Review - Clinical XIV (Obstetrics)

Alternative rap rock, alt-rock, rap rock

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V5.5

[Verse 1: The guitars are palm-muted and chugging tightly with the drum beat. The vocals are dry, up-front, and rhythmic.]

Ectopic pregnancy, h.C.G.positive and  bleeding or pain; perform Ultrasound. Ultra
If not diagnostic; serial h.C.G. ““should double in 2 days” if not miscarriage or ectopic, ectopic
Progesterone below 5 means abnormal , above 20 means normal pregnancy
Let's treat;
Treat; methotrexate; if contraindicated  “surgery”. If ruptured “immediate salpingectomy” salpingectomy
Embryonic cardiac motion, large gestational sac , high h.C.G. , surgery may be better

[Chorus / Breakdown: The electric guitars open up into massive, ringing chords. The Frontman switches from rapping to a strained, urgent melodic rock delivery.]
Not normal h.C.G. rise abnormal pregnancy
Threat Threatened 
Threatened abortion; “bleeding through a closed cervical in the 1st 20 weeks”. Observe, no intercourse.
Bed rest not recommended. Good prognosis if bleeding cramping resolve. Slight increase in preterm birth and placental abruption risk
Inevitable Inevitable 
Inevitable abortion “bleeding with dilation of the cervix”
Incomplete abortion, if infection or hemodynamically unstable then surgery. If not; curettage, expectant management, or misoprostol
Missed Missed 
Missed abortion; closed cervical os, dead products within uterus may be cramping or bleeding. Observation, surgery, or misoprostol

[Verse 2: The heavy guitars drop out entirely. The bass and drums lock back into the tight rap-rock groove. The flow is fast and aggressive.]
Septic Septic 
Septic Abortion “fever, lower abdominal pain, uterine tenderness, foul vaginal discharge”. Broad-spectrum antibiotics, suction evacuation.
Intraabdominal free air or air within the uterus then laparotomy. If necrotic uterus, hysterectomy
Complete abortion, observed for further bleeding (Molar gestation possible if h.C.G. levels plateau or rise)

Molar pregnancy; amenorrhea, uterine bleeding, preeclampsia, low T.S.H. high T4, high h.C.G.s, snowstorm in U.S.G..
Treat with D.&.C.; if h.C.G. rises, plateau, or persistent for > 6 months then malignant gestational trophoblastic disease

Gestational Trophoblastic Neoplasia include invasive mole, choriocarcinoma, placental site trophoblastic tumor. Bleeding, high h.C.G.. Treat with chemo

[Bridge: A tension-building instrumental section. A single, high-pitched guitar note bends and feeds back. The vocals are delivered as a spoken, urgent warning.]

Recurrent Recurrent Recurrent miscarriage 3 consecutive pregnancy losses before 20 weeks (fetus< 500 g.); check genetic errors, anatomic abnormalities, antiphospholipid syndrome

Prenatal visits; 4-week intervals until 28, then every 2 weeks until 36, and weekly thereafter
Initial visit; C.B.C., blood group, HbsAg, screen for syphilis, rubella, H.I.V., V.Z.V., H.P.V. (pap smear), urinalysis & urine culture, chlamydia screening for all, gonococcal for high risk

[Outro: The ultimate rap-rock climax. All instruments slam together at maximum volume. The Frontman rapid-fires the final lines, ending in a soaring shout.]
And lastly, 
Screening 
Screening for G.B.S. at 36-38 weeks’ if positive “intrapartum penicillin”

Prophylaxis when, when for previous infant with invasive G.B.S.; or unknown G.B.S. & fever/< 37 weeks /prior G.B.S. pregnancy/> 18 hr membrane rupture

[Ending: A final, heavy snare-and-cymbal crash. The distorted guitar rings out into feedback before being abruptly cut off. Total silence.]

3683/7500

[Intro: 95 BPM. A solo, distorted bassline plays a gritty, repetitive riff. The drums kick in with a heavy, syncopated breakbeat. The Frontman steps up, delivering the verse with a sharp, staccato rap flow.] [Verse 1: The guitars are palm-muted and chugging tightly with the drum beat. The vocals are dry, up-front, and rhythmic.] Ectopic pregnancy, h.C.G.positive and bleeding or pain; perform Ultrasound. Ultra If not diagnostic; serial h.C.G. ““should double in 2 days” if not miscarriage or ectopic, ectopic Progesterone below 5 means abnormal , above 20 means normal pregnancy Let's treat; Treat; methotrexate; if contraindicated “surgery”. If ruptured “immediate salpingectomy” salpingectomy Embryonic cardiac motion, large gestational sac , high h.C.G. , surgery may be better [Chorus / Breakdown: The electric guitars open up into massive, ringing chords. The Frontman switches from rapping to a strained, urgent melodic rock delivery.] Not normal h.C.G. rise abnormal pregnancy Threat Threatened Threatened abortion; “bleeding through a closed cervical in the 1st 20 weeks”. Observe, no intercourse. Bed rest not recommended. Good prognosis if bleeding cramping resolve. Slight increase in preterm birth and placental abruption risk Inevitable Inevitable Inevitable abortion “bleeding with dilation of the cervix” Incomplete abortion, if infection or hemodynamically unstable then surgery. If not; curettage, expectant management, or misoprostol Missed Missed Missed abortion; closed cervical os, dead products within uterus may be cramping or bleeding. Observation, surgery, or misoprostol [Verse 2: The heavy guitars drop out entirely. The bass and drums lock back into the tight rap-rock groove. The flow is fast and aggressive.] Septic Septic Septic Abortion “fever, lower abdominal pain, uterine tenderness, foul vaginal discharge”. Broad-spectrum antibiotics, suction evacuation. Intraabdominal free air or air within the uterus then laparotomy. If necrotic uterus, hysterectomy Complete abortion, observed for further bleeding (Molar gestation possible if h.C.G. levels plateau or rise) Molar pregnancy; amenorrhea, uterine bleeding, preeclampsia, low T.S.H. high T4, high h.C.G.s, snowstorm in U.S.G.. Treat with D.&.C.; if h.C.G. rises, plateau, or persistent for > 6 months then malignant gestational trophoblastic disease Gestational Trophoblastic Neoplasia include invasive mole, choriocarcinoma, placental site trophoblastic tumor. Bleeding, high h.C.G.. Treat with chemo [Bridge: A tension-building instrumental section. A single, high-pitched guitar note bends and feeds back. The vocals are delivered as a spoken, urgent warning.] Recurrent Recurrent Recurrent miscarriage 3 consecutive pregnancy losses before 20 weeks (fetus< 500 g.); check genetic errors, anatomic abnormalities, antiphospholipid syndrome Prenatal visits; 4-week intervals until 28, then every 2 weeks until 36, and weekly thereafter Initial visit; C.B.C., blood group, HbsAg, screen for syphilis, rubella, H.I.V., V.Z.V., H.P.V. (pap smear), urinalysis & urine culture, chlamydia screening for all, gonococcal for high risk [Outro: The ultimate rap-rock climax. All instruments slam together at maximum volume. The Frontman rapid-fires the final lines, ending in a soaring shout.] And lastly, Screening Screening for G.B.S. at 36-38 weeks’ if positive “intrapartum penicillin” Prophylaxis when, when for previous infant with invasive G.B.S.; or unknown G.B.S. & fever/< 37 weeks /prior G.B.S. pregnancy/> 18 hr membrane rupture [Ending: A final, heavy snare-and-cymbal crash. The distorted guitar rings out into feedback before being abruptly cut off. Total silence.]

0/500