5. Cont.Cont.
CONSULTATIONCONSULTATION
WORKING HOURS: MO INCHARGEWORKING HOURS: MO INCHARGE
ACCORDING TO CLINICACCORDING TO CLINIC
AFTER WORKING HOURS / PUBLICAFTER WORKING HOURS / PUBLIC
HOLIDAY: MO ONCALLHOLIDAY: MO ONCALL
SPECIALIST ONCALLSPECIALIST ONCALL
7. HYPERTENSION INHYPERTENSION IN
PREGNANCYPREGNANCY
BP > 140 / 90BP > 140 / 90
Symptoms and signs of ImpendingSymptoms and signs of Impending
EclampsiaEclampsia
Albuminuria 2+ and moreAlbuminuria 2+ and more
Whenever UNSURE, please do referWhenever UNSURE, please do refer
AndAnd REFER EARLY / IMMEDIATELYREFER EARLY / IMMEDIATELY
8. MEDICAL - DIABETESMEDICAL - DIABETES
All known diabetics ( as early as possible )All known diabetics ( as early as possible )
IMGTT with BSP > 7 mmol/lIMGTT with BSP > 7 mmol/l
AS PER PROTOCOLAS PER PROTOCOL
GDM on diet control can be managed inGDM on diet control can be managed in
the health side and refered for IOL at EDDthe health side and refered for IOL at EDD
9. ANTENATAL CASESANTENATAL CASES
Parameters in mm ( Growth Chart )Parameters in mm ( Growth Chart )
Twins for chorionicity as early as possible ( 1Twins for chorionicity as early as possible ( 1stst
trimester, before 14 weeks )trimester, before 14 weeks )
Dating scan ( as early as possible, 8 weeks – 13Dating scan ( as early as possible, 8 weeks – 13
weeks )weeks )
Symphisiofundal height measurement (serialSymphisiofundal height measurement (serial
measurements, diff of 4cm )measurements, diff of 4cm )
Low lying placenta ( PP ) – after 28 weeksLow lying placenta ( PP ) – after 28 weeks
Abnormal Lie ( non cephalic presentation) - afterAbnormal Lie ( non cephalic presentation) - after
36 weeks36 weeks
10. ANTENATAL CASESANTENATAL CASES
Breech – at term ( > 36 weeks )Breech – at term ( > 36 weeks )
Previous scar – at 36 weeksPrevious scar – at 36 weeks
Teenage pregnancy / Single Parents – 36Teenage pregnancy / Single Parents – 36
weeksweeks
Post Date - 40/52 + 6 daysPost Date - 40/52 + 6 days
- AFI & CTG at EDD- AFI & CTG at EDD
11. MEDICAL – RHESUSMEDICAL – RHESUS
NEGATIVENEGATIVE
SENSITISED MOTHERS ( Coombs testSENSITISED MOTHERS ( Coombs test
positive )positive )
HISTORY OF HYDROPS FETALISHISTORY OF HYDROPS FETALIS
ALL RHESUS NEGATIVE MOTHERSALL RHESUS NEGATIVE MOTHERS
(BEFORE 28 WEEKS For IM Rhogem)(BEFORE 28 WEEKS For IM Rhogem)
12. MEDICAL - ANAEMIAMEDICAL - ANAEMIA
Severe anaemia – Hb < 8g/dlSevere anaemia – Hb < 8g/dl
Not tolerating oral iron supplementsNot tolerating oral iron supplements
Not responding to oral iron supplementsNot responding to oral iron supplements
THALASSAEMIA ( especially if bothTHALASSAEMIA ( especially if both
parents are carriers )parents are carriers )
Kindly pls do anaemia work out beforeKindly pls do anaemia work out before
referring patient ( Ferritin, Iron, TIBC,referring patient ( Ferritin, Iron, TIBC,
FBP )FBP )
13. MEDICAL - CARDIACMEDICAL - CARDIAC
Known cardiac diseaseKnown cardiac disease
Heart murmur and symptomsHeart murmur and symptoms
Symptoms and signs suggestive ofSymptoms and signs suggestive of
cardiac pathology ( ECHO )cardiac pathology ( ECHO )
Kindly pls arrange for ECHO prior to apptKindly pls arrange for ECHO prior to appt
in Combine Clinicin Combine Clinic
14. MEDICAL - ASTHMAMEDICAL - ASTHMA
Uncontrolled bronchial asthma (CombineUncontrolled bronchial asthma (Combine
Clinic )Clinic )
Well controlled asthma can be managed inWell controlled asthma can be managed in
health sidehealth side
15. MEDICAL – THYROIDMEDICAL – THYROID
DISORDERSDISORDERS
Patients on treatment for thyroid disordersPatients on treatment for thyroid disorders
Kindly pls don't do TFT in first trimesterKindly pls don't do TFT in first trimester
unless very suggestive symptoms.unless very suggestive symptoms.
(Difficult to interpret )(Difficult to interpret )
If abnormal in first trimester, can repeat inIf abnormal in first trimester, can repeat in
second or third trimestersecond or third trimester
Patients can breast feed if on low dosePatients can breast feed if on low dose
treatmenttreatment
T4 drops as pregnancy progressesT4 drops as pregnancy progresses
16. MEDICAL – CONNECTIVEMEDICAL – CONNECTIVE
TISSUE DISEASETISSUE DISEASE
REFER ALL PATIENTS IMMEDIATELYREFER ALL PATIENTS IMMEDIATELY
( SLE / RA / NEPHROTIC SYNDROME )( SLE / RA / NEPHROTIC SYNDROME )
17. POSTPARTUMPOSTPARTUM
Episiotomy wound breakdown – pls refer to clinicEpisiotomy wound breakdown – pls refer to clinic
( No need admission unless symptomatic )( No need admission unless symptomatic )
LSCS wound breakdownLSCS wound breakdown
Postpartum high blood pressurePostpartum high blood pressure
Urinary retentionUrinary retention
SECONDARY PPHSECONDARY PPH
POSTPARTUM PYREXIAPOSTPARTUM PYREXIA
HEART DISEASE WITH SYMPTOM OFHEART DISEASE WITH SYMPTOM OF
FAILUREFAILURE
POST PARTUM BLUES/ DEPRESSION/POST PARTUM BLUES/ DEPRESSION/
PSYCHOSISPSYCHOSIS
18. MENSTRUAL DISORDERSMENSTRUAL DISORDERS
Menorrhagia ( > 40 years old, nulliparous,Menorrhagia ( > 40 years old, nulliparous,
DM, Obesity)DM, Obesity)
Menorrhagia not responding to treatment (Menorrhagia not responding to treatment (
< 40 years old )< 40 years old )
Post menopausal bleeding (ASAP)Post menopausal bleeding (ASAP)
Amenorhoea ( primary and secondary )Amenorhoea ( primary and secondary )
Dysmenorhoea ( especially failedDysmenorhoea ( especially failed
treatment like NSAIDS )treatment like NSAIDS )