The HO guide

By Dr Gerard Loh
Edited by Dr Liew Nyan Chin
Places of duty
LDS PAC 4D Antenatal
4C Post Natal
6A Gynae
OT EM Clinic 4A/NC! OT EM/EL
Shift system AM PM ON
LDS
PAC
"a#$6%# wee&day'
"a#$(%# Sat)rday
**a#$**%# wee&day
*+a#$**%# wee&end
*+%#$*+a#
, ( -O' to clinic ne.t
#ornin/ on Mon/0ed/1ri
4D Antenatal ward
4C Postnatal ward
A !ynae"Onco ward
"a#$6%# wee&day
"a#$**a# wee&end
2Gr% in char/e o3 ward4
"a#$(%# Sat)rday
**a#$**%# wee&day
*+a#$**%# wee&end
24D54C4 26A4
*+%#$*+a#
#ards 4D $ A * Gro)% will be in char/e
o3 ward' e6ery ( wee&'
,( -O' /oe' to clinic
$ 10am-2pm (review
mothers in 4A+NICU)
- 2pm-11pm ( ward)
,both ward -O' to 4C
ne.t #ornin/ "a#$*+a#
, ward -O' #)'t do ni/ht
re6iew 3or 4C
, tend' to chan/e 3ro# ti#e to ti#e
*
't
Tri#e'ter *$*(
(
nd
Tri#e'ter *7$("
7
rd
Tri#e'ter (8$4(
Ter# 9 7"$ 4+ wee&'
Preter# 9 :7" wee&'
;iable 9 ((wee&'
EDD 9 4+w&'
EDD 5 </"= %o't date' not allowed 3or GDM= P-= PE
PAC 2Patient A''e''#ent Centre4
'/b or d/w >>> 2Medical o33icer/'%eciali't4
O%stetrics Cler&ing
Age$'ace(
!ra)idity* +arity 2G*P+4 ? !estation age( ? wee&' 5 day' by POA/POG/@EDD
Dates( SOD/!SOD= Menses( %re6io)'ly re/)lar/irre/)lar #en'e'=
Contrace+tion( !CD/barier/OCPA
Scans( Earlie't 'can ? >>wee&'= ')b'eB)ent 'can' corre'%ond' to date
* i U!"#$ earl% s&an ' 10 wee(s) *1 wee(s dis&repan&%) +,## -iven
Allowed dis&repan&%. 1
st
/rimester 01122 (413) ) 2
nd
/rimester 02122(413) ) 5
rd
/rimester0 5122
Marital statusC SMS/(
nd
)nion
Conce+tion$ '%ontaneo)'/ arti3icial/')b3ertility
ANC( 2P-/PE/GDM/ANEMA/!T/!@T/Candidio'i' / hi'tory o3 abortionDDetc4 or )ne6ent3)l
c$o or referred from ,,$!P for-.
Otherwise
no 'how=
no LL=
no !T=
no 3e6er=
no contraction %ain
/ood 1M
/arly +regnancy +ro%lem( 0chec& antenatal %oo& 1 +in& %oo&2
$boo&in/ date ? wee&'= ? EEA >>>>>
$boo&in/ BP>> = re#ain' nor#oten'i6e thro)/ho)t %re/nancy ran/in/ >>>
$Boo&in/ -b>>= ane#icA Late't -b>>
$MGTT doneA 2indicationC 3a#ily h.= a/e F7G= e.ce''i6e wei/ht /ain= %re6 #acro'o#ia/GDM/3etal abnor#alitie'4
$Alb)#in)ria//lyco')riaA
$Blood Gro)% / @he')' 2i3 NEGAT;E= any @ho/)# /i6en= ? >>wee&'
$n3ection' 'creenin/ doneA 2;D@L/-; 'creenin/4 Not reacti6e
Past O%stetric h3(
year= #ode o3 deli6ery= ho'%ital= baby 'e.= wei/ht = any co#%lication'A
, i3 '%acin/ FGyear'$ whyA ;ol)ntaryA Di33 )nionA
, Pay attention to %re6 'car= indication o3 LSCS= co)n'ellin/ 3or ;BAC
,%o't %art)#C 3e6er/%rolon/ed 'tay in ward/ wo)nd brea&down/PP-/blood tran'3)'ionA
Medical$surgical history
$ &nown #edical illne'' or ')r/erie' 2 a'th#a= thyroidi'#= DM= -PT etc4
Social H3( #arital 'tat)' 2#arried/SMS/(
nd
)nion4= occ)%ation= h)'bandH' occ)%ation= '#o&er/alcohol= ty%e o3 ho)'e/rented/own re'ident
Clinical Assesment
!eneralC alert= con'cio)'= not %ale= non tachy%noic= hydration 3air
SystemicC l)n/' clear= C;S D@NM= Thyroid NAD 2/oiter4= Brea't' NAD 2cy't/en/or/ed/#a''4
Pa( 'o3t= non$tender= 'in/leton= )ter)' ?w&'= ce%halic A/G= E10= 'car'A
S+eculum( (i indi&ated$ 66) P7 8leed1prem &9)
Cer6i. healthy 2ectro%ion/3ibroid4= co)/h te't 5/$ Lit#)' te't= %oolin/ o3 liB)or= o' clo'ed=
, any di'char/e 2white c)rdy/%)'4$ ta&e -i/h ;a/inal Swab 2Mandatory i3 %t i' ')bIected to '%ec)l)#4
4e( ;; nor#al 26arico'ity= 6e'icle'=cy't'DDetc4 = O' dilation= Cer6i. e33ace#ent= Station=
;erte.= #e#brane intact/ab'ent= no cord/%lacenta
u$s( Pre'entation= Lie= Placenta Site= A1= E10= CGA = %ara#eter' J BPD= 1L= AC= -C
CT!( Define ris&s* Contractions* 5aseline 6etal Heart 'ate* 4aria%ility* Acceleration* Deceleration
7m+ression( ')##ary o3 %roble# 2(G yo #alay lady= G*P+ ? 78 wee&'= #%C acti6e %ha'e o3 labo)r4
Management(
C$O Clinical assessment
Lower a%d +ain
$ inten'ity
$3reB)ency
a/w 'how/LLA
*4 PA
(4 ;E
