4P1A0L7
F–Fullterm=4   CASES
P–Preterm=1   CASE 1
A–Abortion=0  
• 29yo
L – Living children, total # at the given point in
time = 7   PMP – May 1, 2016
Risk factorization: Factors for high risk pregnancy:   • LMP – June 2, 2016
▪ Ages 35 and above at time of delivery, or 19 • CC – Vaginal Spotting
and below Sun Mon Tue Wed Thu Fri Sat
▪ Parity of 5 and above  1 2 3 4 5 6 7
▪ Multiple pregnancy (triplets)   8 9 10 11 12 13 14
15 16 17 18 19 20 21
• What is the complete initial impression for this 22 23 24 25 26 27 28
patient? Initial Impression = initial diagnosis -> 29 30 31 1 2 3 4
changed to avoid litigations 5 6 7 8 9 10 11
• Diagnosis is a very final term. a. What is the patient’s menstrual cycle?
Other Terms: Admitting impression, working diagnosis, set of • 32-day cycle
diagnosis with differential diagnosis b. What is the patient’s ovulation date from her
▪ From History and Physical examination   previous menstrual cycle?
▪ Used to determine patient management   • May 19-21, 2016 
▪ Location of pregnancy (uterine, c. What is the next best step in the management of the
Transcribed by: ABU, ALIENTO, PELISCO, VILLANUEVA P., VALERIO, VIRADOR, ARBOLEDA, ORINDAY Page 1 of 29
OB-GYN I OB REVIEWER BATCH 2019
case?
• Monitor the bleeding (amount,
characteristics).  
CASE 2
• 32yo
• PMP – April 24, 2016
LMP – May 30, 2016
• Consulted for her annual physical examination
Sun Mon Tue Wed Thu Fri Sat a. What is the patient’s menstrual cycle?
24 25 26 27 28 29 30 • 29-day cycle
1 2 3 4 5 6 7 b. When is the expected ovulation day for the current
8 9 10 11 12 13 14 menstrual cycle?
15 16 17 18 19 20 21 July 9-11, 2016
22 23 24 25 26 27 28
29 30 31 1 2 3 4 AGE OF GESTATION
a. What is the patient’s menstrual cycle? LMP – February 14, 2016 

• 36-day cycle Date of Visit (Check up) – August 3, 2016
b. What dates would correspond to the proliferative phase?
Compute for the Age of Gestation.
April 24, 2016 to May 16, 2016
c. What dates would correspond to the luteal phase?
• So ganito yun, since yung LMP ay last February pa,
May 16-29, 2016 magstart tayo ng February until mag-August.  
d. What is the patient’s follicular phase?
Feb
April 24, 2016 to May 15, 2016 Mar
e. What is the next best step in the management of the
Apr
case? May
• Menstrual monitoring June
July
Aug
 
• And then, ilang days ba meron ang Feb this 2016? Diba 29,
eh nagstart ng 14 so i-less natin yung 14 sa 29 kasi
CASE 3 ang kailangan lang naman nating kuhanin is yung
span kung kelan nagstart yung menstruation until
• 21yo
the date of consultation. Here it goes.....  
Feb (29 - 14) = 15
Mar = 31
Apr = 30
May = 31
June = 30
July = 31
Aug = 03  
171  
PMP – May 26, 2016
• Ayan na, 171 days. And since weeks yung hinahanap natin
LMP – June 24, 2016
kailangan natin syang idivide sa 7 (kasi we have 7
• CC – missed menses
days in a week).
Age of Gestation is 24 weeks and 3 days.

 
Transcribed By: ABU, ALIENTO, PELISCO, VILLANUEVA P., VALERIO, VIRADOR, ARBOLEDA, ORINDAY Page 2 of 29
OB SCORING AND OB INDEX (+) urinary hesitancy hence consult

G (Gravida) – number of pregnancies  DIAGNOSIS:
P (Parity) – number of viable pregnancies delivered G8P7 (7007) PU, 11 wks 5 days, To consider vaginal
regardless of outcome and number  prolapse
T (Term) – delivered full term per head (38-42 weeks) 
P (Preterm) – delivered pre term per head (20-37 weeks)  Vaginal Prolapse kasi yung isang risk factor is present which is
A (Abortion) – per pregnancy (<20 weeks)  yung pagiging multiparous nya. And may vaginal mass na eh,
L (Living) – number of livebirths per head  so lumuwa na yung mass hence nahihirapan na din syang
*M (Multiple) – per pregnancy (if twins/triplets) umihi.
Example : CASE 3
A 46 y/o on her 6th pregnancy came in due to a positive 16 y/o 
pregnancy test. LNMP (Last Normal Menstrual Period) was LMP: June 21, 2016
April 23, 2016. She had 4 term pregnancies, and one preterm PNMP: May 19, 2016
delivery due to triplets. HPI:
• G6P5 (T4P1A0L7M1) 2 weeks PTC  Missed menses
(+) Pregnancy test
MODULE 2 Few hours PTC  (+) dyspnea 
(-) loss of consciousness
CASE 1 DIAGNOSIS:
22 Y/O G1P0 PU, 8 wks 3 days, Pregnancy to rule out
First Pregnancy Asthma
LMP: June 10, 2016
PNMP: May 10, 2016 According to Dra. Francisco, nakipagaway daw muna si
CC: Vaginal Itchiness patient bago magkaroon ng dyspnea. Sa physiologic changes,
HPI: magkakaroon at normal lang na maranasan ng patient yung
1 month PTC  Missed menses dyspnea kasi increase yung progesterone effect. Since may
(+) Pregnancy test presence ng dyspnea iconsider na lang as differential
No consult done diagnosis yung Asthma. More tests should be elicited to the
No medications taken 2 weeks PTC patient para marule out yung Asthma.
Vaginal itchiness with cream like vaginal discharge
DIAGNOSIS: CASE 4
G1P0 PU, 13 weeks, To consider vaginal candidiasis 20y/o
G1
(*PU-Pregnancy Uterine)  LMP: May 31, 2016
*You should request for CBC, Urinalysis, Smear, and UTZ Regularly menstruating
Bakit candidiasis? HPI:
-Kasi based sa history ng patient may vaginal itchiness sya Past medical history of RHD (functional class 3)
and may cream like discharge. Kada STDs kasi may mga (+) loss of consciousness
characteristics yung mga discharges, sa candidiasis cream like DIAGNOSIS:
dapat. G1P0 PU, 11 wks 3 days, High risk pregnancy RHD
(functional class 3) To consider cardiac problem
CASE 2
35y/o  High risk kasi may history sya ng RHD. Because of the loss of
Eighth pregnancy; all previous pregnancies were consciousness, iconsider natin yung cardiac problem
delivered via NSD 
LMP: May 29, 2016 
PNMP: April 30, 2016 
(+) Pregnancy Test 
CC: Vaginal mass
HPI:
3 years PTC  vaginal mass size of an egg, reducible;
no other accompanying s/sx. Advised surgery but
lost to follow up.
2 weeks PTC  increased in size of vaginal mass to a
‘ponkan’ size
CASE 5 placed on either side of the maternal abdomen, and

