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

Find the difference

prepareprepare

How can do it better

Main difference of teaching medicine

In Chinese:

Only new knowledge

In English:

New medical knowledge and Language ability

Goal

Learn new knowledge

Improve English

Prepare – most important

New medical term

Outline

Discussion

Pregnancyembryofetus

placentaamniotic fluid

New term

Gestation week and gestation age

1st trimester

2nd trimester

3rd trimester

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

Antenatal check – normal pregnancy

Before 28 wk : once / month

28 - 36 wk : once/ 2 wks

After 36 wk : once / 1 wk

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

Normal labor and delivery

1st stage

2nd stage

3rd stage

Exam during labor

Vaginal exam

- cervix

- fetal presentation

- amniotic membrane

Fetal monitoring

Operative delivery

Vacuum extraction

Forceps

Cesarean section

Complication of pregnancy

Spontaneous abortion

Hyperemesis gravidarum

Ectopic pregnancy

Preterm labor

Premature delivery

Prolonged pregnancy

Premature rupture of membranes (PROM)

Complication of pregnancy

Pregnancy induced hypertension (PIH)

Gestational diabetes mellitus (GDM)

Fetal growth restriction (FGR)

Small for gestational age (SGA)

Placenta previa

Placental abruption

AbortionAbortion

Definition: termination of pregnancy when Definition: termination of pregnancy when g.a.g.a.28wk28wk ，， fetal weightfetal weight1000g.1000g.

StageStage

early late early late

g.a.g.a. 12 2812 28

10%10%15% of all of the pregnancy are 15% of all of the pregnancy are miscarriage. miscarriage.

80% of miscarriage is in early stage. 80% of miscarriage is in early stage.

Classification of abortionClassification of abortion

Induced abortionInduced abortionSpontaneous abortion (miscarriage)Spontaneous abortion (miscarriage)Threatened abortionThreatened abortionInevitable abortionInevitable abortionIncomplete abortionIncomplete abortionComplete abortionComplete abortionMissed abortionMissed abortionHabitual abortionHabitual abortionSeptic abortionSeptic abortion

Etiology of miscarriageEtiology of miscarriage

Embryo factors: abnormal chromosomeEmbryo factors: abnormal chromosomeMaternal factors:Maternal factors:– Systemic disease (high fever, heart failure, anemia, hypSystemic disease (high fever, heart failure, anemia, hyp

ertension, malnutrition) ertension, malnutrition) – Endocrinology (Luteal Phase Deficiency, hypothyroidisEndocrinology (Luteal Phase Deficiency, hypothyroidis

m, DM)m, DM)– alloimmune (Rh isoimmunization, ACL)alloimmune (Rh isoimmunization, ACL)– Incompetent internal cervical os, uterine malformationIncompetent internal cervical os, uterine malformation– Psychological factors, operation, trauma, alcohol, drugPsychological factors, operation, trauma, alcohol, drug

Environmental factorsEnvironmental factors

Ectopic pregnancy

Fertilized ovum implants on any other than the endometrium, 8090% occur in the fallopian tube.

Symptom—amenorrhea, abdominal pain and abnormal vaginal bleeding

Natural course—abortion, rupture, persistent and abdominal pregnancy

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

Management of ectopic pregnancy

Volume resuscitation

Salpingectomy or salpingostomy via laparoscope or by laparotomy

Nonsurgical methods, MTX 50mg/m2, mass3cm, -hCG 2000IU/L, no heart beat, no contraindication

Hyperemesis gravidarum

Excessive nausea and vomiting before 20 wk

Ketonuria, dehydration, Vitamine B1 deficiency

Admit to the hospital, parenteral nutrition

Pregnancy induced hypertension-1

Hypertention, edema and proteinuria after 20 wk.

Pathophisiology: generalized vasospasm

Classification: mild PIH, preeclampsia, eclampsia, superimposed PIH, chronic essential hypertension

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,

Pregnancy induced hypertension-3

Treatment: bed rest, monitoring, magnesium s

ulfate (MgSO4), antihypertensive medication, p

rompt delivery

MgSO4: 4g loading dose followed by a mainten

ance dose of 1-1.5g/hr.

Magnesium toxicity: patellar reflex, respiration, urine output, serum Mg level, calcium gluconate is the antidote

Pregnancy induced hypertension-4

HELLP syndrome

–HHemolysisemolysis

–EElevated levated LLiver enzymeiver enzyme

– LLow ow PPlatelet syndromelatelet syndrome

Eclampsia: convulsion, comaEclampsia: convulsion, coma

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

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

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

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

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

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)

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

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

Placental abruption-1

Vaginal bleeding, uterine hypertonia, fetal distress

Maternal hypertension, trauma

Mild, moderate and severe

Back pain, uterine tenderness

U/S: retroplacental hematoma

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

Discussion

How much you can understand

Advantage and disadvantage

How to improve

Thanks for your attention!