74 CTG
, Pri#id O' clo'ed/TO1/: 7c# 9 allow ho#e i3 nearby5 tran'%ort a6ailable
,F7c# 9 3or ad#i''ion
Dd. 9 'tone'= a%%endiciti'= AGE
Lea&ing li8uor
$'ince ? ti#e
$ h./clinic ')//e'ti6eA
$ character= den'ity 2ClearA4
$ /)'hin//dribblin//A)rine
$ 'oa& %ant'/'%ot'
$ )'ed %ad'A
*4 PA
(4 S+eculum 9 H4S
74 ;E
44 CTG
G4 Scan J A1
, i3 h. and clinically de#on'trablePP@OM/P@OMA
, i3 not -. ')//e'ti6e= clinically not de#on'trable= ad#it 3or %ad chartK
Start antib. a3ter *8hr'= i3 not deli6ered= E; OL i3 F(4hr'
w1o or si-ns o &horioamnionitis J 3etal and #aternal tachycardia= 3e6er=
#econi)#= 0CC ele6ated
Show
$ ? ti#e
$ #)co)'5blood a/w abd %ainA
$ a/w lea&in/ liB)orA
$ %ad 'oa&ed/'%otty
*4PA
(4 '%ec)l)#/;E
74CTG
, Pri#id O' clo'ed/TO1/: 7c# 9 allow ho#e i3 nearby5 tran'%ort a6ailable
,F7c# 9 3or deli6ery
Dd. 9 P; bleedin/
P4 %leed
$ ? ti#e= a/w %ainA
$ '%otty/'tain/'oa&ed
$ tra)#aA Any POC
$ 'can'/%lacenta
*4 PA
(4 S%ec)l)#
74 CTG 2F74/G(4
, F ((wee&' T@O Placenta %rae6ia / acreta 2detailed 'can4
, : ((wee&' T@O #i'carria/e
, i3 indeter#inate AP-= do not allow %o't date'
Dd. 9 cer6ical ectro%ion
Discharge
$ colo)r= '#ell
$ a#o)nt= )'in/ %adA
$ $dy')ria= itchy= 3e6erA
$ A LL
*4 PA
(4 '%ec)l)# 5 -;S
74 !1EME
C)rdy white 9 6a/inal candidia'i'D Treat with cane'tan %e''ary / ON
:T7 sym+toms
$ dy')ria= b)rnin/
$ 3reB)ent )r/ency
$3e6er
*4 !1EME 2Le)/nitrate 54
(4 !rine C L S
Start antibiotic' 2TD Ce%hale.in G++#/ TDS */G(4
)ral / 'achet td' 7/"
'educed 6M
$ correct 1ECA <a#$<%#
$ )')al ti#e o3 co#%letion
$ ANC %robA h/o tra)#aA
$ h/o !T/candidaA
*4 PA
(4 'can 1-/1M
74 CTG 2F74/G(4
Ob'er6e * day 6,C in ward 2ca'e to ca'e ba'i'4
Teach correct #ethod o3 recordin/ 1EC
i3 %er'i'tently red)ced and at ter#= con'ider OL
High 5P
$ *
't
e%i'ode ? w&
$ on @.A
$ h/o hy%tertn %re6 %re/nancy
$ 'i/n' o3 E
Bl)rrin/ o3 6i'ion= headache=
/iddine''= e%i/a'tric %ain=
re3le.e' bri'&= clon)'
@e%eat BP #an)al i3 F*4+
Adalat *+#/ 'tat then=
#onitor BP Mhrly
Ad#it 3or BP #onitorin/
Daily )rine alb)#in
(4hr !rine %rotein
!1EME
PE %ro3ile
BP #onitorin/ in ward
P7H J -y%erten'ion in %re6io)'ly nor#oten'i6e #other
P/ J Ede#a 5 Protein)ria 5 -y%erten'ion
w1o si-ns o I, J bl)rrin/ o3 6i'ion= bri'& re3le.e'= clon)'= ede#a=
%rotein)ria
/clam+sia J EP- 5 tonic/clonic 'eiN)re'
!DM
$ d. ? w&'
$ diet control/in')lin
$ late't MGTT/BSP
$ E10= la't 'can
MGTT/BSP
Scan
%lot /rowth chart
-bA*C 2APree.i'tin/
DM4
3 %oor diet control= " %oint BSP E; in')lin i3 deran/ed
Do not allow %o't date
detailed 'can 3or 3etal abnor#alitie'/#acro'o#ia
o%thal#o a%%oint#ent
re3er dietician
Prem contraction
$ ? w&'
$ 3reB)ency
$ h/o !T/candidaA
$ de.a /i6enA
Scan
Ti#e contraction
CTG
: 74wee&'= con'ider tocoly'i'
74$7"wee&'= allow labo)r i3 %ro/re'' 2d/w MO4
M De.a#etha'one *(#/ . ( do'e' *( hr' a%art
TD EES 4++#/ td' 3or G/"
Anemia
$ -b ? w&'= late't
$ on he#atinic'/obi#in
$ h. tran'3)'ionA
*4 ane#ic 'i/n'
(4 1BC 2-b/MC-/MC;4
74 Ane#ic %ro3ile 21e4
44 'can
G4 , 1BP/-b Analy'i'
Scan 3or 3etal abnor#alitie'
Deter#ine ty%e o3 ane#ia 2DA= B*(/1olate de33/thala'e#ia etc4
'hesus Negati)e
$ Gra6idity/%arity
$ h)'band/%re6 baby @h
*4 GS-
(4 Coo#b' te't
, @ho/a# at (8w&' and 74wee&'= and within "(hr' %o't %art)#
Thyroidism
$ d. ? w&'
$ hy%o/hy%erthyroidi'#
$ on #edicationA
*4 thyroidi'# 'i/n'
(4 T1T
-y%o 9 L$Thyro.ine
-y%er J PT!
Carbi#aNole a3ter d/w endocrinolo/i't2)nder co#bine clinic e6ery la't
Th)r'day o3 the #onth4
Management of common +ro%lems
7n Acti)e Phase Of La%or
Transfer to LDS
$%lot %arto/ra#
$ ;E on 'tron/ contraction /bearin/ down
$ Ti#e contraction in (hr'= i3 ')bo%ti#al 3or a)/#entation a' %er %rotocol
$ ;D 4%int' -M/(4hr'
ConHt central CTG #onitorin/ with (hrly inter#ittent tracin/
o33er entono.