32y/o gentle but deep pressure is exerted.
G3P2 (2002) Determines the fetal back – best location to hear
LMP: June 1, 2016 fetal heart tone (beats per minute) o Use
Regularly menstruating stethoscope (bell) or fetal Doppler 
CC: vaginal bleeding Get pulse of mother while getting fetal pulse to
PE: ensure that it is the fetal pulse that you are taking.
BP: 150/100 • Third maneuver is performed by grasping with the
Fundus: height is compatible with 5 months size thumb and fingers of one hand the lower portion of
gesation the maternal abdomen just above the symphysis
DIAGNOSIS: pubis.
G3P2 (2002) PU, 11 weeks 2 days, To consider H • Fourth maneuver, the examiner faces the mother’s
Mole feet and, with the tips of the first three fingers of
each hand, exerts deep pressure in the direction of
NOTE: For the activity of Bleeding in the First Trimester, the axis of the pelvic inlet.
please study Trans 3 of Module 2. The cases were
incorporated alongside with the discussion. Thank you. ☺ PARTOGRAPH
CASE 1
LEOPOLD’S MANEUVER
A 35 year old primi stated that she had uterine contractions

at 12:30AM. Hindi nawawala ang sakit ng tiyan ko. Wala pa
namang lumalabas na kahit ano, dugo o parang tubig, wala
pa.
At 7AM, there was a bloody show. Hindi ako kumain ng kahit
ano.
At 10AM, she consulted her doctor.
• Upon IE: 2cm dilatation 60% effaced
• Station -3 (+) BOW FHT = 140
At 2PM:
Review Leopold’s maneuver:  • 4cm dilatation 70% effaced
• First maneuver: permits identification of which fetal • Station -3 (+) BOW
pole—that is, cephalic or podalic—occupies the At 4PM:
uterine fundus. • 6 cm dilatation 70% effaced
• Second maneuver is accomplished as the palms are • Station -3 (+) BOW
At 6PM:
• 8cm dilatation 80% effaced
• Station -3
At 7PM,
• Fully dilated. Pero sabi ni Doc nung activity, station -
2 daw this time.
CASE 2
G1P0 PU 38 wks cephalic
8AM–hypograstric pain with spotting  
12 NN – Admitted with IE 3 cm, 60%, floating, (+)
BOW;  UC 1x in 10 mins; FHT 140’s; oxytocin drip  
2PM – 4cm, 60%, floating, (+) BOW; UC 2-3 mins 40s
 strong; FHT 150’s  
4 PM – 7cm, 70%, station -3, (-) BOW, clear AF on
 Amniotomy; UC same; FHT 150’s  
FHT 150’s   
6PM – 8cm, 70%, station -1, (-) BOW; UC same; FHT
140’s  
8PM – 9cm, 80%, station 0, (-) BOW; UC same; FHT
150’s  
8:30 PM - fully dilated, station +2, (-) BOW; UC same;
FHT 150’s  
9PM – fully dilated, station +5, (-) BOW; Delivered to
a FTL boy BW 3.8kg BL 54 cm AS 8,9  
OB REVIEWER
MDs by 2019
OB REVIEWER
MDs by 2019

OB-Reviewer With Algorithm

Uploaded by

Copyright:

Available Formats

OB-Reviewer With Algorithm

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

OB-Reviewer With Algorithm

Uploaded by

Copyright:

Available Formats

OBSTETRICS AND GYNECOLOGY I

MODULE 1 extrauterine), AoG, risk, OB score

a. What is the patient’s menstrual cycle? LMP – February 14, 2016

Age of Gestation is 24 weeks and 3 days.

OB SCORING AND OB INDEX (+) urinary hesitancy hence consult

CASE 5 placed on either side of the maternal abdomen, and

A 35 year old primi stated that she had uterine contractions

You might also like