Abnormal labour

This week, The WM is continuing with the obstetrics theme.

What does one have to consider when labour is not progressing as expected? Easy. Think of the “3 P’s”!

  • Passenger: infant size, presentation (occiput anterior, posterior, or transverse)
  • Passage: size, shape, and adequacy of the pelvis
  • Power: uterine contractility

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Post-partum hemorrhage

If a woman bleeds more than 500 cc of blood after delivery, she is considered to have post-partum hemorrhage (PPH). In order to resolve this, the cause of the bleeding should be identified. The differential for PPH is described by the “4 Ts”

T = Decreased uterine Tone (the most common cause of PPH)
T = Trauma (e.g. cervical/vaginal laceration, uterine inversion, uterine rupture)
T = Tissue (e.g. placenta accreta, retained placenta)
T = Thrombin (i.e. coagulopathy)

 

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Thanks for reading! Have a great week.

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Fever (part 2)

Last week we talked about rheumatic fever and febrile seizures. But what is your differential for fever anyways?

I’d like to share a mnemonic I came up with that may help remember the different categories of possible diagnoses. If your patient is feeling crummy because of fever, they may have gone through their “Drug TINNS” before coming to you.

Drug = Drug fever

T= Thyrotoxicity
I = Infectious
N = Non-infectious inflammatory condition
N = Neoplastic
S = Syndrome (i.e. fever syndrome)

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Happy Chinese New Year and here is to all the fellow horses out there!

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