M %ethidine "G#/ 5 M %herne/an (G#/ i3 CTG reacti6e
Latent +hase of la%our
ad#it ward 4D
CTG daily
1EC
LPC/ 1-@ 4hrly
;E on Stron/ contraction/ bearin/ down/ or LL
1BC= GS-
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
P'OM$Lea&ing Li8our
ad#it ward 4D
$1BC / GS- / -;S
$LPC / 1-@ 4hrly
$'trict 1EC
$CTG daily
$'trict %ad chart $ to in3or# i3 /reeni'h di'char/e
$watcho)t 3or '/' o3 chorioa#nioniti'
$'tart ; a#%icillin (/ 'tat= i3 not deli6ered a3ter *8hr ? >>-=
then */ OD
$E; OL i3 not deli6ered a3ter (4hr
* i aller-i& to peni&illin - &lindam%&in
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
'educed 6M
ad#it ward 4D
1BC / GS-
LPC / 1-@ 4hrly
'trict 1EC
CTG daily
i3 %er'i'tently red)ced 1M= E; OL
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Premature contraction for tocolysis
ad#it -D0
1BC / GS- / -;S / !1EME
LPC / 1-@ 4hrly
'trict 1EC
TD adalat (+#/ in 4 do'e' e6ery *G#in'
M de.a *(#/ 'tat then *(hr later
boo& 6entilator
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
6alse la%our
Allow ho#e with rea'')rance
TCA 'tat i3 abdo#inal %ain/LL/P; bleed/3o)l '#ellin/ di'char/e
TCA at EDD 5</" 3or OL i3 not yet deli6ered
* :#;1PI<1P,1Indeterminate AP< &annot allow post dates
,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
4aginal Candidiosis
Allow di'char/e with #edication
Cane'ten %e''ary G++#/ ON */"
TCA (/G( clinic to re6iew -;S
TCA 'tat i3 abdo#inal %ain/3e6er/3o)l '#ellin/ di'char/e/PB bleed
:T7
Allow di'char/e with #edication
CD ce%hale.in G++#/ BD
!ral 'achet td' 3or 4/"
4aginal /3amination
;. 4ul)a")agina 2chec& 3or abnor#alitie'$ 6arico'ity= 6e'icle' etc4
<. Os 2deter#ine thi' by #ea')rin/ oneH' 3in/er'4
=. Cer)i3 dilation= con'i'tency= = thic&ne''= len/th= %o'ition 2anterior= a.ial= %o'terior4
$ both li%' 3elt P8c# = 'in/le li% 3elt P <c#= no li%' 3elt 9 3)lly
4. Station J lar/e't dia#eter o3 %re'entin/ %art in relation to %el6ic i'chial '%ine'
>. 4erte3
. Mem%rane intact/ab'ent$ 'li%%ery= balloon$li&e
?. no cord$+lacenta 3elt
S+eculum /3amination
Indi&ation$ lea(in- li=>or) P7 8leedin-1dis&har-e) prem
*D O' o%en/clo'ed
(D Cer6i. healthy 2ectro%ion/%oly%' etc4
7D Pooling of li8uor a %ool o3 liB)or i' de#on'trable in the 6a/ina
4D Cough test liB)or lea&' thro)/h cer6i. when co)/h
GD Litmus test liB)or i' #ore al&aline than )rine
6D Curdy whitish discharge 6a/inal candidio'i'
Always take High Vaginal Swab
!ltra'o)nd Scan
A67
Nor#al 6$(* =
:6 9 Oli/ohydra#nio'
F (* or 'in/le %oc&et 8c# 9 %olyhydra#nio'
LiBo)r AdeB)ate
CL
9 be't
LiBo)r AdeB)ate
#econi)# 'tained
9 %oor
LiBo)r nadeB)ate
CL
9 watch o)t
LiBo)r inadeB)ate
Meconi)# 'tained
9 6ery %oor
7nduction of la%our 2OL4
ndication'
*4 GDM
(4 P-= PE= E
74 %o't date EDD 5 </"
44 ndeter#inate AP-
G4 P@OM F (4hr'
64 red)ced 1M at ter#
Methods(
*4 'tretch and 'wee%
(4 A@M
74 ntra ;a/inal Pro'ta/landin 2Pro'tin$ PGE($7#/4 / Cer6ical 2cer6a/e#4
44 ; O.ytocin 2Pitocin4
, Pre6 'car' #a.i#)# %ro'tin . ( 2E; 7
rd
a3ter d/w '%eciali't
Co#%lication'C 3ailed OL= hy%er'ti#)lation
NOT TO ALLO0 %o't date'Q
*4 GDM
(4 P-= PE=Ecla#%'ia
74 ndeter#inate AP-
APH
*4 Placenta Prae6ia
(4 Placenta abr)%tio
74 ndeter#inate AP- F(( wee&'= a3ter r)le o)t Placenta %rae6ia and Abr)%tio
Placenta Prae)ia
$ can only dia/no'e a3ter (8wee&' 2 : (8w&' &nown a' LO0 LRNG %lacenta4
a4 Minor
Ty%e $ lower %art o3 %lacenta i' FGc# 3ro# O'
Ty%e $ lower 'e/#ent o3 %lacenta i' :Gc# 3ro# O'
b4MaIor
Ty%e J %lacenta co6er' O' %artly= co6er' 3)lly when dilated
Ty%e ; J %lacenta co6er' O' 3)lly= e6en when not dilated
Placenta a%ru+tio
$ PAC hard= woody hard= lar/e abdo#en
$ concealed/re6ealed
$ %er '%ec)l)#= P; bleed 3ro# O'
PPH
Tone J )ter)' #)'cle 3ati/)e= o6er di'ten'ion
Ti'')e J retained %lacenta
Tra)#a J tear'= )terine r)%t)re/in6er'ion
Thro#bin J clottin/ di'order= TP= -ELLP 'yndro#e= D;C

Anemia H% @ ;A
*4 ron De3iciency Ane#ia
Sy#%to#'C 'idero%enic chan/e'$brittle hair/nail'= %allor= tachycardia= %al%itation'
$ 65CC -b= MC; / MC- decrea'ed
$ Anemic +rofileC 'er)# ron decrea'ed = 1erritin increa'ed= TBC increa'ed = !BC increa'ed
$ 6ull 5lood +icture 9 Microcytic= -y%ochro#ic cell'
M.C he#atinic'= 3erro)' 3)#arate= 3olic acid
(4 Thalla'e#ia 2a $thala''e#ia i' #o't co##on in So)thea't A'iaD4
$ 1BCC -b= MC; / MC- decrea'ed
$ Ane#ic %ro3ile #ay be nor#al
$ 1)ll Blood %ict)reC Tar/et cell'
$ -b analy'i'
74 B*(/ 3olate de3iciency ane#ia
$ 1BCC -b decrea'e= MC;/MC- increa'ed
$ Ane#ic %ro3ile nor#al
$ 1)ll blood %ict)reC #e/alobla'tic= hy%erchro#ic
$ 'er)# B*(/3olate decrea'e
, %ernicio)' ane#ia J decrea'ed intrin'ic 3actor 2/a'tric %b4
Hy+ertension
$ BP 'y'tolic F *4+/ dia'tolic F<+
*4 E''ential -PT / 'econdary -PT
(4 P- JPre/nancy ind)ced= F ((w&'=
Late on'et P-
74 Pre Ecla#%'ia J Ede#a5Protein)ria 5 -y%erten'ion 2EP- co#%le.4
!1EME Pro 5= !ric acid ele6ated= ALT/Plt ele6ated 2-ELLP4= Creatinine ele6ated
44 Ecla#%'ia 2 Ede#a= %rotein)ria= hy%erten'ion 5 'eiN)re'4
$ headache= na)'ea= 6o#itin/= e%i/a'tric %ain= bl)rrin/ o3 6i'ion= hy%erre3le.ia
M.
