Gynecology &

Obstetrics department (case 1)

Practice clinical pharmacy

BY : DR. Safia A. Alrezami

Definationis delivary of the baby through operation via abdominalwall

Causes

Related to mother contractedpelvis ,maternal diseases(heart disease eclampsia or

preclampsia , Pelvic tumor

Releated to fetusMalpresentation & malpostion, Multiple pregnancy(twin)

Large baby Planenta previa placenta abrouptionUmblical cord problem

Incidence twin is one in 80 of pregnancies .Types of twins- uniovlar(identical) twin 30% They result from division of a single fertilized ovum-binovular (dizygotic) twin 70%: They result from fertilization of two separate ovum

During labourDelivery must be in hospitalIf labour strat before 38week the mother is given 2g ampicillin IV every 6 hour until delivery to prevent group B streptococcal infection in the newborn.the docter after examintation

give decision about the route of delivery( narmol or need to operation (L.C.S.C )

During pregnancy

-Diet the mother is given more nutrient kilocalories, protein, iron ,Ca, folic acid and vitamins.- frequency moniter by Dr. to give the suitable adivce

Management

Personl historyfile no ,255Patient Name: X

Age: 18 years work as housewife Admission date 3-3-2013 discharge date 8-3-2013

The main compliance The patient 9 month of pregnancy complaining of sever lower abdominal pain associated with vaginal bleeding.

Medical & past historyThe patient has no history of HTN or DM or taken any drugs. Also there is no past history of hospitalization . Both parents have no any chronic diseases

Primary diagnosis -patient in labour. (delivery)

Differential diagnosis_Time of delivery (normal or operation).placenta previa _Abruption placenta.

The physical examination She is look well &awake and can walk BP 130 \95 mmhg Pulse 64 beat per minuteRespiratory rate 20Vaginal examination cervix open 2 fingers and the placenta is first descent the

InvestigationHb =11.88 R.B.S =65mg\dl Blood group ( O+ )

(HIV , HCV , HBsAg ….. Negative )Protective tests

Serum cretinine 0,7 mg \dl.

the operation was done and she birth twin(two bobies), two boys they are in good health then transfer to department to necessary care

NOW what about the Treatment ?

Taken or not therapeutic use

Dose1The drug The trade drug

Yes 2day

Supplement1 3Dextrose 5%

infusion Dextrose

Yes 2day

Supplement1 2

Normal saline

500cc infusion

Normal

Saline

In patient drugs

Taken or not therapeutic use

DoseThe drug The trade drug

Yes 3day

AntibioticAnaerobic)

1 3Metronidazol

500mg infusionFlagyl

Yes 3day

Antibiotic(cephalosporin)

1 2Ceftriaxone

1g vialCefex

In patient drugs

Taken or not therapeutic use

DoseThe drug The trade drug

SOSAnalgesic1 3Tramadol 100mg\ml amp

Tramal

first day

Post op.

PREVENT FIBRINOLYSIS

12

TramexicAcid250mg\2ml

Tramexi c acid

Yes

2Day

StimulateUtrinecontraction

1 1Oxytocin 10 I.U.

Ampule

Oxytocin

In patient drugs

Preoidtherapeutic use

DoseThe drug The trade drug

5 daysAntibiotic1 3MOXACILLINE LAVERUONIC

1g tab )ACIDOne weekAntibiotic1 3

Metronidazole500mg tab

SOSNSAIDs-----Diclofene Sodium)

75mg\3ml ampule IM

Out patient drugs