Perineal tear

classification
Lacerations are classified into four categories:[1] [2]
First degree tear: laceration is limited to the fourchette and superficial
perineal skin or vaginal mucosa
Second degree tear: laceration extends beyond fourchette, perineal skin
and vaginal mucosa to perineal muscles and fascia, but not the anal
sphincter
Third degree tear: fourchette, perineal skin, vaginal mucosa, muscles,
and anal sphincter are torn
Fourth degree tear: fourchette, perineal skin, vaginal mucosa, muscles,
anal sphincter, and rectal mucosa are torn
Third degree tears may be further subdivided into three subcategories:
[3]

3a: partial tear of the external anal sphincter involving less than 50%
thickness
3b: greater than 50% tear of the external anal sphincter
3c: internal sphincter is torn

Uterine prolapse
There are various grades:
Grade 1 - where the uterus has reached the low half of the
vagina.
Grade 2 - where the uterus has reached the opening of the
vagina.
Grade 3 - where the uterus (cervix) is protruding outside the
vagina.
Grade 4 - where the whole uterus and vagina are completely
outside the vaginal opening.

Cervical cancer staging

Stage 0 The carcinoma is confined to the surface layer (cells
lining) of the cervix. Also called carcinoma in situ (CIS).
Stage I The carcinoma has grown deeper into the cervix, but
has not spread beyond it (extension to the corpus would be
disregarded).
IA Invasive carcinoma which can be diagnosed only by microscopy,
with deepest invasion <5mm and the largest extension <7mm
IA1 Measured stromal invasion of <3.0 mm in depth and extension of <7.0
mm
IA2 Measured stromal invasion of >3.0 mm and not >5.0 mm with an
extension of not >7.0mm

IB Clinically visible lesions limited to the cervix uteri or pre-clinical

cancers greater than stage IA
IB1 Clinically visible lesion <4.0 cm in greatest dimension
IB2 Clinically visible lesion >4.0 cm in greatest dimension

Tx TB in pregnancy
If there is believed to be no
significant resistance in the M
tuberculosis strain, then INH and
rifampin (RMP) are used as first-line
therapy. If there is low suspicion of
resistance, then EMB should be
added, while a highly resistant strain
would prompt the consideration of
PZA

Tx TB in pregnancy
INH has been used extensively during
pregnancy. It inhibits the activity of the
enzyme
mycolate
synthetase,
is
bacteriostatic
and
bactericidal,
and
penetrates tissue well.[3] Its major side effect
is an increased risk of hepatitis in patients
older than 35
RMP is a bactericidal agent that penetrates
well into tissues and inhibits DNA-dependent
RNA polymerase in mycobacteria

Tx TB in pregnancy
EMB has a low toxicity profile with the exception of retrobulbar
neuritis, which is probably dosage- and duration-related. Blurred
vision and central scotomata occur before changes in acuity or
color perception.[3] This drug has been used extensively during
pregnancy without noted fetal abnormalities
PZA is recommended by the CDC for treatment of resistant TB in
nonpregnant patients. Because of a lack of teratogenicity data,
the ATS and most authors do not recommend routine use during
pregnancy. Davidson[23] and Miller and Miller,[3] however, note that
it has been used during pregnancy around the world without
significant adverse effects reported. Indeed, it is recommended
for use during pregnancy by most international organizations. [19]
Davidson and Miller and Miller therefore feel it can be given
safely for the treatment of TB that is highly suspected to be
multidrug-resistant.

Tx TB in pregnancy
Streptomycin (SM) is another anti-TB drug
occasionally used in the nonpregnant patient. Its
use during pregnancy is limited because of
reports of increased cranial nerve VIII damage in
the fetus after exposure. Its ototoxic effects
occur in all 3 trimesters. Kanamycin and
capreomysin are also contraindicated during
pregnancy because of similar possible ototoxic
effects. Para-aminosalicylic acid, cycloserine, and
ethionamide use is limited during pregnancy
chiefly because of maternal side effects.

Cervical cancer staging

Stage II Cervical carcinoma invades beyond the uterus, but not to the
pelvic wall or to the lower third of the vagina
IIA Without parametrial invasion IIA1 Clinically visible lesion <4.0 cm in greatest
dimension IIA2 Clinically visible lesion >4.0 cm in greatest dimension
IIB With obvious parametrial invasion

Stage III The tumour extends to the pelvic wall and/or involves lower
third of the vagina and/or causes hydronephrosis or non-functioning
kidney
IIIA Tumour involves lower third of the vagina, with no extension to the pelvic
wall
IIIB Extension to the pelvic wall and/or hydronephrosis or non-functioning kidney

Stage IV The carcinoma has extended beyond the true pelvis or has
involved (biopsy proven) the mucosa of the bladder or rectum. A bullous
oedema, as such, does not permit a case to be allotted to Stage IV
IVA Spread of the growth to adjacent organs

Hiperemesis gravidarum
Tingkat I
a. Muntah yang terus menerus menyebabkan
menurunnya keadaan umum pasien
b. Pasien tampak lemah
c. Nafsu makan berkurang
d. Nyeri di epigastrium
e. Nadi meningkat 100 x per menit
f. Tekanan darah menurun
g. Turgor kulit berkurang, mata cekung

Hiperemesis gravidarum
Tingkat II
a. Pasien tampak lebih lemah dan apatis
b. Turgor kulit lebih mengurang
c. Lidah kering, tampak kotor
d. Nadi kecil dan cepat
e. Suhu naik
f. Mata cekung dan agak ikterik
g. Berat badan menurun dan tensi menurun
h. Hemokonsentrasi
i. Oliguria dan konstipasi
j. Aseton dapat tercium dari hawa pernapasan dapat
ditemukan dalam air kencing

Hiperemesis gravidarum
Tingkat III
a. KU sangat menurun dari somnolen
sampai koma
b. Muntah berhenti
c. Nadi kecil dan lebih cepat
d. Suhu meningkat
e. Tensi turun
f. Ensephalopatia

GERD signs and symptoms include:

A burning sensation in your chest (heartburn),
sometimes spreading to the throat, along with
a sour taste in your mouth
Chest pain
Difficulty swallowing (dysphagia)
Dry cough
Hoarseness or sore throat
Regurgitation of food or sour liquid (acid reflux)
Sensation of a lump in the throat

Anti malarials in pregnancy:

All trimesters: Chloroquine; Quinine;
Artesunate / Artemether / Arteether
2nd trimester: Mefloquine;
Pyrimethamine / sulfadoxine
3rd trimester: Mefloquine; ?
Pyrimethamine / sulfadoxine
Contra indicated: Primaquine;
Tetracycline; Doxycycline; Halofantrine