*4 bed re't
(4 #onitor 6ital' BP 4hrly
74 PE %ro3ileC !1EME= (4hr )rine %rotein= !ric acid= 1BC 2%lt4=
44 PE chartC BP= P@= Bl)rrin/ 6i'ion= @e3le.e'
Anti -PT
; Adalat *+#/
; Labetalol *++$(++$7++#/
; -ydraNaline G#/
; Methyldo%a

La%our Deli)ery Suite
Labo)r @oo# 5 -D0
*D @e6iew %atient note' and hi'tory
(D A''e'' %atientC 6ital'= PA
7D Per3or# A@M 2i3 M4 a' indicatedD Note character o3 liB)orD CBD
4D ;E internal e.a#ination 2O'= C. thic&ne''= location= Station= %re'entin/ %art= cord/%lacenta4
GD 'tart CTG= Plot %arto/ra#
6D 0rite detail' on the board 5 enter data into central CTG
"D Note ti#e o3 ne.t ;E re6iew
6rom Time 7n Name $ AM Diagnosis Os Ne3t 4/ To Do
4#1PAC 0?00< N->%en
A;00222552
:1P" ' 5@122 + ?13
- P+"; (66 A1@hrs)
?&m
;I-A+;-C6
1000<
Tas&s
*D A@M/;E re6iew
(D Deli6ery/E%i'ioto#y
7D Tear/e%i'ioto#y re%air
4D Mother Po't Natal re6iew
GD Baby Po't natal re6iew
A'M 0artificial ru+ture of mem%rane2
*D Ma&e ')re 'can' con3ir# %lacenta !%%er 'e/#ent
(D Per3or# ;E= #e#brane intact 2'#ooth= 'li%%ery balloon$li&e4 or ab'ent 2ro)/h= hair 3elt4
7D 3 M= deter#ine '%ot 3or A@M= a 'li/ht b)l/in/= #ay be elicited by a'&in/ %atient to co)/h
4D Po'ition ( 3in/er' at thi' '%ot= in'ert a#niohoo& between yo)r ( 3in/er'= with hoo& 3acin/ down
GD @otate hoo& )%ward'= )'in/ inde. 3in/er= %)'h the hoo& li/htly a/ain't the #e#brane and 'lowly retract to r)%t)re the #e#brane
6D A /)'hin/ o3 liB)or indicate' a ')cce''3)l A@MD Drain 'o#e liB)or to e.a#ine it' character
a4 Clear LiBo)r
b4 LMSL J li/ht #econi)# 'tained liB)or J watery browni'h 'tained
c4 MMSL $ #oderate MSL 9 watery with tiny %article' 6i'ibile
d4 Thic& #econi)# J #ini#al liB)or= thic& /reeni'h/dar& %article'
Plan(
*D Plot Parto/ra#
(D ;E on 'tron/ contraction/lea&in/ liB)or/bearin/ down
7D O33er enthono.
4D M Pethidine "G#/ 5 M %hener/an (G#/ i C/: rea&tive
GD Ti#e contraction= i3 ')bo%ti#al 3or a)/#entation a' %er %rotocol
6D Contin)o)' central CTG #onitorin/ with (hrly inter#ittent tracin/
"D ;D 4%int' -M o6er (4 hr'
7nform MO
$ S)'%icio)'/Patholo/ical CTG
$ #econi)# 'tained liB)or
$ %olyhydra#nio' 3or controlled A@M
$ abnor#al %re'entation
$ Prolon/ed (
nd
'ta/e C Pri#id F* ho)r= #)lti%ara F7+$4G#in'
$ @etained %lacenta
/+isiotomy
*D 0ait 3or crownin/ o3 the head= /i6e LA
(D in'ert ( 3in/er' a' 'hown= wait 3or thinnin/ o3 the %erine)#
7D C)t at #edio$lateral an/le while %atient i' bearin/ down
4D G)ard with ta#%on
/+isiotomy 'e+air
*D Locate the a+e3 o3 tear and be/in ')t)rin/ *c# abo6e thi' %oint
(D A%%ly contin)o)' ')t)re and end with &not at the fourchette
7D Ne.t= a%%ly interr)%ted ')t)re in the muscular layer
4D 1inally= a%%ly interr)%ted ')t)re to s&in 2n'ide$o)t o)t$in4
Plot Partogram
Time contraction* if su%o+timal for augmentation as +er +rotocol
Contractions
;ild 50se&s
;oderate 50-42se&s
!tron-$*42se&s
"ptimal . 5-4 in 10mins
* h%perstim>lation *4-?
Augementation
CT!
#r C Bravado
*4 De3ine @i'&'
(4 Contraction' 2 (C*+= FG $hy%er'ti#)lation
74 Ba'eline @ate 2**+$*6+b%#4
44 Acceleration
>2 4aria%ility
http$11>tilisCnet1hm12424Chtm
Decelerations 1
Decelerations
*D Early J decel occ)r' with contraction' 26a'o$6a/al re'%on'e= 3etal head co#%re''ion4
(D Late J decel occ)r' a3ter contraction 2)tero$%lacental in')33iciency4
7D ;ariable J ) 'ha%ed= not related to contraction 2cord co#%re''ion4
a4 Early b4 Late
c4 ;ariable d4 Prolon/ed
!ynecology
Hy+eremesis !ra)idarum
;D 6 %int' -M
Daily )rine &etone
;o#it chart= /O chart
; Ma.olon *+#/ td'
; ranitidine G+#/ td'
-y%ere#e'i' ad6ice
Hy+eremesis ad)ice
1C avoid tri--er a&tors
2C avoid ood with odo>r
5C small re=>ent meals
4C avoid oil% ood
2C eat 8eore 8r>shin- teeth
?C drin( water with lemon
3C resh air
@C li-ht e9er&ises
4C stri&tl% ta(e ma9olon even witho>t s9

!DM
" %oint BSP E; n')lin i3 deran/ed
-bA*C
re3er dietician
o%thal#o a%%oint#ent
detailed 'can a%%oint#ent
Miscarriage
;2 7ncom+lete miscarriage
$ e6idence o3 retained POC
$hetero/eno)' echo/eneticity in )ter)'
PlanC E@POC
<2 Threathened miscarriage
$ 6iable 3et)'= 1- acti6ity %re'ent
$ #ea')re C@L 3or datin/
=2 Missed miscarriage
$ colla%'ed e#%ty !GS
TAS F(G## / T;S F(+##
42 Molar +regnancy
$ no 3etal %ole$ only 6e'icle'
$ 'now'tor# a%%earance
$ Beta -CG
>2 T'O ecto+ic +regnancy
$ e#%ty )ter)'
$ %re'ence o3 adne.al #a'' with 3ree 3l)id
$ ta&e beta -CG
O6arian Cy't
PCOS
The !ynae Onco HO guide
%y Dr !erard Loh
*4 %reche#o . 9 1BC/@P/ Ca #ar&er' 2CA*(G/CEA/A1P4 or B$-CG de%endin/ on h. 2i3 F7+year' 5 @BS4
(4 Gynae cler&in/
74 Trace blood .= in3or# con')ltant the re')lt'=
44 Bran)laC #a. ( atte#%t' allowed= i3 )nable to 'et= /et ')%erior to try
G4 Che#o chart$ e6ery %atient ha' a che#o chart with re/i#e= dia/no'i'= how #any cycle'= ne.t CT 'can etc
$ 'elect the a%%ro%riate 3or# and 3ill inC
Ab'ol)te Ne)tro%hil Co)nt F (D+ = i3 :(D+ to /i6e Ne)%o/en %rior to che#o
, %re%are che#o chart= ob'er6ation chart and #edication chart be3ore ro)nd'
, %re%are needle' Green/%in&= %la'ter 2bandaid4= 7M %la'ter'= /lo6e'= 'wab= 'yrin/e'= bran)la'
, %rinci%le J to /et a /ood line= to #aintain line 2r)n NS 3a't4
'adiothera+y
ndicated in Cer6ical cancer
Date H% Plt T#C $ ANC Creat CrCl ,9 Na9 :rea Ca mar&ers
Nor#C F*+ F*++E F7E :*"" FG+ 7D7$GD+ *7G$*4G (D6$"D"
!estational Tro+ho%lastic Disease
PTD B Progressi)e Tro+ho%lastic Disease
'egimes
Single Agent Methotre3ate 0#HO score @?2 ;A days
Day *$ ; MTS G+#/ in (++#l DGT o6er *G#in'
Day ($ M 1olinic Acid 6#/ 27+hr' later4
Day 7 MTS UD Day 4 1olinic AcidUDD, alternate to co#%lete *+ day'
+epeat ater interval o 3 da%s) to &omplete 2 more &%&les ater B<C: A2 IU16
MTC"Actinomycin"D regime ;A days
D* $ ; MTS G+#/ in (++#l DGT o6er *G#in'
D($ ; Actino#ycin$D +DG#/ bol)' 5 M 1olinic Acid 6#/
D7 MTSUD4 Actino$D 5 1AUDalternate )% to *+ day'
+epeat ater interval o 3 da%s) to &omplete 2 more &%&les ater B<C: A2 IU16
MA regime 0high ris&2 4 days
0-O 'core F"
/MA"CO 9 /to%o'ide $ MTS $ Actino#ycin 2*
't
wee&4 5 Cyclo%ho'%ha#ide $ Onco6in 2;incri'tine4 2(
nd
wee&4
, 3 3ail EMA$CO 3ailDD
/MA"C/ 9 /to%o'ide $ MTS $ Actino#ycin 2*
't
wee&4 5 Ci'%latin$ /to%o'ide 2(
nd
wee&4
* Ater 5-4 wee(s normal B<C:) o8serve monthl% B<C: or 2 %ears
Pre"med 0D;"<2 27+ #in' be3ore che#o4 C ; De.a#etha'one 8#/ bol)' 5 ; Odan'etron 8#/
Prehydration 0D;"<2C ; D/S G++#l o6er 7+#in'
ChemoC
D*C PM5P- $ ; Actino#ycin$D +DG#/ bol)' 5 MTS *++#//#
(
bol)' 5 ; MTS (++#//#
(
in G++#l NS o6er *(hr'
D(C PM5P- $ ; Actino#ycin$D +DG#/ bol)' 5 M 1olinic Acid 7+#/ 5 M 1olinic Acid 2*(hr' later4
D7C M 1olinic Acid 7+#/ 5 M 1olinic Acid 2*(hr' later4
D4C M 1olinic Acid 7+#/
@e%eat a3ter " day' inter6al to co#%lete ( #ore cycle' a3ter B-CG : ( !/L
O)arian Cancer
E%ithelial o6arian cancer
E%ithelial t)#or' re%re'ent the #o't co##on hi'tolo/y 2<+T4 o3 o6arian t)#or'D Other hi'tolo/ie' incl)de the 3ollowin/C
Se.$cord 'tro#al t)#or'
Ger# cell t)#or'
Pri#ary %eritoneal carcino#a
Meta'tatic t)#or' o3 the o6ary
1i6e #ain hi'tolo/ic ')bty%e'= which are 'i#ilar to carcino#a= ari'e in the e%ithelial linin/ o3 the cer6i.= )ter)'= and 3allo%ian t)be=
Sero)' 23ro# 3allo%ian t)be4
Endo#etrioid 2endo#etri)#4
M)cino)' 2cer6i.4
Clear cell 2#e'one%hro'4
Brenner
Stage 7AC Growth li#ited to * o6ary= no t)#or on the e.ternal ')r3ace= ca%')le intact= no a'cite' %re'ent containin/ #ali/nant cell'
Stage 75C Growth li#ited to both o6arie'= no t)#or on the e.ternal ')r3ace'= ca%')le' intact= no a'cite' %re'ent containin/ #ali/nant
cell'
Stage 7CC T)#or either 'ta/e A or B= b)t with t)#or on ')r3ace o3 * or both o6arie' with ca%')le r)%t)red=, with a'cite' %re'ent
containin/ #ali/nant cell'= or with %o'iti6e %eritoneal wa'hin/'
Stage 77C Growth in6ol6in/ * or both o6arie' with %el6ic e.ten'ion
Stage 77ACE.ten'ion and/or #eta'ta'e' to the )ter)' and/or t)be'
Stage 775CE.ten'ion to other %el6ic ti'')e'
Stage 77CC T)#or either 'ta/e A or B= b)t with t)#or on ')r3ace o3 * or both o6arie'= with ca%')le2'4 r)%t)red=, with a'cite'
%re'ent containin/ #ali/nant o6arie'= or with %o'iti6e %eritoneal wa'hin/'
Stage 777C T)#or in6ol6in/ * or both o6arie' with hi'tolo/ically con3ir#ed %eritoneal i#%lant' o)t'ide %el6i' and/or %o'iti6e
retro%eritoneal or in/)inal node'V ')%er3icial li6er #eta'ta'i'V t)#or li#ited to tr)e %el6i'= b)t with hi'tolo/ically %ro6en #ali/nant
e.ten'ion to '#all bowel and o#ent)#
Stage 777AC T)#or /ro''ly li#ited to the tr)e %el6i'= with ne/ati6e node'= b)t with hi'tolo/ically con3ir#ed #icro'co%ic 'eedin/ o3
abdo#inal %eritoneal ')r3ace' or hi'tolo/ically %ro6en e.ten'ion to '#all bowel #e'entery
Stage 7775CT)#or o3 * or both o6arie' with hi'tolo/ically con3ir#ed i#%lant'= %eritoneal #eta'ta'i' o3 abdo#inal %eritoneal
')r3ace' W ( c# in dia#eterV node' are ne/ati6e
Stage 777CCPeritoneal #eta'ta'i' beyond the %el6i' F ( c# in dia#eter and/or %o'iti6e retro%eritoneal or in/)inal node'
Stage 74( Growth in6ol6in/ * or both o6arie' with di'tant #eta'ta'e'V i3 %le)ral e33)'ion i' %re'ent= %o'iti6e cytolo/y #)'t be
a%%arent to allot a ca'e to 'ta/e ;V %arenchy#al li6er #eta'ta'i' B)ali3ie' a' 'ta/e ; di'ea'e
TableD TNM and 1GO Cla''i3ication' 3or O6arian Cancer
Primary tumor 0T2
/N; DI:"
TS Pri#ary t)#or cannot be a''e''ed
T+ No e6idence o3 %ri#ary t)#or
T* T)#or li#ited to the o6arie' 2* or both4
T*a A T)#or li#ited to * o6aryV ca%')le intact= no t)#or on o6arian ')r3aceV no #ali/nant cell' in a'cite' or %eritoneal
wa'hin/'
T*b B T)#or li#ited to both o6arie'V ca%')le' intact= no t)#or on o6arian ')r3aceV no #ali/nant cell' in a'cite' or %eritoneal
wa'hin/'
T*c C T)#or li#ited to * or both o6arie' with any o3 the 3ollowin/C ca%')le r)%t)red= t)#or on o6arian ')r3ace= #ali/nant
cell' in a'cite' or %eritoneal wa'hin/'
T( T)#or in6ol6e' * or both o6arie' with %el6ic e.ten'ion
T(a A E.ten'ion and/or i#%lant' on the )ter)' and/or t)be2'4V no #ali/nant cell' in a'cite' or %eritoneal wa'hin/'
T(b B E.ten'ion to other %el6ic ti'')e'V no #ali/nant cell' in a'cite' or %eritoneal wa'hin/'
T(c C Pel6ic e.ten'ion 2T(a or T(b4 with #ali/nant cell' in a'cite' or %eritoneal wa'hin/'
T7 T)#or in6ol6e' * or both o6arie' with #icro'co%ically con3ir#ed %eritoneal #eta'ta'i' o)t'ide the %el6i'
T7a A Micro'co%ic %eritoneal #eta'ta'i' beyond the %el6i' 2no #acro'co%ic t)#or4
T7b B Macro'co%ic %eritoneal #eta'ta'i' beyond the %el6i' F ( c# or le'' in /reate't di#en'ion
T7c C Macro'co%ic %eritoneal #eta'ta'i' beyond the %el6i' F ( c# in /reate't di#en'ion and/or re/ional ly#%h node
#eta'ta'i'
'egional lym+h nodes 0N2
/N; DI:"
NS @e/ional ly#%h node' cannot be a''e''ed
N+ No re/ional ly#%h node #eta'ta'i'
N* C @e/ional ly#%h node #eta'ta'i'
Distant metastasis 0M2
/N; DI:"
M+ No di'tant #eta'ta'i'
M* ; Di'tant #eta'ta'i' 2e.cl)de %eritoneal #eta'ta'i'4
Note'C
The %re'ence o3 non#ali/nant a'cite' i' not cla''i3iedD The %re'ence o3 a'cite' doe' not a33ect 'ta/in/ )nle'' #ali/nant cell'
are %re'entD
Li6er ca%')le #eta'ta'i' i' T7/'ta/e V li6er %arenchy#al #eta'ta'i'= M*/'ta/e ;D Ple)ral e33)'ion #)'t ha6e %o'iti6e
cytolo/y 3or M/'ta/e ;D
Prognosis
G year ')r6i6al rate
Sta/e A $ 8"T
Sta/e B $ "*T
Sta/e C $ "<T
Sta/e A $ 6"T
Sta/e B $ GGT
Sta/e C $ G"T
Sta/e A $ 4*T
Sta/e B $ (GT
Sta/e C $ (7T
Sta/e ; $ **T
O6erall ')r6i6al rate J 46T
Metastasis
$ %eritoneal 2dia%hra/#= %aracolic /)tter'= bladder= li6er=#e'entery= 'ero'a o3 bowel= o#ent)#= )ter)'4
$ %le)ral ca6ity= l)n/'= and /roin ly#%h node'D
Chemothera+y for O)arian tumours
'egimes
E%ithelian o6
arian cancer
;. Car%o+latin$Paclita3el 0Car%o$Ta3ol2
<. Single Car%o+latin
=. Car%o+latin$ Li+osomal Do3oru%icin 0CA/LDC2
4. Car%o+latin$Do3oru%icin
Premeds ++++-rC ; De.a#etha'one 8#/ bol)' 5 ; Eytril 8#/
+rehydration ( ; G++#l D/' o6er 7+#in'
chemothera+y( /i6en o6er *hr
Home( TD Ma.alon *+#/ td' 7/" 5 TD@anitidine *G+#/ BD 7/" 5 TD De.a#etha'one (#/ td' 7/" 2C in DM4
, TCA Day *+ 3or 1BC= TCA 7 wee&' 3or ne.t cycle 27 wee&ly . 64
@ec)rrent E%ithelial O6arian Ca
Car%o+latin 9 gemcita%ine 0= wee&ly 3 cycles2
D;( Pre#ed' 5 Prehydration 5 74 !emcita%ine 9 74 Car%o+latin
HomeC TD Ma.alon *+#/ td' 7/" 5 TD@anitidine *G+#/ BD 7/" 5 TD De.a#etha'one (#/ td' 7/" 2C in DM4 ,TCA Day 8
DE( Pre#ed' 5 Prehydration 5 74 !emcita%ine
HomeC TD Ma.alon *+#/ td' 7/" 5 TD@anitidine *G+#/ BD 7/" 5 TD De.a#etha'one (#/ td' 7/"
Ger# cell T)#o)r
5/P" 5leomycin* /to+oside* Cis+latin
, 'trict /O chart
D*C X-ydrationY 5 XPre#ed'53r)'e#ideY 5 X74 /to+osideY $ Mannitol $ X74 Cis+latinY J X-ydrationY 5 7M 5leomycin
D(C X-ydrationY 5 XPre#ed'53r)'e#ideY 5 X74 /to+osideY $ Mannitol $ X74 Cis+latinY J X-ydrationY 5 7M 5leomycin
D7 C X-ydrationY 5 XPre#ed'53r)'e#ideY 5 X74 /to+osideY $ Mannitol $ X74 Cis+latinY 5 X-ydrationY
D8 C 7M 5leomycin
D*G C 7M 5leomycin
Cer)ical Cancer
TableD TNM and 1GO Cla''i3ication' 3or Cer6ical Cancer
Primary tumor 0T2
TNM 67!O Surgical"Pathologic 6indings
Cate-ories !ta-es
TS Pri#ary t)#or cannot be a''e''ed
T+ No e6idence o3 %ri#ary t)#or
Ti' Carcino#a in 'it) 2%rein6a'i6e carcino#a4
T* Cer6ical carcino#a con3ined to the cer6i. 2di're/ard e.ten'ion to the cor%)'4
T*a A n6a'i6e carcino#a dia/no'ed only by #icro'co%yV 'tro#al in6a'ion with a #a.i#)# de%th o3 GD+ ## #ea')red
3ro# the ba'e o3 the e%itheli)# and a horiNontal '%read o3 "D+ ## or le''V 6a'c)lar '%ace in6ol6e#ent= 6eno)' or
ly#%hatic= doe' not a33ect cla''i3ication
T*a* A* Mea')red 'tro#al in6a'ion W 7D+ ## in de%th and W "D+ ## in horiNontal '%read
T*a( A( Mea')red 'tro#al in6a'ion F 7D+ ## and W GD+ ## with a horiNontal '%read W "D+ ##
T*b B Clinically 6i'ible le'ion con3ined to the cer6i. or #icro'co%ic le'ion /reater than T*a/A(
T*b* B* Clinically 6i'ible le'ion W 4D+ c# in /reate't di#en'ion
T*b( B( Clinically 6i'ible le'ion F 4D+ c# in /reate't di#en'ion
T( Cer6ical carcino#a in6ade' beyond )ter)' b)t not to %el6ic wall or to lower third o3 6a/ina
T(a A T)#or witho)t %ara#etrial in6a'ion
T(a* A* Clinically 6i'ible le'ion W 4D+ c# in /reate't di#en'ion
T(a( A( Clinically 6i'ible le'ion F 4D+ c# in /reate't di#en'ion
T(b B T)#or with %ara#etrial in6a'ion
T7 T)#or e.tend' to %el6ic wall and/or in6ol6e' lower third o3 6a/ina and/or ca)'e' hydrone%hro'i' or
non3)nctional &idney
T7a A T)#or in6ol6e' lower third o3 6a/ina= no e.ten'ion to %el6ic wall
T7b B T)#or e.tend' to %el6ic wall and/or ca)'e' hydrone%hro'i' or non3)nctional &idney
T4 ; T)#or in6ade' #)co'a o3 bladder or rect)# and/or e.tend' beyond tr)e %el6i' 2b)llo)' ede#a i' not ')33icient to
cla''i3y a t)#or a' T44
T4a ;A T)#or in6ade' #)co'a o3 bladder or rect)# 2b)llo)' ede#a i' not ')33icient to cla''i3y a t)#or a' T44
T4b ;B T)#or e.tend' beyond tr)e %el6i'
'egional lym+h nodes 0N2
NS @e/ional ly#%h node' cannot be a''e''ed
N+ No re/ional ly#%h node #eta'ta'i'
N* @e/ional ly#%h node #eta'ta'i'
Distant metastasis 0M2
M+ No di'tant #eta'ta'i'
M* Di'tant #eta'ta'i' 2incl)din/ %eritoneal '%readV in6ol6e#ent o3 ')%racla6ic)lar= #edia'tinal= or %ara$aortic ly#%h node'V
and l)n/= li6er= or bone4
Pro/no'i' o3 cer6ical cancer de%end' on di'ea'e 'ta/eD n /eneral= the G$year ')r6i6al rate' are a' 3ollow'C
Sta/e $ Greater than <+T
Sta/e $ 6+$8+T
Sta/e $ A%%ro.i#ately G+T
Sta/e ; $ Le'' than 7+T
1or early in6a'i6e cancer= ')r/ery i' the treat#ent o3 choiceD n #ore ad6anced ca'e'= radiation co#bined with che#othera%y i' the
c)rrent 'tandard o3 careD
Treat#ent by Sta/e
J Loo% E.ci'ion
A* 9 Total hy'terecto#y= radical hy'terecto#y= and coni'ation
A(= B= A 9 radiation with brachythera%y or radical hy'terecto#y with bilateral %el6ic ly#%hadenecto#y
B$;A 9 @adiation thera%y 5 ci'%latin$ba'ed che#othera%y
PAP smear

Parameters ACS 'ecommendations
A/e to 'tart 'creenin/ Be/in 'creenin/ with cytolo/y at (* year' old= re/ardle'' o3 'e.)al hi'tory
Screenin/ inter6al a/e
(*J(<
Screen with cytolo/y alone e6ery 7 year'D, -P; te'tin/ 'ho)ld not be )'ed in thi' a/e /ro)%D
Screenin/ inter6al a/e
7+$6G
Screen with a co#bination o3 cytolo/y and -P; te'tin/ e6ery G year' 2%re3erred4 or cytolo/y alone e6ery 7
year'D Screenin/ by -P; te'tin/ alone i' /enerally not reco##endedD,
A/e to 'to% 'creenin/ A/e 6G= i3 the wo#an ha' adeB)ate ne/ati6e %rior 'creenin/ and i' not otherwi'e at hi/h ri'& 3or cer6ical
cancer
Screenin/ a3ter
hy'terecto#y
Not indicated 3or wo#en witho)t a cer6i. and witho)t a hi'tory o3 a hi/h$/rade %recancero)' le'ion 2e/=
CN( or CN74 in the %a't (+ year' or cer6ical cancer e6er
-P;$6accinated
wo#en
Screen accordin/ to the 'a#e reco##endation' a' 3or )n6accinated wo#en
PAP smear results
Negati)e for intrae+ithelial lesion or malignancy
E%ithelial cell abnor#ality
!=>amo>s &ell
Aty%ical 'B)a#o)' cell' 2ASC4 o3 )ndeter#ined 'i/ni3icance 2ASC$!S4 or aty%ical 'B)a#o)' cell' that cannot e.cl)de
-SL 2ASC$-4
Low$/rade 'B)a#o)' intrae%ithelial le'ion' 2LSL4= incl)de' h)#an %a%illo#a6ir)' 2-P;4= #ild dy'%la'ia= and CN *
-i/h$/rade 'B)a#o)' intrae%ithelial le'ion' 2-SL4= incl)de' #oderate to 'e6ere dy'%la'ia= carcino#a in 'it)= CN (= and
CN 7
SB)a#o)' cell carcino#a
:land>lar &ell
Aty%ical /land)lar cell' 2AGC4= '%eci3y endocer6ical= endo#etrial= or not otherwi'e '%eci3ied 2NOS4
Aty%ical endocer6ical cell'= 3a6or neo%la'tic= '%eci3y endocer6ical or NOS
Endocer6ical adenocarcino#a in 'it) 2AS4
Adenocarcino#a
Management of women with ASC":S
Eomen a-e 21 or -reater with A!C-U!
Per3or# re3le. -P; te'tin/
3 %o'iti6e 3or -P;= then %roceed with col%o'co%y
3 ne/ati6e 3or -P;= then re%eat Pa% '#ear in *(
#onth'
Eomen a-e 20 or less with A!C-U!
@e%eat Pa% '#ear at *( #onth'
3 re%eat cytolo/y 'how' -SL or wor'e= %er3or#
col%o'co%yV otherwi'e re%eat cytolo/y a3ter *(
#onth'
3 'econd re%eat cytolo/y i' ne/ati6e= ro)tine
'creenin/ #ay be re')#edV i3 ASC or /reater=
%roceed with col%o'co%yD
Pre-nant women with A!C-U!
Mana/ed 'a#e a' non%re/nant wo#enV
endocer6ical c)retta/e 2ECC4 i' contraindicated in
%re/nant wo#en and 'ho)ld not be collected i3
col%o'co%y i' %er3or#edD De3errin/ col%o'co%y )ntil
at lea't 6 wee&' %o't%art)# i' al'o %o''ibleD
Management of women with ASC"H
@e3er to col%o'co%y
Management of women with LS7L
Eomen a-e 21 or -reater with 6!I6
@e3er to col%o'co%y
Eomen a-e 20 or less with 6!I6
@e%eat %a% '#ear in *( #onth'V 3ollow /)ideline'
3or ASC$!S
Pre-nant women with 6!I6$
Mana/ed 'a#e a' non$%re/nant wo#enV
endocer6ical c)retta/e 2ECC4 i' contraindicated in
%re/nant wo#en= and 'ho)ld not be collected i3
col%o'co%y i' %er3or#edD t i' al'o acce%table to
de3er col%o'co%y )ntil at lea't 6 wee&' %o't%art)#D
Postmenopa>sal women with 6!I6
Acce%table o%tion' incl)de re3le. -P; te'tin/=
re%eat Pa% at 6 and *( #onth'= and col%o'co%yD 3
-P; ne/ati6e or no CN on col%o'co%y= re%eat
cytolo/y in *( #onth'D
Management of women with HS7L
@e3er to col%o'co%y re/ardle'' o3 a/e
Pre-nant women with <!I6
Mana/ed 'a#e a' non%re/nant wo#enV
endocer6ical c)retta/e 2ECC4 i' contraindicated in
%re/nant wo#en and 'ho)ld not be collected i3
col%o'co%y i' %er3or#edD
Management of women with A!C
Eomen with A:C) in&l>din- A!C-N"!) A:C-avor
neoplasia) and AI!
@e3er to col%o'co%y with endocer6ical 'a#%lin/ and
-P; DNA te'tin/
3 a/e 7G or /reater or with other ri'& 3actor' 3or
endo#etrial neo%la'ia= endo#etrial 'a#%lin/ 'ho)ld
al'o be %er3or#edD
Eomen with at%pi&al endometrial &ells$
Per3or# endo#etrial bio%'y and endocer6ical
'a#%lin/D 3 no %atholo/y 3o)nd= %roceed with
col%o'co%yD
Management of women with %enign endometrial cells
found in cer)ical cytology
No additional e6al)ation i' reB)ired in
a'y#%to#atic %re#eno%a)'al wo#en
n %o't#eno%a)'al wo#en= %er3or# endo#etrial
bio%'y
Management of women age =A and older who are Pa+
negati)e and HP4 +ositi)e
@e%eat Pa% and -P; DNA te'tin/ in *( #onth'
3 Pa% ne/ati6e= -P; ne/ati6e= re'creen no 'ooner
than 7 year'
3 Pa% abnor#al with any -P; re')lt= 3ollow
ASCCP /)ideline'
3 Pa% ne/ati6e= -P; %o'iti6e= re3er to col%o'co%y
Another o%tion wo)ld be to %er3or# -P; *6 and *8 te'tin/
3 *6 or *8 %o'iti6e= re3er to col%o'co%y
3 *6 and *8 ne/ati6e= re%eat Pa% and -P; te'tin/ in
*( #onth'
3 Pa% ne/ati6e= -P; ne/ati6e= re'creen no 'ooner
than 7 year'
3 Pa% abnor#al with any -P; re')lt= 3ollow
ASCCP /)ideline'
3 Pa% ne/ati6e -P; %o'iti6e= re3er to col%o'co%y
LL/TF
Cone 5io+sy